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62 Cards in this Set
- Front
- Back
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What does personal protective equiptment incude |
Gloves eye protection mask
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What are some advantages of endotracheal intubation |
Direct access to trachae for pulmonary hygiene Protect the airway from aspiration Does not cause gastric distention And danger of the regurgitation Maintaining a patent airway and assist in avoiding further obstruction For example laryngeal edema and burn injury Delivery of erosonalized medication
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Main indications for intubation |
Airway protection inadequate ventilation inadequate oxygenation High metabolic demmand Hemodynamic instability
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Wentling suspect the patient cannot maintain airway protection |
secretions gsc <8 airay edema |
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when ill u suspect pt has inadequate ventilation |
rising paco2 respiratory acidosi mental status change |
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when do yu supect pt is not oxygenating well |
sp02 <90 ps02 <55 |
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CI to intubation |
gag reflex likly to react with laryngospasms to intubation attempt like children with epiglotitis basiar skull fracture |
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equipment required for intubation |
Laryngoscope endotracheal tube Stylet 10 ml syringe Suction catheter CO2 detector Oral and nasal airway Bag valve mask |
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Normal size ett |
7 to 7.5 for women 7.5- 8 for men |
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How long should you not exceed attempt at intubation |
30 seconds |
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Is a cxr Definitive in telling you placement of endotracheal tube |
No it does not tell you if you're in the trachea or the esophagus |
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What is the better way of detecting placement of the endotracheal tube |
CO2 detector |
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What is a difficult tracheal intubation |
successful intubation requiring three attempts or taking longer than 10min |
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What is a difficult mask |
Inability to maintain sp02 over 90% f for inability to prevent or reverse the signs of a adequate ventilation like mental status not changing |
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What is a difficult airway |
Clinical situation in which a conventionally trained anesthesia provider experiencing difficulty with face mask ventilation difficulty with tracheal intubation or both |
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What are some predictor of a difficult airway |
C-spine demobilization Trauma patient Short thick neck Prominent upper incisors Buckteeth Reseeding mandible High arched palate Beerd or facial hair Dentures Limited jaw opening Limited cervical mobility Upper airway condition FaceAnd neck oral trauma Laryngeal trauma Airway edema or obstruction Morbidly obese
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airway pneumonic for laryngoscopy |
Lemon |
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Airway pneumonic forbag mask ventilation |
Moan |
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And wait pneumonic for supraglottic device |
Rods |
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Airway pneumonic for surgical airway |
Short |
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What does moan stand for |
mask seal Obesity or obstruciton AgeOver 55 No teeth stiff or snores |
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What will cause difficulty in maintaining a mask seal |
Small hands Wrong size Mask odd ShapeFace bushy beard blood vomit facia trauma |
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why does obesity/ obstruciton cause difficultyin maintianign mask seal |
heavy chest wall abdomina contests inhibit movment of the diaphragm increased supraglotting ressitance billowing cheeks difficult mask seal quicker desaturation
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how does pregnancy affect bag mask |
3rd trimester increase body size quick desaturation increased malampati score gravid uterus inhibits movement of the diaphragm |
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how does age affect ability to bag |
over 55 or Look that age loss of dentition loss of airway tone loss of skinelasticity |
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what does n stand for in moan |
no teeth |
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stiff or snores referes to |
poopr compliance, rective airway disease copd pulmoanry edema and pneumonia hx of snoring and sleep apnea have a higher mallampati score |
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what does lemons stand for |
look externally evaluate 332 mallampati score obstruciton neck mobility scene and situation |
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what factors does 332assess |
bottom of jaw/chin to neck >3 fingers jaw/palate >3 fingers wide mouth opens >2 fingers wide |
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what does the 332 assesment mean |
if they do not meet the 332 expect a difficult intubation |
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what quesitosn doyou ask in 332 assessmen |
doe spt open mouth wide enough to accomodate 3 fingers will3 fingers fit between the mentum and hyoid bone will 2 fingers fit between the hyoid and thyroid notch |
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what is the thyromentla distance |
distance between the mentum to the thyroid notch
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what position is the neck when doing thyromentla distance |
fully extended |
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what does thyromental distnacehelp ith |
detemrin how readily the laryngeal axis will fall in line with the pharyngeal axis |
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how is mandibulohyoid distance measured |
from mentum to the top of the hyoid bone |
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how to asses smalampati |
sit up stick out tongue withoutphonating |
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modified malampati |
use aryngoscope blade like a otngue blade ot visualize the oropharynx |
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class 1 malampati |
little - no difficutly able to view soft palate fauces uvula pilars entire glottic opening is visualized with laryngoscope |
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mallampati class 2 |
able to see soft palate fauces and uvula lose view of pillars |
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malampati class 3 |
able to view soft palate and base of uvula
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malampati class 4 |
soft palate is not visualized at all only see hard palate |
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neck placement when intubation |
extend back about 35 degrees |
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what does rods stand for |
restructed mouth opening obstruction of upper airway disrupted or distorted airway stiff |
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what does SHORTS stand for |
surgury/disrupted airwya hematoma or infection obesity or access prolems like c collar radition or restirctions tumor |
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these drugs are induciton agent |
etomidate ketamine propofol thiopental |
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pros and cons of etomidate |
good for low bp and hypovolemia
causes nausea and vomiting on emergence |
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pro and con of ketamine |
good for low bp hypovolemia and asthma
caustion in elevated icp or heart disease |
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not used in elevated icp or heart disease |
ketamine |
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good for asthma |
ketamine |
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pro and con of propofol |
rapid onset and recovery
caution in hypovolemic or risk of hypotension and mulitple drug interactions |
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etomidate dose |
0.3mg/kg |
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ketmaine dose |
1.5mg/kg |
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propofol dose |
2-2.5mg/kg |
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thiopental dose |
3-5mg/kg |
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properties of theopental |
negative inotrope and cuses hemodynamic compromise |
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these drugs ar parylitics |
succynocholine rocuronium vecuronium atracurium |
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succ dose |
1-1.5mg/kg |
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rocuro dose |
0.6-1.2mg/kg |
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vecuronium dose |
0.08-0.1mg/kg |
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atracurium dose |
0.4-0.5mg/kg |
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pro and cons of succinylcholine |
rapid onset and recovery, CI in hyperkalmea, trauma, crash injury, renal failrue, burns, elevated icp or IOP |
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how to prevent aspiration |
suctiona dn cric pressure |
