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114 Cards in this Set
- Front
- Back
True or false: Airway management and ventilation are the second steps in assessment of patients.
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False. Airway management and ventilation are the first and most critical steps in the initial assessment of every patient you encounter.
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True or false: Deliberate and precise use of simple, basic skills is the key to successful airway management and patient outcome.
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True
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Define pneumothorax
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The presence of gas or air in the plural cavity
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________________ of the airway is an immediate threat to the patients life and a true emergency.
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Blockage or obstruction
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Define upper airway obstruction
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An interference with air movement through the upper airway
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What are the five causes of airway obstruction?
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Tongue
Foreign bodies Trauma Laryngeal spasm and edema Aspiration |
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The ____________ is the most common airway obstruction.
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tongue
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What is the narrowest part of an adults airway?
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The glottis
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Since the glottis is the narrowest part of an adults airway, __________ or ____________ of the vocal cords is potentially lethal.
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edema, spasm
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Define extubation
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Removing a tube from a body opening
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What is the most common cause of laryngeal spasm?
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Overly aggressive intubation
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What is the most immediate concern with every patient?
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Maintaining a patent airway and adequate oxygenation and ventilation.
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What does RSI stand for?
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Rapid sequence intubation. Rapid sequence induction describes the classic procedure, but has been modified in the EMS setting. The difference between the two is RSIntubation does not utilize a general anasthetic agent.
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What are the indications for RSI?
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Impending respiratory failure (pts may be awake, responsive, agitated, or combative)
Acute airway disorder that threatens airway patency AMS with significant risk of vomiting and aspiration Significant gag reflex, clinched teeth, or too much airway muscle tone to allow intubation |
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The basic physiology involved in RSI centers around the ___________________ _______________ - the connection between peripheral nerves and skeletal muscle.
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neuromuscular junction
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Define faciculations
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Generalized involuntary muscle twitching. Caused by stimulation effect from depolarizing agents such as Succinylcholine.
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What is the most common depolarizing agent used for RSI?
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Succinylcholine
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Define the pathology of depolarizing agents.
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Depolarizing agents block acetylcholine at the neuromuscular junctions. This results in relaxation of skeletal muscle and paralysis.
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How do depolarizing and nondepolarizing agents differ?
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Depolarizing agents block acetycholine at the neuromuscular junction causing relaxation of skeletal muscle, but nondepolarizing agents block the uptake of acetycholine and do not allow stimulation of the muscles; do not cause fasciculations.
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Give 3 examples of nondepolarizing nuromuscular agents.
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Vecuronium, atracuronium, pancuronium
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What is the dose for Sux? (Adult and pediatric)
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1.5 mg/kg IV bolus in adults
2 mg/kg IV bolus in children less than 10. |
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What is the onset of action of Sux?
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60-90 seconds
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What is the duration of Sux?
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3-5 minutes
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State several contraindications for Sux.
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Penetrating eye injuries, pts with burns greater than 8 hours duration, massive crush injuries, and neurological injuries greater than one week out
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________________ is generally the second-line paralytic used when Sux is contraindicated. What is the dose, onset of action, and duration?
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Vecuronium (Nocuron). Used because it has fewer cardiac and hypotensive side effects. The dose is 0.15 mg/kg IV bolus (paralyzing) and 0.01 mg/kg IV bolus (priming). Onset is 2-3 minutes and the duration is 45 minutes.
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Atracuroium (Tracrium) is useful for pts with _____________ or ____________ disease because these conditions do not prolong its duration.
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kidney, liver
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Define paradoxical breathing
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Assymetrical chest will movement that lessens respiratory efficiency
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Define flail chest
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Defect in the chest wall that allows a segment to move freely, causing paradoxical motion
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When obtaining a history, what information is considered important?
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Onset of symptoms
Symptom development Associated symptoms Past medical history Recent history What makes s/s better or worse |
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What are things to look for while doing an inspection of the pt?
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Skin
Position Dyspnea Modified forms of respiration RR Pattern Mentation |
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Define cyanosis
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Bluish discoloration
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Define dyspnea
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An abnormality of breathing rate, pattern, or effort
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Define hypoxia
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Oxygen deficiency
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Define anoxia
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The absence or near absence of oxygen
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What are 5 modified forms of respiration?
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Coughing
Sneezing Hiccoughing(hiccups) Sighing Grunting |
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Explain coughing as a modified form of respiration
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Forceful exhalation of a large volume of air from the lungs. Protective function in expelling foreign materials from the lungs.
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Define sneezing as a modified form of respiration
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A sudden, forceful exhalation from the nose, usually caused by nasal irritation.
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Define hiccoughing as a modified form of respiration
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Sudded inspiration caused by spasmodic contraction of the diaphragm with spastic closure of the glottis. There is no known physiologic purpose.
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Define sighing as a modified form of respiration
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Slow, deep, involuntary respiration followed by a prolonged expiration. It hyperinflates the lungs and reexpands the alveoli. Normally occurs once a minute.
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Define grunting as a modified form of respiration
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A forceful expiration that occurs against a partially closed epiglottis. Usually an indication of respiratory distress.
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Define Kussmaul's respirations
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Deep, slow or rapid, gasping breathing, commonly found in diabetic ketoacidosis.
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Define Cheyne-Stokes respirations
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Progressively deeper, faster breathing alternating gradually with shallow, slower breathing indicating brain stem injury
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Define Biot's respirations
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Irregular pattern of rate and depth with sudden, periodic episodes of apnea, indicating increased intracranial pressure
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Define Central Neurogenic Hyperventilation
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Deep, rapid respirations indicating increased inreacranial pressure
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Define Agonal respirations
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Shallow, slow or infrequent breathing, indicating brain anoxia
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What is the primary indication of breathing is significant or if significant hypoxia is present?
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Altered mentation
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Where is the first place you should ascultate after intubation?
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Over the epigastrium
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What are 5 indications of airflow compromise?
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Snoring
Gurgling Stridor Wheezing Quiet |
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What is 2 indications of inadequate gas exchange?
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Crackles or rhonci when ascultating for lung sounds
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Snoring is a result of...
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partial obstruction of the upper airway
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Gurgling results from...
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accumulation of blood, vomitus or other secretions in the upper airway
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Define stridor
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A harsh, high-pitched sound heard on inhalation, associated with laryngeal edema or constriction.
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Define wheezing
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A musical, squeeking, or whistling sound heard in inspiration and/or expiration, associated with bronchiolar constriction.
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Quiet lung sounds, diminished or absent lung sounds, indicate a serious problem with the _____________, _____________ or both.
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airway, breathing
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Define crackles
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A fine, bubbling sound heard on inspiration, associated with fluid in the smaller bronchioles.
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What is another term for crackles?
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Rales
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Define rhonchi
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A coarse, rattling noise heard on inspiration, associated with inflammation, mucus or fluid in the bronchioles.
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True or false: Air movement into the epigastrium may sometimes mimic breath sounds.
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True
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Define compliance
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The stiffness or flexability of the lung tissue
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_____________ __________ abnormalities may suggest respiratory compromise.
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Pulse rate
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________________ usually acompanies hypoxemia in an adult, while ________________ hints at anoxia with imminent cardiac arrest.
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Tachycardia, bradycardia
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A ________ in pulse rate in a pt with airway compromise is an ominous finding.
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fall
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Define pulse oximetry
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A measurement of hemoglobin oxygen saturation in the periphreal tissues.
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The greater the PaO2, the ____________ will be the oxygen saturation.
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greater
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Pulse ox readings between ____ and ____% indicate mild hypoxia.
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91, 94
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What is a normal SaO2 reading?
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Between 95% and 99%
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Pulse ox readings between ____% and ____% indicate moderate hypoxia and should be given supplemental oxygen.
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86, 91
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Pulse ox readings ____% and below indicarte sever hypoxia. Pt should be given supplemental oxygen and ventilatory support.
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85
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Define capnography
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The measurement of exaled carbon dioxide concentration.
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In the absence of cervicel spine trauma, what is the best technique for opening the airway in an unresponsive pt who is not protecting his own airway?
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Head tilt/chin lift
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What are the two manuvers to open a pts airway that can be performed with a c-collar in place?
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Jaw thrust w/o head tilt
Modified jaw-thrust |
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What is the main purpose of the Sellick's maneuver?
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To help prevent regurgitation and reduce gastric distention
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To perform the Sellick's manuever, you apply gentle pressure ______________ on the anterior _______________ _____________.
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posteriorly, cricoid cartilage
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True or false: Since they work better, it is best to place a mechanical airway instead of messing with other manuevers.
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False. Always attempt any appropriate manual manuever before placing an mechanical airway.
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Name 3 advantages to the nasopharyngeal airway
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Rapid, blind insertion
It bypasses the tongue, providing a patent airway May be used in pts with a gag reflex May be used in pts with oral cavity trauma Can suction through it Can be used when pts teeth are clenched |
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Name 3 disadvantages of nasopharyngeal airway's
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Smaller than the OPA
Does not isolate the trachea Difficult to suction May cause severe nosebleeds May cause pressure necrosis of the nasal mucosa May kink and clog, obstructing the airway Difficult if nasal trauma is present May not be used in pts having or suspected of having a basilar skull fx |
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What are 3 situations in which you would not use a NPA?
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Pt who is predisposed to nosebleeds
Nasal obstruction Suspected basilar skull fx |
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What are 3 advantages of an OPA?
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Easy to use
Air can pass around and through device Helps prevent obstruction by teeth and lips Helps manage airway of unconscious pts Makes suctioning the pharynx easier Effective bite block |
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What are 3 disadvantages of an OPA?
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Does not isolate the trachea or prevent aspiration
Cannot be inserted when teeth are clenched May obstruct airway if not inserted properly Easily dislodged May produce vomiting if gag returns |
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Do not use an OPA in _________________ or ___________________ pts who have a gag reflex, as it may cause vomiting or laryngospasm.
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conscious, semiconscious
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_____________________ intubation is the preferred method of advanced airway management in prehospital emergency care, as it allows the greatest control of the airway.
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Endotracheal
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What is the name of a curved laryngoscope blade?
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Macintosh
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What is the name for a straight laryngoscope blade?
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Miller
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What is the size range for laryngoscope blades?
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0 for infants to 4 for large adults
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The curved blade is designed to fit into the ______________.
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vallecula
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The straight blade is designed to fit under the ________________ and lift it out of the way.
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epiglottis
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What type of blade is better for intubation of infants?
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Straight blades because they stabilize the floppier epiglottises and provide greater displacement of their relatively larger tongues. This would also be true for the occasional adult with a floppy epiglottis or large tongue.
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ET tubes range from 2.5mm-4.5mm, _____________, and _____mm-_____mm cuffed.
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uncuffed, 5.0, 9.0
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What is the generally accepted ETT size for both males and females?
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7.5 mm
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Define stylet
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Plastic-covered metal wire used to bend the ETT into a J or hockey-stick shape.
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What are 4 indications for ET intubation
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Respiratory of cardiac arrest
Unconscious or obtusion w/o gag reflex Risk of aspiration Obstruction Respiratory extremis due to disease Pneumo, hemothorax or hemopneumothorax with respiratory diffuculty |
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True or false: Intubation should not be attempted prehospital if epiglotitis is present unless airway failure is imminent.
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True. Attempts to manipulate the airway in epiglotitis are likely to result in vigorous laryngospasm.
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What are 3 advantages of ET intubation?
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Isolation of the trachea and complete control of the airway
Impedes gastric distention No need to maintain a mask seal Offers a direct route for suctioning Permits administration of select meds |
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What are the drugs that are able to be give down the ETT?
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Lidocaine
Epi Atropine Narcan (LEAN) |
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What are 3 disadvantages of ET intubation?
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Requires training and experience
Requires special equipment Requires direct visualization of vocal cords Bypasses the upper airways function of warming, filtering, and humidifying inhaled air |
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Name 3 complications of ET intubation
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Equipment malfunction
Teeth breakage and soft tissue lacerations Hypoxia Esophageal intubaion Endotracheal intubation Tension pneumothorax |
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To avoid hypoxia during intubation, limit each intubation attempt to no more than _____ _____________ before reoxygenating the pt.
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30 seconds
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What are 3 indications of esophageal intubation?
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Absence of chest rise and fall
Absence of breath sounds w/mechanical ventilation Gurgling sounds over the epigastrium Absence of breath condensation in tube Persistant air leak Cyanosis and progressive worstening of pts condition Phonation ETCO2 detector Falling pulse ox reading |
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What is the most reliable method for confirming proper placement of an ETT?
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Direct visualization of the tube through pts vocal cords
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To prevent endobronchial intubation, how far should you advance the distal cuff of an ETT?
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No more than 1-2 cm past the vocal cords
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If an ETT is misplaced into the right or left mainstem, __________________, such as a pneumothorax, can occur because a BVM insufflates enough air for two lungs, but air flows into only one.
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barotrauma
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What is the purpose of noting the number marking on the side of the ETT where it emerges from pts teeth, gums, or lips?
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It helps indicate if there is any change in tube placement.
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Although it will vary, the average ETT depth for an adult woman is _____ cm, and _____ cm for men.
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21, 23
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What are 3 indications of endobronchial intubation?
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Breath sounds are present on one side, but diminished or absent on the other
Poor compliance (resistance to ventilations) Cyanosis, cardiac dysrhythmias, or other evidence of hypoxia |
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What should be done if the ETT has been placed in the L or R mainstem?
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The cuff should be deflated and the tube withdrawn until ETT breath sounds are present and equal bilaterally.
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In addition to mainstem bronchus intubation, what is a cause of tension pneumothorax?
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Using too much volume from a BVM on a small adult or child using the full BVM volume against diseased lungs with poor compliance.
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What are some indications of a tension pneumothorax?
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Progressively worstening compliance
Diminished unilateral breath sounds Hypoxia and hypotension Distended neck veins Trachial deviation away from the side of the pneumo Decreased cardiac output |
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What is the most widely used and preferred path for endotracheal intubation?
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Orotracheal
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You know you have misplaced the ETT into the esophagus if you see ____________ in the tube instead of _____________, which you will see with a tracheal intubation.
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vomitus, condensation
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It is important to verify and document at least 3 indications of proper placement. What are 3 indications?
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Visualization of the tube between the cords
Presence of bilateral breath sounds Absence of breath sounds over the epigastrium Positive end-tidal CO2 change Verification by esophageal detector device Condensation in the tube Absence of vomit in the tube Absence of phonation once tube is placed |
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When confirming tube placement in transillumination intubation, little or no light visible through the anterior neck indicates what?
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Possible esophageal intubation
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What form of intubation allows you to intubate without directly visualizing the glottic opening?
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Transillumination intubation
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What is the biggest limitation to transillumination intubation?
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Ambient light can make the transillumination to see.
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If you see a ________________ ____ ___________ at the pts Adam's apple, the transillumination stylette is correctly placed
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circle of light
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