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49 Cards in this Set
- Front
- Back
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Role of oral endotracheal intubation? |
Oral ETI is an advanced airway procedure involving the insertion of an ETT under laryngoscopy into the trachea in |
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Indications for ETI? |
Actual loss of airway patency and/or airway protection |
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Contraindications for ETI? |
Conscious breathing patients |
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Complications of ETI? |
Unrecognised oesophageal intubation Malposition Aspiration Hypoxia Laryngospasm Oropharyngeal trauma Vagal stimulation |
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What are the three designs of endotracheal tube used by QAS? |
1) Cuffed Parker Flex Tip (Adult) 2) MICROCUFF ETT (Paed) - supplied without Murphy eye 3) COVIDEN cuffless ETT (neonate) - single Murphy eye |
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Specifics of the Frova Intubating Catheter (Bougie)? |
70cm pre-curved airway introducer 14 Fr 30 degree angled tip For use with ETTs size 6 and over |
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Predictors of airway difficulty? |
L- LOOK externally E- Evaluate 3-3-2 rule M- Mallampati score O- Obstruction N- Neck Mobility |
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Predictors of airway difficulty? |
L- LOOK externally E- Evaluate 3-3-2 rule M- Mallampati score O- Obstruction N- Neck Mobility |
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Mallampati score? |
Class I: Soft palate, uvula and pillars visible Class II: Soft palate, uvula visible Class III: Soft palate, base of uvula visible Class IV: Only hard palate visible |
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Mallampati score? |
Get patient to open their mouth for inspection Class I: Soft palate, uvula and pillars visible Class II: Soft palate, uvula visible Class III: Soft palate, base of uvula visible Class IV: Only hard palate visible |
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3-3-2 Rule? |
3 fingers in open mouth 3 fingers under chin (tip of mention to hyoid bone) 2 fingers to thyromental distance |
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What are the different axis for intubation which you are trying to align? |
Oral Axis Pharyngeal Axis Laryngeal Axis |
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Techniques to optimise view during laryngoscopy? |
Laryngeal manipulation Lip retraction SALAD technique |
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How far in should an ETT be placed? |
Male: 22-24cm (at lips) Female: 20-22cm (at lips) |
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How far in should an ETT be placed? |
Male: 22-24cm (at lips) Female: 20-22cm (at lips) |
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Procedure for adult ETI? |
Visualise the larynx Gently advance bougie into trachea (rotate anti-clockwise if resistance felt) Request ETT placement over bougie Insert ETT through vocal cords with 2 ring markers either side of VC Rotate ETT anti-clockwise if resistance felt Hold ETT at the lips Remove bougie Remove laryngoscope Inflate cuff- ensure pilot balloon remains inflated Commence ventilation and confirm tracheal placement Secure tube and insert bite block. Check pressure with manometer |
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Length at lips for paediatrics? |
Neonate: 9.5cm 6 months: 11cm 1 year: 12cm > 1 year: (age/2) + 12 |
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Length at lips for paediatrics? |
Neonate: 9.5cm 6 months: 11cm 1 year: 12cm > 1 year: (age/2) + 12 |
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ETT cuff pressure in paediatrics? |
Never more than 20cmH2O |
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Oral ETI length at lips for newborn? |
6+ weight (kg) |
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When must the failed airway algorithm commence? |
If intubation is unable to be achieved within 30 seconds or after 2 attempts. |
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ETI Sizing for Adults? |
Size 7.0: Adult female Parker Flex Tip- Use bougie Size 8.0: Adult female/male Parker Flex Tip- Use bougie Size 9.0: Adult male Parker Flex Tip- Use bougie |
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ETI Sizing for Adults? |
Size 7.0: Adult female Parker Flex Tip- Use bougie Size 8.0: Adult female/male Parker Flex Tip- Use bougie Size 9.0: Adult male Parker Flex Tip- Use bougie |
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Paediatric ETI sizing? |
Size 2.5: Pre-term infants COVIDEN (cuffless) - 6Fr stylet Size 3.0: 3kg - 7 months Microcuff- 6Fr stylet Size 3.5: 8 months - 1 year Microcuff- 6Fr stylet Size 4.0: 2-3 years Microcuff- 6Fr stylet Size 4.5: 4-5 years Microcuff- 10Fr stylet Size 5.0: 6-7 years Microcuff- 10Fr stylet Size 5.5: 8-9 years Microcuff- 10Fr stylet Size 6.0: Large child Parker Flex-Tip- Use bougie |
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What are the 2 QAS aids to secure an ETT? |
Cloth tape Thomas tube holder |
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What are the 2 QAS aids to secure an ETT? |
Cloth tape Thomas tube holder |
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Complications of securing an ETT? |
Venous obstruction |
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What is the PYLANT manometer? |
Disposable, single use device used to measure ETT cuff pressure. |
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What is the PYLANT manometer? |
Disposable, single use device used to measure ETT cuff pressure. |
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What are the indications for using a manometer? |
Any patient intubated with a cuffed ETT |
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What is the PYLANT manometer? |
Disposable, single use device used to measure ETT cuff pressure. |
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What are the indications for using a manometer? |
Any patient intubated with a cuffed ETT |
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Contraindications for using a manometer? |
When ETT placement has not been confirmed by capnography When using an uncuffed ETT |
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What is the PYLANT manometer? |
Disposable, single use device used to measure ETT cuff pressure. |
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What are the indications for using a manometer? |
Any patient intubated with a cuffed ETT |
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Contraindications for using a manometer? |
When ETT placement has not been confirmed by capnography When using an uncuffed ETT |
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Complications with manometer use? |
ETT under-inflation: - Aspiration - Inadequate ventilation - Accidental extubation ETT Over-inflation: - Pain - Tracheal stenosis/rupture - Ulceration - Necrosis |
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Procedure for manometer use? |
1) Occlude the port and insert air into manometer with port occluded. Achieve 10-30mmHg pressure and ensure it maintains to ensure adequate function 2) Place manometer between pilot balloon and syringe 3) Inflate cuff to appropriate pressure - adults: 25cm H2O - Paeds: <20cm H2O 4) Consider leaving in situ to provide ongoing monitoring |
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What is waveform capnography? |
Continuous, quantitative measurement of exhaled carbon dioxide. |
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What are the 4 key phases of the EtCO2 capnogram? |
Phase 1: Inspiratory baseline. Reflects inspired gas (no CO2) Phase 2: Expiratory upstroke. Reflects transition of anatomical dead space and alveolar gas from the alveoli. Phase 3: Alveolar Plateau. Reflects last of the alveolar gas being sampled. Phase 0: Inspiratory downstroke. The beginning of respiration Alpha angle: Transition between phase 2 and 3. An angle greater than 90 degrees can indicate V/Q mismatch. Beta angle: Transition between phase 3 and 0. Can identify rebreathing if angle greater than 90 degrees |
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Indications for use of waveform capnography? |
CPR Sedation and procedural sedation Endotracheal intubation Ongoing monitoring of ventilation |
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Indications for use of waveform capnography? |
CPR Sedation and procedural sedation Endotracheal intubation Ongoing monitoring of ventilation |
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Contraindications for use of capnography? |
Nil |
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Complications of EtCO2 capnography? |
When performing effective CPR, capnography should not be used to vary IPPV from recommended rate |
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When is the T piece indicated? |
The administration of nebulised medications in patients requiring IPPV or CPAP |
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Where does the T piece sit between the BVM and the patient? |
The T piece sits as close to the patient as possible. So between the licorice stick and the filter |
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Where does the T piece sit between the BVM and the patient? |
The T piece sits as close to the patient as possible. So between the licorice stick and the filter |
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If only one source of oxygen is available, how do I use the T piece? |
Connect the single oxygen source to the T piece and then use the BVM at room air |
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Where does the T piece sit when being used for CPAP? |
Between the CPAP mask and the vectored flow valve |
