1. Advanced Airway Management Flashcards
MARCHE
Massive hemorrhage
Airway
Respirations
Circulatory
Hypothermia
Environment
*used for primary assessment
Indications to intubate
Failure to oxygenate/ventilate with less invasive interventions
Predicted clinical course
Failure to protect airway
Patient/crew safety
HEAVEN criteria
*predict difficult airway
Hypoxemia
Extreme size
Anatomic challenges
Vomit/blood/fluid
Exsanguination
Neck mobility
How to over come hypoxia in a difficult airway patient
Pre oxygenate
Passive oxygen
Ventilate with peep
How to over come extreme size in a difficult airway patient
Ramp the patient to position them appropriately
How to over come anatomic challenges in a difficult airway patient
Remove obstructions
Reduce edema
How to over come vomit/blood/fluid in a difficult airway patient
Lead with suction
How to over come exsanguination in a difficult airway patient
Stop the bleed and replace lost volume
How to over come neck mobility in a difficult airway patient
Manually hold c-spine
ETT size equation
(Age in years/4) +4
SALAD technique
Suction Assist
Laryngoscope
Airway Decontamination
Placement confirmation of ETT on X-ray
5cm above Carina
Inline with collar bone junction
OR
T2-T4
RSI vs DSI
RSI is in an emergency with back to back sedation and paralytic
DSI allows time between the sedation and paralytic to oxygenate for hemodynamic optimization
RASS
Richard Agitation Sedation Scale
+4 combative
+3 very agitated
+2 agitated
+1 restless
0 alert and calm
-1 drowsy
-2 light sedation
-3 moderate sedation
-4 deep sedation
-5 unarousable
Failed airway definition
Failure to oxygenate
OR
Failure to ventilate
DSI sequence
Pre treatment
Analgesics
Sedation (induction)
Paralytics
Post intubation management
Atropine purpose in RSI
Prevent bradycardia from stimulation of the vagal nerve
Etomidate purpose in RSI
Anxiolytic sedation
Hypnotic agent
Amnestic
Fentanyl purpose in RSI
Analgesic
Vasodilation
Pain management
Ketamine purpose in RSI
Dissociative anesthetic
Analgesic
Midazolam purpose in RSI
Benzodiazepine
Retrograde amnesia
Calm CNS
Propofol purpose in RSI
Anesthetic
Short acting amnesia
Succinylcholine purpose in RSI
Depolarizing paralytic
Rocuronium purpose in RSI
Non depolarizing paralytic
Vecuronium presuppose in RSI
Non depolarizing paralytic
