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Critical Care Paramedic > 3-1: Advanced Airway Control > Flashcards

3-1: Advanced Airway Control Flashcards

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1
Q

What is the normal ventilation rate for an adult?

A

10-12 (one every 6 sec)

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2
Q

What is the hyperventilation rate for an adult?

A

20 (one every 3 sec)

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3
Q

What is the typical tidal volume?

A

5-10 ml/kg

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4
Q

How many airway adjuncts can you place at one time?

A

three: two NPAs and 1 OPA

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5
Q

What is the mnemonic for remembering difficult BVM ventilations? What does it mean?

A

MOANS
Mask seal: facial hair/anatomy/blood
Obesity
Age: >55 more difficult
No teeth: lack of support/leave dentures in for BVM ventilation and remove for intubation
Stiff: non-compliant lungs resistant to ventilation/reactive airway disease (asthma, COPD)

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6
Q

What can be inserted during periods of prolonged BVM ventilation and why?

A

NG tube- relieves developing gastric insufflation. should be performed on all patients who have received BVM ventilation.

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7
Q

For an LMA, most adult women are a size ___ and most adult men are a size ___

A

4, 5

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8
Q

An i-gel is not intended for >__ hours

A

4

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9
Q

what mnemonic is used for difficult surgical cric?

A

SHORT
S- surgery (distorted anatomy)
H- hematoma
O- obesity
R- radiation distortion
T- tumor

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10
Q

What is the gold standard of endotracheal tube confirmation?

A

ETCO2

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11
Q

What is a “cola complication” when referring to ETI confirmation?

A

CO2 in the stomach may interfere with correct interpretation. Can lead to a false positive.

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12
Q

ETCO2 of less than ___ after ___ minutes of CPR is a reliable indicator that resuscitation will be unsuccessful.

A

10, 20

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13
Q

Flattening of the capnograph indicates what?

A

migration of the ET tube into the mainstem bronchus or hypopharynx

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14
Q

What happens to the waveform when a vented patient is trying to breathe on their own (or loss of paralysis)

A

there is a dip in the waveform

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15
Q

What is the mnemonic used for RSI and what do the letters mean?

A

SOAPME
S- suction: turned on with hard tip next to the patient
O- oxygen: turned on with NRB on the patient
A- airway equipment: stylets, ET tubes, scope and backups
P- pharmacology: all drugs LABELLED IN SYRINGES
ME- monitoring equipment: pulse ox, capnography, cardiac monitor

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16
Q

What are the 7 Ps of RSI?

A

Preparation
Preoxygenation
Pretreatment
Paralysis with induction
Protection and positioning
Placement with proof
Post-intubation management

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17
Q

7 Ps of RSI: Preparation

A

assess the patient for how hard the intubation might be- use Cormack-Lehane (ideal view is grade 1 and worse view is grade 4)

18
Q

What is the mnemonic used to assess for difficult intubation?

A

LEMON
L- look externally
E- evaluation 3-3-2
M- mallampati (class I through IV- I is the best view)
O- obstruction
N- neck mobility

19
Q

7 Ps of RSI: Preoxygenation- what is the purpose and what are the 3 ways you can do this?

A

“nitrogen washout”- replacing nitrogen in the lungs with 100% oxygen.

  1. 100% O2 in NRB for 3 min
  2. instruct pt to take 8 max capacity breaths on 100% O2
  3. 100% O2 administration via BVM for 3 minutes
20
Q

What is the average time to desaturation for a healthy adult after receiving proper preoxygenation?

A

8 minutes

21
Q

7 Ps of RSI: Pretreatment
What is this step for?

A

Intubation and airway manipulation can have adverse physiologic effects on patients. These include marked sympathetic discharge causing increased heart rate and blood pressure, increase in intracranial pressure i and bronchospasm.

22
Q

7 Ps of RSI: Paralysis with induction- what is the goal?

A

Goal: cause a rapid LOC immediately prior to admin of neuromuscular blocking agent.

23
Q

7 Ps of RSI: Paralysis with induction- what are the meds + dosages

A

Induction agents:
Etomidate - 0.3 mg/kg
Midazolam - 0.2-0.3 mg/kg
Ketamine - 2 mg/kg
Propofol - 1.5-3 mg/kg

Neuromuscular blocking agents:
Depolarizing:
Succinylcholine (** WILL SEE the name: Anectine **) - 1-2 mg/kg
Non- depolarizing:
Vecuronium (Norcuron)- 0.1-0.15 mg/kg, 0.3-0.4 for induction
Pancuronium - not in US anymore
Rocuronium (Zemuron)- 1 mg/kg

24
Q

7 Ps of RSI: Protection and positioning

A

Place pt with head extended

25
Q

7 Ps of RSI: Placement and proof - when should the intubation attempt be discontinued?

A

when the SPO2 drops below 90%

26
Q

7 Ps of RSI: Placement and proof - what are the two gold standards of this step?

A
  1. direct visualization of tube passing through the cords
  2. ETCO2 with waveform
27
Q

7 Ps of RSI: Post-intubation management - what is common in the post intubation period?

A

hypotension

28
Q

What are the contraindications of RSI?

A

no absolute contra!

relative
- if it is going to be way too hard to do it
- major masses in the way
- angioedema with swollen tongue
- burns or significant airway edema

29
Q

What are complications that can arise from RSI meds and intubation?

A

bronchospasm, sympathetic discharge, vagal stimulation

30
Q

What are the three non-depolarizing paralytics?

A

Pancuronium (pavulon)
Rocuronium (zemuron)
Vecuronium (norcuron)

31
Q

What is the other name for Succinylcholine?

A

Anectine

32
Q

What is the dose for induction with etomidate?

A

0.3 mg/kg

33
Q

What is the dose for induction with midazolam?

A

5mg or 0.3 mg/kg

34
Q

What are some considerations when using midazolam for induction?

A
  • hypotension
  • apnea at high doses
  • caution in elderly, renal pts
  • variable response
35
Q

What is the dose for induction with ketamine?

A

2 mg/kg

36
Q

What is the dose for induction with propofol?

A

2 mg/kg

37
Q

What is the dose for paralysis with Anectine (Sux)?

A

1 mg/kg

38
Q

What is the dose for paralysis with Vecuronium

A

0.1 mg/kg

39
Q

What is the dose for paralysis with Rocuronium?

A

1 mg/kg

40
Q

What are three ways to do a nitrogen washout?

A
  1. NRB for 3 minutes
  2. 8 max capacity breaths while receiving 100% oxygen
  3. BVM ventilation for 3 min with 100% O2
41
Q

What are complications that can arise from RSI meds and intubation?

A
  • increase in ICP
  • increase in intraocular pressure
  • bronchospasm in pts with reactive airway disease
  • sympathetic discharge
  • vagal stimulation

Critical Care Paramedic (20 decks)

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