3-1: Advanced Airway Control Flashcards
What is the normal ventilation rate for an adult?
10-12 (one every 6 sec)
What is the hyperventilation rate for an adult?
20 (one every 3 sec)
What is the typical tidal volume?
5-10 ml/kg
How many airway adjuncts can you place at one time?
three: two NPAs and 1 OPA
What is the mnemonic for remembering difficult BVM ventilations? What does it mean?
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)
What can be inserted during periods of prolonged BVM ventilation and why?
NG tube- relieves developing gastric insufflation. should be performed on all patients who have received BVM ventilation.
For an LMA, most adult women are a size ___ and most adult men are a size ___
4, 5
An i-gel is not intended for >__ hours
4
what mnemonic is used for difficult surgical cric?
SHORT
S- surgery (distorted anatomy)
H- hematoma
O- obesity
R- radiation distortion
T- tumor
What is the gold standard of endotracheal tube confirmation?
ETCO2
What is a “cola complication” when referring to ETI confirmation?
CO2 in the stomach may interfere with correct interpretation. Can lead to a false positive.
ETCO2 of less than ___ after ___ minutes of CPR is a reliable indicator that resuscitation will be unsuccessful.
10, 20
Flattening of the capnograph indicates what?
migration of the ET tube into the mainstem bronchus or hypopharynx
What happens to the waveform when a vented patient is trying to breathe on their own (or loss of paralysis)
there is a dip in the waveform
What is the mnemonic used for RSI and what do the letters mean?
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
What are the 7 Ps of RSI?
Preparation
Preoxygenation
Pretreatment
Paralysis with induction
Protection and positioning
Placement with proof
Post-intubation management
7 Ps of RSI: Preparation
assess the patient for how hard the intubation might be- use Cormack-Lehane (ideal view is grade 1 and worse view is grade 4)
What is the mnemonic used to assess for difficult intubation?
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
7 Ps of RSI: Preoxygenation- what is the purpose and what are the 3 ways you can do this?
“nitrogen washout”- replacing nitrogen in the lungs with 100% oxygen.
- 100% O2 in NRB for 3 min
- instruct pt to take 8 max capacity breaths on 100% O2
- 100% O2 administration via BVM for 3 minutes
What is the average time to desaturation for a healthy adult after receiving proper preoxygenation?
8 minutes
7 Ps of RSI: Pretreatment
What is this step for?
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.
7 Ps of RSI: Paralysis with induction- what is the goal?
Goal: cause a rapid LOC immediately prior to admin of neuromuscular blocking agent.
7 Ps of RSI: Paralysis with induction- what are the meds + dosages
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
7 Ps of RSI: Protection and positioning
Place pt with head extended
7 Ps of RSI: Placement and proof - when should the intubation attempt be discontinued?
when the SPO2 drops below 90%
7 Ps of RSI: Placement and proof - what are the two gold standards of this step?
- direct visualization of tube passing through the cords
- ETCO2 with waveform
7 Ps of RSI: Post-intubation management - what is common in the post intubation period?
hypotension
What are the contraindications of RSI?
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
What are complications that can arise from RSI meds and intubation?
bronchospasm, sympathetic discharge, vagal stimulation
What are the three non-depolarizing paralytics?
Pancuronium (pavulon)
Rocuronium (zemuron)
Vecuronium (norcuron)
What is the other name for Succinylcholine?
Anectine
What is the dose for induction with etomidate?
0.3 mg/kg
What is the dose for induction with midazolam?
5mg or 0.3 mg/kg
What are some considerations when using midazolam for induction?
- hypotension
- apnea at high doses
- caution in elderly, renal pts
- variable response
What is the dose for induction with ketamine?
2 mg/kg
What is the dose for induction with propofol?
2 mg/kg
What is the dose for paralysis with Anectine (Sux)?
1 mg/kg
What is the dose for paralysis with Vecuronium
0.1 mg/kg
What is the dose for paralysis with Rocuronium?
1 mg/kg
What are three ways to do a nitrogen washout?
- NRB for 3 minutes
- 8 max capacity breaths while receiving 100% oxygen
- BVM ventilation for 3 min with 100% O2
What are complications that can arise from RSI meds and intubation?
- increase in ICP
- increase in intraocular pressure
- bronchospasm in pts with reactive airway disease
- sympathetic discharge
- vagal stimulation
