A-E Flashcards by Maddie YEAR 3 & 4

Causes of airway obstruction?

Reduced conscious level
Foreign body - blood, object, vomit
Oedema narrowing the airway - anaphylaxis, burn, infection
Tumour or lymphadenopathy causing a local mass effect
Laryngospasm caused by asthma, GORD, intubation

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Sign of partial and complete obstructed airways?

Snoring
Gurgling
Strider
Use of accessory muscle
Silent chest
See-saw chest

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Head maneouvre to open the airway?

Head tilt, chin lift, jaw thrust

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What are airway adjuncts?

Nasopharyngeal and oropharyngeal airways

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When should you not do a head tilt to open the airways?

If any concern about a c-spine injury e.g trauma

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When are nasopharyngeal airways best?

During seizures as may not be able to insert a OPA
If conscious as better tolerated than OSA

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What are the main issues with an oropharyngeal airway?

Poorly tolerated if conscious or semi-conscious as can induce the gag reflex
Can cause trauma to teeth and mucous membranes

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How do we measure OPA and NPAs?

OPA - hard to hard - middle of teeth to edge of mandible
NPA - soft to soft - nose to tragus of ear

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What are issues with NPAs?

Can cause epistaxis or nostril trauma
Contraindicated in basal skull fracture

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Signs of a basal skull fracture?

Raccoon eyes
Halo sign
Battle sign
CSF rhinorrhoea
CN palsy
Bleeding from nose and ears
Hemotympanum
Deafness, nystagmus
Vomiting

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What is good about an OPA?

Easy to insert and use
No paralysis required
Ideal for very short procedures or for bridging to more definitive airways

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What are supraglottic airways?

A group of devices that sit abutting the larynx, above the vocal cords.
They are typically used as alternatives to endotracheal airways in short or low-risk anaesthetic cases. Also used in prehospital and cardiac arrest settings

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Issues with supraglottic airways?

They do not protect against aspiration and therefore do not provide a definitive airway.
Complications include gastric insufflation, aspiration, laryngospasm and partial airway obstruction.
They should not be used if there is poor mouth opening, pharyngeal pathology or obstruction at/below the level of the larynx.

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Examples of supraglottic airways?

Laryngeal mask airway
iGel

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What is a laryngeal mask airway?

A reusable supraglottic device made of silicone rubber tube ending with an elliptical spoon-shaped mask that fits over the larynx and forms a low-pressure seal

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What is an IGel?

A single-use supraglottic airway device made up on a non-inflamatable thermoplastic elastomer that seals around the larynx and peri-laryngeal structures when warmed to body temperature

What is a self-inflating bag-valve resuscitator?

Aka a bag valve mask
Provides oxygenation and ventilation prior to the placement of a definitive airway
Consists of a face mask attached via a shutter valve to a flexible air chamber and the tubing connects the mask to a flow meter or oxygen cylinder
Pts can breathe spontaneously or be ventilated by squeezing the bag

General sizing rule for endotracheal tubes for men and women?

7.0 for women and 8.0 for men

Describe the structure of an endotracheal tube?

One end has a universal plastic connect that fits bag valve masks or ventilating tubing
The other end is shaped to ensure ventilation of the right and left bronchi and has a small hole which can be used for ventilation should the end pf the tube become obstructed
Cm markings indicate the depth to which ther tube has been inserted (in adults it should sit 20-24cm at the teeth)
An inflatable cuff seals the trachea to protect against airway contamination and gas leaks

What is a gum elastic bougie?

A flexible instrument that can be moulded into a curved shape and placed into the airway before an endotracheal tube is railroaded over the top
Typically used in situations where an airway may be challenging to intubate

What are the 2 types of tracheastomies?

Cricothyroidotomy is performed in emergencies such as airway obstruction using needle or scalpel dissection to insert an airway through the membrane between the cricoid and thyroid cartilage.
Surgical tracheostomy refers to an airway inserted directly through the trachea below the cricoid cartilage. It is performed by trained ENT surgeons in a controlled operating theatre environment.

Causes of bradypnoea?

Sedation
Opioid toxicity
Raised ICP
Exhaustion in airway obstruction with CO2 retention

Causes of tachypnoea?

Airway obstruction
Asthma
Pneumonia
PE
Pneumothorax
Pulmonary oedema
HF
Anxiety

Causes of acute SOB?

Pneumothorax
Haemothorax
PE
Cardiac tamponade
Pleural effusions
Aortic stenosis
Acute HF
MI
Pneumonia
Anaphylaxis
Acute exacerbation of asthma or COPD
Acute pulmonary oedema
Trauma
Anaemia
Sepsis
Metabolic e.g. DKA
OD/poisoning
Anxiety attack

What are Cheyenne-stokes respirations?

Cyclical apnoeas with varying depths of inspiration and rate of breathing/cyclical episodes of apnoea and hyperventilation

What are kussmaul respirations?

rapid, deep breathing at a consistent pace They are indicative of metabolic acidosis

What will the trachea deviate away from?

A tension ponemothrax and large pleural effusions

what will the trachea deviate towards?

Lobar collapse and a pnuemonectomy

Causes of tachycardia?

Hypovolaemia Arrhythmias Infections Hypoglycaemia Thyrotoxicosis Anxiety Pain Drugs

Causes of bradycardia?

ACS or IHD Electrolyte abnormalities e.g. hypokalaemia Drugs e.g. beta blockers Sick sinus syndrome Heart block Raised ICP Hypothermia

Causes of hypotension?

Sepsis Anaphylaxis Hypovolaemia from dehydration or haemorrhage Insufficient cardiac output e.g. ACS, anaemia, PE Neurogenic shock Drugs e.g. opioids, diuretics, antihypertensives Adrenal crisis

What should you use if you cannot manage to get IV access?

Interosseous access

Resuscitation fluids?

500ml fluid bolus of a Crystalloids (normal saline or hartmanns) over <15 minutes Repeat up to 4 times and then seek expert help!

Routine maintenance fluids for adults?

25-30ml/kg/d water 1 mmol/kg/day Na+, K+, Cl- 50-100g/day glucose So, for a 80kg patient, for a 24 hour period, this would translate to: 2 litres of water 80mmol potassium

Main cause of pinpoint pupils?

OD of an opioid

Main cause of dilated pupils?

TCA overdose Amphetamines, cocaine use, topical mydriatrics Traumatic iridoplegia Phaeochromocytoma Congenital

Main cause of unequal pupils?

Intracranial event e.g. SOL, stroke, raised ICP Adies pupil Horners syndrome Third nerve palsy

Ethical issues around consent in the acutely unwell pt?

In a setting of clinical emergency and if not possible to find out pt’s wishes then Tx can be provided without pt consent provided this Tx is immediately necessary to save their life or prevent a serious deterioration of their condition Pt’s should be treated as individuals and their dignity respected. When there is doubt to as the appropriateness of Tx, there should be a presumption in favour of providing life-sustaining treatment If a decision is time-critical, consideration should be made of whether the pt is likely to regain capacity in sufficient time to allow them to give consent. If not, and a delay in initiating Tx would likely be detrimental to the pt’s wellbeing, a best interest decision should be made When there is choice of Tx, the Tx provided must be the least restrictive on the patient’s future choices

What is the bolam test?

this is a test judged by the medical professional’s peers to determine whether thr actions of a doctor are in line with the actions of other doctors in their position. They must be able to show that any medical professional who was in the same position as them would have done the same, giving the same outcome.