Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine > ABCDE > Flashcards

ABCDE Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

MC reason that airways get obstructed

A

tongue and submandibular musculature

if you are not conscious that stuff lays on the back of your throat and blocks your airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when would you use a jaw thrust alone to open airway

A

if you have not witnessed injury and it could be a C spine injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

review of what airway compramise looks like

A
  • Universal choking sign
  • Unconscious, deeply sedated (intoxication or medication)
  • Respiratory distress, position preference (you don’t want to lie down)
  • Getting sleepy while working to breathe
  • Changes in level of consciousness - come in talking - now difficult to arouse •

Sedated + vomiting

  • Head trauma, facial trauma
  • Infection somewhere along the airway
  • Burns - smoke inhalation (get edema from heat/smoke inhalation)
  • Face, tongue, neck edema
  • Severe bleeding from nose, mouth (flooded your airway)
  • Cyanosis, shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

inspiratory stridor indicates

A

narrowing at the glottis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what can airway trouble sound like

A

stridor

voice changes- hoarseness and can’t get
words out

gurgling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when would you use a nasopharyngeal airway

A

for semi-conscious pts with a gagreflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Nasopharyngeal Airway placement

A

tip of the nose to the tragus should be the fit

bevel to septum with lube
floor of the nose down until the opening is at the nostril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Oropharyngeal Airway is used for

A

Use only in unconscious, unarousable patients

NOT IN A PT WITH A GAG REFLEX–> vomit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Oropharyngeal Airway measurement

A

corner of the mouth to the angle of the jaw

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how should you be holding laryngoscopes

A

with left hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what should you do before intubating

A

make sure your balloon inflates but always insert with balloon deflated

Secures the airway by placing a tube in the airway space - secures a lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CO2 monitor should turn what color following intubation

A

Yellow-Yes

purple= poor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

laryngoscope with straight blade

A

Miller

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

laryngoscope with curved blade

A

macintosh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

indications for intubation

A

Can’t protect/maintain their own airway:
Alterations in level consciousness
Airway patency threatened
Edema, secretions, blood, infection,
trauma

Breathing indications
Failure to ventilate or oxygenate
Pulmonary, cardiac, systemic problem,
trauma

Preemptive
Threat to airway patency (consciousness), oxygenation, ventilation, aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

first thing to do to prop for intubation

A

Bag Valve Mask – BVM – essential skill

Pre-intubation ventilation – 100% O2

do this right after to before putting them on a ventilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

S.O.A.P M.E checklist

A 
Suction
Oxygen
Airway equipment
Pharmacy
Monitoring Equipment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

prep for intubation

A

BVM
SOAPME
Have Plan A, Plan B, Plan C
RSI - Rapid Sequence Intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

RSI- What are the steps KNOW THIS

A

Pt is paralyzed to gain control; intubation easier, deals with full stomach - prevents aspiration

ii. The 7 P’s
1. Possibility of success
2. Prepare
3. Pre-oxygenation
4. Pre-treatment
5. Induction/Paralysis
6. Positioning/Protection
7. Pass it, prove it, post procedure tasks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

why should you beware of paralyzing a pt

A

Paralyzed patient = no respiratory effort

You MUST be able to adequately ventilate the patient with bag-valve-mask

Must anticipate a successful intubation or do not paralyze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

tubing the goose

A

don’t pass through the chords, pass into the esophagus

will get a shift CO2 reading
happens witt big pts, looking away

No color change, low pulse ox, no breath sounds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

why do we get a CXR post intubation

A

to check depth NOT to see if it’s the esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what to do if you can’t see the chords very easily

A

LMA-Laryngeal Mask Airway
or Bougie

i. Supraglottic airway devices
ii. Designed for blind insertion - goal is esophagus, not trachea
iii. LMA for minor surgery common, good Plan B
Nasotracheal intubation and/or fiber optic guided

All designed to minimize risk of the failed airway-

24
Q

king tube

A

goes into the esophagus

inflate giant balloon and

25
Q

Causes of Inadequate Ventilation-i. Increased airway resistance

A
  1. Airway collapse, hyper-reactivity, edema
  2. Small decreases in diameter significant
  3. COPD, emphysema, asthma
26
Q

Causes of Inadequate Ventilation-Decreased airway compliance

A
  1. Interstitial edema and alveolar collapse

2. Pulmonary edema, effusion, shock, sepsis, aspiration, drowning, smoke inhalation, ARDS, trauma

27
Q

Abnormalities of ventilation/perfusion

A
  1. Acute left ventricular failure, pneumonia, pulmonary embolus, anemia, ARDS, etc…
28
Q

Impaired wall mechanics

A
  1. Perfused but under-ventilated alveoli

2. Pneumothorax, pneumonia, effusion, neuromuscular problems, rib fx, trauma

29
Q

Hypoventilation/hyperventilation

A
  1. Poisoning, toxic overdoses, intoxication
  2. Acidosis
  3. Endocrine disorders
  4. CNS lesions
30
Q

Inadequate Ventilation leads to

A

Leads to Hypoxia… and hypercarbia

31
Q

Hypoxia causes

A
  1. Low arterial O2 tension - alveoli aren’t transferring O2 from lungs to circulation
  2. Ventilation-perfusion mismatch
32
Q

Hypercarbia:

A
  1. Alveolar hypoventilation
  2. Increased lung “dead space”
  3. Acidosis from CO2 retention
  4. Altered mental status à will cause you to become sleepy and unconsciousness and will affect your breathing
33
Q

RED FLAGS of respiratory distress

A 
•	Can they talk? 
•	How many word sentences? (<4 NOT GOOD)
•	Fighting for each breath - anxiety?
•	Tachypnec?  >30/min?
•	Posture - tripod? Won’t lie down? 	•	
        Accessory muscles? 
•	Handling secretions?
•	Diaphoretic? Cyanotic?
•	Altered? Sleepy?
•	Gag reflex?
•	Stridor?
34
Q

if your pt is in respiratory distress

A 
	Give supplemental O2 now; beta-agonist now if appropriate
-->bronchodilators 
	Prepare for definitive airway control
	Vital signs, Pulse Ox
	IV access, cardiac monitor
	Undress
	Pre-hospital hx, PE, interventions
	Rapid assessment: <1 min
	Focused history, PE
35
Q

treatment goals

A 
	Airway control
	Reverse hypoxemia
           Supplemental O2
            Improve ventilatory effort/status
	Avoid/treat hypercapnea
          	Increase effective tidal volume
        	Improve alveolar ventilation
	Find and treat the cause
36
Q

placing nasal cannula

A

tubes down

37
Q

Maybe tachypnec but full sentences, no posturing, 2-4L/min

what type of O2 threapy

A

ii. Nasal cannula - no/slight distress

38
Q

Moderate distress & O2 deficit, 4-10L/min

A

iii. Face mask

39
Q

Limitations of Pulse Oximetry

A

Measures % oxygen saturation of hemoglobin in arterial blood (SaO2 measured = SpO2)

Useful only if arterial O2 above 60%
Hyperventilation, anemia can give false readings

Pulse Ox tells us very little about adequacy of ventilation

Pulse Ox tells us nothing about CO2/hypercarbia

40
Q

really important questions for red flags

A

have you had this before
how long?
what medications are you on and did you run out of them?

associated sxs- rash, fever, cough, hemoptysis, DOE, CP, orthopnea, edema, trauma, syncope

home O2? –> lung issues

ever been intubated?

41
Q

ROS for SOB

A 
rash-allergies
fever
cough
hemoptysis
DOE
CP
orthopnea
edema
trauma
syncope
42
Q

vital sign red flags

A

a. Blood pressure
Often elevated (think cardiac too) – very
common
Hypotension - ominous sign–> intubation

Respiratory rate - tachypnea is sensitive

Pulse - tachycardia common, beta agonists?

Pulse – bradycardia – ominous sign

Temperature - infectious process

Pulse Oximetry – improvement with O2?

43
Q

PE

A

look at the bare torso –> accs muscles

listen to breath sounds

Cardiac exam, pulses – rhythm, m/r/g
Check capillary refill time: <2secs normal. >2secs? Think shock!
Abdomen – distention, ascites
Eyes (pallor), mouth (tongue, thrush) neck (JVD, masses, swelling)
Skin – rash, diaphoresis
Extremities – edema, clubbing? Think CHF, DVT, COPD
Neuro – mental status, muscle weakness

44
Q

Common Pulmonary Causes of respiratory distress

A 
	Asthma or COPD exacerbation
	Pneumonia, infectious
	Pleural effusion
	Pneumothorax
	Pulmonary embolus
	Malignancy
	Trauma
	Rhematologic, connective tissue Dz, Sickle Cell
	Pulmonary manifestations
	Aspiration, foreign body
45
Q

Common Non-Pulmonary Causes

A 
	Acute coronary syndrome
	Sepsis
	CHF/pulmonary edema (pump problem)
	Pericardial effusion/pericarditis
	Anemia
	Renal and metabolic disturbances
	Environmental, toxic ingestion
	Allergy, anaphylaxis
	Neuromuscular
	Psychiatric
46
Q

a. ED Diagnostics respiratory distress

A

IV, 02, monitor
triple scan
CXR
EKG

LAB
CBC
CMP
UPREG
UTOX
Lactic acid
47
Q

Case specific - consider:

A
  1. Cardiac enzymes
  2. D-Dimer, lower extremity ultrasound
  3. ABG/VBG, PT/INR
  4. Aspirin level: mixed acid base picture and first sign of aspirin tox is tachypnea
  5. BNP?
    CHEST CT
    NIPPV-
48
Q

Non-invasive Positive Pressure Ventilation

A

Hypercapnic, hypoxemic respiratory failure

49
Q

d. BiPAP - “bilevel positive airway pressure”

A

i. Nasal mask

ii. Use to vary inspiratory and expiratory pressures (COPD)

50
Q

c. CPAP - “continuous positive airway pressure”

A

i. Mask over mouth/nose

ii. Continuous inspiratory/expiratory pressure (CHF)

51
Q

NIPPV can be used for

A

i. COPD exacerbations, severe asthma
ii. Pulmonary edema/CHF
iii. Obstructive sleep apnea
iv. Post-extubation, chest trauma

52
Q

Positive Pressure Ventilation-what does it do exactly

A

i. Reduces the work of breathing
ii. Maintains alveolar inflation, assists ventilation (O2 in, CO2 out)
iii. Improves airway compliance
iv. Reduces preload and afterload

53
Q

CI for NIPPV

A
  1. Pt cannot breathe on own if mask falls off
  2. Must be relatively stable, not agitated or unconscious
  3. Intact face - avoid subcutaneous air
54
Q

21 YR o F partier
cut her hand
resisted going to the ED

sleeping deeply without arousing to shake and shout
ETOH .28

what are your airway issues and options

A

vomiting
sedated
on her back

could use a nasal trumpet
rescue position on side

suction nearby

will pull it out
could put a nasal cannula

55
Q

case 2 55 yo M robbed by youths, hit in the face by the bat, can’t speak or open his mouth

can’t speak

A

jaw is probably broken –> difficult to

suction the hell out of him
reevaluate need for intubation

56
Q

43 YO M brought in by ambulance from house fire

A

preemptively intubate because of worry about edematous

57
Q

lil guy with lip swelling

A

epinephrine

package for anaphylaxis

Emergency Medicine (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions