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ABCs > Abcs > Flashcards

Abcs Flashcards

1
Q

Neutral position is for:

A
  • initial assessment and management of the airway
  • patients at risk of cervical spine injuries
    (Maintains neutral anatomical alignment of the spinal column)
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2
Q

Sniffing position is for:

A
  • patients requiring airway management
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3
Q

Head tilt, chin lift is for:

A
  • Initial assessment and management of the airway

(Ideally combined with the neutral position during Initial assessment and management)

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4
Q

Lateral position is for:

A
  • patients with altered conscious state not requiring active airway management
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5
Q

SGA indications

A

1) unconscious patient without gag reflex

2) ineffective ventilation with BVM and basic airway management

3) >10 minutes of assisted ventilation required

4) unable to intubate

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6
Q

SGA contras

A
  • intact gag reflex or resistance on insertion
  • strong jaw tone or trismus
  • suspected epiglottis or upper airway obstruction
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7
Q

SGA precautions

A
  • inability to prepare patient in the sniffing position
  • patients who require high airway volumes
  • vomit in airway
  • paediatric patients who have enlarged tonsils
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8
Q

SGA side effects

A

Correct placement does not prevent passive regurgitation or gastric distension

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9
Q

NPA indications

A

Support airway patency in the unconscious patient

(NPA may be preferred in patients with trismus, gag reflex, oral trauma or in addition to other adjuncts)

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10
Q

NPA contras

A

NONE

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11
Q

NPA precautions

A
  • facial fracture or basal skull fracture

(Any CSF from nares or ears = possibility of cerebral intrusion and only insert if absolutely necessary to maintain patent airway)

  • TBI/nTBI
    Stimulating a gag reflex in this group can significantly worsen ICP- only insert if absolutely necessary to maintain patent airway
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12
Q

NPA insertion and NOTES

A
  • Select correct size by measuring corner of nose to earlobe
  • lubricate distal end and insert into widest nostril at 90°

-An NPA is an adjuct that can assist with relieving anatomical obstruction

  • the distal end once inserted is intended to displace the tongue and soft tissues anteriorly, relieving obstruction
  • nasal pharyngeal may also be improved by widening/support of the nasal passage
  • less likely to produce a gag reflex and can be used in patients with higher conscious states

-2 NPAs may be inserted

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13
Q

OPA indications

A
  • support airway patency in the unconscious patient
  • bite block in an intubated patient
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14
Q

OPA contras

A

-trismus
-gag reflex
-TBI/nTBI w/adequate ventilation/oxygenation (stimulating a gag reflex in this patient can worsen ICP)

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15
Q

OPA precautions

A

NONE

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16
Q

OPA procedure and NOTES

A

Measure from angle of jaw to middle of incisor (front teeth)

  • hold opa by the flange and insert until halfway in = this is to clear the tongue to prevent pushing it back into the airway
  • rotate 180° over tongue while continuing to insert

*if patient gags remove immediately

*incorrect size can exacerbate airway obstruction

Paediatrics
- Paediatric have softer palates more likely to be damaged by upside down insertion. A laryngoscope may be used to help opa past tongue

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17
Q

PEEP indications

A
  • All patients receiving IPPV with cardiac output
  • All neonates recieving IPPV
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18
Q

PEEP contras

A

-adult and paediatric patients in cardiac arrest = NO PULSE NO PEEP

  • PEEP is indicated in neonate cardiac arrest to establish and maintain lung volume and improve oxygenation
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19
Q

PEEP Precautions

A

Patients with the below should be closely monitored for haemodynamic compromise/tension pneumothorax

  • hypovolaemia/severe hypotension
  • tension pneumothorax
  • elevated ICP
  • right ventricular failure
20
Q

Triple airway manoeuvre is for:

A

Airway management and troubleshooting

  • ideally combined with sniffing position or neutral position (if necessary)
21
Q

3 steps of the triple airway manoeuvre are:

A

-head tilt
-jaw thrust
-open mouth

22
Q

Bag Valve Mask indications:

A
  • apnoea
  • inadequate ventilations
23
Q

Bag Valve Mask contras:

A

NONE

24
Q

BVM grips x 3 are:

A

VE grip (vice grip) (2 ppl) = both thumbs on top of mask to secure, slightly bent and other fingers under lifting the jaw

  • CE grip (1 person) = 1 hand C grip over mask, other hand for bvm
  • Double CE (2 ppl) =2 hands securing mask to face
25
Q

How to get a neutral position:

A

While supine elevate the patients head with the aim of bringing EXTERNAL AUDITORY MEATUS to the level of MID-CLAVICLE

2 to 5cm in most patients

  • pads have prominent occiputs and short necks so may require thoracic elevation to achieve neutral head position
26
Q

How to achieve SNIFFING position:

A

While supine elevate the patients head with the aim of bringing EXTERNAL AUDITORY MEATUS to level of MID STERNUM.

  • this requires lower neck flexion and upper neck extension- with face parallel to the ceiling
  • elevating the head of the stretcher can assist with achieving this position
27
Q

Laryngoscopy indications:

A

Patients with Altered conscious state requiring inspection of the airway

28
Q

Laryngoscopy contras:

A

NONE

29
Q

How do we select the appropriately sized LARYNGOSCOPY blade?

A

-Place proximal aspect of blade at upper incisor (front teeth)
The tip of the blade should fall within 1cm of the angle of the mandible

30
Q

Insertion for laryngoscopy:

A
  • laryngoscope on pts left side head
  • suction equipment on right side
  • left hand grips base of handle
  • right hand supports head
  • open month
    -insert blade down R/side
  • sweep tongue to the left side

Suction/remove foreign bodies as required

31
Q

Nasogastric tube indications:

A

Following intubation or sga insertion

32
Q

Nasogastic tube contras:

A
  • severe middle facial fracture
  • recent nasal surgery
  • suspected basal skull fracture
  • known oesophageal varices
33
Q

Nasogastric tube precautions:

A

-coagulopathy
- advanced cirrhosis or liver failure (due to risks with oesophageal varices)

34
Q

Nasal capnography indications:

A
  • post sedation
  • altered conscious state in the setting of drug or alcohol intoxication

NO CONTRAS
NO PRECAUTIONS

35
Q

Nasal capnography NOTES. High and low readings?

A

nasal capnography measures the partial pressure of exhaled carbon dioxide in a spontaneous ventilating patient

Useful for: monitoring airway patency and identify trends in ETC02 value

HIGH ETC02 = hypercapnia (respiratory acidosis) low PH.
= Pt is hypoventilating and retaining too much C02 .

LOW ETC02= hypocapnia respiratory alkalosis) high PH
=PT is hyperventilating and blowing off too much C02

36
Q

Oxygen cylinder presentations:

A

C cylinder = 400- 490 litres

D cylinder = 1500- 1650 litres

37
Q

Oxygen side effects:

A

Drying of mucus members of the upper airway

38
Q

SGA indications:

A

1) unconscious patient w/out a gag reflex

2) ineffective ventilation w/BVM and basic airway management

3) >10minutes of assisted ventilation required

4) Unable to intubate

39
Q

SGA contras

A
  • intact gag reflex
    -strong jaw tone of trismus
    -suspected epiglottis or upper airway obstruction
40
Q

SGA precautions:

A

-inability to prepare patient in the sniffing position

  • patients who require higher airway volumes
  • vomit in airway

-paeds who have enlarged tonsils

41
Q

SGA troubleshooting:

A

If early resistance encounter or inadequate seal- correct with:

-clockwise/anti clockwise rotation while exerting downward pressure

AND/OR

Jaw thrust while inserting/reinserting.

MAX 3 attempts

42
Q

Suction indications:

A

Suspected fluid obstruction in the airway or airway device

43
Q

Suction contras

A

NONE

44
Q

Suction precautions:

A

-epiglottis
(extremely caution, stimulation of the epiglottis may cause complete airway obstruction.

  • Croup
    Does not require routine suction and may worsen swelling and distress
45
Q

3 types of suction equipment:

A
  • Y suction
    Best for ETT, NPA, STOMA OROPHARYNGEAL, NEONATE suction
  • Yankauer
    Best for visible secretions fluids in the oropharynx or external nares
  • Ducanto
    Best for large volume regurgitation, emesis or bleeding particularly during intubation
46
Q

How does the triple airway manoeuvre enhance the assessment of the airway:

A

The aim is to life the soft tissue away from the posterior wall of the oropharynx, relieving the obstruction of the airway.

47
Q

How bloody good is Rachel for making this:

A

10/10 bloody fantastic!!

ABCs (1 decks)

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