Advance Airway Management Flashcards
What does MOANS stand for?
Mask seal
Obesity/Obstruction
Age
No teeth
Stiff lungs
What does BOOTS stand for?
-Beard
-Obese
-Older
-Toothless
-Snores
What does LEMON stand for?
Look externally
Evaluate 3-3-2
Mallampati Score
Obstruction
Neck mobility
3-3-2 Rule
Mouth opening - 3 fingers
Under the chin - 3 fingers
Two fingers to the cricoid cartridge
Mallampti Scores
Class I is the easiest, Class IV the hardest
What is the goal of airway management
Oxygen in
CO2 out
Prevent aspiration
Indications for Endtracheal Intubation
Failure of airway maintenance or protection
Failure of ventilation or oxygenation (assess min volume)
Predicted clinical course
Laryngoscopy equipment (STOPICBARS)
Suction (yanker tip) & Stethoscope
Tubes
Oxygen via a BVM
Pharmacology
IV Access
Connection & Confirmation
-EKG, NIBP, SpO2, etco2 EDD
Blades and Bougie
Alternate intubation device
Rescue Oxygenation device
Surgical Airway
What does PEEP do?
Recruit Alveoli and maintain oxygenation
What does the vagus nerve do?
If stimulated will decrease heart rate which will decrease BP
What drug do we use to premeditate peds pts prior to intubation?
Atropine, it is anticholenergic so it blocks to parasympathetic nervous system
Which blade is better for large tongues?
Miller
What does a score of 2 or higher mean on the LEMON scale
Score of 2 or higher indicates a difficult intubation
What is a Mac Blade
Curved
What is a miller blade
A straight blade
Succinylcholine dose
1-1.5mg/kg
Contraindications of succinylcholine
Hyperkalemia, rhabdomylsis, muscle trauma, burns, hypertension, bradycardia, hypersensitivity
Indications for succinylcholine
To facilitate tracheal intubation and to provide muscle relaxation prior to surgery
Fentanyl indications
-pain management
-Facilitate intubation
-sensitive to morphine but requires anagelsia
Fentanyl dose
25 to 50mcg every 10 mins with a max of 150mcg for ACPS
Fentanyl contraindications
Hypersensitivity
Indications for Versed
Sedation prior to intubation or cardioversion
Sedation of intubated pts
Sedation of agitated pts
Anticonvulsant
Contraindications for versed
Hypersensitivity, acute narrow angle glaucoma
Versed dose
Intubation: 2-5mg IV
Chemical restraint: 2.5-5mg IV/IN
Seizures 2.5-5mg IV 5mg IN
Indications for atropine
Symptomatic Bradycardia
Organophosphate poisoning
Prior to peds intubation
Contraindications for atropine
Tachycardia, hypersensitivity to anticholinergics
Atropine dose
0.5 to 0.6mg IV/IO push up to 3mg
The 7ps of ETI
-prepare
-preoxygenate
-pretreatment
-paralysis
-position
-placement with proof
-post intubation management
Prepare
-LEMONS
-BOOTS
-RODS
-SHORT
Preoxygenate
100% oxygen
3mins or 8 vital capacity breaths
Pretreatment
Lidocaine if awake
Fentanyl
Or both
ET tube confirmation
Objective confirmation
-watching the ETT go through the cords
-ETCO2
-Esophageal detector device
DOPES
Dislodgement
Obstruction
Pneumothorax
Equipment
Sedation
Rocuronium dose
0.6-1.2mg/kg
Rocuronium indications
To provide airway paralysis to facilitate ET intubation
Rocuronium contraindications
Renal dysfunction, liver dysfunction, hypersensitivity, pt is not already under anesthesia
Vecronium dose
0.08-0.1mg/kg IV
Vecronium indications
To achieve paralysis for ET intubation
Vecronium contraindications
Hypersensitivity
Lidocaine dose
1.5mg/kg
10mg\spray
Ketamine dose
0.5-1mg/kg
Ketamine indications
Rapid sequence induction
Ketamine contraindications
Hypersensitivity, pain, hypertension
What does RODS mean
restricted mouth opening
obstruction
dislodgement
stiff lung
