Advanced Airway

Question 1

Indications for Advanced Airway

Answer 1

Unable to swallow
Can’t ventilate
Can’t Oxygenate
GCS <8
Burns/ Anaphylaxis
Apnea
Obstruction
pH <7.2
CO2>55
PaO2<60

Question 2

ETT Size for Pediatrics

Answer 2

(16-age) / 4

Question 3

What age do you began needle Cric?

Answer 3

<8

Question 4

LEMON

Answer 4

Look
Evaluate 3-3-2
Mallampati 1-4
Obstructions
Neck Mobility

Question 5

Bougie size

Answer 5

Adult 15Fr
Pediatric 10 Fr

Question 6

High flow nasal canula

Answer 6

20-60 LPM
Humidified

Question 7

Cuff pressure

Answer 7

20-30mmHg
25mmHg ideal

Question 8

ETT chest X ray confirmation

Answer 8

5cm +- 2 cm above carina
T3-T4
Murphy’s eye inline with clavicles

Question 9

Esophageal Intubation Detector (EID)

Answer 9

Bulb check
Esophagus will collapse and not allow air back into bulb

Question 10

Colorimetric Device

Answer 10

No numerical value
Purple upon opening package
Should turn Yellow if tube is placed correctly
Yellow Yes/ Purple pull

Question 11

RSI 7 Ps of Success

Answer 11

Preparation
Preoxygenate
Pretreatment
Paralysis with induction
Protect and position
Placement with proof
Post intubation management

Question 12

RSI Preparation

Answer 12

> 93%
SBP >100
Cardiac monitor
IV established
BVM w/mask
Suction
OG/NG tube
Capnography
Correct blade and backup
Cuff check
Load and shape Stylet
10ml syringe
RSI meds ready

Question 13

Preoxygenate

Answer 13

3-5 minutes passive oxygenation via NC @ 10-15lpm
8 vital capacity breaths with BVM at 15lpm / PEEP 15

Question 14

Pretreatment

Answer 14

LOAD
Lidocaine: blunts cough reflex
Opiates: Blunts pain response
Atropine for infants: reflexive bradycardia
Defasiculating Dose: 1/10 dose of ROC or VEC
Analgesics: Fentanyl
Induction Agents: Etomidate, Ketamine, Midazolam, Propofol

Question 15

RSI Paralysis

Answer 15

Succinylcholine: 1-2mg/kg, depolarizing
Rocuronium: 1mg/kg, Nondepolarizing
Vecuronium 0.1-0.15mg/kg Nondepolarizing

Question 16

RSI Protect and Position

Answer 16

SALAD technique: (Suction assisted laryngoscopy airway decontamination)
Once airway is cleared place suction in esophagus
Ramping ear to sternal notch
pad behind shoulder of pediatrics

Question 17

RSI Placement with Proof

Answer 17

Direct visualization
Inflate cuff
EtCO2
Auscultate
Secure ETT

Question 18

RSI Post intubation management

Answer 18

Fentanyl: 0.5-1.5mcg/kg IVP every 5 minutes
Ketamine: 0.5-1.0mg/kg IVP every 15 minutes
Midazolam:0.05 - 0.1 mg/kg/hr

Question 19

Fentanyl

Answer 19

1mcg/kg
Onset 3-5 minutes
Duration 30-60 minutes
May cause muscle wall rigidity if given too quickly or in high doses

Question 20

Etomidate

Answer 20

Induction agent
0.3mg/kg
Onset 15-45 seconds
Duration 3-12 minutes
Do not use in Pts with adrenal suppression
- Addison’s disease, or Sepsis
Avoid in COPD or Asthmatic Pts

Question 21

Ketamine

Answer 21

Hypnotic analgesic
Dose 1-2mg/kg IV (RSI)
Onset 40-60 seconds
Duration 10-20 minutes
Bronchodilator
May increase secretions
-give atropine

Question 22

Midazolam (Versed)

Answer 22

Benzodiazepine
2-5 mg IV
Onset 30-60 seconds
Duration 15-30 minutes

Question 23

Propofol (Diprivan)

Answer 23

Hypnotic
1-2mg/kg IV
25-50 mcg/kg/min (maintenance)
Onset 15-45 seconds
Duration 5-10 minutes
Decreased Cerebral perfusion pressure and MAP
Avoid with shocky Pts or head injuries

Question 24

Succinylcholine (Anectine)

Answer 24

Depolarizing
Causes fasciculations
1-2 mg/kg
Onset <1 minute
Duration 4-6 minutes
can cause hyperkalemia
Contraindication
-crush injuries
-eye injuries
-narrow-angle glaucoma
-history of malignant hyperthermia
-Burns >24 hours old
-hyperkalemia
-nervous system disorders like Guillain-Barre, Myasthenia gravis

Question 25

Malignant Hyperthermia

Answer 25

Can be caused by Succinylcholine or inhaled anesthetics Caused by a defect in muscles that results in and inability to remove calcium from cell S/S: Masseter spasm (trismus) Tetanic muscle contractions rapid increase in temperature Increased ETCO2 Tachycardia HTN Mixed acidosis Tx: Dantrolene Sodium 2.5mg/kg Rapid IV bolus Do not give calcium channel blockers

Question 26

Rocuronium (Zemeron)

Answer 26

Nondepolarizing 2 minute onset Duration 30-60 minutes 1mg/kg 0.1-0.2 mg/kg IV every 20-30 minutes Reverse with Sugammadex (Bridion) 16mg/kg

Question 27

Vecuronium (Norcuron)

Answer 27

Nondepolarizing Used secondary to ROC or SUC Onset: 90-120 seconds Duration: 60-75 minutes 0.15mg/kg 0.01-0.1mg/kg (maintenance)

Question 28

Shock Pts RSI medication

Answer 28

Use 1/2 induction dose -less needed due to depleted catecholamine stores Double the paralytic dose -low cardiac output slows the onset of action

Question 29

CRIC indications

Answer 29

Cant intubate Cant Ventilate Cant Oxygenate