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Flight Medic > Advanced Airway > Flashcards

Advanced Airway Flashcards

1
Q

Indications for Advanced Airway

A

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

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2
Q

ETT Size for Pediatrics

A

(16-age) / 4

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3
Q

What age do you began needle Cric?

A

<8

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4
Q

LEMON

A

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

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5
Q

Bougie size

A

Adult 15Fr
Pediatric 10 Fr

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6
Q

High flow nasal canula

A

20-60 LPM
Humidified

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7
Q

Cuff pressure

A

20-30mmHg
25mmHg ideal

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8
Q

ETT chest X ray confirmation

A

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

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9
Q

Esophageal Intubation Detector (EID)

A

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

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10
Q

Colorimetric Device

A

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

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11
Q

RSI 7 Ps of Success

A

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

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12
Q

RSI Preparation

A

> 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

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13
Q

Preoxygenate

A

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

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14
Q

Pretreatment

A

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

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15
Q

RSI Paralysis

A

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

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16
Q

RSI Protect and Position

A

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

17
Q

RSI Placement with Proof

A

Direct visualization
Inflate cuff
EtCO2
Auscultate
Secure ETT

18
Q

RSI Post intubation management

A

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

19
Q

Fentanyl

A

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

20
Q

Etomidate

A

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

21
Q

Ketamine

A

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

22
Q

Midazolam (Versed)

A

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

23
Q

Propofol (Diprivan)

A

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

24
Q

Succinylcholine (Anectine)

A

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

25
Q

Malignant Hyperthermia

A

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

26
Q

Rocuronium (Zemeron)

A

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

27
Q

Vecuronium (Norcuron)

A

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

28
Q

Shock Pts RSI medication

A

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

29
Q

CRIC indications

A

Cant intubate
Cant Ventilate
Cant Oxygenate

Flight Medic (5 decks)

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