Advanced Airway Flashcards
What dissociative drug utilized in rapid sequence induction makes the patient appear awake however they are unresponsive to pain and amnestic to the procedure?
Ketamine
When placing a patient with COPD on a mechanical ventilator, what ventilator setting would you alter to avoid air trapping?
Inspiration/expiration (I/E) ratio. Change from the normal of 1:2 to 1:4 or 1:5
What is the difference between the laryngeal mask airway (LMA) and a intubating laryngeal mask airway (LMA Fastrach)?
The patient can be intubated with an 8.0 endotracheal tube through the laryngeal mask airway Fastrach. Once intubated, the laryngeal mask airway Fastrach can be removed or remain in position
During rapid sequence induction, muscle fasciculations are observed with the use of which medications?
Depolarizing blocking agents
What has typically happened when the mechanical ventilator low pressure has alarmed?
The circuit has been disconnected
When should a surgical airway be considered?
When ventilation via the nasal or oral routes cannot be achieved, endotracheal intubation or rescue airways fail to ventilate, massive head or neck trauma, total upper airway occlusion
Describe Sellick’s maneuver.
Application of pressure on the cricoid cartilage just below the Adam’s apple to facilitate view of the vocal cords during intubation
Neostigmine, pyridostigmine, and edrophonium are medications used for what?
Reversal agents to reverse neuromuscular blockade
You have paralyzed your patient but you are unable to intubate. What must you do?
Positive pressure ventilations until the paralytic wears off and consider a rescue or surgical airway
What other type of medication should be given to a patient that receives a neuromuscular blockade agent?
Sedative
What is a BAAM used for?
Beck airway airflow monitor used to assist with nasotracheal intubation in patients that are still breathing on their own
What are causes of decreased end tidal CO2?
Any condition that causes poor perfusion including obstruction, bronchospasm, pulmonary embolism, shock, and cardiac arrest
What structures are assessed during the Mallampati classification system?
Tonsillar pillars, uvula, soft and hard palates
When the laryngeal mask airway is inflated, where in the airway is the mask seated?
Supraglottic
Where is the needle placed for retrograde intubation?
Cricothyroid membrane
What methods are used to detect proper placement of an open cricothyrotomy?
Chest rise, auscultation, end-tidal CO2 detector
What is a gum elastic bougie or Eschmann tracheal tube?
Straight, semi-rigid stylette with a 30 degree bend at the tip utilized to facilitate difficult intubation
What is the short-acting non-barbiturate of choice in the prehospital setting due to its safety and effectiveness?
Etomidate
A patient presents with a head injury after falling from a ladder. What premedication should be considered prior to administering a neuromuscular blockade agent?
Lidocaine
What are the four phases of rapid sequence induction?
Premedication, induction, neuromuscular blockade, maintenance therapy
How is a patient properly ventilated when a needle cricothyrotomy has been established?
Transtracheal jet insufflation or mechanical ventilator
What is the BURP maneuver?
Backward Upward Rightward Pressure used to improve visualization of the vocal cords during endotracheal intubation
What premedication should be given to all pediatric patients under the age of five prior to rapid sequence induction?
Atropine (note: age ranges for this premedication vary from 3 - 8 years of age)
How is proper tidal volume estimated?
5-10 mL/kg ideal body weight
What are disadvantages to positive end-expiratory pressure (PEEP)?
Reduction of right ventricular venous return, barotrauma, pneumothorax, pneumomediastinum
Inability to be used in pediatrics or patients less than 4 feet or greater than 7 feet tall are disadvantages of which rescue airway?
Endotracheal combitube (ETC)
What precautions must be taken for the cornea with the use of paralytics?
Patient does not have a blink reflex when paralyzed and requires instillation of artificial tears at least every 4 hours
What are examples of alternative rescue airways?
Endotracheal combitube (ETC), pharyngotracheal lumen airway (PtL), laryngeal mask airway (LMA), intubating laryngeal mask airway (LMA Fastrach), Cobra perilaryngeal airway (PLA), Ambu laryngeal mask (ALM), and King LT airway
What drugs block acetylcholine’s neurotransmitter action thus inducing flaccidity of muscles without depolarizing the synaptic membrane?
Nondepolarizing blocking agents
After placing an endotracheal combitube (ETC), you observe that you have poor compliance upon ventilating through the blue portion of the tube. Where then is the tip of the tube and what should you do?
Ventilate the patient via the other tube since you essentially have an endotracheal intubation with the tip properly placed in the trachea
What is the difference in tidal volume between assist/control (AC) and synchronized intermittent mandatory ventilation (SIMV)?
Assist control tidal volume is preset and delivered with every ventilator breath and patient initiated breath. Synchronized intermittent mandatory ventilation tidal volume is only delivered with the ventilator breath. The patient initiated breaths in between are at the patient’s own volume
