Advanced airway management Flashcards
What are the 4 indications for intubating a patient
- Failure to protect the airway leading to an increased risk of aspiration
- Failure to oxygenate or ventilate
- When you predict that the patient will decompensate further
- Hypoxic driven cardiac arrest
What are the difficulties in bag mask ventilation
M> Mask seal problems (Beards)
O> Obstruction
A> Advanced age (This is because these patients may have poor muscle tone and skin turgor)
N> No teeth
S> Stiff lungs (This requires high pressure ventilation)
What are the difficulties related to ETT airways
L> Look (These are the external features that make the airway difficult e.g. body hiatus, Neck anatomy, mouth opening
E> 332 rule
M> Mallampati
O> Obstruction and obesity
N> Neck mobility
What is the 332 rule
- Distance between the incisors is 3 fingers
- The mentum to the hyoid is 3 fingers
- The distance between the hyoid and the thyroid is 2 fingers
What are the surgical predictors of a difficult airway
S> Scars or previous surgery
H> Haematomas
O> Obesity
R> History of radiation theropy
T> Tumors
What are the indications of a difficult supraglottic airway
R> Restricted mouth opening
O> Obstructions
D> Distorted airway
S> Stiff neck
What are the 7 P’s in in the prep and placement of a ETT in a rapid sequence intubation
- Preparation
- Pre oxygenate
- Positioning and pretreatment
- Paralysis
- Placement (Of the tube)
- Proof of placement
- Post intubation care
What are the parts of the equipment that you need to prepare for a rapid sequence intubation
SOAP-ME
S> Suction
O> Oxygenation
A> Airway equipment
P> Pharmacy and muscle paralytic
ME> Monitoring equipment
How long should preoxygenation last
3-5 mins
What are the premedication treatment that are given to patients in a rapid sequence induction
LOAD
1. Lignocaine: This is given to patient that have an increased intracranial pressure and is given to blunt the coughing reflex which causes a spick in ICP
2. Opioids (Fentanyl): These help to limit the sympathetic responses such as tachy and hypertension
3. Atropine: This is indicated for paediatric patients to prevent the risk of bradycardia and vagal tone increases
4. Defasciculating agents (Roc): Used in patients with increased ICP and intraocular pressure
On which side of the patients mouth is the blade inserted
Right
What are the 2 methods of making sure that the ETT tube is placed correctly
- Auscultation of the lung fields
- ETCO2 monitoring
What are 6 factors that can affect the pulse oximetry
- Nail polish
- High ambient light
- CO poisoning
- Cardiac arrest
- Hypotension
- Hypothermia
What are the 4 main areas of concern if the SPO2 drops
DOPES
D: There is displacement of the ETT
O: Obstruction in the ETT or in the breathing circuit
P: Pneumothorax
E: Equipment failure
S: Stomach is full of air
What are 6 common complications of an ETT
- Trauma: Of the vocal cords, mouth or teeth
- Infection from the tube
- Broncho or laryngospasms
- Esophageal intubations
- Right main bronchus intubation
- Tension pneumothorax
What is the sequence in case of a failed ETT
- Try a laryngoscope
- Supraglottic airway
- Attempt mask
- Crico
