Advanced Airway Management Flashcards
Why we fail at airway management
Lack of protocol lack of planning or preparation Lack of plan A, B, and C Intubation failure lack of equipment availability, use, or training Approach Communication failures
Indications for airway management
Unable to swallow Patient can't ventilate/oxygenate FBAO Apnea Respiratory failure indicated by ABG Expected clinical course of illness
PAT
Appearance
WOB
CIrculation
HEAVEN Criteria
Hypoxemia: SPO2 <93
Extremes of size
Anatomic challenges
Vomit/blood/fluid
Exsanguination/anemia:
potential accelerated desaturations
Neck mobility issuesFailed airway algorithm
Patient requires secured airway- can’t intubate - can’t ventilate- can’t oxygenate >90% - Cric
What should the ETT tube cuff be inflated to prevent mucosal tissue damage?
20 - 30 mmHg; 25 mmhg is the standard; truly only enough to make a seal
How do you confirm tube placement with X-ray?
Distal tip of tuble should be 2-3 cm above carina, or 1 inch above carina, or at the level of T2 or T3
Analgesic dose for Fentanyl
1 mcg/kg
What is the onset of Fentanyl
3-5 minutes, 30-60 minute duration
RSI dose for Etomidate
0.4 mg/kg
Contraindications for Etomidate
Adrenal suppression: Avoid in Septic Shock or Addison’s Disease; Avoid in COPD and Asthmatic patients
RSI dose for Ketamine
1-2 mg/kg
Pain dose for Ketamine
0.1 - 0.2 mg/kg
Combative dose for Ketamine
5 mg/kg IM
Why is Ketamine preferred induction medication for Asthmatic patients?
it is a potent bronchodilator (beta 2)
When should Fentanyl be avoided?
In patients with: increased ICP, hypoventilations (can cause chest wall rigidity), hypotension and bradycardia
What is the reversal agent for Versed?
Flumazenil (Romazicon)
What is the onset of Ketamine?
40-60 seconds; 10-20 minute duration
RSI dose for Succinylcholine
1-2 mg/kg
Contraindications for Succinylcholine
Crush injuries; eye injuries; narrow angle glaucoma; malignant Hyperthermia, burns > 24 hrs; any nervous system disorder (ie. Guillain-Barre, Myasthenia Gravis)
A class/grade of airway view where all of the structures of the airway are visible; i.e. soft palate, uvula, anterior/posterior tonsillar pillars. Often associated with tall, thin necks.
Grade/Class 1 view (aka Mallampati 1) No difficulty
A class/grade of airway view where tonsillar pillars are hidden by the tongue
Grade/Class 2 view (aka Mallampati 2) No difficulty
A class/grade of airway view where only the base of the tongue can be seen.
Grade/Class 3 view (aka Mallampati 3) moderate difficulty
A class/grade of airway view where the uvula cannot be seen and is typically associated with short, fat or muscular necks. No airway structures visible.
Grade/Class 4 view (aka Mallampati 4) difficult airway
