Advanced Airway Principles Flashcards

1
Q

Intubation Indications

A

Unable to swallow
cannot ventilate/oxygenate (failed airway algorithm)
GCS <8
Expected clinical course (inhal. burns, circum. burns, anaphylaxis)
Apnea
Airway obstruction
Respiratory Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In respiratory failure, only one value needs to be off to indicate the need to intubate. These values include:

A

pH, CO2, PaO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

LEMON pneumonic

A
Look
Evaluate 3-3-2
Mallampati (I-IV)
Obstructions
Neck Mobility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

3-3-2 rule

A

3 fingers in mouth
3 fingers btw jaw and hyoid
2 fingers between hyoid and thyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Airway Grading

A

Mallampati

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Mallampati I

A

soft palate
uvula
anterior/posterior tonsillar pillars visible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Patients with a tall, thin neck are usually graded Mallampati

A

I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Difficulty level of Mallampati I

A

none

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mallampati II

A

Tonsillar pillars hidden by tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Difficulty level of Mallampati II

A

none

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mallampati III

A

Only base of uvula seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Difficulty level of Mallampati III

A

Moderate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mallampati IV

A

Uvula cannot be seen

Short, fat or muscular neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Difficulty level of Mallampati IV

A

Severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Curved blade that lifts vallecula

A

Macintosh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Straight blade that lifts the epiglottis

A

Miller

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Direct downward pressure on the thyroid cartilage occluding esophagus and preventing aspiration during intubation:

A

Sellick’s Maneuver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Do NOT release Sellick’s Maneuver or BURP until intubation is

19
Q

BURP pneumonic

A

Backward
Upward
Rightward
Pressure

20
Q

FAILED AIRWAY ALGORITHM

A

Patient requires secured airway
3 attempts of direct laryngoscopy unsucc.
Ventilate by BVM/simple airway/blind airway
Unable to ventilate/oxygenate SaO2 >90%
Cricothyroidotomy indicated (Cric)

21
Q

Gold standard of placement confirmation

A

Chest X-ray

22
Q

Distal tip of ETT should be

A

2-3 cm above carina or
1” above carina or
level of T2 or T3 vertebrae

23
Q

2nd most reliable confirmation method

A

visualization of tube passing thru cords

24
Q

When inflating the distal cuff on an ETT, the pressure should be between

A

20-30 mmHg to prevent mucosal tissue damage (only use amt required to make good seal)

25
Consider saline instead of air in ETT
cuff
26
Tube check
Bulb placed over ETT after intubation to confirm placement
27
End tidal CO2
Measurement of CO2 in expired air; confirms ETT placement in trachea
28
Colimetric Device
one-time device that changes colors when CO2 passes through it
29
CapnoCheck
reusable ETCO2 device that both ETCO2 and RR (aka EMMA Emergency Capnometer)
30
Capnography
measures EtCO2, waveform
31
7 P's pneumonic
``` Preparation Preoxygenate Pretreatment Paralysis with induction Protect and position Placement with proof Post intubation management ```
32
Preparation
Make sure equipment is serviceable
33
Preoxygenate
3-5 minutes, 10-15 LPM if possible
34
Pretreatment
LOAD
35
Paralysis with induction
Neuromuscular blockade (NMB), induction agent, and pain control
36
Protect and position
sniffing position | towel under patient's shoulder blades
37
Placement with proof
tube passing through cords CXR Capnography
38
Post intubation management
Maintain sedation, oxygenation
39
LOAD pneumonic (RSI pretreatment)
Lidocaine (head/lung injury) Opiates Atropine for infants Defasciculating dose
40
(LOAD) Lidocaine
blunts cough reflex preventing ICP increases (head/lung injury)
41
(LOAD) Opiates
blunts pain response
42
(LOAD) Atropine
prevents reflexive bradycardis in infants < 1 y/o (0.02 mg/kg)
43
(LOAD) Defasiculating Dose
Succinylcholine Rocuronium Vecuronium