Airway Flashcards
Dyspnea
Shortness of breath
page 779
Hypercapnia
Decrease in carbon dioxide elimination resulting in a buildup of carbon dioxide in the blood
page 780
Hypocapnia
Increase of carbon dioxide elimination which lowers the carbon dioxide content of the blood
page 780
Intrapulmonary Shunting
Blood entering the lungs from the right side of the heart bypasses the alveoli and returns to the left side of the heart in an unoxygenated state
page 781
After load
The amount of resistance against which the ventricle must contract
page 781
Paradoxical Motion
When part of the chest wall moves in on inhalation and out on exhalation, Opposite normal chest movement
Oxyhemoglobin / Hbo2
Hemoglobin that is occupied by oxygen
Reduced Hemoglobin
Hemoglobin after the oxygen has been released to the cells
Carboxyhemoglobin / COHb
Hemoglobin loaded with Carbon Monoxide / CO
BURP maneuver
aka Laryngeal manipulation
Backward, upward, rightward pressure is applied to the lower one-third of the thyroid cartilage
Can help improve the view of the glottic opening and vocal cords
page 838
L.E.M.O.N
L - look externally
E - evaluate 3-3-2 - 3 fingers fit in between the teeth, 3 fingers from the tip of the chin to the hyoid bone, 2 fingers distant from the hyoid bone to the thyroid notch
M - mallampati classification - how much you see of the pharynx
O - obstruction
N - neck mobility
page 829-830
Carina
A ridge at the base of the trachea when it splits into 2 branches
The membrane of the carina is the most sensitive area of the trachea and larynx for triggering a cough reflex
Mallampati classification
Class 1 - entire posterior pharynx is fully exposed
Class 2 - Posterior pharynx is partially exposed
Class 3 - posterior pharynx cannot be seen; base of the uvula is exposed
Class 4 - no posterior pharyngeal structures can be seen
Main risks to providers when intubating
Risk of infection
Exposure «< think of all the different things that could cause exposure
Common provider errors of intubation
Not ventilating properly Failure to anticipate a problem Not having all equipment near by Not double checking tube placement Not securing pt's head/neck so ET tube is more likely to dislodge Taking more than 30 seconds to intubate
How to clear an obstructed tracheostomy
Suction the trach to clear out obstructions
-hard cath suction around the outside
-soft cath suction down the tube
Common obstructions are thick secretions
Possibly need to put in an ET tube in if there is swelling around the stoma
Next steps after initial ventilations are unsuccessful
Check for obvious obstructions like secretions
Check for swelling
Make sure the head is in a good position to have the airway open
Place OPA/NPA if needed/able
If continues to be unsuccessful, attempt supraglottic airway
If that does not work and pt is not awake open up the airway and look for an obstruction
If no obstruction is visible, attempt intubation
Indications for intubation
Airway control needed as a result of a coma, resp arrest, cardiac arrest
Ventilatory support before impending respiratory failure
Prolonged ventilatory support required
Absence of a gag reflex
Traumatic brain injury
Unresponsiveness
Impending airway compromise (burns, trauma)
Main reasons why we intubate
To protect and secure the airway
Protect from aspiration
Have more control of the airway
Cannot secure and protect the airway by any less advanced techniques
Page 833
Nasotracheal intubation indication
Pts breathing spontaneously but require definitive airway management
Intact gag reflex
page 847
Indications / requirements for needle cricothyrotomy
Not able to secure an airway through any other means
Pt under the age of 8 years old (depending on protocols could go up to 12)
Burns
Facial trauma
Swelling
Stylet - When and How
When - Can be used almost any time intubating
- Has mostly been replaced with the bougie
- When using VL the stylet can make the ET tube ridged and not straighten out after the bend, possibly causing damage
How - Place stylet in ET tube.
- Do //NOT// go past the end of the ET tube
- Stylet is stiff and could damage structures
- Bend the ET tube and stylet just above the cuff for easiest insertion
Bougie - When / How
When - Can use it almost at any time
- Need to be cautious as to not force it in and possibly damage structures
How - Able to put it in first without the ET tube which makes it a bit easier
- Able to possibly feel the vibrations of the bumps in the trachea for a confirmation of placement
- Another confirmation is putting the bougie in until it hits the carina. If it were to continue then you are in the esophagus
Intubating with c-spine concerns
Need to keep the head in a neutral position to protect c-spine
Easiest way to intubate is with video laryngoscopy
Need to make sure you just lift the jaw and not move the head
Benefits of using a ventilator
Let's whoever would be ventilating be able to perform other actions Can't get distracted or tired Consistent More controls of MV and TV Amount of oxygen can be adjusted more
Signs of Tension pneumothorax
Unequal breath sounds
Unequal chest rise and fall
Difficult to ventilate
Tracheal deviation is a super late sign. If you see it, pt is probably dead
page 1017
Indications of needle decompression
JVD
Hypertension
Decreased breath sounds
Uneven chest rise and fall
Removing foreign body
Chest thrusts
Back slaps
Repositioning
Suction
Finger sweep ONLY if you can see an object
If pt becomes unconscious begin chest compressions
Get forceps and if pt tolerates it, go in and try to pull out or suction out the airway
Common neuromuscular blocking agents
aka paralytics Roc - rocuronium Succ - succinylcholine Vec - vecuronium Pancuronium
page 657, 863
Common benzodiazepines
aka sedatives
Versed
Midazolam
Ketamine
page 658
Why use paralytics when intubating
Increase first-time pass rate
Can remove gag reflex
Common opioids
aka pain reliever
Fentanyl
Morphine
Rhonchi
Rattling breath sounds normally found in the lower airway
Indicates thick mucus in the lungs
Most prominent on expiration
Signs of respiratory distress
Accessory muscle use or retractions Increase breathing rate Color changes Grunting Nasal flaring Retractions Sweating Wheezing Body position
Normal PaCO2
35-45 mmHg
Normal PaO2 range
80-100 (idk of what)
Normal Ph range
7.35-7.45 (idk of what)
Equipment needed for intubation
BVM, OPA/NPA, Igel, Oxygen, capnography, ET tube - multiple sizes, check for cuff inflation, Mac blade (Macintosh, curved), miller blade (straight), check light on blades, VL intubation kit, Syringe to inflate ET tube cuff, suction, PPE - eye protection, mask, gloves, Magill forceps, bougie, stylet, pain reliever, paralytic, sedative / anxiety med
Anatomical features viewed during intubation
Epiglottis - flap that covers the trachea during swallowing
Vocal cords - top parts of ‘the triangle’ sometimes seen as white
Posterior cartilage - bottom part of ‘the triangle’
page 837
Physiology of ventilation
aka breathing
Movement of air through the conducting passages between the atmosphere and the lungs
Anatomical differences between pediatric and adult airways
Pedi
Cricoid cartilage is the narrowest part of the airway (just below the vocal cords)
Tongue is a lot larger
Jaw is a lot smaller
Epiglottis is more floppy and U-shaped
Trachea is funnel-shaped below the vocal cords making a cuff on an ET tube less necessary
Infant and small kids (up to age 5-6) have large heads so they end up in a flexed position when laying supine
page 2151
Least to most invasive airway management
Nasal cannula
Simple mask
Non rebreather
CPAP/BiPAP as long as pt maintains adequate MV
BVM
NPA/OPA
Igel
Superglotic airway
ET intubation
Needle cric for less than 8 years old (depends on protocols)
Surgical cric for older than 8 years old (depends on protocols)
Trismus
Clenched teeth caused by spasms of the jaw muscles
page 897
