Airway Flashcards
Critical values
Ph< 7.2, CO2>55, and PAO2 <60
LEMON
Look, evaluate (3,3,2), Mallampati, Obstructions, Neck Mobility
Mallampati 2
Tonsillitis pillars hidden by tongue
Mallampati 3
Only base of uvula can be seen
Mallampati 4
Uvula cannot be seen
HEAVEN
Hypoxemia = 93% at time of laryngoscope
Extreme size: less than 8yo or obese
Anatomic challenges
Vomit, blood, fluid
Exsanguination/anemia
Neck mobility
Ramping
Ear to sternal notch
Sellicks maneuver
Posterior pressure on cricoid cartilage, no longer recommended.
(Choke time sellick who doesn’t work anymore)
BURP
Backward, upward, rightward pressure
External laryngeal manipulation
Provider brings cords into view and then airway assistant maintained positioning
Mac blade
Lifts epiglottis via the vallecula
Miller
Direct displacement of epiglottis
Neonates, infants
Bougie
Adults 15 fr
Pediatrics 10 fr
High flow nasal cannula
20-60 liters per min
Ett cuff pressure
20-30 mmhg
(25 is standard)
Standard of placement
Chest X-ray, 4-5 cm above carina
T3-t4
End tidal CO2
Inhalation ⬇️ expiration ⬆️ expiratory plateau ➡️ ETCO2
Colorimetric device
Yellow is yea, purple is pull
RSI 7ps
Prep
Preoxygenate
Pretreatment
Paralysis with induction
Protect and position
Placement with proof
Post intubation management
RSI LOAD
Lidocaine: blunts cough reflex
Opiates: pain response
Atropine for infants: prev reflexive Brady cardia
Defasicilating dose: 1/10 dose of roc or vec
Fentanyl
1mcg/kg
Onset 3-5 min
Duration 30-60 min
Etomidate
.3 mg/kg
Contraindicated for pt with adrenal suppression, copd or asthmatic
No analgesic
Ketamine
1-2 mg/kg iv(rsi)
.1-.2 mg/kg pain
5mg/kg I’m )combative
Midazolam
2.5-5 mg iv
Flumazeni = .2 mg
Propofol
1-2 mg/kg
25-50 mcg/kg/min mtn dose
Decreases map and cpp
Succinylcholine
1-2 mg/kg
Requires refrigeration
Contraindications: crush, eye MH, etc
Malignant hyperthermia
Rapid increase in temperature.
Treat with DANTROLENE SODIUM
seen after succs or other inhaled anestetics
Rocuronium
Does not cause .6-1.2 mg/kg
.1.2mg/kg maintained
Good for 30 days after refrigeration
Sugannadex(bridion) 16mg/kg reversal
Vecuroniun (norcuron)
.15 mg/kg
Used post roc or succ to keep paralyzed
Hemodynamicly unstable pts for rsi
Use 1/2 induction dose
Double paralytic dose
SALAD
Suction assisted laryngoscope airway decontamination
Post intubation mngt
Fentanyl: .05-1.5 mcg/kg q 5 min
Ketamine: .5-1 mg/kg q 15min
Midazolam: 2-5mg q 15 min
Post intubation infusions
Fentanyl: 1-3 mcg/kg/hr
(Mix 500mcg/100ml = 5mcg/ml)
Ketamine: 1-2 mg/kg/hr
(500mg/250ml= 2mg/ml)
Versed: .05-.1mg/kg/hr
When to cric
Can’t intubate, can’t ventilate, can’t oxygenate
Tidal volume
How much air the pt breaths in normal breath
Inspiration reserve volume
Amount of air that can be forcefully inhaled in addition to normal tidal volume
Expiratory reserve volume
Amount of air that can be forcefully exhaled after normal tidal volume breath
Vital capacity
Tidal volume + inspiration reserve volume + expiratory reserve volume
Residual volume
Amount of air left after forceful exhalation
Total lung capacity
Irv+TV+ERV+RV
Dead space
2ml/kg
Surface of airway not involved is gaseous exchange
Central chemoreceptors
Medulla/pons
Drivin by CO2 and H in csf
Peripheral chemoreceptors
Located in aortic arch/carotid bodies
Drivin by O2, CO2 and H
Your body’s pulse ox
Ducks law of diffusion
Gasss travel from area of higher concentration to lower
Apneustic
Deep gasping inspiration with pause at full inspiration and insufficient release
Ataxic
Completely irregular breathing
Biots
Quick shallow inspiration followed by regular or irregular periods of apnea
Cheyne-stokes
Deeper and sometimes faster breaths followed by gradual decrease/apnea
(Associated with decorticate/cushings)
Kussmaul
Respirations gradually become deep labored and gasping
