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ITLS > AIRWAY > Flashcards

AIRWAY Flashcards

1
Q

General anesthetic two principal mechanisms

A

Increase in inhibition through activity at GABA receptors (benzos, barbs, propofol, etomidate, isoflurane, enflurane, halothane) and
Decreased excitation through NMDA receptors (ketamine, nitrous oxide, xenon)

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2
Q

Onset of unconsciousness in all induction agents minus midaz

A

30 seconds

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3
Q

Dosing of induction agents should be based on

A

LBW, decreasing to IBW if pt is hemodynamically compromised
Fatties 0.3 of excess body weight (TBW-IBW) added to IBW
1/2-1/3 in oldies due to extra fat, less muscle, less ability to compensate

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4
Q

Etomidate pharmacology

A

Hypnotic, no analgesic properties. Second most hemodynamically stable (next to ketamine)
Increases GABA. Attenuates ICP by decreasing CBF and CMRO2 (cerebral metabolic rate for oxygen)
Hemodynamically stable so preservers CPP
No histamine release
No bronchodilatory effect

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5
Q

Etomidate indications

A

Good for hemodynamic instability, or ICP because of decreased CMRO2 and CPP.
Pregnancy category C
Not FDA approved for peds but still probably okay for peds

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6
Q

Etomidate doses

A

0.3mg/kg
0.2mg/kg in hemodynamic compromised pts
Fatties do 0.3mg/kg plus 30% of TWB-IBW

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7
Q

Etomidate adverse

A 
Pain on injection
Myoclonic movements (don't matter but look like a seizure) 
Blockage of 11-B hydroxylase decreases serum cortisol and aldosterone
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8
Q

T1/2A and T1/2B

A

Distribution half life and elimination half life

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9
Q

Etomidate pharmacology

A

Onset 15-45 seconds
T1/2A 2-4 minutes
Duration 3-12 minutes
T1/2B 2-5 hours

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10
Q

Ketamine pharmacology

A

Onset 45-60 seconds
T1/2A 11-17 minutes
Duration 10-20 minutes
T1/2B 2-3 hours

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11
Q

Clonus

A

a series of involuntary, rhythmic, muscular contractions and relaxations.

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12
Q

Failed airway definition (3 things)

A

Failure to maintain acceptable O2 during or after one or more failed laryngoscopy attempts
Three failed attempts by an experienced provider even with proper oxygenation
Single best attempt at tubing fails in the “forced to act” scenario

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13
Q

Cormack and Lehane

A

Visualizing larynx during laryngoscopy. 3 and 4 are correlated with failed intubation
Grade 1 - Visualization of entire glotic aperture
Grade 2 - visualization of posterior portion of the cords or arytenoids
Grade 3 - only epiglottis visible
Grade 4 - No glottic structures visible

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14
Q

Cromack and Lehane Grade 2a/2b

A

2a shows an portion of the cords and 2b shows only arytenoids (2b airways behave more like 3)

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15
Q

LEMON

A 
For identifying difficult intubations
Look externally
Evaluate 3-3-2
Mallampati score
Obstruction/Obesity
Neck mobility
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16
Q

L in LEMON

A

Look externally, if an airway looks difficult it probably is.
Overall feeling, things like lower facial disruption, bleeding, obese, agitated, short neck, small mouth etc.

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17
Q

E in LEMON

A

Evaluate 3-3-2. Based on angles for proper alignment to create a direct line of site.
Based on mouth opening wide enough for visualization, long enough mandible for tongue to be displaced, glottis is a sufficient distance caudad to the base of the tongue that cords can be visualized

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18
Q

Ludwigs angina

A

rare skin infection that occurs on the floor of the mouth, underneath the tongue. This bacterial infection often occurs after a tooth abscess, which is a collection of pus in the center of a tooth. It can also follow other mouth infections or injuries.

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19
Q

M in LEMON

A

Mallampati score

Class I and II are easy, IV may fail more than 10% of the time.

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20
Q

Mallampati class I

A

Soft palate, uvala, facues, pillars - no difficulty

21
Q

Mallamapti class II

A

Soft palate, uvala, facues - no difficulty

22
Q

Mallamapti class III

A

Soft palate, base of uvala - moderate difficulty

23
Q

Mallampati IV

A

Hard palate only, severe difficulty

24
Q

O in LEMON

A 
Obstruction/obesity
Muffled voice (hot potato), difficulty swallowing, stridor, sensation of dyspnea are 4 cardinal upper airway obstruction signs.
Stridor and sensation of dyspnea being most worrisome.
25
Q

Stridor

A

<50% of normal airway caliber or diamater of less than 4.5mm

26
Q

N in LEMON

A

Neck mobility. C-spine or ankylosing spondylitis, RA.

27
Q

Difficult BMV acronym

A 
Radiation/restriction
Obesity/obstruction/obstructive sleep apnea
Mask seal/Mallampati/Male sex
Age
No Teeth
28
Q

R in ROMAN

A

Radiation tx to neck is one of strongest predictors of difficult BMV
Restrictive airway disease pts (COPD) or pulmonary edema, ARDS, pneumonia

29
Q

O in ROMAN

A

Fatties/preggos difficult to bag from resistance on diaphragm.
Angioedema, ludwig angina, abscesses, epilglottits

30
Q

M in ROMAN

A

Mask seal/mallampati/male
Beards (try jelly but not too much to make the whole face slippery) Male sex and mallampati 3 or 4 are predictors of difficult BVM

31
Q

A in ROMAN

A

Over 55 tougher from loss of muscle and tissue tone.

32
Q

N in roman

A

No teeth. Leave dentures in if possible, use gauze in the cheeks or roll lower lip down toward chin and use inner mucosal surface as contact point for bottom of mask

33
Q

Reasons to tube

A

Failure of airway protection
Failure of ventilation or oxygenation
Anticipated clinical course

34
Q

7ps

A 
Preparation
Preox
Pretube optimization
Paralysis with induction
Positioning
Placement with proof
Post tube management
35
Q

LMA

A
  1. Test cuff on flat surface, make sure no wrinkles then lube
  2. Open airway with head tilt or jaw lift
  3. Press back of LMA against hard palate as you slide it in,
  4. If leaking, ensure head and neck alignment correct, withdraw device 6cm (cuff stays inflated) and reinsert (this frees a folded or trapped epiglottis)
    Sizes 3 40-50
    4 50-70
    5 >70kg
36
Q

King tube

A

Insert until 15/22 bag connector touches incisors, inflate, slowly withdraw while bagging.
Walls says 1-2cm more after

37
Q

SMART acronym

A 
Surgery
Mass
Access/Anatomy
Radiation
Trauma
38
Q

Cric

A 
Be on dominant hand side
Locate laryngeal prominence
1 finger below is cricothyroid membrane, find dent
R hand Incise skin 2cm vertical
Re identify membrane
1cm horizontal 
L hand hook
R hand insert tube
Inflate and confirm
39
Q

DOPE

A

Displacement
Obstruction
Pneumothorax
Equipment

40
Q

Prep

A 
Assess difficulty
Prepare backups
Lines
Draw drugs
Equipment
41
Q

Preoxygen

A

8 vital breaths or
NRB and NC 3 mins
Fatties preox sitting up

42
Q

Etomidate dose for keeping down

A

0.3mg/kg
0.2mg/kg if unstable
IBW plus 30% of excess weight

43
Q

Ketamine dose

A

1.5mg/kg more can cause myocardial depression and hypotension if catechol depleted

44
Q

Atropine dose

A

0.01mg/kg for drying effect for awake tubing

45
Q

Propofol dose

A

1.5mg/kg

1/2 to 1/3 reduction in compromised oldies

46
Q

Midaz

A

0.3mg/kg

47
Q

Fentanyl

A

3-5mcg/kg

48
Q

Ketamine to keep them down

A

1mg/kg q 10

49
Q

Roc to keep down

A

0.5mg/kg q 20 prn

ITLS (8 decks)

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