Airway and Breathing Flashcards
B01-B06
What three categories/ reasons to intervene on the airway?
- Obtain or maintain their airway
- Oxygenation or ventilation issue
3.Clincal progression of emergency
What is NODSAT?
Nasal cannula @5lpm while ventilating with a bvm @15lpm
How do you measure a OPA?
Corner of mouth to ear lobe
How do you measure a NPA?
From tip of nose to the tragus of ear
At what Sat’s do you provide supplemental o2? (In most cases)
<94%
What is PEEP? When do you use it?What are the contraindications?
-Positive End Expiratory Pressure
-Pt.’s that remain hypoxic even after high flow o2 and ventilatory support
-Contraindicated in: cardiac arrest, >12 YOA when SBP <90mmHg, <12 Systolic blood pressure ≤ lower limit for age range as per pediatric vital signs, suspected pneumo, traumatic cause of respiratory issues
What PEEP do you start with? What is the max?
start with 5cmH2O and max is 10cmH2O
When is a SGA indicated?
When a pt. is unable to protect their airways due to unconsciousness
What are the contraindications for a SGA?
-inabilities to place the device due to difficulties with mouth opening
-Known or suspected FBAO
-Trauma to trachea, neck or oropharynx
-Caustic ingestion
-Active vomiting
what is CPAP?
Continuous Positive Airway Pressure
When is CPAP indicated?
-Able to maintain their own airway, with no vomiting
-13 and older
-Resp rate >24, Sats of <94% even when on 02
-Asthma, Pneumonia, Submersion injuries, COPD
When is CPAP contraindicated?
Patient age 12 years and less
Decreased level of consciousness, or inability to follow commands
Respiratory arrest or hypoventilation
Patients who are in imminent or actual respiratory failure (i.e., whose respirations are slow, feature shallow tidal volumes, and whose level of consciousness is falling) are not candidates for CPAP; these patients must be ventilated with a bag-valve mask (and may benefit from PEEP use)
Unable to fit mask to patient’s face
Vomiting or any other risk of aspiration
Traumatic cause of respiratory distress
Tracheostomy
Suspected or known pneumothorax
Systolic blood pressure < 90 mmHg
Awake intubation Indicators?
- Patients with predicted difficult airway anatomy
- Predicted difficult physiology
- You must call clinical prior to intubation
What are the procedures of the awake intubation?
-call clinicall to discuss plan
-Bring sats of pt. to the highest you can get (usually above 94%)
-NODSAT placed (Nasal cannula at 5lpm)
-500ml’s N/S bolus (for adults, 10ml/kg for children)
-Induction agents: Ketamine, fentanyl, midaz
-Lidocaine for topical anesthetic of cords (spray as you go approach)
-DL or VL approach (VL has a higher rate of first pass succes)
What is the procedure of confirming tube is placed correctly in the trachea?
There has to be 2 of the following to confirm placement:
1. See the tube pass the cords
2. End tidal wave form (not just the number, actual wave form)
3. Auscultation of stomach for air entry (this is a bad sign and confirms tube was placed in esophagus)
4. Auscultation of lungs to confirm air entry/ Right main stem
What is the anesthetic induction plan?
Based upon 4 criteria:
1. Amnesia
2. Analgesia
3. Autonomic Stability
4. Areflexia
What is shock index?
Greater than 1 or equal to:
- HR is equal to or greater then the SBP
Less then 1:
- HR is less then SBP
Shock index is a standard to indicate that the pt. is compensating for shock, comparing HR to SBP.
Ketamine Dosing for induction
Shock index of greater than or equal to 1:
-1mg/kg for induction
-half the amount for induction for maintence every 10-15mins
Fentanyl Dosing for induction
50-100mcg for induction and maintenance every 10-15mins
Phenylephrine dosing for periintubation
100mcg every 3-5 mins to maintain SBP >90mmHg
Greater than 500mcg Clinicall is required to give more
The dosing for all meds that could be used? (the diagram off BCEHS Handbook)
SOAPME
- Suction
- O2
- Airway equipment (DL/VL, different size blades, ET tube with 10cc, lube, back up option, bougie, stylet.
- Pharmacology
- Monitor and thresholds set
- End tidal
When is surgical airways indicated?
When the pt. is unable to be ventilated or oxygentiated by other means.
What methods are used for surgical airways?
- > or equal then 12 years of age:Bougie-assisted cricothyrotomy using a scalpel, bougie and 6 tube
- < 12 years of age: Needle cricothyrotomy
Contraindications for surgical airways?
Inability to landmark
Do you ventilate or start compressions when you find a pulseless pt.?
Unconscious patients should have their breathing and circulation assessed concurrently. If the patient is found to be pulseless, immediately begin chest compressions and attach a defibrillator – do not attempt to ventilate these patients prior to beginning CPR. In cardiac arrest, the lack of a patent airway is significantly less important than the need to establish circulation.
When do you provide abdominal thrusts?
When the pt. has a fully obstructed airway and still conscious
At what age do you perform back blows and chest compressions? What is the ratio?
<1 year of age, 5 back blows followed by 5 chest compression, then look in mouth for FB to remove, follow this until dislodged or unconscious.
What characteristics are accompanied in a bronchoconstriction pathology?
wheezing
coughing
airway inflammation
I:E ratio that increase on the expiratory phase due to air trapping
What is the progression of treatments for status asthmaticus?
- O2
- Salbutamol
- Ipratropium
- Dex (Clinicall consult required)
- IM EPI
6.IV EPI - Mag
- CPAP
- Intubation
WHIPS
Worst you ever had it?
Hospitalized for this?
Infections/ ICU stays for your bronchospasms
Puffer use?
Steroid use?
BREATHE
Bacterial infection
Reactive airway
Embolism (PE)
Anaphalyxsis
Tension Pneumo
Heart Failure
Electrical excitation of the heart
What portions does croup and epiglottitis inflame?
the upper airways causing narrowing, this is especially concerning for pediatric population
What is the main difference between croup and epiglottitis?
drooling! of the pt. This is highly indicative of epiglottitis
Barking cough like a seal is highly indicative of croup
Treatments for croup?
5mg EPI in 5ml nebulized over 15mins
Dex (Clinicall consult required)
Antipyresis - 15mg/kg tylenol
WELLS Criteria
Clinical signs of a DVT
PE is the most likely
HR >100
Immobilization for 3 days or more or surgery in the last 4 weeks
Previous Dx. of DVT or PE
Hemoptysis
Malignancy within the last 6 months
Virchows Triad
Hypercoagulability
Endothelial injury to Blood vessels
Stasis of blood flow
