Airway and CV Assessment Flashcards
What is the order of airway attempts?
CI to LMA?
What are the usual sizes of LMA for female and males?
WHat is the combitube?
head-tilt chin-lift, OPA/NPA, intubation, LMA, cricothyroidotomy.
CI to LMA if complete upper airway obstruction.
Female: Size 4 LMA
Male: Size 5 LMA
Combitube is a double lumen airway devices that can be inserted blindly into the airway. it functions when placed in either the esophagus or the trachea. Ventilate through blue port.
Rapid Sequence Intubation:
-what are the 7 P’s (key steps)
7Ps:
- preparation
- pre-oxygenation
- pretreatment
- paralysis with induction
- protection and positioning
- placement with proof
- post intubation management.
RSI:
- Step 1; describe this
- Step 2: describe this
- Step 3: describe this
Step1: preparation
- STOP MAID:
- -Suction
- -Tools for intubation
- -Oxygen source for preoxygenation/ventilation
- -Positioning
- -Monitors: ecg, pulse ox, BP, capnography
- -Assistant; ambu bag, airway devices, airway assessment.
- -Intravenous access
- -Drugs
Step2: Preoxygenation
- administer high flow oxygen
- pt take 8 vital capacity breaths w/O2
- maintain patency of upper airway w/ NPA/OPA
- 5L of O2 per NC during apneic
Step3: Pretreatment
- atropine for peds to prevent vagal response
- lidocaine (asthma or head injury)
- opioids (fentanyl)
Rapid Sequence Intubation:
- step 4; describe this
- step 5: describe this
- step 6: describe this
- step 7: describe this
Step4:
- paralysis with induction
- -versed
- Neuromuscular blocking agents (paralytics)
- -succinylcholine or vecuronium
Step 5: protection and positioning
–cricoid pressure; BURP = backwards, upwards, rightward, pressure…may bring the larynx into view.
Step 6: placement proof
- place ETT w/ direct laryngoscopy (visualize the cords)
- inflate cuff
- confirm placement with ETCO2, asculatation of breath sounds, esophageal intubation detection devices, CXR
Step 7: postintubation management
- secure endotracheal tube
- support blood pressure
- mechanical ventilation
- determine need for ongoing sedation or paralysis
T/F, if properly preoxygenated the patient may tolerate up to 4 minutes of apnea with minimal decrease in saturation.
True.
Cricothyroidotomy:
- indications
- procedure steps
Indications:
-when pt has failed to be oxygenated adequately by all other possible methods and intubation has failed.
Procedure:
- step 1: identify cricothyroid membrane via plapation
- step2: make vertical incision
- step 3: prior to removal of the scalpel the hook is placed and directed inferiorly, caudal traction is used to stabalize the larynx.
- step4: insert tracheostomy tube into the trachea
Cardiovascular Collapse:
- what is the formula for CO
- signs?
CO = HR x SV
Signs:
- decreased CO leads to tachycardia
- hypotension causes an increase in systemic vascular resistance and decreased tissue perfusion
- decreased coronary perfusion = increased cardiac ischemia and further LV systolic dysfunction (decreased stroke volume)
