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ATLS > Airway and Ventilatory management > Flashcards

Airway and Ventilatory management Flashcards

1
Q

Which patients should receive supplemental Oxygen?

A

All trauma patients

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2
Q

What can a combative / agitated patient be a sign of

A

Altered mental state secondary to:
- HI
- Intoxication
- Hypoxia
- Hypercapnia

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3
Q

Definitive airway definition

A

Tube inserted into trachea with cuff inflated below level on vocal cords, and connected to oxygen enriched assisted ventilation

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4
Q

Signs of airway compromise include

A

Head / neck injury
Tachypnoea
Agitation
Low SpO2
Stridor / snoring
Absent breath sounds in fields
Subcutaneous emphysema at head, neck or chest
Deviated trachea

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5
Q

Patients at risk of compromised ventilation

A

Unconscious with HI
Obtunded pt (intoxication or hypercapnia)
Thoracic injuries
Facial burns
Inhalation injuries

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6
Q

Purpose of a definitive airway in patients at risk of compromised ventilation

A

Provide an airway
Deliver supplemental O2
Support ventilation
Prevent aspiration

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7
Q

Signs of potential airway obstruction in maxillofacial trauma

A

Fractures of Nasopharynx / Oropharynx
Oropharyngeal haemorrhage
Dislodged teeth

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8
Q

Triad of laryngeal fracture signs

A

Hoarse voice
Subcutaneous emphysema
Palpable fracture

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9
Q

Sign of ventilation problems caused by C spine injury

A

Diaphragmatic breathing
Compromised ability to meet rising oxygen demands

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10
Q

Sign of ventilation problem caused by complete cervical cord transection

A

Abnormal breathing
Paralysis of intercostal muscles

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11
Q

Causes of asymmetrical chest wall movements

A

Splinting rib cage
Pneumothorax
Flail chest

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12
Q

Causes of reduced breath sounds to hemithorax

A

Thoracic injury - haemo / pneumothorax

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13
Q

Indications of definitive airway placement

A

A - impending or potential airway compromise
B - apnoea or inability to maintain adequate oxygenation by facemask
C - agitation due to cerebral hypoperfusion
D - GCS 8 or lower, sustained seizure activity, protect against aspiration

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14
Q

Helmet removal process

A

2 people
Person 1 provides manual inline motion restriction from below
Person 2 expands the sides of helmet and removes from above
Re-establish inline restiction from above and secure the head and nec during airway management

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15
Q

Factors indicating difficult airway

A

Obese
Beard
Elderly / Paediatric
Spinal trauma / arthritis / immobilisation
Edentate

Maxillofacial / mandibular trauma

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16
Q

Mnemonic for assessing an airway

A

LEMON

Look externally
Evaluate 3-3-2 rule
Mallampati
Obstruction / Obesity
Neck mobility

17
Q

3-3-2 rule for airway assessment

A

Mouth opening distance between incisors 3 fingers
Mandible to hyoid distance 3 fingers
Floor of mouth (?or hyoid bone) to thyroid cartilage distance 2 fingers

18
Q

Mallampati class 1

A

Soft palate
Uvula
Fauces
Pillars

19
Q

Mallampati 2

A

Soft palate
Uvula
Fauces

20
Q

Mallampati 3

A

Soft palate
Base of uvula

21
Q

Mallampati 4

A

Hard palate only visible

22
Q

Contraindications to nasopharyngeal or oropharyngeal airways

A

Basal skull fracture
Midface fractures

23
Q

Methods of intibation

A

Orotracheal intubation
Nasotracheal intubation

24
Q

Technique preferred for intubation of trauma patient

A

3 person technique:

Person 1 inserts tube (always test inflation of cuff)

Person 2 provides adjuncts (eg. suction, bougie, cricoid pressure) and connects tube to ventilator support

Person 3 provides C spine stabilisation

25
Q

Options when unable to intubate

A

Use recue airway devices
Needle cricothyroidotomy followed by surgical airway
Establish surgical airway

26
Q

Rapid sequence induction indications

A

Pt needs intubation but intact gag reflexes
Pt sustained head injury

27
Q

RSI drug options

A

Ketamine / Thiopentone / Propofol
Suxamethonium / Rocuronium
Fentanyl / Opioid

28
Q

Benefit of using Ketamine in RSI

A

Raises BP rather than causing hypotension which most other agents do

29
Q

Needle cricothyroidotomy

A

Provides oxygen until definitive airway can be placed
Preferred for children < 12 yrs of age
Percutaneous transtracheal oxygenation technique (PTO)

30
Q

Surgical cricothyroidotomy

A

Usually preferable to emergency tracheostomy
Not recommended for children < 12 yrs of age

31
Q

Cricoid pressure technique

A

BURP

Backwards, Upwards and Rightward pressure

32
Q

Complications of positive pressure ventilation following intubation

A

Converting simple pneumothorax to tension pneumothorax
Causing pneumothorax secondary to barotrauma

33
Q

Method to improve mask seal in edentate patients

A

Pack space between cheeks and gum with gauze

34
Q

Methods to assess sufficient ventilation

A

ABG
Continual end tidal carbon dioxide analysis

35
Q

Indications for a surgical airway (cricothyroidotomy or tracheostomy)

A

Oedema of the glottis
Larynx fracture
Severe oropharyngeal haemorrhage that obstructs airway
Inability to place endotracheal tube through vocal cords

ATLS (14 decks)

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