Airway Extra Cards Flashcards
What medications/Ventilation support can you give to sedate someone for an awake intubation?
Ketamine, Precedex, NC running at 10-20 Lpm
Who has a dynamic airway that you should consider intubating early?
Bullets (Neck trauma)
Bites (Angioedema/Anaphylaxis)
Burns
How do you decide to awake or RSI intubate a patient?
Urgency, Difficult airway, Vomiting risk
What is an example of an urgent case that should undergo awake intubation?
Stable GI bleed req. endoscopy
Slowly progressing NM weakness
What is an example of a difficult airway that should undergo awake intubation?
Fixed flexion deformity of the neck
If they cannot open their mouth
Who should you RSI with a vomiting risk?
Upper GI bleed, Bowel obstruction, Vomiting in the ED
Who should you stay away from RSI with?
Known difficult airway
What are the steps for laryngoscopy?
- Find the epiglottis
- Optimize the head
- Seat the blade
- Optimize the Larynx
Black stripe on the bougie is at what location?
25 cm at the lips, mid trachea in adult male
The higher the dose of Rocuronium, the _____ success of intubation
Higher
As you increase the dose of Roc, the onset time ______
Decreases
Sux Duration of action?
5-10 minutes
Roc duration of action?
30-90 minutes
What are physiologic Killers?
Hypotension
Hypoxemia
Metabolic Acidosis
What is the induction drug of choice and dose in shock patients?
Ketamine (sympathetic surge and pain control)
Dose: 0.5 mg/kg IV
What is the paralytic agent of choice in shock patients?
Rocuronium
Which drugs take longer to work in shock states?
Paralytics (CO dependent)
Rocuronium, at what dose will give the same onset muscle relaxation as sux in addition to safer longer apnea time
1.6 mg/kg (Compared to 2 mg/kg of sux)
What is the pressor agent of choice to give push dose?
Epinephrine
What is the push dose for Phenylephrine?
50-100 mcg
What should you consider if you cannot get O2 sat above 95%?
Lung Shunt Physiology - Use Apneic CPAP recruitment
What types of patients do you want to avoid intubating if at all possible?
“pH kills”
What are the 3 interventions for Lung-Shunt Physiology?
- NC @ 15 LPM, BVM @ 15 LPM, PEEP valve @ 5-15 cmH20
- Delayed Sequence Intubation (0.5-1 mg/kg of Ketamine)
- BUHE
What are the 2 interventions for acidotic patients?
- Bicarb (only if they can ventilate)
- VAPOX (Ventilator-Assisted Pre-oxygenation)
What Ventilator mode and settings (VT, FiO2, PS, RR, PEEP, Inspiratory flow) would you use for an acidotic patient in VAPOX? (After you have already placed the patient on 15 LPM O2)
SIMV + PS
VT: 8 ml/Kg
FiO2: 100 %
PS: 5-10 cm H20
RR: 0
PEEP: 5
Inspiratory Flow: 30 lpm
What type of breaths will they get on SIMV + PS with a RR of 0?
ONLY spontaneous breaths that will be pressure supported
What intervention can you do for a patient who is at high aspiration risk?
NGT prior to intubation, Intubate in semi-upright position
