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PEM Lectures dirigées > Airway Management > Flashcards

Airway Management Flashcards

1
Q

What is the most frequent indication for intubation in pediatrics?

A

neurologic failure - brain injury, cardiac arrest, status epilepticus

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2
Q

What are the anatomic features in children that are pertinent to laryngoscopy and intubation?

A 
Smaller airway structures
Smaller field of vision
Common adenoidal hypertrophy
Developing teeth & primary teeth
Large tongue relative to oropharynx size
Superior larynx
Hyoepiglottic ligament - less strong
Epiglottis - narrow and angled acutely, covering tracheal opening more
Narrowest point at level of cricoid cartilage
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3
Q

Where does the larynx sit in infants? in adults?

A

Infants: C3-C4
Adults: C4-C5

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4
Q

What are the physiologic features in children that are relevant for intubation?

A

Lung - smaller and fewer alveoli, decreased gas exchange surface area, absent collateral channels of ventilation
Cartilagenous chest wall (poor recoil, increased compliance). greater tendency for atelectasis and collapse.
Increased O2 consumption in infants
High vagal tone - greater tendency for bradycardia with hypoxia

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5
Q

What is the maximum rate at which high-flow nasal cannula delivers O2?

A

60L/min (adults)

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6
Q

What are the minimum and maximum flow rates suggested for children <5kg?

A

6-8L/min

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7
Q

What are the minimum and maximum flow rates suggested for children 5-10kg

A

8-15L/min

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8
Q

What are the minimum and maximum flow rates suggested for children 10-20kg

A

15-20L/min

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9
Q

What are the minimum and maximum flow rates suggested for children 20-40kg?

A

25-40L/min

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10
Q

What are the minimum and maximum flow rates suggested for children > 40kg

A

25-60L/min

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11
Q

What are the absolute contraindications to using non-invasive ventilation?

A

Patient requires immediate intubation
Impaired mental status
Patient requires airway protection

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12
Q

What are the relative contraindications to to non-invasive ventilation?

A

Facial injury
Upper GI bleeding
Untreated pneumothorax
Significant or escalating vasopressor support

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13
Q

What are the significant complications of non-invasive ventilation?

A

barotrauma
aspiration
hemodynamic instability due to decreased venous return

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14
Q

What are the 7 Ps of RSI?

A 
Preparation
Preoxygenation
Pretreatment/preoptimization
Paralysis with induction
Positioning
Placement of the tube
Postintubation management
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15
Q

How do you calculate the appropriate size of uncuffed ETT?

A

4+ (age in years / 4)

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16
Q

How do you calculate the appropriate sized of cuffed ETT?

A

3.5 + (age in years / 4)

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17
Q

What size of laryngoscope blade is used for children <2 y/o?

A

Size 1

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18
Q

What size of laryngoscope blade is used for children 2-10 y?

A

Size 2

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19
Q

What size of laryngoscope blade is used for children 10+ y/o?

A

Size 3

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20
Q

How can you approximate the size of laryngoscope needed when age not known?

A

Laryngoscope blade that approximates the distance between the upper incisors and the angle of the mandible

21
Q

What are the sedative options for intubation?

A 
Benzos
Narcotics (fentanyl)
Ketamine
Etomidate
Propofol
22
Q

Sedative dose of benzos for intubation

A

0.2-0.3mg/kg

23
Q

Sedative dose of fentanyl for intubation

A

1-2mcg/kg

24
Q

Sedative dose of ketamine for intubation

A

1-3mg/kg

25
Q

Sedative dose of etomidate for intubation

A

0.3mg/kg

26
Q

Sedative dose of propofol for intubation

A

1-4mg/kg

27
Q

What are the benefits of Ketamine for sedation for intubation?

A
  • dissociative
  • rapid onset
  • augments hemodynamics
  • preserves airway reflexes and respiratory drive
  • bronchodilator
28
Q

What are the disadvantages of Ketamine?

A
  • vomiting
  • laryngospasm
  • emergence delirium
  • increases oral secretions (sialogogue)
  • possibly increases ICP
29
Q

What are the advantages of Etomidate for procedural sedation?

A
  • rapid onset
  • cardiovascular stability
  • no effect on ICP
30
Q

What are the disadvantages of Etomidate for procedural sedation?

A
  • increased risk of hypotension in sepsis
  • increased risk of ARDS
  • increased risk of multi-organ dysfunction in severely injured trauma patients
  • longer ventilator courses and hospital stays
  • *adrenal suppression
31
Q

What are the disadvantages of Propofol for procedural sedation?

A
  • vasodilator
  • myocardial depressant
    therefore increased risk of hypotension
32
Q

What medication can be used as an antidote for benzodiazepines?

A

Flumazenil

33
Q

What are the advantages of benzodiazepines for procedural sedation?

A
  • amnestic
  • anticonvulsant
  • minimal cardiovascular depression
34
Q

What are the disadvantages of Benzodiazepines for procedural sedation?

A

higher doses required for induction

slower onset

35
Q

What is the time of onset of Succinylcholine? duration of action?

A

30-60 seconds

3-8 minutes

36
Q

How does succinylcholine work?

A

depolarizing

37
Q

What are the disadvantages of succinylcholine?

A

causes muscle fasciculations

  • muscle pain
  • myoglobinuria
  • hyperkalemia
  • histamine release

INCREASED RISK of malignant hyperthermia

  • transient bradycardia
38
Q

What is the dose of succinylcholine for RSI?

A

1-2mg/kg

39
Q

What is the dose of rocuronium for RsI?

A

0.6-1.2mg/kg

40
Q

What is an example of a non-depolarizing paralytic?

A

Rocuronium

41
Q

What is the duration of action of rocuronium?

A

30-45 mins

42
Q

What is the antidote for rocuronium?

A

sugammadex

43
Q

What are the advantages of rocuronium over succinylcholine?

A

longer action - good for multiple intubation attempts or need to go to imaging
no muscle fasciculations

44
Q

How can lidocaine be used as an adjunctive agent in intubation?

A
  • blunts autonomic effects of laryngoscopy on hemodynamics and ICP
  • recommended for intubation secondary to TBI

NOT routinely recommended

45
Q

Why do needle instead of surgical cricothyroidotomy in children?

A

i. Risque élevé de dommage au cartilage cricoïde qui est le seul support circonférentiel de la trachée supérieure
ii. C’est l’endroit le plus petit de la trachée, et donc risque de passer au travers
iii. Le cartilage cricoïde est peu palpable avant l’âge de 12 ans

46
Q

Signs of possible laryngeal or tracheal fracture

A

crepitus over larynx
laryngeal or tracheal tenderness
flattened thyroid prominence
anterior neck deformity
severe resp distress
abnormal neck radiography

47
Q

Rescue devices/techniques

A
  • LMA
  • Video laryngoscopy
  • Tube that has both ETT + one in esophagus – combitube
  • Laryngeal tube
  • Cricothyrotomy
  • More experienced provider
  • Flexible fiberoptic intubation
48
Q

Adverse effects of ketamine

A

hypoxia
emesis
laryngospasm
recogery agitation (hyperactivity, hallucinations, euphoria, unpleasant sensations, dreams, flashbacks)

PEM Lectures dirigées (28 decks)

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