Airway Management Flashcards
What type of PT HX should you get?
OPQRST/SAMPLE, previous HX airway compromise, trauma/dental surgeries, asthma/COPD/anaphylaxis
What are some S/S for the need of airway management?
SOB/abnormal rate/depth/effort, use of accessory muscles, wheezing, stridor, rales, rhonchi, hoarseness, pallor or cyanosis, AMS, hypoxemia/hyper or hypo-carbia
What are some possible differentials to keep in mind?
Head injury/stroke, drug OD or airway obstruction, pulmonary edema/ ARDS, cardiac arrest or inhalation injury, or COPD/asthma/anaphylaxis
What is ARDS?
Acute Respiratory Distress Syndrome
How do you open, assess, and clear the airway?
Head-tilt/chin-lift or modified jaw thrust, finger sweep, if obstructed, perform abdominal or chest thrusts five times and attempt to ventilate, and repeat until airway is clear
What are the guidelines for SL1?
General patient care, open assess, clear airway, suction, BVM ventilations, NPA/OPA, O2, and high flow nasal cannula
What is the rate for assisted ventilations on an adult?
<10 and >30 as needed
When do you not use an OPA?
pt is conscious or gag reflex intact
How much LPM NC do PTs get if SpO2 is <85%?
5-25 LPM
What are the guidlines for SL2 and SL3
Supraglottic airway, EtCO2, needle decompression, PEEP valve, CPAP, and suction
When do you use an EtCO2?
When a PT is lethargic, AMS, hypotensive or w/SGA
When do you do a needle decompression?
If tension Pneumothorax is suspected with EMT x/TCCC Tier 2 and OLMD approval for anterior or lateral placement
What is a PEEP valve?
positive end-expiratory pressure valve
What are the guidelines for SL4?
Open, access, clear airway, cricothyroidotomy, suction, EtCO2, and post-intubation sedation and pain control
What are the guidelines for SL2 and SL3
Supraglottic airway, EtCO2, needle decompression, PEEP valve, CPAP, and suction
What are the guidelines for SL2 and SL3
Supraglottic airway, EtCO2, needle decompression, PEEP valve, CPAP, and suction
What does SL3 do to open, access, and clear airway?
utilize Magill forceps as needed to remove obstruction
What do you do if SGA is not effective or patient requires ETT to allow for tracheal suctioning?
Video Laryngoscopy (w/wo Bougie) or Direct Laryngoscopy (w/wo Bougie)
When do you do the cricothyroidotomy?
emergency to secure an airway, unless require by PT condition, severe airway edema or edema/burns from smoke inhalation
What should you consider for suction?
Where the OG tube placement is after you advanced airway if gastric distention is present and if perform ETT suction
What is ETT?
Endotracheal tube
What do you do when you perform ETT suction PRN?
Inject 10mL NS into ETT/Cric prior to suction for thick secretions
What is the primary method for post-intubation sedation and pain control?
Ketamine 2mg/kg IV/1O/IN, and repeat q 10 - 15 min PRN to sedation control/nystagmus
What is PRN?
Pro re nata “when necessary” and/or as needed
What is the alternate method for post-intubation sedation and pain control?
- Midazolam 2.5 - 5mg IV/IO/IN and repeat q 5 - 10 min PRN to max dose 10mg
- Fentanyl 1mcg/kg IV/IO/IN (max single dose 100mcg) and repeat q 5 - 10 min PRN to 200mcg
What do you do when a patient is on post-intubation sedation and pain control?
Must be placed on continuous cardiac, EtCO2 and SpO2 monitoring, document vitals/BP q 5 min for the first 15 min then q 15 min thereafter
What are the primary types of supraglottic airways?
iGel and Ng tube
What is an alternate form of a supraglottic airway?
King-LT/LTs-D
What is a contingency form of supraglottic airway?
LMA
What size and color is 30-60kg iGel?
small (3)/yellow
What size and color is 50-90kg iGel?
Medium (4)/ Green
What size and color is 90+kg iGel?
Large (5)/ Orange
What is the max NG tube for 30-60kg?
12F
What is the max NG tube for 50-90kg?
12F
What is the max NG tube for 90+kg?
14F
What is the size and color for 4-5ft King-Lt/LTS-D?
Size 3/yellow
What is the size and color for 5-6ft King-Lt/LTS-D?
Size 4/red
What is the size and color for 6+ft King-Lt/LTS-D?
Size 5/pruple
What is the size and color for 6+ft King-Lt/LTS-D?
Size 5/purple
What is the size for 30-50kg LMA?
Size 3
What is the size for 50-70kg LMA?
Size 4
What is the size for 70+kg LMA?
Size 5
How many mg/mL of ketamine do you give for 50kg?
100mg/2mL
How many mg/mL of ketamine do you give for 60kg?
120mg/2.4mL
How many mg/mL of ketamine do you give for 70kg?
140mg/2.8mL
How many mg/mL of ketamine do you give for 80kg?
160mg/3.2mL
How many mg/mL of ketamine do you give for 90kg?
180mg/3.6mL
How many mg/mL of ketamine do you give for 100kg?
200mg/4mL
How many mg/mL of ketamine do you give for 110kg?
220mg/4.4mL
How many mg/mL of ketamine do you give for 120kg?
240mg/4.8mL
What happens if you do not math the patient’s rate/volume (minute ventilation)?
You may cause the the PT decompensate faster
What are two key point on intubations?
- Limited to 30 seconds
- No more than two attempts
What kind of PTs are at isk for respiratory failure?
AMS, lethargy, increasing EtCO2/continued hypoxemia
What should you consider if NIBP (MAP) is showing decreasing trends?
Needle decompression
What does D.O.P.E. mean/stand for?
Change in condition, decreased SpO2/vent alarms
- Dislodgement
- Obstruction
- Pneumothorax
- Equipment
What does M.O.A.N.S. mean/stand for?
BVM seal
- Mask seal
- Obesity/Obstruction
- Age (>55)
- No teeth
- Sleep apnea/Stiff lungs
What does R.O.D.S. mean/stand for?
Difficult extraglottic
- Restricted mouth opening
- Obstruction
- Disrupted/Distorted airway
- Still lung /cervical Spine
What does B.U.R.P. mean/stand for?
Vocal cord
- Backwards
- Upwards
- Rightward
- Pressure
What does L.E.M.O.N. mean/stand for?
Difficult laryngoscopy
- Look
- Evaluate
- Mallampati
- Obstruction/Obesity
- Neck rigidity
What does S.H.O.R.T. mean/stand for?
Difficult cricothyroidotomy
- Surgery/Scars )or other obstruction)
- Hematoma (or infection/abscess/mass)
- Obesity
- Radiation distortion (and other deformity)
- Tumor
