airway management

Question 1

what is the vascular area of the nasal pharynx called

Answer 1

kesselbacks plexus

Question 2

what can happen if kesselbacks plexus is irritated

Answer 2

hypertensive crisis epitaxis

Question 3

how to avoid damaging this area

Answer 3

lube NPA or ET, bevel up for NPA, atomized lidocaine

Question 4

preparing for ET what do you do

Answer 4

Mallinpati score, have suction running, SALAD or standard tonsil tip

Question 5

what is the selliks maneuver

Answer 5

push below cricoid pressure0 helpful to help prevent regurgitation, can also help bring airway into view while intubating

Question 6

six P’s of elective airway

Answer 6

Preparation, preoxygenation, pretreatments+meds, paralysis, placement of the ETT, post intubation management and strategies

Question 7

what is the 3:3:2

Answer 7

3 fingers in mouth, 3 fingers under chin, 2 fingers to the cartilage trachea opening

Question 8

what is the mallampati score (what each score represents)

Answer 8

class I- easy can see bottom of uvula
class II- harder- cant see bottom of uvula
class III- top of uvula- difficult
Class IV- cant see uvula at all and very difficult

Question 9

what does the SALAD technique mean

Answer 9

suction assisted laryngoscopy and airway decontamination

Question 10

how do you perform SALAD

Answer 10

suction cath into hypopharynx while performing laryngoscopy to deliver ETT, involved suction into esophagus to control emesis before ETT to help prevent aspiration

Question 11

what is the time in minutes for obese (127kg) on oxyhemoglobin desaturation graph

Answer 11

just under 3

Question 12

what is the time in minutes for normal child (10kg) on oxyhemoglobin desaturation graph

Answer 12

3.5

Question 13

what is the time in minutes for moderately ill 70kg adult on oxyhemoglobin desaturation graph

Answer 13

little under 5

Question 14

what is the time in minutes for normal adult 70kg on oxyhemoglobin desaturation graph

Answer 14

8

Question 15

common induction agents

Answer 15

etomidate, ketamine, high dose fentanyl

Question 16

etomidate

Answer 16

(amidate) unless known adrenal inefficiency
0.3 MG/KG IV or IO

Question 17

ketamine

Answer 17

trauma or resp cases
1.5-3 MK/KG IV or IO
back up with versed

Question 18

high dose fentanyl

Answer 18

2-20 MCG/KG IV or IO

Question 19

whats a con with using fentanyl for induction

Answer 19

chest wall rigidity- chest muscle become very firm and difficult for gas exchange or ventilation

Question 20

commonly used short term paralysis agents

Answer 20

succinylcholine, rocuronium, cisatracurium (nimbex)

Question 21

succinylcholine

Answer 21

depolarizing agent
2mg/kg IV or IO

Question 22

rocuronium

Answer 22

0.6-1.6 mg/kg IV or IO
less you give last shorter, more you give last longer
might need to give more to act appropriately- 1mg/kg seems to work good though

Question 23

cisatracurium (nimbex)

Answer 23

0.15-.2 mg/kg IV or IO
long lasting non depolarizing blocker- potentially not the best for RSI

Question 24

sedation long term agents

Answer 24

propofol, benzodiazepine, opiate, paralysis

Question 25

propofol

Answer 25

Diprovan
5-50mcg/kg/min
too much can cause hypotension
pt can wake up fairly easily with stimulation

Question 26

benzodiazepine

Answer 26

versed 2.5mg as needed

Question 27

opiate

Answer 27

fentanyl 25-100mcg as needed

Question 28

paralysis

Answer 28

vecuronium
0.1 mg/kg IV/IO as needed to maintain paralysis
keep in mind to have appropriate sedation