airway management Flashcards
what is the vascular area of the nasal pharynx called
kesselbacks plexus
what can happen if kesselbacks plexus is irritated
hypertensive crisis epitaxis
how to avoid damaging this area
lube NPA or ET, bevel up for NPA, atomized lidocaine
preparing for ET what do you do
Mallinpati score, have suction running, SALAD or standard tonsil tip
what is the selliks maneuver
push below cricoid pressure0 helpful to help prevent regurgitation, can also help bring airway into view while intubating
six P’s of elective airway
Preparation, preoxygenation, pretreatments+meds, paralysis, placement of the ETT, post intubation management and strategies
what is the 3:3:2
3 fingers in mouth, 3 fingers under chin, 2 fingers to the cartilage trachea opening
what is the mallampati score (what each score represents)
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
what does the SALAD technique mean
suction assisted laryngoscopy and airway decontamination
how do you perform SALAD
suction cath into hypopharynx while performing laryngoscopy to deliver ETT, involved suction into esophagus to control emesis before ETT to help prevent aspiration
what is the time in minutes for obese (127kg) on oxyhemoglobin desaturation graph
just under 3
what is the time in minutes for normal child (10kg) on oxyhemoglobin desaturation graph
3.5
what is the time in minutes for moderately ill 70kg adult on oxyhemoglobin desaturation graph
little under 5
what is the time in minutes for normal adult 70kg on oxyhemoglobin desaturation graph
8
common induction agents
etomidate, ketamine, high dose fentanyl
etomidate
(amidate) unless known adrenal inefficiency
0.3 MG/KG IV or IO
ketamine
trauma or resp cases
1.5-3 MK/KG IV or IO
back up with versed
high dose fentanyl
2-20 MCG/KG IV or IO
whats a con with using fentanyl for induction
chest wall rigidity- chest muscle become very firm and difficult for gas exchange or ventilation
commonly used short term paralysis agents
succinylcholine, rocuronium, cisatracurium (nimbex)
succinylcholine
depolarizing agent
2mg/kg IV or IO
rocuronium
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
cisatracurium (nimbex)
0.15-.2 mg/kg IV or IO
long lasting non depolarizing blocker- potentially not the best for RSI
sedation long term agents
propofol, benzodiazepine, opiate, paralysis
propofol
Diprovan
5-50mcg/kg/min
too much can cause hypotension
pt can wake up fairly easily with stimulation
benzodiazepine
versed 2.5mg as needed
opiate
fentanyl 25-100mcg as needed
paralysis
vecuronium
0.1 mg/kg IV/IO as needed to maintain paralysis
keep in mind to have appropriate sedation
