Airway Management Flashcards
What does lack of oxygen lead to?
Ischemia (reversible)
Injury (reversible)
Infarction (irreversible)
What stages does cellular death occur at?
Brain/nervous cell is 4-6min
Cardiac death is 30min
Muscle/Organ death is 1 hour
What is required for adequate ventilation?
Open airway
Open respiratory tract
Adequate pulmonary blood flow
Stimulation to breathe
What is the act of respiration?
The movement of gases through a membrane.
What are the major gases of respiration?
Oxygen - ATP production
Carbon - primary building block for almost everything in the body
Hydrogen - body pH
What is ventilation?
Process of moving air in and out of the lungs.
Inspiration and expiration
Where is the respiratory control center?
The medulla
What is inspiration?
Decreased thoracic pressure form increased space allows air in.
What is expiration?
The chest wall relaxes and decreases thoracic space, increasing pressure.
What muscles contract for inspiration?
Sternocleidomastoid muscles, pectoralis minor and external intercostal.
What muscles contract for expiration?
Internal intercostal muscles contract and abdominal contract.
How much air is exchanged between each ventilation?
500-800 cc
How much air reaches the alveoli?
350cc
What is minute volume?
Amount of air exchanged over the course of one minute
What is tidal volume?
Amount of air inhaled and exhaled over the course of one ventilation.
What is posterior sites for auscultation?
Paraspinal border above the scapula
And
8th intercostal space
What are the 4 things needed for adequate oxygenation?
Adequate concentration of inspired O2 (FiO2)
Movement of O2 across the alveolar capillary membrane (external respiration)
Adequate RBC and Hgb to transport oxygen (oxygen tranpsort)
Offloading of O2 at the cellular level (internal respiration)
What is hypoxia?
Decreased or inadequate supply of oxygen.
What is partial pressure of O2?
It is the amount of O2 needed in the blood to passively diffuse into cells.
What does pulse oximeter measure?
The percentage of Hgb that is saturated with O2.
When is pulse oximetry inaccurate?
Reduction in peripheral blood flow produced by peripheral vasoconstriction.
Bright ambient light
Shivering
Nail polish
What is ETCO2?
It measures the concentration of CO2 at the end of exhalation.
What problem is there if the ETCO2 shows less than 10mmHg on a cardiac arrest?
Poor chest compressions.
What is the order of oxygen delivery from lowest to highest?
Pocket mask - 16
Nasal cannula - 25-45
Simple face mask - 40-60
NRB - 80-100
BVM - 90-100
What does each BVM hold?
Adult - 1l to 1.6l of air
Child - 500 to 700ml
Infant - 150 to 240ml
What are some advantages to BVM?
Immediate means of ventilatory support
Can ventilate for long periods of time without time
What are some disadvantages to BVM?
Difficult skill to master
Hard to maintain an adequate seal when delivering the required volume of air
Hard to do BVM when holding C-spine
Can cause lung damage
What are the dangers of poor BVM?
Hypoxia
Vomiting and aspiration
Cerebral vasoconstriction
Acid base imbalances
Gastric insufflation
How does OPA insertion goes for infants?
Straight in (no rotation)
What are the advantages of an OPA?
Insertion is easy and quick
Large suction tube can pass on either side
What are some disadvantages of an OPA?
Does not isolate the trachea
Cannot be inserted when the patients teeth are clenched
Can be dislodged easily
Can cause trauma if improperly placed.
What are advantages of an NPA?
Insertion is quick and easy, may be inserted blindly.
Gag reflex is present
What are disadvantages of an NPA?
Does not isolate trachea
Difficult to suction through
Can cause severe nosebleed
What are some rules to suctioning?
Each attempt should last 15 seconds or less
Patient should be hyper-oxygenated before and after each attempt
Suction on the way out
What are some precautions to consider when suctioning?
Can stimulate gag reflex
Can cause Vagal stimulation
Can stimulate patient to cough which can increase ICP in patients with a head injury
What are some BIADs?
King LT
LMA
I-Gel
What are the sizes for a King-LT?
4-5 feet is yellow
5-6 feet is red
Greater than 6 feet is purple
What are the sizing for LMA?
Less than 5kg is 1
10 - 20 is 2
30-50 is 3
50-70 is 4
70-100 is 5
What are some contraindications for BIADs?
Intact gag reflex
Upper airway burns
Ingestion of caustic substances
Esophageal varices
What are 7ps of intubation?
Preoxygenate - BVM 3 mins with NC 15 LPM or NRB 100% for 8 full capacity breaths.
Prepare
Pretreatment
Paralysis
Position
Placement
Proof
What airways aligns the ear to sternly notch?
Oral
Pharyngeal
Laryngeal axis
What is BIAD proof?
3 consecutive ETCO2 waveforms
Plus positive lung sounds and negative epigastric sounds.
How to troubleshoot a BIAD?
Displacement
Obstruction
Pneumothorax
Equipment
What are common tank constants?
D = 0.16
M = 1.56
