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First Aid EM Ch. 1: Resuscitation > Airway Management > Flashcards

Airway Management Flashcards

1
Q

Amount of people without gag reflex

A

12-25%

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2
Q

Causes of impending upper airway obstruction (6)

A
  1. Facial burns
  2. Severe Angioedema
  3. Penetrating Neck Trauma
  4. Expanding Hematoma
  5. Foreign Body
  6. Epiglottis
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3
Q

When to intubate (4)

A
  1. Failure to maintain patent airway
  2. Loss of protective reflexes
  3. Failure to adequately oxygenate or ventilate
  4. Anticipated clinical deterioration
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4
Q

When possibly not intubate with GCS <8

A

Rapidly reversible cause (i.e. hypoglycemia, opioid overdose)

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5
Q

Causes of hypercapnia (2)

A
  1. Diminished central respiratory drive
    - CNS injury
    - sedatives
    - alcohol
  2. Peripheral process
    - Guillain Barre
    - Myasthenia gravis
    - Muscular dystrophy
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6
Q

When expect anticipated clinical deterioration with need to intubate? (4)

A
  1. Status epilepticus
  2. Poly-trauma (+head inj)
  3. TCA overdose
  4. Tiring asthmatic
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7
Q

Are airway adjuncts (OPA or NPA) temporary or permanent measures?

A

Temporary

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8
Q

Contraindications for OPA

A

gag reflex

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9
Q

OPA sizing

A

Mouth to angle of the mandible

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10
Q

OPA placement for peds

A
  1. Compress tongue with depressor

2. Advance device without inversion

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11
Q

NPA sizing

A

Nares to angle of mandible

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12
Q

Contraindications for NPA

A

Midface or basilar skull fx

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13
Q

Should pop off valves be used in ped BVM use?

A

No

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14
Q

Minimum volume of bag for peds BVM

A

450mL

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15
Q

Appropriate volume for BVM?

A

Achieves chest rise

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16
Q

O2 flow for BVM

A

15L/min

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17
Q

Which technique is preferred with BVM?

A

Two-handed

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18
Q

What to do if suspect air trapping while BVM?

A

stop bagging and squeeze chest to help patient exhale

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19
Q

Make sure to remove these to protect airway

A

dentures

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20
Q

What if pt has a beard while BVM?

A

use lubricating KY jelly

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21
Q

Normal ET tube size for adult male

A

7.5- to 9.0-mm

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22
Q

Normal ET tube size for adult female

A

7.0- to 8.0-mm

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23
Q

How much smaller is a type for nasal intubation?

A

0.5-1.0 mm

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24
Q

Peds ET tube size (cuffed & uncuffed)

A

Uncuffed
(age/4)+4
Cuffed
(age/4)+3.5

or estimated from Broselow tape

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25
Q

Ped cuff pressure

A

< 20cm H2O

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26
Q

Macintosh vs Miller blades

A 
Macintosh
-curved
-lifts epiglottis via hyoepiglottic ligament
Miller
-straight
-preferred in peds (especially < 3yo)
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27
Q

Laryngoscope blade sizing based on age

A

Premature infants: 0
Normal infants: 1
Older children: 2
Adults: 3-4

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28
Q

Best single means of confirming ET tube placement?

A

End-tidal CO2 after 6 manual breaths

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29
Q

What is the positive ETco2 color?

A

Yellow

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30
Q

What gives false positive ETco2?

A
  1. Tube in supraglottic region
  2. Gastric distention
  3. Immediately following sodium bicarb administration
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31
Q

What causes false negative ETco2?

A

Poor pulm perfusion (cardiac arrest, massive pulm embolism)

in cardiac arrest, CO2 >2% = correct placement

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32
Q

When is using the bougie helpful?

A
  1. when can visualize the arytenoids or epiglottis

2. cord opening is narrow

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33
Q

At what distance will you typically hit the carina when using a bougie?

A

27-30 cm

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34
Q

BURP

A

Backward, Upward, Rightward Pressure

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35
Q

ET Tube Depth for males, females and children

A

Male: 23 cm
Female: 21 cm
Children: 3 x ET tube size

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36
Q

Gold standard to confirm ET tube placement

A

Fiberoptic visualization of tracheal rings through ET tube

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37
Q

Esophageal detector device

A

No resistance or bulb inflates = tracheal intubation

Resistance = esophageal intubation

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38
Q

Causes of postintubation hypotension (3)

A
  1. PTX
  2. Decreased venous return from PPV
  3. Drop in peripheral resistance from induction and paralysis
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39
Q

6 P’s of rapid sequence intubation

A 
Preparation
Preoxygenation
Pretreatment
Paralysis with induction
Placement of tube
Postintubation management
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40
Q

When to consider RSI pretreatment (PREMED)

A 
Pediatric (<10 yo)
Reactive Airway Disease
Elevated ICP
MI
Elevated BP
Dissection
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41
Q

What are the pretreatment medications?

A

Lidocaine, fentanyl, and atropine

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42
Q

Pretreatment used in reactive airway disease

A

Lidocaine (mitigate bronchospasm)

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43
Q

Pretreatment used in MI/CAD

A

Fentanyl (mitigate tachycardic response)

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44
Q

Pretreatment for elevated ICP

A

Lidocaine

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45
Q

Pretreatment in peds (<10 yo)

A

Atropine (symptomatic bradycardia)

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46
Q

When should pretreatment medications be administered?

A

3 min prior to induction meds

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47
Q

Mechanism of Lidocaine

A

Lower ICP

Lower bronchospamstic response to intubation

48
Q

Indication for Lidocaine

A

Lower ICP
Raise intraocular pressure
Reactive airway disease

49
Q

Dosing for Lidocaine

A

1.5 mg/kg

50
Q

Mechanism of Fentanyl

A

Lower sympathetic response to intubation

51
Q

Indication for Fentanyl

A

Lower ICP
Intracranial bleed or aneurysm
Heart disease
Aortic dissection

52
Q

Dosing for Fentanyl

A

3 micro-g/kg

53
Q

Mechanism for Atropine

A

May lower symptomatic bradycardia due to enhanced vagal tone from laryngoscopy
Lower bronchorrhea due to ketamine

54
Q

Indication for Atropine

A

<10 yo

55
Q

Dosing for Atropine

A

0.02 mg/kg

56
Q

Why should ketamine be used with caution in patients with known CAD?

A

causes tachycardia -> demand ischemia

57
Q

Reversal of nondepolarizing neuromuscular blockade

A

Edrophonium (0.5-1mg/kg IV) given after administration of atropine (0.01 mg/kg IV) once partial motor activity has been regained

58
Q

Class of drug - Etomidate

A

imidazole derivative

59
Q

Class of drug - Ketamine

A

PCP derivative

60
Q

Class of drug - Midazolam

A

benzo

61
Q

Class of drug - Propofol

A

GABA agonist

62
Q

Benefit - Etomidate

A

Lower ICP

Hermodynamically neutral

63
Q

Benefit - Ketamine

A 
Bronchodilator
Dissociative amnesia
Short acting
Preserves respiratory drive (awake intubation)
Safe in head injury
64
Q

Benefit - Midazolam

A

Lower ICP

Anticonvulsant effects

65
Q

Benefit - Propofol

A

Lower ICP
Lower Airway Resistance
Short onset and duration of action

66
Q

Side Effects - Etomidate

A

Brief clonus

Lowers cortisol

67
Q

Side Effects - Ketamine

A

Increases secretions
Increases HR
Emergence phenomenon

68
Q

Side Effects - Midazolam

A

Negative inotropy -> lowers BP

69
Q

Side Effects - Propofol

A

Negative inotropy, vasodilation -> lowers BP

Apnea

70
Q

Dosing - Etomidate

A

0.3 mg/kg

71
Q

Dosing - Ketamine

A

1-2 mg/kg

72
Q

Dosing - Midazolam

A

0.1-0.2 mg/kg

73
Q

Dosing - Propofol

A

1.5-3 mg/kg

74
Q

When should you avoid using succinylcholine?

A

Hyperkalemia

75
Q

Things that increase risk of succinylcholine-induced hyperkalemia

A
  1. Neuromuscular diseases
    - ALS, MS, muscular dystrophy, myasthenia gravis
  2. Skeletal muscle denervation
    - Stroke, spinal cord injury
  3. Major burns
  4. Prolonged abdominal sepsis >5 days
  5. Malignant hyperthermia hx
  6. ESRD
  7. Crush injury
76
Q

Depolarizing vs Nondepolarizing Agents

A 
Depolarizing
-Succinylcholine
Nondepolarizing
-Vecuronium
-Rocuronium
77
Q

Onset - Succinylcholine

A

45-60s

78
Q

Onset - Vecuronium

A

2-4min

79
Q

Onset - Rocuronium

A

1-3min

80
Q

Duration - Succinylcholine

A

5-9min

81
Q

Duration - Vecuronium

A

40-60min

82
Q

Duration - Rocuronium

A

30-45min

83
Q

Complications - Succinylcholine

A
  1. Hyperkalemia
  2. Fasciculations
  3. Trismus/masseter spasm
  4. Increased ICP/IOP
  5. Malignant Hyperthermia
  6. Prolonged action if low pseudocholinesterase activity
84
Q

Complications - Vecuronium

A

Prolonged action in obese/elderly/hepatorenal dysfunction

85
Q

Complications - Rocuronium

A

Tachycardia

86
Q

Dosing - Succinylcholine

A

1.5 mg/kg

87
Q

Dosing - Vecuronium

A

0.1 mg/kg

88
Q

Dosing - Rocuronium

A

1 mg/kg

89
Q

Postintubation management

A
  1. Confirm tube placement with ETco2 and auscultation
  2. Sedate with benzos or propofol and provide analgesia with opioid
  3. Paralyze only if necessary
90
Q

What ages of children typically have adult airway proportions?

A

8-10 yrs

91
Q

Difficult bag mask pt (BAG’EM)

A 
BMI (obese)
Airtight seal (beard, facial trauma)
Geriatric
Edentulous
Mobility (decreased neck mobility or pulm compliance)
92
Q

How to overcome large occiput for airway management?

A

Towel under thorax

93
Q

Characteristics of peds vs adult airway (4)

A
  1. Anterior/superior larynx
  2. Large/floppy epiglottis
  3. Large tongue
  4. High O2 consumption
94
Q

Typical length of infant trachea

A

5cm

95
Q

Typical length of 18mo trachea

A

7cm

96
Q

Typical length of adult trachea

A

12cm

97
Q

How to calculate placement of tube in peds?

A

Depth at teeth + 3 x ET tube size

98
Q

Mallampati Score 1

A

soft palate, uvula, fauces, tonsillar pillars

99
Q

Mallampati Score 2

A

soft palate, uvula, fauces

100
Q

Mallampati Score 3

A

soft palate, base of uvula

101
Q

Mallampati Score 4

A

hard palate only

102
Q

Difficult Cricothyrotomy (SLICE)

A 
Surgery/radiation
Large neck (or short)
Infection
Cancer
Expanding hematoma
103
Q

what is an awake intubation?

A

Sedation without paralysis

104
Q

how to perform an awake intubation?

A
  1. Administer local airway anesthetic (4% lidocaine or topical benzocaine at base of tongue )
  2. Sedated with ketamine (10-20 mg per dose)
  3. Intubate
105
Q

contraindications to blind nasotracheal intubation (6)

A
  1. Less than 10 years old
  2. Mid face trauma or basilar skull fracture
  3. Increased intracranial pressure
  4. Anticoagulation/thrombolysis
  5. Combative patient
  6. Apnea
106
Q

which we should bevel face during nasotracheal intubation?

A

The septum

107
Q

What is the typical depth of the ETT for male and females in nasotracheal intubation?

A

28 cm for males

26 cm for females

108
Q

how is inserting a GlideScope C-MAC laryngoscope different?

A

Insert blade midline without sweeping tongue

109
Q

how much do you inflate LMA cuff?

A

20-40 mL air

110
Q

What are the sizes of the Combitube or KING LT supraglottic airways

A

37F: Small adults/large child
41F: Larger adults

111
Q

Which port of Combitube is ventilation given?

A

Longer (blue) connector (may do it through shorter/clear tube if think ventilating stomach)

112
Q

What is the surgical airway of choice in children < 10-12 years old?

A

Needle cricothyrotomy

113
Q

What needle should be use for needle cricothyrotomy?

A

12 to 14-gauge

114
Q

How to oxygenate using needle cricothyrotomy?

A

Deliver 100% O2 for 1 sec, then release for 4 seconds to allow for expiration using jet-ventilation system

115
Q

What size ETT should be used for cricothyrotomy?

A

5.5 or 6.0 cuffed ET tube

116
Q

How are the incisions oriented for cricothyrotomy?

A
  1. Vertical incision through skin

2. Horizontal incision through cricothyroid membrane

117
Q

Should you do abdominal thrusts in a patient who is speaking or coughing?

A

No, urge them to continue coughing

First Aid EM Ch. 1: Resuscitation (10 decks)

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