Airway Management Ch15 (Krek) Flashcards
Does transillumination intubation involve a laryngoscope?
No
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What is transillumination intubation?
A bright light placed inside the trachea in an endotracheal tube that is visible on the outside of the trachea.
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What would the light in a transillumination intubation look like if the ET tube was correctly placed in the trachea?
A tightly circumscribed light slightly below the thyroid cartilage indicates the tip has entered the trachea.
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Describe the basics of how a retrograde intubation is performed.
A needle is placed in the cricothyroid membrane and a wire is fed toward the head through the trachea and into the mouth. The wire is then used as a guide for the induction of the ET tube.
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What is the technique called for a face-to-face intubation?
The Tomahawk method
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Why is the tongue swept to the right in the Tomahawk method of face-to-face intubation?
The medic holds a Mac blade in the right-hand and sweeps the tongue to the right because he is facing the patient.
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What percentage of intubations are considered failed attempts?
Define what is meant by a failed attempt?
5%
The failure to maintain oxygen saturation during or after one or more failed attempts or a total of three failed attempts even if oxygen saturation can be maintained.
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What is tracheobronchial suctioning?
Passing a suction catheter into the ET tube to remove secretions.
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What is the first rule in tracheobronchial suctioning?
Don’t do it if you don’t have to because it can cause cardiac dysrhythmias. Suctioning should last no more than 10 seconds.
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What is the only reason to consider an extubation?
What should you expect if an extubation is performed?
If a patient is unreasonably intolerant of an ET tube and is unable to be sedated
Expect the patient to vomit and sit them up.
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Name five differences in a pediatric airway.
- A large head causes a flexed neck position
- The tongue is larger and the mandible is smaller
- Epiglottis is very floppy and must be lifted
- Trachea is more anterior and superior
- A cuff on an ET tube could damage the airway and is not needed
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How do you determine the size of an ET tube for pediatric patient?
Braslow tape, width of the nail on the little finger, inside diameter of one of the nares.
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At what age do you begin to use a cuffed ET tube in a pediatric patient?
8-10
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What is the appropriate depth of an ET tube in a pediatric patient?
2 to 3 cm beyond the cords
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Why would you give atropine sulfate to a pediatric patient prior to intubation? What is the dose?
Stimulation of the parasympathetic nervous system can result in bradycardia.
.02 mg/kg
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Where is the depth of an ET tube in a pediatric patient recorded?
At the right side corner of the mouth
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A colorimetric ETCO2 detector cannot be used in children weighing less than ________, or an esophageal bulb if they weigh less than ________.
15kg
20kg
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What is the mnemonic to troubleshoot an acute deterioration of a pediatric pt?
DOPE
Displacement, Obstruction, Pneumothorax, Equipment failure
What are the two major classes of sedatives used in airway management?
Analgesics and sedative hypnotics
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Why is sedation used in airway management?
To reduce anxiety, induced amnesia, and decrease the gag reflex
p. 810
Give an example of butyrophenones used in sedation and why
Haldol and Inapsine
Used for anxiolysis
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Provide an example of a benzodiazepine used for sedation
What is an additional benefit of these medications?
Name a benzodiazepine antagonist.
Diazepam (Valium) and midazolam (versed)
Anxiolytic, anti-seizure, retrograde amnesia
Flumazenil (romazicon)
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Name to common side effects of benzodiazepines?
Respiratory depression and slight hypotension
How are opioids used in intubation?
What are the common side effects
As premedication during induction and in maintenance of sedation or amnesia
Profound respiratory and central nervous system depression and severe hypotension
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What is a non-narcotic, non-barbiturate hypnotic-sedative drug used in the induction of general anesthesia?
Etomidate
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What muscle tissue do paralytics affect?
Skeletal muscle tissue
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Why are paralytic medications referred to as neuromuscular blocking agents?
They function at the neuromuscular junction and relax the muscle by impeding the action of acetylcholine. They are classified into either depolarizing or non-depolarizing agents
p. 811
What is the medication classification of succinylcholine?
Describe how it works.
Depolarizing neuromuscular blocker
Competitively binds with acetylcholine receptor sites but is not affected by acetylcholinesterase.
p. 812
What are fasciculations why do they occur?
Brief twitching of small muscle groups in the face, neck, trunk, and extremities. They occur because depolarization is occurring at the neuromuscular junction.
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In what types of patients should succinylcholine be used with caution?
Why should atropine be given to pediatric patients prior to administering succinylcholine?
Patients with burns, crush injuries, and blunt trauma due to the possibility of hyperkalemia.
The possibility of succinylcholine induced bradycardia.
p. 812
Give an example of the nondepolarizing neuromuscular blocker and describe how it works
Vecuronium
Rapid onset of 2 min duration of 45 min.
Prevents fasciculations because the amount of the medication in the receptor exceeds the amount of acetylcholine and prevents the threshold of depolarization from occurring.
6 steps for RSI
- Pre-oxygenate
- Defasciculating dose (10%) of non-depolarizing paralytic, lidocaine, or atropine
- Sedate
- Paralyze
- Intubate
- Maintain adequate sedation
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Contra indications of Combitube usage
Esophageal trauma varices or cancer, caustics ingestion, alcoholic, children> 16.
What tube is first ventilated through on a Combitube?
The longest blue tube. Chest rise indicates tracheal placement. No chest rise indicates esophogeal placement, switch ports and ventilate.
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What device surrounds the opening of the larynx with an inflatable silicone cuff positioned in the hypopharynx with the tip inserted into the proximal esophagus, that provides a conduit from the glottic opening to the ventilation device?
LMA
Disadvantage does not provide aspiration protection
The LMA can be used as an ET tube guide, allowing for intubation with what size tube?
6.0
What airway when properly placed in the esophagus, can an ET tube inducer be used, in order to intubate the patient?
King LT-D
Name the two methods of securing a patent airway that can be used when conventional techniques and methods fail.
The open Cricothyrotomy and the translaryngeal catheter ventilation (nonsurgical or needle Cricothyrotomy)
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What vessels are located near the Cricothyroid membrane?
The superior Cricothyroid vessels are located at a transverse angle across the upper third of the cricothyroid membrane. The external jugular veins run vertically and are located lateral to the cricothyroid membrane
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When is an open cricothyrotomy indicated and when is it not?
Indicated when a patent airway cannot be secured by a more conventional means, as in extreme facial trauma or upper airway obstructions and swelling It is not indicated if the patient can be effectively ventilated with a bag mask ventilation technique or > 8 yo.
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Displacement of the ET tube during a cricothyrotomy should be suspected when…
Subcutaneous emphysema is encountered by air infiltrating the subcutaneous fat and characterized by a crackling sensation.
p. 826
Name that landmarks associated with a Cricothyrotomy.
Palpate for the V notch of the thyroid Cartlidge. Slide down into the depression between the thyroid and cricothyroid Cartlidge, this is where you make a 1 to 2 cm vertical incision.
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What size ET tube is used in the cricothyrotomy?
- 0 and the bottom 1/3rd is cut off.
p. 826
Describe the process for a needle cricothyrotomy.
A 14-16 gauge needle is inserted at a 45° angle caudally, into the cricothyroid membrane. The catheter is left in place and hooked to a high-pressure jet ventilator. This method allows for future intubation.
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