Airway Management & CV Collapse

Question 1

What does ABC mean in an emergent setting?

Answer 1

Airway
Breathing
Circulation

Question 2

Airway Management in General

Answer 2

Head tilt-chin lift
Jaw thrust
Suction if needed
BVM if no respiratory effort
Insert NPA/OPA

Question 3

Airway Management in Unconscious Patient with Respiratory Effort

Answer 3

Administer high-flow oxygen
Ensure no upper airway obstruction
Insert NPA/OPA
Suspected lower airway obstruction: Heimlich maneuver

Question 4

Types of “High-Flow” Oxygen

Answer 4

Nasal cannula: 6 L/min
Venti-masks
Non-rebreather mask

Question 5

In what type of patient is a NPA better tolerated compared to the OPA?

Answer 5

Conscious patients

Question 6

When can a NPA be used?

Answer 6

Conscious
Unconscious
Patients with intact gag reflex

Question 7

Complication of a NPA

Answer 7

Epistaxis

Question 8

How to Measure a NPA

Answer 8

Tip of nose to earlobe

Question 9

When are oropharyngeal airways generally used?

Answer 9

Unconscious patients

Question 10

Why does an OPA need to be inserted carefully?

Answer 10

So the tongue is not pushed back into the pharynx blocking the airway

Question 11

How to Measure an OPA

Answer 11

Mouth to angle of the mandible

Question 12

Indications for a Laryngeal Mask Airway (LMA)

Answer 12

Rescue device after failed intubation
Attempted quickly while another person preparing for cricothyroidotomy
Prehospital setting
Plan for short term intubation
Good alternative to BVM ventilation: decrease intubation risk

Question 13

Where does an LMA sit?

Answer 13

Patient’s hypo pharynx and covers the supraglottic structures
Isolates the trachea

Question 14

Where is an LMA used?

Answer 14

OR
ED
EMS

Question 15

Contraindications to an LMA

Answer 15

Cannot open mouth

Complete upper airway obstruction

Question 16

How to Insert an LMA

Answer 16

Select proper size
Inflate/deflate cuff
Lubricate back of mask
Patient placed in sniffing position
Slide mask down posterior pharyngeal wall until resistance felt
Inflate mask
Confirm tube position

Question 17

LMA Complications

Answer 17

Necrosis: if cuff overinflated
Mask tip can fold and cause obstruction by pushing on epiglottis
Mask tip can fold back on itself

Question 18

Intubation “Rules”

Answer 18

Oxygenate before and after intubations
Intubate early
Intubate as soon as you think of it
Make sure patient isn’t a DNI/DNR

Question 19

Why are rapidly acting sedatives and a neuromuscular blocking agent used in intubation?

Answer 19

Minimize risk of aspiration of stomach contents

Question 20

Indications for Rapid Sequence Intubation (RSI)

Answer 20

Standard of care for intubations not anticipated to be difficult

Question 21

Contraindications of RSI

Answer 21

Anticipating difficult airway placement

Inability to ventilate patient (paralytic may be contraindicated)

Question 22

7 P’s of RSI

Answer 22

Preparation
Pre-oxygenation
Pre-treatment
Paralysis
Protection and positioning
Placement with proof
Post-intubation management

Question 23

Pneumonic for Preparation in RSI

Answer 23

STOP MAID

Question 24

What does STOP MAID stand for?

Answer 24

S: suction
T: tools for intubation
O: oxygen source
P: positioning
M: monitors
A: assistant, Ambu bag with face mask, airway devices, airway assessment
I: IV access
D: drugs

Question 25

Tools Used in Intubation

Answer 25

Laryngoscope blades Handle Video laryngoscope

Question 26

Types of Monitors Necessary for Intubation

Answer 26

``` ECG Pulse oximetry Blood pressure ETCO2 Esophageal detectors ```

Question 27

Preoxygenation in RSI

Answer 27

``` Administration of high-flow oxygen Take 8 VC breaths Manual ventilation if necessary Maintain potency of upper airway 5L of O2 via NC ```

Question 28

Pretreatment in RSI

Answer 28

Atropine for pediatric patients Lidocaine Opioids

Question 29

Medications that can be Used for Paralysis with Induction

Answer 29

``` Etomidate Ketamine Midazolam (versed) Propofol Thiopental sodium Methohexital ```

Question 30

Benefits of Etomidate

Answer 30

Excellent sedation with little hypotension

Question 31

Contraindications of Etomidate

Answer 31

Known to suppress adrenal cortisol production

Question 32

Benefits of Ketamine

Answer 32

Stimulates catecholamine release | Bronchodilation

Question 33

Contraindications of Ketamine

Answer 33

Elevated ICP | Elevated BP

Question 34

When may Ketamine be an excellent induction agent?

Answer 34

Bronchospasm Septic shock Hemodynamic compromise

Question 35

Benefits of Midazolam (Versed)

Answer 35

Potent dose-related amnesic properties

Question 36

Contraindications of Midazolam (Versed)

Answer 36

Dose-related myocardial depression can result in hypotension

Question 37

Benefits of Propofol

Answer 37

Bronchodilation

Question 38

Relative Contraindication of Propofol

Answer 38

Dose-related hypotension

Question 39

Benefits of Thiopental Sodium

Answer 39

Cerebroprotective and anti-convulsive properties

Question 40

Contraindications of Thiopental Sodium

Answer 40

Potent venodilator and myocardial depressant Relative: reactive airway disease due to histamine release Acute intermittent and variegate porphyrias

Question 41

Benefits of Methohexital

Answer 41

Cerebroprotective

Question 42

Contraindication of Methohexital

Answer 42

Acute intermittent and variegate porphyrias

Question 43

Neuromuscular Blocking Agents (Paralytics)

Answer 43

Succinylcholine | Vecuronium or rocuronium

Question 44

Contraindications of Succinylcholine

Answer 44

``` Hyperkalemia Neuromuscular disease Ocular trauma Malignant hyperthermia Rhabdomyolysis Stroke or burn >72 hours old ```

Question 45

Reasons for Cricoid Pressure

Answer 45

Collapse the esophagus to prevent regurgitation of gastric contents Facilitate visualization of vocal cords

Question 46

Confirmation of Placement of ET Tube

Answer 46

ETCO2 monitor Auscultation of breath sounds Esophageal intubation detection device CXR: can just tell how far tube is in

Question 47

What color is the ETCO2 monitor on inhalation and exhalation?

Answer 47

I: purple E: yellow

Question 48

Postintubation Management

Answer 48

Secure ET tube CXR to evaluate depth of tube and assess for barotrauma Support BP Mechanical ventilation

Question 49

Indications for a Cricothyroidotomy

Answer 49

When patient has failed to be oxygenated adequately by all other possible methods and intubation has failed

Question 50

Relative Contraindication of a Cricothyroidotomy

Answer 50

Young children due to shape of airway- may lead to subglottic stenosis

Question 51

Step 1 of a Cricothyroidotomy

Answer 51

Identify the cricothyroid membrane by palpation

Question 52

Step 2 of a Cricothyroidotomy

Answer 52

Horizontal stab incision through skin and cricothyroid membrane

Question 53

Step 3 of a Cricothyroidotomy

Answer 53

Hook placed prior to removal of scalpel | Caudal traction used to stabilize larynx

Question 54

Step 4 of a Cricothyroidotomy

Answer 54

Insert tracheostomy tube into the trachea

Question 55

How does cardiovascular collapse occur?

Answer 55

Hypotension causes an increase in systemic vascular resistance and decreased tissue perfusion Repeat until complete collapse