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Emergency Medicine > Airway Management & CV Collapse > Flashcards

Airway Management & CV Collapse Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What does ABC mean in an emergent setting?

A

Airway
Breathing
Circulation

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2
Q

Airway Management in General

A 
Head tilt-chin lift
Jaw thrust
Suction if needed
BVM if no respiratory effort
Insert NPA/OPA
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3
Q

Airway Management in Unconscious Patient with Respiratory Effort

A

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

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4
Q

Types of “High-Flow” Oxygen

A

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

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5
Q

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

A

Conscious patients

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6
Q

When can a NPA be used?

A

Conscious
Unconscious
Patients with intact gag reflex

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7
Q

Complication of a NPA

A

Epistaxis

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8
Q

How to Measure a NPA

A

Tip of nose to earlobe

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9
Q

When are oropharyngeal airways generally used?

A

Unconscious patients

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10
Q

Why does an OPA need to be inserted carefully?

A

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

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11
Q

How to Measure an OPA

A

Mouth to angle of the mandible

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12
Q

Indications for a Laryngeal Mask Airway (LMA)

A

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

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13
Q

Where does an LMA sit?

A

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

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14
Q

Where is an LMA used?

A

OR
ED
EMS

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15
Q

Contraindications to an LMA

A

Cannot open mouth

Complete upper airway obstruction

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16
Q

How to Insert an LMA

A 
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
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17
Q

LMA Complications

A

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

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18
Q

Intubation “Rules”

A

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

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19
Q

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

A

Minimize risk of aspiration of stomach contents

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20
Q

Indications for Rapid Sequence Intubation (RSI)

A

Standard of care for intubations not anticipated to be difficult

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21
Q

Contraindications of RSI

A

Anticipating difficult airway placement

Inability to ventilate patient (paralytic may be contraindicated)

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22
Q

7 P’s of RSI

A 
Preparation
Pre-oxygenation
Pre-treatment
Paralysis
Protection and positioning
Placement with proof
Post-intubation management
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23
Q

Pneumonic for Preparation in RSI

A

STOP MAID

24
Q

What does STOP MAID stand for?

A 
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
25
Q

Tools Used in Intubation

A

Laryngoscope blades
Handle
Video laryngoscope

26
Q

Types of Monitors Necessary for Intubation

A 
ECG
Pulse oximetry
Blood pressure
ETCO2
Esophageal detectors
27
Q

Preoxygenation in RSI

A 
Administration of high-flow oxygen
Take 8 VC breaths
Manual ventilation if necessary
Maintain potency of upper airway
5L of O2 via NC
28
Q

Pretreatment in RSI

A

Atropine for pediatric patients
Lidocaine
Opioids

29
Q

Medications that can be Used for Paralysis with Induction

A 
Etomidate
Ketamine
Midazolam (versed)
Propofol
Thiopental sodium
Methohexital
30
Q

Benefits of Etomidate

A

Excellent sedation with little hypotension

31
Q

Contraindications of Etomidate

A

Known to suppress adrenal cortisol production

32
Q

Benefits of Ketamine

A

Stimulates catecholamine release

Bronchodilation

33
Q

Contraindications of Ketamine

A

Elevated ICP

Elevated BP

34
Q

When may Ketamine be an excellent induction agent?

A

Bronchospasm
Septic shock
Hemodynamic compromise

35
Q

Benefits of Midazolam (Versed)

A

Potent dose-related amnesic properties

36
Q

Contraindications of Midazolam (Versed)

A

Dose-related myocardial depression can result in hypotension

37
Q

Benefits of Propofol

A

Bronchodilation

38
Q

Relative Contraindication of Propofol

A

Dose-related hypotension

39
Q

Benefits of Thiopental Sodium

A

Cerebroprotective and anti-convulsive properties

40
Q

Contraindications of Thiopental Sodium

A

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

41
Q

Benefits of Methohexital

A

Cerebroprotective

42
Q

Contraindication of Methohexital

A

Acute intermittent and variegate porphyrias

43
Q

Neuromuscular Blocking Agents (Paralytics)

A

Succinylcholine

Vecuronium or rocuronium

44
Q

Contraindications of Succinylcholine

A 
Hyperkalemia
Neuromuscular disease
Ocular trauma
Malignant hyperthermia
Rhabdomyolysis
Stroke or burn >72 hours old
45
Q

Reasons for Cricoid Pressure

A

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

46
Q

Confirmation of Placement of ET Tube

A

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

47
Q

What color is the ETCO2 monitor on inhalation and exhalation?

A

I: purple
E: yellow

48
Q

Postintubation Management

A

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

49
Q

Indications for a Cricothyroidotomy

A

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

50
Q

Relative Contraindication of a Cricothyroidotomy

A

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

51
Q

Step 1 of a Cricothyroidotomy

A

Identify the cricothyroid membrane by palpation

52
Q

Step 2 of a Cricothyroidotomy

A

Horizontal stab incision through skin and cricothyroid membrane

53
Q

Step 3 of a Cricothyroidotomy

A

Hook placed prior to removal of scalpel

Caudal traction used to stabilize larynx

54
Q

Step 4 of a Cricothyroidotomy

A

Insert tracheostomy tube into the trachea

55
Q

How does cardiovascular collapse occur?

A

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

Emergency Medicine (17 decks)

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