Airway management/drugs

Question 1

What is a major cause of preventable death?

Answer 1

Managing airway

Question 2

What is the pediatric assessment triangle?

Answer 2

A- Appearance
B-Work of breathing
C- Circulation

Question 3

How do you determine ETT size for pediatrics?

Answer 3

16-age in years /4

estimated by using the child’s nares size or diameter of index finger

Question 4

Describe the LEMON difficult intubation assessment?

Answer 4

L=Look E=Evaluate 3-3-2 (3 fingers in mouth, 3 finger between jaw and hypoid, 2 fingers between hyoid and thyroid. M=Mallampati (I-IV). O=Obstructions N= Neck mobility

Question 5

What age is the minimum for cric

Answer 5

8 years old in age

Question 6

What is the HEAVEN criteria?

Answer 6

H=Hypoxemia <93% at the time of initial tube
E= Extremes in size
A= Anatomic challenges (trauma, mass, swelling, etc.)
V=Vomit/blood/fluid (use the SALAD technique)
E=Exsanguination/Anemia
N= Neck Mobility

Question 7

What is sellick’s maneuver?

Answer 7

Posterior pressure to cricoid (to prevent aspiration)
This is not recommended any longer
Can occlude esophagus

Question 8

What is BURP?

Answer 8

Backward, upward. rightward pressure

Pressure must be maintained until intubation is complete

Question 9

What is External Laryngeal manipulation?

Answer 9

This is a hold that brings cords into view

Assistant holds position

Question 10

What is the gold standard for checking tube placement?

Answer 10

Chest X-ray

Question 11

Where should you see the distal tip of your ET tube?

Answer 11

4-5 cm above carina +/- 2

around level of T2-T3

Question 12

Where should you see the murphy’s eye

Answer 12

Where the clavicles meet

Question 13

Where can you find the carina?

Answer 13

About T5-T7

Question 14

What should your ETT cuff be inflated at?

Answer 14

20-30

25 gold standard

Question 15

Optimal intubation should be performed with patient’s ear level to where?

Answer 15

Sternal notch

Question 16

What airway adjunct provides maximum protection against aspiration?

Answer 16

ETT

Question 17

What are two treatments you should consider if your patient is hypotensive prior to induction?

Answer 17

Fluid bolus and push dose pressors

Question 18

What are induction agents for intubation?

Answer 18

Etomidate
Ketamine
Versed
Propofol

Question 19

What is the onset and duration for Etomidate?

Answer 19

15-45 seconds onset

3-12 min duration

Question 20

Which induction agent is best used for conscious sedation?

Answer 20

Etomidate

Question 21

What is the onset and duration of Ketamine?

Answer 21

40-60 second onset

10-20 minute duration

Question 22

What can ketamine be used for?

Answer 22

Pain
Sedation
Behavioral

Question 23

What is the onset and duration for Versed?

Answer 23

30-60 seconds onset

15-30 min duration

Question 24

What is the reversal agent for overdose on Versed and the dose?

Answer 24

Romazicon (flumazenil) 0.2 mg

May adversely affect BP

Question 25

What is the onset and duration of Propofol?

Answer 25

15-45 seconds onset

5-10 minutes duration

Question 26

What is Propofol good for?

Answer 26

Decreases CPP and MAP, use with caution on Head injury (Not good in hemodynamically unstable patients)

Question 27

What is the onset and duration of Succinylcholine?

Answer 27

< 1 minute onset

4-6 minute duration

Question 28

Is succs good for pre-hospital?

Answer 28

NO

Question 29

What can administration of sucs cause?

Answer 29

Malignant hyperthermia
Hyperkalemia
Causes Fasciculations (muscle twitching)

Question 30

Is succs non-depolarizing or Depolarizing?

Answer 30

Depolarizing

Question 31

What is onset and duration of Rocuronium?

Answer 31

< 2 minutes onset

30-60 minute duration

Question 32

Is Rocuronium depolarizing or non depolarizing?

Answer 32

Non- deplarizing

Question 33

What are the contraindications of succs?

Answer 33

Crush injuries, eye injuries history of malignant hyperthermia, burns> 24 hrs old, hyperkalemia, nervous system disorder

Question 34

What is the onset and duration of Vecuronium?

Answer 34

Onset 90-120 seconds

Duration 60-75 min

Question 35

What is vecuronium normally used for?

Answer 35

To keep patient paralyzed after Succs or Roc had been administered

Question 36

If you have a hemodynamic unstable patient, what is your dose of your medication?

Answer 36

1/2 the induction dose and double the paralytic dose

Question 37

What is the treatment for malignant hyperthermia? The Dose?

Answer 37

Dantrium (Dantrolene Sodium)

2.5 mg/kg rapid IV push

Question 38

What are signs and symptoms of malignant hyperthermia?

Answer 38

• Lockjaw (masseter spasm/trismus)
• Sustained tetanic muscle contraction
• Rapid increase in temp
• Increased ETCO2
• Tachycardia/hypertension
• Mixed acidosis

Question 39

What are the determination points for cric?

Answer 39

o Pt requires secured airway
o 3 unsuccessful ET attempts
o Unable to ventilate/oxygenate above 90%
o Difficult airway determined by HEAVEN or LEMON
CAN’T INTUBATE, CAN’T VENTILATE, CAN’T OXYGENATE=CRIC

Question 40

Should you give calcium channel blockers for a patient suspected of malignant hyperthermia?

Answer 40

No

Question 41

What is the cause of malignant hyperthermia?

Answer 41

Problem with Calcium being removed from the cells

Question 42

Which neuro blocking drugs do not require refrigeration?

Answer 42

Vecuronium and Rocuronium

Question 43

Which neuro blocking agent requires refrigeration?

Answer 43

Succinylcholine

Question 44

What is the reversal agent of Rocuronium? Dose?

Answer 44

Sugammadex (Bridion) 16 mg/kg