Airway Mang 16 Test Review Flashcards
Know the difference in which pt gets a nasal cannula and which gets NRB.
NC- Best for those that need long term therapy. Less immediate respiratory distress. 1-6LPM, can deliver 24-44% FiO2.
NRB - Preferred in pre-hospital setting. For more acute respiratory distress. 12-15LPM, can deliver 90-100% FiO2.
Tank Sizes - D tank - 0.16 Cylinder Constant
If your tank has 2,000 psi, subtract the 200psi(safe residual pressure) = 1,800psi.
1,800psi X 0.16constant=288
288/2LPM=144 Minutes
5 Breakfast Question:
Motorcycle crash: what would be a good reason to not treat an obviously injured leg?
Pt was unable to maintain his own airway
Which size tank would be most commonly used to go to a pts bedside?
D tank
Which selection is true about the BURP Manuever?
Applying pressure to the cricoid cartilage, upward, backward, and right to bring the larynx into view, improve view of glottic opening and vocal cords for intubation.
How to clear airway obstruction in a 3 mo?
5 back slaps, chest compressions until FB is expelled, or baby goes unresponsive. Then CPR
What is a high pitched, continuous, sound as air flows through constricted lower airway. Can be heard on inspiration or expiration. Cause?
Wheezes - Heard in Lower chest
Asthma/Bronchiolitis
Brochodilators
What is low pitched, continuous sound, that indicates mucus or fluid in the larger, lower airways? Causes?
Rhonchi - in the Bronchi - Upper Chest
Pulmonary edema or pneumonia or bronchitis
Providing O2, adm bronchodilator, consider CPAP depending on possible underlying conditions, such as COPD.
Discontinuous breath sounds that may occur seither early or late in the inspiratory cycle, occurs when airflow causes mucus or fluid in the airways to move into the lower airways.
Crackles (Rales) - Heard in the back
CHF/COPD
Breath sounds that result from foreign body aspiration, infection, swelling, or trauma within or above the glottic opening, Loud high-pitched sound is typically heard during the inspiration phase.
Stridor
Remove Obstruction
Breath sounds that result from inflammation that causes the pleura to thicken allowing the visceral and parietal pleura to rub together.
Pleural friction rub
Which is a common complication of sedating a pt prior to intubation?
Which would negatively affect alveolar diffusion?
What is your 1st priority in an unconscious, supine, trauma pt with vomit in their mouth?
Which age group is at the highest risk for foreign body airway obstruction?
Older adults
Alcohol/Dentures
Each rib fx can lose approx 125ml of fluid. If you break 4 ribs, how much blood loss into chest would you expect?
500ml
Atelectasis - Non-Functional Alveoli. What would cause it?
Submersion
Pulmonary Edema
Average RR & Tidal Volume for adults
12-20
500mL
Ventilation rate, post intubation, for adults
8-10
Mnemonic to remember abnormal ETCO2
D - Dislodgement
O - Obstruction
P - Pneumothorax
E - Equipment Failure
How far past vocal cords do you push the proximal end of ET tube?
1-2cm
What is the narrowest areas of an adult airway?
Glottic Opening
What is the narrowest area of a pediatric airway?
Cricoid Ring
Max weight limit on a Broslow tape?
34-36kg
What could an improperly sized OPA cause?
The pt’s tongue to be pushed backward into the pharynx, creating an airway obstruction.
All ET tubes have this in common
15-22mm adapter
Commonly used mnemonic to determine airway difficulty
L - Look externally - Obesity, Short, thick necks bad
E- Evaluate 3-3-2 (3 fingers for mouth, 3 fingers chin/hyoid, 2 hyoid/thyroid notch)
M - Mallampati Classification - pt sitting upright, that can fully open mouth, good
O - Obstruction - F.B, hematoma, obesity, masses
N- Neck Mobility - Sniffing Position. Trauma, Osteoporosis
Poor sizing of ET tubes can cause-
Too Small - will lead to increased resistance to airflow & difficulty ventilating
Too Large - May cause trauma
Average size ET tubes for males? Females?
Males: 7.5-8.5
Females: 7-8
Average sized ET tubes for peds.
2.5-5mm (inside diameter)
Will usually not be cuffed.
The narrowest portion of ped airway, cricoid ring, will automatically form a seal w/the ET tube.
Anatomic indicators for proper ET tubes size
Internal nostril diameter is approx the same size as glottic opening.
The little finger or thumbnail.
ET Tubes range for length
12-32cm
MAC & Miller Blades
How to size blades. Lips to Adam’s Apple
MAC - Curved - Conforms to Tongue
Miller - tip lifts glottis (infants and small children)
Peds have softer, rounder epiglottis “omega shaped”
Size:
0 - Preemie’s
1 - Infants
2 - Toddlers
3-4 Adults
vomit in mouth of supine unresponsive, trauma pt, what is your priority
Suction airway, remove emesis to prevent aspiration
How to determine tube size based on age.
Age divided by 4, plus 4 = tube size
What is a contraindications for an open cricothrotomy, but available for a needle cricothrotomy?
Age. The larynx of a small child is generally unable to support a tube large enough to produce effective ventilation for an open cric, but can be supported in needle cric.
What is the most serious sign in a ped w/airway problem?
Low/Decreased HR
Which age group has a normal RR of 22-34
3-5yo
What would you use an NPA for and how to properly install it.
Measure from nare to tragus, Bevel towards the septum, measure on the largest nare, for pt’s who need airway management w/ an intact gag reflex, can be suctioned through. Contraindications: severe facial trauma, pt intolerance, skull fx. Improper technique can cause bleeding, does not protect from aspiration
Best reason for ET Intubation vs other advanced airways
Only secure airway - prevents aspiration
When is the glottis opening the largest
On Inspiration, opens to allow sufficient airflow into the lungs
small fleshy tissue structure that prevents food and liquids to enter the nasopharynx when swallowing
Uvula
thin flaplike cartilaginous structure that allows air to pass in the trachea but prevent food and liquids from entering
Epiglottis
Small wedge-shaped depression in the throat that sits between the tongue and the epiglottis
Vallecula
Hypoglottis
Underside of tongue
Which age group is most likely to experience a foreign airway obstruction?
Older Adults:
Alcohol/Dentures
What would you do to improve fio2 level on non breathing ventilated pt ?
For pt on ventilator: To improve FiO2 levels in a non-breathing ventilated patient, adjust the ventilator settings to increase the FiO2 percentage delivered.
Contact med control for specific orders.
Ventilated by BVM: Increase ventilations/O2 flow, confirm tube placement.
What do gurgling sounds indicate and what do you do about it?
Fluid accumulated in upper airway. Adjust body position to drain fluid, suction.
What do snoring respirations indicate?
Blocked airway. Reposition pt, Open airway.
Can you pick out the most accurate statement using dual lumen airway in trauma pts,
a dual lumen tube (DLT) can be valuable in trauma situations when lung isolation is needed for procedures like one-lung ventilation, particularly when significant chest injuries or bleeding is present, but its insertion can be challenging due to potential airway instability in trauma patients; meaning it is useful for specific scenarios but may be difficult to place due to the nature of trauma injuries.
Pediatric choking victims and what to do if they’re apneic
For pediatric choking victims who are apneic Check the child’s mouth for any visible object and try to remove it. Begin CPR immediately. - Use one hand for compressions and proceed with 30 chest compressions followed by 2 rescue breaths. Continue until the child begins to breathe.
Going to use a stylette, proper technique in preparing stylette
Inserted into the endotracheal tube so that the stylette does not extend beyond the tube’s distal end, ensuring smooth intubation and minimizing trauma. insert it into the endotracheal tube (ETT) ensuring the tip of the stylet does not extend beyond the tube’s distal end, then gently bend the stylet to create a slight curve, often described as a “hockey stick” shape, to help guide the ETT into the trachea during intubation
which is a common complication of sedating a pt prior to intubation.
A common complication of sedating a patient before intubation is respiratory depression, which can lead to hypoxia (low oxygen levels) due to the sedative medication impacting the patient’s breathing rate and depth, potential to take a pt from can ventilate to can’t intubate to can’t ventilate to can’t intubate. Sedation will relax a pt but will not paralyze them. Their gag reflex can remain intact w/ sedation which will still inhibit intubation. Can also cause tongue to occlude the airway which contributes to “can’t ventilate” scenario.
performing digital intubation: blind intubation.
A digital intubation, also known as a blind intubation, involves using your fingers to palpate and lift the epiglottis within the patient’s airway, guiding an endotracheal tube into the trachea without direct visualization
suction- suction cardiac arrest. How to do it properly
Suction during cardiac arrest should be performed quickly and efficiently to minimize interruptions in chest compressions. Use a suction catheter to clear the airway of fluids, vomit, or foreign material. Limit suctioning to 10 seconds or less, and resume CPR immediately after clearing the airway. Ensure suction equipment is ready and functioning properly before starting resuscitation.
treating ped trauma- hr drops significantly, what caused the drop. Decompensated shock- maybe airway obstruction
Hypovolemic shock, cardiac tamponade, tension pneumo, COMPROMISED AIRWAY
Infant Airways
A child’s airway is smaller in diameter and length. It is also more narrow and flexible. In proportion, the child’s epiglottis is larger and floppier. The narrowest part of the child’s airway is the cricoid cartilage, whereas the adult’s narrowest area in the airway is the vocal cords. The tongue is larger in proportion.
know about nasal tracheal intubation-
use respirations to guide tube into place
advance as pt’s inhales
vocal cords open widest during inhalation, facilitate placement of tube into trachea
prepare equipment and pre oxygenate pt
insert tube into nostril with bevel to septum
lubricate distal end of tube
normally use right nostril d/t curvature of tube
aim tip of tube straight back toward ear
goal is to follow floor of nasal cavity
do not insert with tip aimed up towards eye, can damage turbinates and cause significant bleeding
As you advance tube, you will hear air rushing in and out of tube as the pt breathes
goal is to place tube just above glottic opening, as pt inhales tube will be sucked into trachea
negative pressure facilitates movement of tube through glottic opening
gently advance tube w/ inhalation
Soft tissue bulge on either side of airway= tube inserted into piriform fossa
hold pt’s head still
slightly withdraw tube
attempt advancement again during inhalation
if no air is moving through tube, likely placed in esophagus
after proper positioning, inflate cuff and ventilate pt
use multiple confirmation methods
list of unresponsive- which one needs assisted ventilations-
too fast, too slow, not at all, or inadequate depth-
math. Evaluating 42 yo f, normal minute volume. How many L of o2 is inspired per min
6-8LPM
Cardiac arrhythmias can indicate hypoxia, especially in peds
bradycardia in peds is typically caused from hypoxia, the Bradycardia then leads to the cardiac arrest, Bradycardia is a late sign of pediatric hypoxia ]
which of the following anatomical structures is primary responsibility of the trapped air in asthmatics
the bronchioles.
Who benefits the most from an advanced airway:
Patients who are unable to maintain their own airway due to a decreased level of consciousness, severe trauma, facial injuries, obesity, or other medical conditions that obstruct breathing would benefit the most from an advanced airway, as it provides a secure and controlled method to deliver oxygen and ventilation
What would negatively effect alveolar diffusion
Thickening of the alveolar membrane makes it less permeable, causes the diffusion process to be more difficult
Esophageal dual lumen airway, who to use on, indications, contraindications
Esophageal dual lumen airways. Indications: Used in emergency situations where intubation is not possible. - Useful in unconscious patients requiring airway management. Contraindications:- Not recommended if the patient has known esophageal disease. - Avoid if there is an intact gag reflex or risk of vomiting and aspiration.
Which one of these devices has a negative feedback on PEEP
An endotracheal tube (ETT) is the device that typically has a negative feedback on PEEP
Suctioning
Tracheobronchial Suction
involves passing suction catheter into E T tube to remove pulmonary secretions
should only be done when necessary
requires strict sterile technique
potential to introduce bacteria into lungs
lubricate French suction catheter before insertion
can inject 3-5ml sterile water into E T tube ot loosen thick secretions
gently inter catheter until you feel resistnce
suction while extracting catheter, in rotating motion
not to exceed 10secs
Once complete, continue to ventilate
Patent ventilating non intubated ped pt @ 60x /min what is most likely to happen
Hyperventilation could occur, potentially leading to respiratory alkalosis and a decrease in CO2 levels in the blood. This may result in decreased oxygenation due to vasoconstriction
sizing npa and opa
OPA-corner of the mouth to the angle of the jaw. NPA- measure the distance from the tip of the nose to the tragus of the ear.
How to suction through and ET tube
Ensure the patient is adequately oxygenated before suctioning.
Insert the suction catheter without applying suction. Gently insert the suction catheter into the ET tube until resistance is met or the patient coughs, indicating the carina has been reached. Do not apply suction while inserting to avoid trauma to the airway. Apply suction while withdrawing the catheter. Re-oxygenate the patient after suctioning.
Which unresponsive pt will most likely benefit from an ng tube placed by ems
A patient with gastric distention may benefit from an NG tube to decompress the stomach.
Adventitious breath sounds in pediatric, lower airway.
In pediatric patients, adventitious breath sounds in the lower airway typically manifest as wheezing, a high-pitched whistling sound heard during exhalation, often indicating a narrowing or obstruction in the smaller airways due to conditions like asthma, bronchiolitis, or foreign body aspiration; other potential lower airway adventitious sounds include coarse crackles, which can be heard with fluid buildup in larger airways.
Proper procedure in suction apneic adult pts
pre-oxygenating the patient with 100% oxygen, rapidly inserting a suction catheter into the airway, applying suction only during withdrawal, limiting suction time to 10-15 seconds per pass, and monitoring the patient’s vital signs closely throughout the process
Dual lumen airways, where to inflate first and what to do if you don’t hear BS on first breath
Inflate the tracheal cuff first. If breath sounds are not heard, check the tube position and ensure proper ventilation. Adjust or reposition if necessary.
Know about using nc and appropriate flow rates
Provides low to moderate oxygen enrichment and most beneficial to patients with mild hypoxemia and patients who require long time oxygen therapy. Best used in Spo2 of 90-93%. Flow rates from 1-6 lpm
Know at NT intubation and when to advanced the tube
insertion of an ET tube into the trachea through the nose. Best for patients that would be difficult or hazardous to preform laryngoscopy, or in the pt’s best interest to not use sedatives. Preformed on responsive patients who are spontaneously breathing but will require definfinitive airway management to prevent further deterioration. Not used on patients who are apneic, suffered head trauma and possibly have mid face fractures. Tube is advanced when the patient inhales.
Which of the following is true regarding pulmonary circulation
Pulmonary circulation is the process by which deoxygenated blood is transported from the heart to the lungs and back to the heart after oxygenation. This circulation is crucial for gas exchange, allowing carbon dioxide to be expelled and oxygen to be absorbed into the bloodstream. Blood goes through the heart and into the lungs via the pulmonary arteries, in the lungs the hemoglobin becomes oxygenated, and back into the heart via the pulmonary veins, to be circulated into the body.
Which of the following is true regarding pulmonary circulation
Ventilation: physical act of moving air in and out of lungs
o Inhalation: active part of ventilation
o passive: exhalation part of ventilation
· Oxygenation: process of loading oxygen onto hemoglobin
o Amount of oxygen inhaled must be adequate
o cannot not occur w/o ventilation
· Respiration: process of exchanging oxygen and CO2o External respiration aka pulmonary respiration
§ exchanging oxygen and co2 between alveoli and blood in pulmonary capillaries
o internal respiration aka cellular respiration
exchanging oxygen and co2 between systemic circulation and cells of the body
o oxygenation is required for respiration
§ does not guarantee that respiration is taking place
think “poor perfusion” w/ good ventilation and oxygenation
What would be your highest priority when pt is c/c difficulty breathing and also has distended neck veins.
the highest priority should be to immediately assess for signs of right-sided heart failure and initiate interventions to stabilize their circulation, as distended neck veins often indicate increased central venous pressure, which is a key sign of right-sided heart failure
Know how to clear airway obstructions in 3mo old.
5 back slaps, chest compressions until object is dislodged or baby goes unresponsive
Peak expiratory flow
A test ran to determine effectiveness of treatments. Test should be ran before and after administration of bronchodilator. Have the pt blow 3 times and take the highest reading. Adult average range is 350ml-750ml. Or 550ml.
The higher the capno..
the lower the ph
The lower the capno…
The higher the ph
resuscitation traumatic cardiac arrest pt, automated vent, pt color no improving, no pulse.
If you are resuscitating a traumatic cardiac arrest patient on an automated ventilator, and their color is not improving and they still have no pulse, despite ongoing CPR, this indicates a likely need for immediate advanced interventions like a rapid assessment for potential reversible causes of the arrest, including tension pneumothorax, pericardial tamponade, massive hemorrhage, and consideration for a surgical intervention if necessary
Capnography can indicate…
adequate cpr, effective ventilations, and rosc. (Capnography. For CPR should read no lower than 15)
