Airway Quiz Flashcards
Indications for Airway Management
Inability to protect airway, inability to ventilate, predicted clinical course
Goals of pre oxygenation?
Saturation of hemoglobin, maximize PaO2, De-nitrogenation
Preoxygenation techniques?
Non-Rebreather and Nasal cannula at 15Lpm, Bipap, Cpap, and BVM
Theory of Pre oxygenation?
If the patients oxygenation levels are less than 99% the patient will decompensate very quickly. If you pre ox and the sats get greater than 100 then the PO2 can be saturated greater than 100.
The three killers?
Hypoxia, Shocks, Acidosis
How long should you PreOx for?
3-5 minutes
Upper Airway structures?
Nasopharynx, Oropharynx, Epiglottis, Larynx
What is the function of the upper airway?
Heat, Humidify, and filter incoming air.
What aids in the management of PEEP?
Upper airway structures
What are the 6 things that make up the 3 phases of RSI?
Preparation, PreOx, Premedication, Paralysis, Placement with proof, Post intubation management
What makes up Phase 1 of RSI?
Preparation, PreOx, premedication
What makes up Phase 2 of RSI?
Paralysis, Placement with proof
How many Phases of RSI are there?
3 Phases
What makes up Phase 3 of RSI?
Post Intubation Management
What does the lower airway consist of?
Trachea, Major Bronchi, Bronchioles, Alveoli
What is the function of the lower airway?
Provides a conduit for air to pass into the alveolar space and The place where actual gas exchange with the circulatory system occurs.
What triggers spontaneous breaths?
Brain stem, specifically the medulla oblongata
Most common cause of a decline in PH?
Increase in Carbon Dioxide
What is the Hypercapnic response?
A decline in PH and and increase in serum carbon dioxide
Factors that can decrease pH?
Elevated lactate (Shock), DKA, Poisoning (TCA, ASA, Methanol)
What is pH?
A measurement of H+ (Hydorgen ion without a bound electron to neutralize the charge)
Normal pH level range?
7.35 - 7.45
Low pH values mean the patient is?
Acidotic
High pH levels mean the patient is?
Alkalotic
As H+ increases pH does what?
Decreases
Once stimulated the medulla signals what?
The diaphragm to contract
Contraction of the diaphragm causes?
The Intrathoracic space to increase.
The increase in intrathoracic space causes what?
A negative pressure gradient that pulls air from the atmosphere to normalize the pressure difference
When the diaphragm relaxes what does it cause?
It causes reduction in intrathoracic space.
The increase of intrathoracic pressures during exhalation does what?
Intrathoracic pressures push air out of the lungs
What happens to the carbon dioxide during exhalation?
Carbon dioxide waste is expelled from the body and the process repeats
How many oxygen molecules can attach up to hemoglobin?
Up to 4 oxygen molecules to each hemoglobin
Hemoglobin is a unique protein binds to what?
Oxygen
Where does the binding of Oxygen and Hemoglobin occur?
The pulmonary capillaries where high concentration of oxygen is
What does High partial pressures cause?
The oxygen to cross the alveolar membrane into the capillaries and bind to the hemoglobin
This prevents the rebinding of oxygen to the hemoglobin?
As each oxygen atom is lost, hemoglobins affinity is reduced.
What causes hemoglobin to release its oxygen?
Lower concentrations of oxygen in the tissues
What three things affect the binding of Oxygen to hemoglobin?
pH, Carbon Dioxide, and Temperature
Ideal positioning for peri intubation?
Ear to sternal plane, tilt head back into sniffing position. Morbidly obese patients might requires ramping with significant padding under shoulders.
Ideal positioning for patient pre intubation?
Try to keep the patient sitting up when using NRB, NC, Bipap, Cpap.
Ideal positioning post intubation?
Sit your patient up
What is Ketamine?
Ketamine is a NMDA receptor antagonist, opioid receptor agonist, dopamine reuptake inhibitor, and a Catecholamine reuptake inhibitor
What is an NMDA receptor antagonist?
Binds to an allosteric site of the N-methyl, D-aspartame receptor located in the brain.
What is the dose for ketamine?
Analgesia 0.1-0.3 mg/kg IV/IM
Dissociation 1-2 mg/kg IV or 2-4 mg/kg IM
How does ketamine affect blood pressure, heart rate, and respiratory drive?
Respiratory drive remains intact, blood pressure and heart rate can slightly increase with higher dosages.
Side effects of ketamine?
Hypersalivation, transient periods of apnea if pushed too fast, emergence phenomenon.
What is emergence phenomenon?
Hallucinations and psychosis caused by ketamine administration.
What kind of state does ketamine cause?
A dissociative state which allows for the prevention of multiple negative side effects associated with more classic CNS depressants.
On top of sedation it can provide a bronchodilatory effect?
Ketamine
What is the onset and duration of Ketamine?
60 seconds and approx. 20 mins.
Common name for ketamine?
Ketalar
Common name for Etomidate?
Amidate
Contraindications of Etomidate
Shock, sepsis
Use caution with Etomidate during rapid infusions why?
Can cause fasciculations and vomiting
What kind of agonist is Etomidate?
GABA agonist
Etomidate is considered?
Hemodynamically flat. Along with neuro and cardio-protective
Dose of Etomidate?
0.3 mg/kg to a max of 40mg
Etomidate causes
Classic CNS depression and does not control pain.
Etomidate is used for?
Procedural sedation, especially RSI
What type of agonist is Propofol?
GABA Agonist
Common name for Propofol?
Diprivan
Propofol dosages?
10-100 mcg/kg/min
Onset and duration of propofol?
30 seconds and lasts 3-5 minutes. Must remain on for continuous sedation
What is propofol infusion syndrome?
A rare but life threatening side effect associated with long term infusion (Typically more than 24 hrs) can cause rhabdo, hyperkalemia, and acute renal failure
Drug that contains egg whites?
Propofol
What drug has to be added in to patients nutrition count and how much is it?
Propofol and it is 110 calories per bottle
Propofol has what effects?
Sedative and anticonvulsant effects
Lowers cerbreal oxygen demand and has theoretical benefit in neurocritical patient
propofol
How does propofol affect blood pressure?
Typically drops your blood pressure.
What type of agonist is benzodiazepines?
GABA agonists
What drugs are considered benzodiazepines?
Lorazepam, Midazolam, Diazepam,
What does Benzodiazepines do?
Potent anticonvulsant properties along with sedation and anxiolytic effects
What are benzos typically used for?
anxiety, seizures, procedural sedation, severe muscle spasms/tremors
What is the common name for Lorazepam?
Ativan
Common name for midzolam?
Versed
Common name for diazepam?
Valium
Dose for Ativan?
Adult: 1-4mg IV/IO/IM/IN
Pediatric: 0.1 mg/kg IV/IO/IM/IN
Onset and duration of ativan?
3-5 minutes and lasts 30-45 minutes.
How does Ativan effect blood pressure?
Hemodynamically flat
what drug works well IV but doesn’t absorb well IM/IN?
Ativan
Can be given post intubation as an adjunct for sedation?
Ativan
Works best when given IM?
Versed.
How does versed effect the blood pressure?
Has a profound effect on the blood pressure via vasodilation and decreased cardiac output
What is the dose of versed?
0.1 mg/kg
What is the onset and duration of Versed?
3-5 minutes and lasts 10-15 minutes.
What induction agent should be used in isolated head injuries?
Etomidate
What drug should be used with Etomidate in ICP and what is the dose?
Fentanyl 2-3 mcg/kg IVP
What drug is an anticholinergic and parasympathetic agent?
Atropine
How does atropines anticholinergic properties work?
They help reduce oral secretions that may be hindering the intubation attempt
What drug do you use in pediatric intubations and why?
Atropine and to help increased vagal tone
Paralyzation drugs?
Rocuronium, Succinylcholine, Vecuronium
What is the common name of Rocuronium?
Zemuron
Common name of Succinylcholine?
Anectine
Common name of Vecuronium?
Nocuron
Dosage of Rocuronium?
0.6-1.2 mg/kg (1mg/kg)
On set and duration of Rocuronium?
60 seconds and lasts 30-40 minutes
Rocuronium is a what neuromuscular blocker?
A Non-depolarizing neuromuscular blocker
What is the dose of Succinylcholine?
1-2 mg/kg IVP
Succinylcholine is a what neuromuscular blocker?
A depolarizing neuromuscular blocker
On set and duration of Succinylcholine?
45 seconds and lasts 5-7 minutes.
Administration of Succinylcholine can cause dysrhythmias, hypotension and death because?
Patients with an elevated serum of potassium levels. (Sepsis, acidosis, poor renal perfusion)
Succinylcholine prevents what?
Cells from repolarizing, leaving them in a state with potassium channels open
Rare side effect of succinylcholine administration?
Malignant Hyperthermia
Succinylcholine is less than ideal in patients with?
Increased ICP due to the fasciculations is a danger for herniation
Vecuronium is a what neuromuscular blocker?
Non-depolarizing neuromuscular blocker
Onset and duration of Vecuronium
Onset up to 5 minutes and duration of 45 minutes to an hour
Dose of Vecuronium
0.1 mg/kg IVP
Absolute must during intubation/post intubation?
Waveform capnography
