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CC Quiz Study Guides > Airway Quiz > Flashcards

Airway Quiz Flashcards

1
Q

Indications for Airway Management

A

Inability to protect airway, inability to ventilate, predicted clinical course

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2
Q

Goals of pre oxygenation?

A

Saturation of hemoglobin, maximize PaO2, De-nitrogenation

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3
Q

Preoxygenation techniques?

A

Non-Rebreather and Nasal cannula at 15Lpm, Bipap, Cpap, and BVM

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4
Q

Theory of Pre oxygenation?

A

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.

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5
Q

The three killers?

A

Hypoxia, Shocks, Acidosis

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6
Q

How long should you PreOx for?

A

3-5 minutes

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7
Q

Upper Airway structures?

A

Nasopharynx, Oropharynx, Epiglottis, Larynx

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8
Q

What is the function of the upper airway?

A

Heat, Humidify, and filter incoming air.

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9
Q

What aids in the management of PEEP?

A

Upper airway structures

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10
Q

What are the 6 things that make up the 3 phases of RSI?

A

Preparation, PreOx, Premedication, Paralysis, Placement with proof, Post intubation management

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11
Q

What makes up Phase 1 of RSI?

A

Preparation, PreOx, premedication

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12
Q

What makes up Phase 2 of RSI?

A

Paralysis, Placement with proof

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13
Q

How many Phases of RSI are there?

A

3 Phases

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14
Q

What makes up Phase 3 of RSI?

A

Post Intubation Management

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15
Q

What does the lower airway consist of?

A

Trachea, Major Bronchi, Bronchioles, Alveoli

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16
Q

What is the function of the lower airway?

A

Provides a conduit for air to pass into the alveolar space and The place where actual gas exchange with the circulatory system occurs.

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17
Q

What triggers spontaneous breaths?

A

Brain stem, specifically the medulla oblongata

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18
Q

Most common cause of a decline in PH?

A

Increase in Carbon Dioxide

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19
Q

What is the Hypercapnic response?

A

A decline in PH and and increase in serum carbon dioxide

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20
Q

Factors that can decrease pH?

A

Elevated lactate (Shock), DKA, Poisoning (TCA, ASA, Methanol)

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21
Q

What is pH?

A

A measurement of H+ (Hydorgen ion without a bound electron to neutralize the charge)

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22
Q

Normal pH level range?

A

7.35 - 7.45

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23
Q

Low pH values mean the patient is?

A

Acidotic

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24
Q

High pH levels mean the patient is?

A

Alkalotic

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25
Q

As H+ increases pH does what?

A

Decreases

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26
Q

Once stimulated the medulla signals what?

A

The diaphragm to contract

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27
Q

Contraction of the diaphragm causes?

A

The Intrathoracic space to increase.

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28
Q

The increase in intrathoracic space causes what?

A

A negative pressure gradient that pulls air from the atmosphere to normalize the pressure difference

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29
Q

When the diaphragm relaxes what does it cause?

A

It causes reduction in intrathoracic space.

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30
Q

The increase of intrathoracic pressures during exhalation does what?

A

Intrathoracic pressures push air out of the lungs

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31
Q

What happens to the carbon dioxide during exhalation?

A

Carbon dioxide waste is expelled from the body and the process repeats

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32
Q

How many oxygen molecules can attach up to hemoglobin?

A

Up to 4 oxygen molecules to each hemoglobin

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33
Q

Hemoglobin is a unique protein binds to what?

A

Oxygen

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34
Q

Where does the binding of Oxygen and Hemoglobin occur?

A

The pulmonary capillaries where high concentration of oxygen is

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35
Q

What does High partial pressures cause?

A

The oxygen to cross the alveolar membrane into the capillaries and bind to the hemoglobin

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36
Q

This prevents the rebinding of oxygen to the hemoglobin?

A

As each oxygen atom is lost, hemoglobins affinity is reduced.

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37
Q

What causes hemoglobin to release its oxygen?

A

Lower concentrations of oxygen in the tissues

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38
Q

What three things affect the binding of Oxygen to hemoglobin?

A

pH, Carbon Dioxide, and Temperature

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39
Q

Ideal positioning for peri intubation?

A

Ear to sternal plane, tilt head back into sniffing position. Morbidly obese patients might requires ramping with significant padding under shoulders.

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40
Q

Ideal positioning for patient pre intubation?

A

Try to keep the patient sitting up when using NRB, NC, Bipap, Cpap.

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41
Q

Ideal positioning post intubation?

A

Sit your patient up

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42
Q

What is Ketamine?

A

Ketamine is a NMDA receptor antagonist, opioid receptor agonist, dopamine reuptake inhibitor, and a Catecholamine reuptake inhibitor

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43
Q

What is an NMDA receptor antagonist?

A

Binds to an allosteric site of the N-methyl, D-aspartame receptor located in the brain.

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44
Q

What is the dose for ketamine?

A

Analgesia 0.1-0.3 mg/kg IV/IM
Dissociation 1-2 mg/kg IV or 2-4 mg/kg IM

45
Q

How does ketamine affect blood pressure, heart rate, and respiratory drive?

A

Respiratory drive remains intact, blood pressure and heart rate can slightly increase with higher dosages.

46
Q

Side effects of ketamine?

A

Hypersalivation, transient periods of apnea if pushed too fast, emergence phenomenon.

47
Q

What is emergence phenomenon?

A

Hallucinations and psychosis caused by ketamine administration.

48
Q

What kind of state does ketamine cause?

A

A dissociative state which allows for the prevention of multiple negative side effects associated with more classic CNS depressants.

49
Q

On top of sedation it can provide a bronchodilatory effect?

A

Ketamine

50
Q

What is the onset and duration of Ketamine?

A

60 seconds and approx. 20 mins.

51
Q

Common name for ketamine?

A

Ketalar

52
Q

Common name for Etomidate?

A

Amidate

53
Q

Contraindications of Etomidate

A

Shock, sepsis

54
Q

Use caution with Etomidate during rapid infusions why?

A

Can cause fasciculations and vomiting

55
Q

What kind of agonist is Etomidate?

A

GABA agonist

56
Q

Etomidate is considered?

A

Hemodynamically flat. Along with neuro and cardio-protective

57
Q

Dose of Etomidate?

A

0.3 mg/kg to a max of 40mg

58
Q

Etomidate causes

A

Classic CNS depression and does not control pain.

59
Q

Etomidate is used for?

A

Procedural sedation, especially RSI

60
Q

What type of agonist is Propofol?

A

GABA Agonist

61
Q

Common name for Propofol?

A

Diprivan

62
Q

Propofol dosages?

A

10-100 mcg/kg/min

63
Q

Onset and duration of propofol?

A

30 seconds and lasts 3-5 minutes. Must remain on for continuous sedation

64
Q

What is propofol infusion syndrome?

A

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

65
Q

Drug that contains egg whites?

A

Propofol

66
Q

What drug has to be added in to patients nutrition count and how much is it?

A

Propofol and it is 110 calories per bottle

67
Q

Propofol has what effects?

A

Sedative and anticonvulsant effects

68
Q

Lowers cerbreal oxygen demand and has theoretical benefit in neurocritical patient

A

propofol

69
Q

How does propofol affect blood pressure?

A

Typically drops your blood pressure.

70
Q

What type of agonist is benzodiazepines?

A

GABA agonists

71
Q

What drugs are considered benzodiazepines?

A

Lorazepam, Midazolam, Diazepam,

72
Q

What does Benzodiazepines do?

A

Potent anticonvulsant properties along with sedation and anxiolytic effects

73
Q

What are benzos typically used for?

A

anxiety, seizures, procedural sedation, severe muscle spasms/tremors

74
Q

What is the common name for Lorazepam?

A

Ativan

75
Q

Common name for midzolam?

A

Versed

76
Q

Common name for diazepam?

A

Valium

77
Q

Dose for Ativan?

A

Adult: 1-4mg IV/IO/IM/IN
Pediatric: 0.1 mg/kg IV/IO/IM/IN

78
Q

Onset and duration of ativan?

A

3-5 minutes and lasts 30-45 minutes.

79
Q

How does Ativan effect blood pressure?

A

Hemodynamically flat

80
Q

what drug works well IV but doesn’t absorb well IM/IN?

A

Ativan

81
Q

Can be given post intubation as an adjunct for sedation?

A

Ativan

82
Q

Works best when given IM?

A

Versed.

83
Q

How does versed effect the blood pressure?

A

Has a profound effect on the blood pressure via vasodilation and decreased cardiac output

84
Q

What is the dose of versed?

A

0.1 mg/kg

85
Q

What is the onset and duration of Versed?

A

3-5 minutes and lasts 10-15 minutes.

86
Q

What induction agent should be used in isolated head injuries?

A

Etomidate

87
Q

What drug should be used with Etomidate in ICP and what is the dose?

A

Fentanyl 2-3 mcg/kg IVP

88
Q

What drug is an anticholinergic and parasympathetic agent?

A

Atropine

89
Q

How does atropines anticholinergic properties work?

A

They help reduce oral secretions that may be hindering the intubation attempt

90
Q

What drug do you use in pediatric intubations and why?

A

Atropine and to help increased vagal tone

91
Q

Paralyzation drugs?

A

Rocuronium, Succinylcholine, Vecuronium

92
Q

What is the common name of Rocuronium?

A

Zemuron

93
Q

Common name of Succinylcholine?

A

Anectine

94
Q

Common name of Vecuronium?

A

Nocuron

95
Q

Dosage of Rocuronium?

A

0.6-1.2 mg/kg (1mg/kg)

96
Q

On set and duration of Rocuronium?

A

60 seconds and lasts 30-40 minutes

97
Q

Rocuronium is a what neuromuscular blocker?

A

A Non-depolarizing neuromuscular blocker

98
Q

What is the dose of Succinylcholine?

A

1-2 mg/kg IVP

99
Q

Succinylcholine is a what neuromuscular blocker?

A

A depolarizing neuromuscular blocker

100
Q

On set and duration of Succinylcholine?

A

45 seconds and lasts 5-7 minutes.

101
Q

Administration of Succinylcholine can cause dysrhythmias, hypotension and death because?

A

Patients with an elevated serum of potassium levels. (Sepsis, acidosis, poor renal perfusion)

102
Q

Succinylcholine prevents what?

A

Cells from repolarizing, leaving them in a state with potassium channels open

103
Q

Rare side effect of succinylcholine administration?

A

Malignant Hyperthermia

104
Q

Succinylcholine is less than ideal in patients with?

A

Increased ICP due to the fasciculations is a danger for herniation

105
Q

Vecuronium is a what neuromuscular blocker?

A

Non-depolarizing neuromuscular blocker

106
Q

Onset and duration of Vecuronium

A

Onset up to 5 minutes and duration of 45 minutes to an hour

107
Q

Dose of Vecuronium

A

0.1 mg/kg IVP

108
Q

Absolute must during intubation/post intubation?

A

Waveform capnography

CC Quiz Study Guides (11 decks)

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