Airway review Flashcards
What is COPD?
Chronic obstructive pulmonary disease
Chronic Bronchitis classic presentations…
Blue (cyanotic), overweight, productive cough (sputum), excessive mucus in airway, and causes a tight airway (difficultly with inspiration and expiration)
Emphysema classic presentations:
Cough only no sputum, pursed lip breathing, alveoli distinction since they aren’t opening during exhalation.
Pulmonary Embolism
Thrombosis in the pulmonary arteries
Risk factors for PE
Cancer, smokers, long distance travel, recent surgery, birth control, pregnancy
Scenario question:
Answer 1, 2, 3, 4
1 suction airway first
2 open the airway
3 start bvm ventilations immediately
4 provide oxygen via nrb mask
2 open the airway
Scenario question:
CHF, asthma, pneumonia, or COPD?
Pneumonia
What does asthma, anaphylaxis, and COPD have in common?
Wheezing
Scenario question:
Absent lung sounds, wheezing, stridor, vomiting
Stridor
Describe the lung sound-Wheezing
Mnemonic for wheezing
Wheezing is constriction in the upper airway. AAC-Asthma, Anaphylaxis, COPD
Describe lung sounds-Rhonchi
Conditions: Pneumonia
“Junk in the lungs” . Hypersecretion of mucus in lungs. Infection/mucus
Describe lung sounds: Rales
Rales are fluid in the lungs. Most common in CHF patients. Pulmonary edema (fluid in lungs)
What cartilage is an important visual landmark for endotracheal intubation?
Arytenoid
What patient is most likely to have an ETCo2 of 20 mm Hg?
A 22 year old male being hyperventilated by bag-valve mask
A 59 yo male became I’ll while shipping. His eyes are open but he does not respond to verbal stimulus. He has peripheral cyanosis with rapid and shallow respirations. What should you do?
Assist ventilations with high flow oxygen by bag valve mask
A 30 year old male has overdosed on codeine. Vital signs are p 60, r 6 and shallow. What condition is developing?
RESPIRATORY ACIDOSIS
A 50 year old male complains of shortness of breath that awoke him in the middle of the night. His medications are furosemide, lisinopril, and digoxin. Vital signs are bp 150/80, P 88 and irregular, R 24 with crackles. What should you suspect?
Pulmonary Edema
What causes a pink complexion with hypoxemia?
Polycythemia
A 28 year old unconscious male had his torso trapped for 3 hours under heavy debris. His jaw is clenched and you hear gurgling in the airway. What medication should you administer to facilitate securing the airway?
Vecuronium
What paralytic is contraindicated in a severe trauma scenario?
Succinylcholine
What secondary method should you use to confirm ET intubation placement?
ETC02
Following placement of a dual lumen airway device your assessment reveals absent epigástrico sounds. You note chest rise with each assisted ventilation. Where is the location of the device?
Esophagus. Equal chest rise and negative epigástric sounds means correct placement.
Common ET tube size for men
7-8
Name the supraglottic airway devices (4)
Combi-tube, LMA, King-tube, and I-gel
Common ET tube size for women
7
How do you figure the size for a pediatric CUFFED tube?
Age (years) divided by 4. PLUS 3.5
How do you figure the size for a pediatric UNCUFFED tube?
Age (years) divided by 4. PLUS 4
MNUEMONIC for BLS
OPEN (airway), CLEAR (secretions), KEEP (opa/npa), Ventilate (BVM).
Mallampoti Score ranges
1-4. 1 being best. 4 being worst.
Score 1 on Mallampoti Score
VISIBLE: Soft palate, the whole uvula, and the pillors (easy airway)
Score 2 on Mallampoti Score
VISIBLE: Soft palate, some of the uvula, but no pillors
Score 3 on Mallampoti score
Visible: Soft palate, just the tip of the uvula (difficult airway)
Score 4 on mallampoti
Visible: Hard palate only. No soft palate, no uvula. (Most difficult airway)
6 “P’s” of RSI
Preparation, Pre-oxygenate, Pre-treatment, Paralysis, Place and confirm tube placement, and Post-intubation management.
What are the three types of drugs you need to consider for RSI
Sedative, Paralytic, Analgesia
What is an important consideration prior to RSI?
Is my airway difficult? Mellampoti score
Warning signs of a difficult airway
Obesity, short/thick neck, severe overbite, small jaw/chin
Normal pH values
7.35-7.45
Normal Carbon Dioxide levels (PaCO2)
35-45
Normal Bicarbonate levels (HCO3)
22-26
As your RR/Depth goes up….(What happens to your CO2 levels)
CO2 levels go up (you’re retaining more.
With airway obstructions, opiods, strokes, your resp. rr/depth goes down. Increasing your CO2. What is this (Resp acid/alka)?
Respiratory Acidosis
As your RR/Depth goes up…your CO2 goes….
CO2 goes down. You’re exhaling more and more and there is less in your body.
As your RR goes up and your CO2 goes down, what is this doing? (resp acid/alka)
Respiratory Alkalosis (panic attacks, pulmonary embolism, hyperventilation)
What three drugs are paralytics?
Rocuronium, Succinylcholine, and Vecuronium,
