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Instruments & pics krish > Art of war I & I > Flashcards

Art of war I & I Flashcards

1
Q

airway

definitive

4 points

A
  1. cuffed beneath the glottis
  2. attached to oxygen (except tracheostomy)
  3. secured in place
  4. airway is therefore protected from aspiration
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2
Q

Nasopharyngeal airway

What is it

Use: 2

Complications: 2

Indications: 2

Contraindications: 2

A

Non- definitive airway adjunct - keep the airway patent and prevents tongue obstructing the airway

  • Use:
    • ​sized against pt’s little finger diameter
    • secured with safety pin
  • complications:
    • ​bleeding - trauma to nasal mucosa
    • Intracranial placement
  • Indications:
    • airway adjunct in pt with gag reflex
    • can still trigger gag reflex
  • Contrainidcations:
    • BoS # or facial injuries
    • severe coagulopathy
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3
Q

Oropharyngel (or Guedel) airway

What is it

Use: 1

Complications: ?

Indications: 3

Contraindications: 1

A
  • What is it:
    • non-definitive airway adjunct - keeps airway patent and prevents tongue obstructing the airway
  • Use:
    • sized from angle of mandible to level of the incisors
  • Complications: ??
  • Indications:
    • Pt breathing in an obstructed manner - some degree of partial upper airway obstruction
    • only used if pt has reduced GCS as it can initiate a gag reflex
    • if pt conscious -> nasopharyngeal airway (usually inserted in right nostril)
  • Contraindications:
    • pt has injuries to face or a condition that prevents the mouth from opening
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4
Q

iGel vs LMA

A
  • iGel
    • Newer version with small tube that shows if pt has vomited (early LMAs did not)
    • Has another port to allow NG tube passage for suction
    • Does not inflate, but gel moulds to pt anatomy with heat
    • Single use only
  • LMA
    • Can be autoclaved for reuse
    • Pilot balloon and inflatable seal
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5
Q

Laryngeal mask airway

Use: 3

Indications: 1

Disadvantages: 2

Complications: 4

A
  • Use:
    • Inflatable cuff to seal over larynx
    • Listen for an air leak if tube not positioned correctly
    • Muscle paralysis is not required
  • Indications:
    • Day cases where intubation not required
  • Disadvantages:
    • Not definitive - above the glottis so does not prevent reflux
    • Not suitable for high pressure ventilation or PEEP
  • Complications:
    • Dislodgement
    • Leak
    • Pressure necrosis in airway
    • Aspiration
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6
Q

Mc Kintosh laryngoscope

Indications: 1

‘blades’: 2

use: 1
cautions: 2
complications: 3

A
  • Indication:
    • ET intubation
  • Blades:
    • McKintosh = curved;
    • Miller = straight - paeds
  • Use:
    • Held in left hand, tongue swept to the side, ET placed with R hand
  • Caution:
    • Pts with RA or ank spond -> atlantoaxial instability
    • Loose teeth
  • Complications:
    • Mouth / teeth trauma
    • Cervical spine damage
    • Failure
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7
Q

Endotracheal tube

Use: 3

How to check positioning: 5

Types and indications: 3 types

Murphy’s eye

Complications: 4

A
  • Use:
    • Cords between two black lines
    • Bougie may be used for difficult airways
    • Position confirmed and secured with tape
  • Checking its in the right place:
    • Inspect for symmetrical expansion
    • Listen over epigastrium for gurgling
    • Listen over each lung for air entry
    • Check end tidal CO2 - waveform capnography
    • Check SpO2
  • Types & indications:
    • Singe lumen cuffed ET tube
    • Indications:
      • Surgery with a risk of aspiration
      • Inadequate pre-op fasting (emergency)
      • Delayed gastric emptying (pregnancy or obstruction)
      • Hiatus hernia with reflux
      • All abdominal, thoracic, pelvic and neurosurgery
      • Whenever access to the airway is limited - Oral surgery, head and neck, ENT
      • Surgery in prone position
    • Double-lumen cuffed ET tube: Allows separate ventilation of the two lungs.
      • Indications:
        • Lobectomy, pneumonectomy, bronchopulmonary lavage
    • Uncuffed ET tube
      • Indications:
        • children as the trachea is not as strong.
  • Murphy’s eye:
    • second hole at the end of the tube in case main hole becomes blocked
  • Complications:
    • Failure to intubutate, intubation of oesophagus or one bronchus only
    • Oropharyngeal / laryngeal trauma
    • C-spine injury - atlanto-axial instability
    • Long term use -> stenosis, difficulty weaning, sore throat
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8
Q

Cricothyroidotomy: 3

When? How long? larynx?

A
  • Emergency where ET intubation has failed
  • Allows approximately 30 minutes of ventilation.
  • Cricothyroidotomy will only work with at least a partially patent larynx.
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9
Q

Tracheostomy tube (definitive surgical airway)

Position: 1

Inserts: 2

Indications: 3

Advantages: 6

disadvantages: 1

Complications; immediate/early/late

A
  • Position:
    • 2 rings beneath cricoid cartilage
  • Inserts:
    • Non-fenestrated - no risk of aspiration, but cannot talk
    • Fenestrated - risk of aspiration, but allows pt to talk by diverting air through vocal cords
  • Indications:
    • Long term ventilation (ITU)
      • Easier to wean off ventilator - vocal cords are not passed
      • Reduces dead space so ventilation is more efficient
      • Allows more effective suctioning
    • Upper airway obstruction; max-fax injuries
    • Post laryngeal surgery
  • Advantages over ET tube:
    • Easier to wean pts
    • No need for sedation
    • Decreased discomfort
    • Easier to maintain oral and bronchial hygiene
    • Decreased risk of glottis trauma
    • Decreased dead space -> reduced work of breathing
  • Disadvantages:
    • Dries secretions, humidified air usually required
  • Complications:
    • Immediate - haemorrhage, surgical trauma to oesophagus, r. laryngeal n., pneumothorax
    • Early - tracheal erosion, tube displacement, obstruction, surgical emphysema, aspiration pn.,
    • Late - trracheomalacia (softening of the tracheal cartilage causing collapse on expiration), trachea-oesophageal fistula, tracheal stenosis
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10
Q

Oxugen delivery systems: 2 examples

_Variable performance_ (vs fixed)
Deliver a proportion of the patient’s ventilatory requirements - depends on:
  • Oxygen flow rate, respiratory pattern (RR, peak insp/exp flow rate & pause)
  • The amount of air entrained
A

Examples:
Nasal Canulae:

  • Can deliver 24-30% O2 at flow rates from 1-4 l /min
  • Dry & uncomfortable
  • Use for short period only

Face mask (Hudson):

  • Max O2 conc. achieved is 60%
  • Not to be used for COPD patients
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11
Q

Fixed performance oxygen delivery systems: 2 exmples

Can deliver all of the patients ventilatory requirements
Inspired O2 concentration determined by the oxygen flow rate & _not the respiratory pattern_

A

Venturimask

Non rebreather

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12
Q

Venturi masks

descrition + colours

A

is a fixed performance oxygen delivery system that:

Can deliver all of the patients ventilatory requirements
Inspired O2 concentration determined by the oxygen flow rate & not the respiratory pattern

O2 masks (Hudson) with colour coded venturi heads
Have different air-entrainment apertures for different O2 concentration delivery
Colours (written on side)
  • Blue - 24%Boys -
  • Want - White - 28%
  • Only - Orange - 31%
  • Young - Yellow - 35%
  • Randy - Red - 40%
  • Girls - Green - 60%
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13
Q

Non-rebreather

description: 3
indications: 1

Use: 2

A
  • Describe:
    • it is a fixed performance oxygen delivery system that:
      • Can deliver all of the patients ventilatory requirements
      • Inspired O2 concentration determined by the oxygen flow rate & not the respiratory pattern
    • High flow oxygen at 90%
  • Indications:
    • resus
  • Use:
    • first inflate the bad by pressing on button tabs
    • then place on pt
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14
Q

Non-invasive ventilations

2 types

A

CPAP

  • Recruits collapsed lung units
  • Decreased shunt therefore increases PaO2
  • Increased lung volume - improves compliance - decreases work of breathing
  • Little effect on PaCO2

BiPAP

  • Biphasic positive airway pressure
  • Used in severe T2RF
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15
Q

Invasive ventilation

?airway tyoe

Infications: 4

Complications: 5

A
  • Airway:
    • ET or tracheostomy
  • Indications:
    • Respiratory failure refractory to less invasive tx
    • At risk airway
    • Elective post-op ventilation
    • Physiological control (eg hyperventilation in raised ICP)
  • Complications:
    • Cardiovascular compromise
    • Pneumothorax
    • Fluid retention
    • Ventilator acquired pneumonia
    • Complications of artificial airway
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16
Q

Stiff neck collar

Indications: 1

Use: 2

Complications: 2

A
  • Indications:
    • Stabilise cervical spine
  • Use:
    • Sized from clavicle to angle of mandible - compared to sizing peg on the hard collar
    • Used in conjunction with two sandbags and tape
  • Complications:
    • Incorrect placement - neck not in neutral alignment
    • Chin not flush with end of chin piece
17
Q

Clearing cervical spine

clinical; NEXUS

Radiological: 3

A

Clinical clearance: NEXUS criteria - NSAID

  • N - neurological deficit
  • S - Spinal tenderness in the midline
  • A - Altered consciousness (GCS)
  • I - Intoxication
  • D - Distracting injury
  • Also inability to rotate 45° L&R

Radiological clearance:

  • If pt doesn’t meet criteria for clinical clearance
  • Lateral & AP +/- swimmer’s view cervical spine XRs
  • CT if abnormal XR
18
Q

Ryles tube/NG tube

Use

Indications1

?lumens: 1

?positioning: 2

Complications: 3

A
  • Use:
    • Lubricated and inserted straight back at the nose
    • Ask pt to swallow tube down
    • Check in correct place
  • Indications:
    • Bowel obstruction and decompression
  • Multiple lumens - for free drainage or decompression
  • Checking correct place:
    • Metal end for XR imaging
    • Aspirate - pH should be <5.5
  • Complications:
    • Wrongly inserted into lung -> aspiration pneumonia
    • Chronic irritation -> oesophageal stenosis
    • Local damage (CI in BoS fracture)
19
Q

Feeding tube

(?different from ryles)

Insertion: 2

Indications: 3

Complications: 2

?check position: 2

A

Smaller, made of silicon

  • Insertion:
    • Placed past the stomach into the first past of the jejunum
    • Needs guide wire
  • Indications:
    • High output stoma
    • Bulbar palsy
    • Unsafe swallow eg post stroke
  • Complications:
    • Of tube
    • Of enteral feeding - refeeding synd., aspiration pneumonia
  • Check position with XR:
    • Tube should be below the diaphragm
    • Or aspirate for pH<5
20
Q

Rigid sigmoidoscope

Inidcations: 4

Use: 3

A
  • Indications:
    • used in clinic to look within rectum; CANNOT SEE SIGMOID!
    • PR bleeding, change in bowel habit, IBD
    • To dx a rectal tumour
    • Cannot see haemorrhoids - need a proctoscope
  • Use
    • Pt in left lateral position
    • Attach light source, bellows and eye piece
    • Visualise mucosa as scope withdrawn
21
Q

proctoscope

inidcations: 3

Use: 1

A
  • Indications:
    • Perianal pathology - haemorrhoids, low rectal ca
    • Examination of anal canal and lower rectum
    • Therapeutic banding and sclerotherapy
  • Use
    • Pt in left lateral position
22
Q

Shouldered / Gabriel syringe

Indications: 1

Complications (imm2/late1)

A
  • Indications:
    • Injection of haemorrhoids with 5% phenol - sclerosant
  • Complications:
    • Immediate
      • Pain if injected below dentate line; damage local structures
      • 1° haemorrhage
    • Late
      • Prostatitis; impotence
23
Q

ORTHOP11+

Instruments & pics krish (5 decks)

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