Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Emed 4 > AW management > Flashcards

AW management Flashcards

1
Q

2 classes of AW management techniques

A

Noninvasive vs Invasive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of noninvasive AWs?

A

Passive oxygenation
Bag-valve mask ventilation
Supraglottic airways
Noninvasive positive-pressure ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of invasive AWs?

A

Endotracheal intubation
Cricothyroidotomy
Transcutaneous needle jet ventilation
Tracheostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of AW obstruction

A

Fx - Unconscious pt

Mechanical - FOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Respiratory failure characteristics?

A

Hypoventiliation and hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypoventiliation is?

A

inadequate CO2 excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hypoxia is?

A

inadequate alveolar O2 content

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

S/S of respiratory failure?

A 
Weakness
Fatigue
Chest pain
SOB
ABNL breath sounds
Increased work of breath
AMS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Prolonged Respiratory failure (hypoventiliation/hypoxia) can present with?

A

AMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ABNL breath sound findings w/ respiratory failure?

A

Audible wheezing
Stridor
Silent chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Respiratory failure - Signs of increased work of breath

A 
Dyspnea
Tachypnea
Hyperpnea/Hypopnea
Accessory muscle use
Cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Classifications of respiratory failure?

A

Type 1 - hypoxia w/out hypercapnia

Type 2 - Hypoxia w/ hypercapnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Type 1 respiratory failure - Notes

A

Hypoxia w/out hypercapnia
Afx oxygenation but not ventilation (Ex - PNA, PE)
TXT - optimizing oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Type 2 respiratory failure - Notes

A

Hypoxia w/ hypercapnia
Afx affect ventilation (COPD)
TXT - optimizing oxygenation & supporting ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Performing BVM difficult situations

A 
MOANS
M- Mask seal
O- Obesity/obstruction
A- Age - >55yo
N- No neeth
S- Stiff lungs/chest wall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Performing Supraglottic AW difficult situations

A 
RODS
R- Restricted mouth opening
O- Obesity/obstruction
D- Disrupted/distorted AW
S- Stiff lungs or cervical spine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

O2 delivery of - Nasal cannulae

A

O2 flow- 2-5L

Fio2 - 20-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

O2 delivery of - Simple face mask

A

O2 flow- 6-10L

Fio2 - 40-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

O2 delivery of - Non-rebreather mask

A

O2 flow- 10-15L

Fio2 - Near 100%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Fio2 is

A

Inhaled fraction of O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Preperation of AW placement - pt position for upper AW obstruction who is unconscious?

A

Extend neck w/ anterior displacement of mandible

Add forward neck flexion by placing folding towel under occiput (sniffing position)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

OPA - Notes

A

PVTs tongue base from occluding hypopharynx

Indications - comatose/deeply obtunded pt w/out gag reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

NPA - Notes

A

Displaces soft palate and posterior tongue

Indicated if Pt has intact gag reflex W/OUT midface trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

BVM - Notes

A

PVT re-inhalation of exhaled air

Delivers 75% o2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
NIPPV - Notes
Reduces work of breathing via face/nasal mask Doesn't use ET tube Augments spontaneous respiration Reqs cooperative pt w/ protective AW reflex and intact ventilatory efforts
26
NIPPV settings?
CPAP- continuous POS AW pressure | BiPAP- bilevel POS AW pressure
27
NIPPV CI's
``` absent/agonal effort absent/impaired gag reflex severe maxillofacial trauma basilar skull Fx life threatening epistaxis bullous lung dz ```
28
NIPPV use circulation consideration?
HOTN - Positive pressure will worsen it
29
NIPPV reduces work of breathing by 60% via
``` Pulmonary compliance Recruits/stabilize collapsed aveoli Shifts Pulm edema into vasculature Improves cardiac fx Increases tidal volume/min vent ```
30
NIPPV complications
``` Mask seal Pt discomfort Aspiration (rare) Air trapping Pulm barotrauma Anxiety/agitation (claustrophobic) ```
31
Supraglottic - notes
Placed in Oropharynx -Oxygenates and vent w/out ET tube Best for short periods Indicated - apneic/unconscious pts.
32
Supraglottic - AWs
Shiley - esophageal tracheal AW King Laryngeal Tube (King LT) Laryngeal Mask Airway (LMA)
33
Shiley - esophageal tracheal AW - Notes
Double-lumen tube inserted blindly Proximal cuff seals pharyngeal Distal cuff seals esophagus
34
King Laryngeal Tube (King LT) - Notes
MC - (95% of the time) Single lumen - inserted blindly Proximal cuff seals post oropharynx Distal cuff occludes esophagus
35
Laryngeal Mask Airway - (LMA) - Notes
Placed blindly occludes structures around larynx Single cuff
36
Shiley/King LT - complications
Hypoxia - ventilating incorrect port Esophageal perforation Aspiration pneumonia Tongue engorgement (King LT)
37
Laryngeal Mask Airway - (LMA) - complications
Partial/complete AW obstruction | Aspiration of gastric contents
38
RSI (mechanical ventilation) is?
sequential administration of an induction agent and NMBA for endotracheal intubation
39
Pts not ideal for RSI?
Deeply comatose | Cardiac/Respiratory arrest
40
Mechanical ventilation indications?
``` Failure to protect AW Failure to O2 or Ventilate Clinical anticipation course - GCS <8 - Deterioration - Transport - Impending AW compromise (Facial burns, Fxs, expanding pharyngeal hematoma) ```
41
RSI preperation reqs
``` Clinical assessment Pulse Ox Capnography Expected course Equipment ```
42
MIller blade - Notes
Straight Lifts epiglottis to visualize larynx Easier if pt has smaller central incisors
43
Macintosh blade - Notes
Curved Placed in vallecula- indirectly lifts epiglottis off larynx Less trauma Less likely to stimulate AW reflex
44
RSI position?
Sniffing position - aligns oropharyngeal-laryngeal axis Ear horizontally aligned w/ sternal notch Reposition if initial attempts fail
45
RSI - preoxygenation purpose
``` Begin ASAP (PVTs possible hypoxia w/ O2 reservoir) -displaces nitrogen in aveoli ```
46
RSI - preoxygenation method
100% O2 for 3m using NRB mask 15 L/min
47
Is using a nasal cannula OK for RSI preoxygenation?
No
48
RSI pretreatment - purpose
Attenuate adverse physiologic responses to laryngoscopy/intubation
49
When should RSI pretreatment begin?
3-5m prior RSI
50
Possible adverse effects of RSI?
Reflex sympath response (BAD - ICP/MI/Aortic dissect) Resp - Laryngospasm, cough, bronchospasm Children- Vagal responses
51
RSI Pretreatment agents
Lidocaine Fentanyl Atropine
52
RSI Pretreatment - Lidocaine indications
Elevated ICP Bronchospasm Asthma
53
RSI Pretreatment - Fentanyl indications
Elevated ICP Cardiac ischemia Aortic dissection
54
RSI Pretreatment - Atropine indications
Children <5 y with bradycardia Children <10 y receiving succinylcholine + bradycardia Adults - Bradycardia from repeat succinylcholine
55
Will pretreating children w/ atropine universally PVT bradycardia?
NO
56
RSI - Induction Agents
Etomidate Propofol Ketamine
57
Etomidate - onset/duration
<1m / 10-20m
58
Propofol - onset/duration
20-40s / 8-15m
59
Ketamine - onset/duration
1m / 10-20m
60
Benefits of Etomidate
↓ ICP ↓ Intraocular pressure Neutral BP
61
Benefits of Propofol
Antiemetic Anticonvulsant ↓ ICP
62
Benefits of Ketamine
Bronchodilator "Dissociative" amnesia Analgesia
63
SEs/Caveats of Etomidate
Myoclonic jerking/seizures and vomiting in awake pts No analgesia ↓ Cortisol
64
SEs/Caveats of Propofol
Apnea ↓ BP No analgesia
65
SEs/Caveats of Ketamine
↑ Secretions ↑ BP Emergence phenomenon
66
Etomidate - NOTES
Nonbarbituate hypnotic Not an analgesic Does not blunt sympathetic response to intubation
67
Propofol - NOTES
Sedative with anticonvulsant & antiemetic properties | Not an analgesic
68
Ketamine - NOTES
Dissociative agent Analgesia & amnesia Preserves respiratory drive (ideal for awake intubation)
69
Depolarizing NMBA
Succinylcholine
70
Nondepolarizing NMBA
Rocuronium, Vecuronium
71
RSI - Paralytic agents
Succinylcholine - Depo (Short acting) Rocuronium - Non-depo (intermediate/long) Vecuronium - Non-depo (intermediate/long)
72
Succinylcholine MOA
High affinity for cholinergic receptors of the motor end plate and are resistant to acetylcholinesterase
73
Rocuronium, Vecuronium MOA
Compete w/ Ach for cholinergic receptors and can be antagonized by anticholinesterase agents
74
Purpose of paralytic agents?
NMBA can facilitate tracheal intubation, improve mechanical ventilation, & help control intracranial HTN
75
Are paralytic agents anxiolytics or analgesics?
No
76
Prior to admin paralytic agents ensure?
Sedation during initial paralysis to avoid patient awareness
77
Rocuronium - onset/duration
1-3m / 30-45m
78
Vecuronium - onset/duration
2-4m / 25-40m or 60-120m depending on dose
79
Succinylcholine - onset/duration
45-60s / 5-9m
80
Rocuronium - comments
Tachycardia | MC alternative to succinylcholine for RSI
81
Vecuronium - comments
Hepatorenal dysfx, old, DM = prolonged recovery
82
Succinylcholine - comments
Best intubation conditions in the shortest amount of time
83
Succinylcholine can cause kyperkalemia in what pts?
``` >5d old injuries - -Burns -Denervation injury -Significant crush injury -Severe infection Preexisting - Myopathies ```
84
Succinylcholine complications and CI's
Fasciculations Transient pressure INC w/ intragastric, intraocular, ICP Masseter spasm alone Malignant hyperthermia Bradycardia Prolonged apnea w/ pseudocholinesterase deficiency Myasthenia gravis
85
After ETT insertion perform?
Confirm placement | Suction tracheobronchial tree w/ lubricated, soft, curved tip cath
86
Complications of improper RSI ETT placement?
``` Hypoxia/hypoxemia Dysrhythmia HOTN Pulmonic collapse Direct mucosal injury ```
87
Doubt correct placement of ETT RSI?
Take it out and try again
88
Most reliable way to confirm placement? Follow w/?
Direct visualization passing vocal cords Not 100% accurate checks - Auscultate chest/epigastric - check condensation - chest expansion
89
Labs to assess confirmed placement?
Expired (end-tidal) carbon dioxide (ET co2) via Capnometers/capnographs
90
After RSI intubation - what imagins to order for confirmation?
CXR - locate Bad = ETT in mainstem bronchus/esophagus
91
Is CXR full proof to reliably distinguish ETT placement?
No
92
RSI complications?
``` Esophageal/mainstem bronchus intubation Tube displacement or obstruction ETT cuff leaks or displacement Arytenoid cartilage avulsion Pyriform sinus intubation Pharyngeal-esophageal perforation Subglottic stenosis ```
93
Alternate AW management methods?
``` Nasotracheal intubation Digital intubation Transillumination Fiberoptic laryngoscopy Indirect fiberoptic laryngoscopes Video laryngoscopy Retrograde tracheal intubation Extraglottic devices ```
94
Nasotracheal intubation alternate AW method - NOTES
Indicated if Laryngoscopy, cricothrotomy and NMBA problematic Use Topical nasal vasoconstrictor anesthetic ETT is smaller
95
Digital intubation alternate AW method - NOTES
Useful when anatomy cannot be seen with a laryngoscope | Patient must be in deep coma, arrest, or blockaded
96
Transillumination alternate AW method - NOTES
Lighted stylet Helps to confirm placement/position Useful when laryngoscopy is anatomically impossible
97
Fiberoptic laryngoscopy alternate AW method - NOTES
Useful when vocal cords are not visualized | Relative CI
98
Indirect fiberoptic laryngoscopes alternate AW method - NOTES
Incorporates fiberoptics into a laryngoscope Good w/ -difficult airways -immobilized necks -w/ reduced oral openings -anterior larynx anatomy No diagnostic capabilities like direct fiberoptics
99
Video laryngoscopy alternate AW method - NOTES
Enhanced visualization Useful in pts w/ small mouths, difficult AW or restricted cervical mobility Shared visualization and recording
100
Retrograde tracheal intubation alternate AW method - NOTES
Useful w/ cervical & mandibular ankylosis or upper AW masses Landmarks are that of a cricothyrotomy Guidewire technique Time consuming procedure - rarely used in ED
101
Nasotracheal intubation alternate AW method - Process?
Advance along nasal floor w/ bevel toward septum Steady gentle pressure or slow rotation Once near occiput rotate until max airflow is heard Advance at initiation of inspiration Presence of vocal sounds = failed attempt Advance ETT to correct depth at the nares Standard post-intubation confirmation checks
102
Difficult AW means?
Can maintain O2 sat > 90% even w/ optimal position/adjuncts
103
Failed AW means?
3 unsuccessful attempts at intubation by experienced operator
104
Difficult BVM for AW obstacles?
``` Facial hair Obesity Edentulous patient Advanced age Snoring ```
105
Mallampati III has a failure rate of?
5% pts
106
Mallampati IV has a failure rate of?
20% pts
107
3 common ventilator methods?
``` Continuous mechanical ventilation (MC in OR) Assist control (A/C) (perfer w/ pts in resp distress) Synchronized intermittent mandatory ventilation (SIMV) ```
108
Is extubation performed in ED?
No - rarely

Emed 4 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions