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ACP COPR > Basic/Misc/Scores/Airway > Flashcards

Basic/Misc/Scores/Airway Flashcards

1
Q

O2 Cylinder Constant and Equation

A

D: 0.16
E: 0.28
M: 1.56
Equation:
((psi-200psi) x Tank Constant) / Flow, LPM

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2
Q

O2 Delivery

A

NC: 1-6LPM, 24-48% FIO2
Venturi: 6-12LPM, 24-50%
NRB: 15LPM, 90-100%
BVM: 15LPM, 100%

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3
Q

Lung Capacities

A

Total: 6L
Vt: 5-7ml/kg (adults) 6-8ml/kg(peds)
Minute Volume: Vm= RR+Vt
Alveolar Vm: Va - dead space x RR
IRV: Amount forcibly inhaled after Vt
Functional Residual: Amount forced after normal exhalation
Expiratory Reserve: Air exhaled after normal exhalation
Residual Capacity: Air remaining after forcible exhalation

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4
Q

Ventilation Mechanics and Control

A

Primarily regulated by the pH of CSF(directly related to PaCO2). Receptors in carotid and aortic bodies measure PaCO2 and signal resp centers via CN 9+10.

Pons: Apneustic- Stimulates long/deep breaths. Antagonized by stretch receptors and pneumotaxic center. Pneumotaxic- Inhibits resp, finely controls resp.
Medulla: HR, RR, BP
Motor Nerves: Phrenic and intercostal

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5
Q

Signs of Inadequate Respiration

A

1) <12 or >20 breaths/min
2) Shallow respiration
3)Adventitious sounds
4)AMS
5) Cyanosis

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6
Q

Respiration and gasses

A

External / Internal
97% O2 bound to Hgb, remaining is dissolved in serum
The majority of CO2 is transported in serum as HCO3 Ions, approx 33% bound to Hgb.

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7
Q

Rates

A

Adult: 12-20
Child: 15-30
Infant: 25-50

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8
Q

Abnormal Respiration Patterns

A

Cheyne Stokes: Crescendo and decrescendo rate and volume. Brain stem injury
Kussmaul: Deep, rapid, and gasping. Metabolic acidosis
Biot: Irregular rate, rhythm, and depth, with intermittent apnea. Progression of increased ICP.
Agonal: Slow, shallow, irregular. Cerebral anoxia, cardiac arrest.
Apneustic: Increased I time. (fish breathing). Pons injury
Ataxic: Irregular reps, similar or same? to Biots
Central Neurogenic Hyperventilation: Kussmal without metabolic acidosis.

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9
Q

Ideal Gas Laws

A

Boyle’s: Pressure is inversely related to volume. TP
Charles’: Gas expands when heated
Dalton’s: Pressure gas mixture is the sum of components
Graham’s: Diffusion of gas is inversely proportional to the square root of the mass. (lighter molecules move across faster, larger are slower)
Henry’s: Gas dissolved in a liquid is directly proportional to pp of gas in liquid
Ficks: Gas diffusion across a membrane is influenced by 1) the chemical nature of the membrane. 2) pp gradient. 3) Thickness of membrane

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10
Q

APGAR

A

Appearance. 2= Pink. 1=Periperial cyanosis. 0=Central cyanosis.

Pulses. 2= >100. 1= <100, >60. 0= <60, Absent

Grimace. 2= Strong Cry. 1= Grimace. 0= No response

Activity. 2= Active. 1=Some Flexion of Ext. 0= Limp

Respiration. 2= Strong Cry. 1= slow/irregular. 0= Absent

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11
Q

GCS

A

Eye Opening. Verbal Response. Motor Response.

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12
Q

Rule of 9s Adult

A

Head:18
Chest/Abdo: 18
Back: 18
Arms: 9/9
Groin: 1
Legs: 18/18

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13
Q

Rule of 9s Child

A

Head: 12
Chest/Abdo: 18
Back: 18
Arms: 9/9
Groin: 1
Legs: 16.5/16.5

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14
Q

Rule of 9s Infant

A

Head: 18
Chest/Abdo: 18
Back: 18
Arms: 9/9
Groin: 1
Legs: 13.5/13.5

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15
Q

Local IV Site Rxn

A

Infiltration
Thrombophlebitis(Infection, seen hours later)
Occlusion
Vein Irritation
Hematoma
Nerve/Tendon/Ligament Damage
Arterial Puncture

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16
Q

Systemic IV Rxn

A

Allergic Reaction
Pyrogenic Reaction(fever within 30m)
Circulatory Overload
Air Embolus
Vasovagal Reaction
Cannula Shear

17
Q

Enteral Medication

A

Absorbed through some portion of GI tract. Oral, gastric tube,rectal

18
Q

Parenteral Medication

A

Route other than GI tract.
Dermal(any level), IM, IV, IO, Percutanous

19
Q

Bicarb Buffer Equation

A

H⁺ + HCO₃ = H2CO3 = H₂O + CO₂

20
Q

Mallampati Score

A

Class 1: Complete visualization of the oropharynx.
Class 2: Uvula is completely visible.
Class 3: Uvula is half visible.
Class 4: Only the hard palate is visible.

Class 3 and 4 are considered difficult

21
Q

Difficult BVM and ETI

A

MOANS and LEMON

No Nancy weirdness, same as school.

22
Q

Axes of Airway

A
  1. Oral plane
  2. Pharyngeal plane
  3. Tracheal plan

Line up in the sniffing position, 20-degree extension of atlantooccipital joint and 30-degree flexion of the neck at C6/C7

Use Sellick

23
Q

Tube Conformation

A
  1. Visualization (most reliable)
  2. Auscultation (lungs and gastrum)
  3. ETCO2
  4. EDD(Not very reliable)
    *Use at least 2 methods.
24
Q

Steps to reposition tube if right main stem intubation.

A
  1. Loosen or remove the tube securing device.
  2. Deflate the distal cuff
  3. Place stethoscope over left chest.
  4. While ventilation continues, listen for breath sounds on the left side.
  5. Stop as soon as bilateral sounds are heard.
  6. Note the depth at teeth.
  7. Reinflate cuff
  8. Secure tube
  9. Resume ventilations.
25
Q

Intubation Steps

A
  1. Use PPE (Gloves + Face Shield
  2. Pre-oxygenate for 2-3min with BVM @ 100%
  3. Check, prepare, and assemble equipment.
  4. Position Pt in sniffing
  5. Place the blade into the right side of the mouth and push the tongue to the left.
  6. Gently lift the laryngoscope along the long axis until cords are seen.
  7. Insert the tube through the right corner, and visualize entry through cords.
  8. Remove the laryngoscope from the mouth.
  9. Remove stylet/bougie
  10. Inflate the distal cuff with 5-10ml
  11. Attach ETCO2 and confirm ETCO2.
  12. Attach BVM, ventilate, and auscultate over epigastrum and lungs.
  13. Confirm placement and secure tube.
  14. Place the bite block in pt mouth.
26
Q

Peds Airway Differences

A
  1. Larger, rounder occiput. The neck is flexed in a supine position.
  2. Larger tongue with a smaller mandible (easier to obstruct).
  3. Epigolttis is floppy and omega-shaped. It must be lifted or positioned.
  4. Tracher is smaller, shorter, narrower, and positioned more anteriorly and superiorly.
  5. Cricoid ring is the narrowest portion of AW. Located subglottic making airway funnel shaped.
27
Q

Peds Blade Sizes

A

Premature: 0 Miller
Full-term to one year: 1 Miller
Two years to adolescent: 2 Miller
Adolescent + : 3 Miller or Mac.

Should measure from mouth to tragus
Broslow Tape

28
Q

Peds Tube Sizes

A

Uncuffed: Age / 4 + 4
Cuffed: Age / 4 + 3

Broslow Tape

29
Q

Random Nancy Intubation Equipment Stuff

A

Have three tubes ready. 1 Smaller, 1 Larger, and one the right size.

Tube size: Internal diameter of nare, little finger, or size of the thumbnail.

Chose blade size for adults based on experience and pt size.

30
Q

DOPE

A

Displacement
Obstruction
Pneumothorax ( if lung sounds are present on the right, but not left, and don’t respond to repositioning, assume pneumo).
Equipment Failure

ACP COPR (20 decks)

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