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PARAMEDIC SCHOOL > BLOCK 6: AIRWAY MANAGEMENT > Flashcards

BLOCK 6: AIRWAY MANAGEMENT Flashcards

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1
Q

how long can brain cells survive without oxygen before permanent damage occurs

A

6 minutes

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2
Q

the upper airway includes all structures above ___

A

the glottis

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3
Q

what is the glottis

A

space between the vocal cords

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4
Q

what is the first and largest anatomic structure to manipulate when managing patient’s airway

A

tongue

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5
Q

if the tongue is not managed during airway what does it tend to do

A

fall back into the posterior pharynx

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6
Q

2 things the uvula does

A

prevents food we eat from going up your nose and triggers gag reflex when stimulated

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7
Q

what is the muscular tube that extends from nose and mouth to the esophagus and trachea

A

pharynx

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8
Q

the pharynx starts and ends where

A

starts: nose and mouth
ends: esophagus and trachea

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9
Q

what composes the pharynx (3 in order from top to bottom)

A

nasopharynx, oropharynx, laryngopharynx

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10
Q

where does the lower airway start and end

A

starts: glottis
ends: pulmonary capillary membrane

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11
Q

what marks where the upper airway ends and lower airway begins

A

larynx

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12
Q

shield-shaped structure palpable on the anterior neck

A

thyroid cartilage

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13
Q

superior part of the thyroid cartilage that forms a V shape

A

thyroid notch

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14
Q

what is laryngeal prominence also known as

A

Adam’s apple

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15
Q

where is the laryngeal prominence

A

immediately inferior to the thyroid notch

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16
Q

where is the thyroid cartilage located

A

directly anterior to glottic opening and vocal cords

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17
Q

what does the cricoid cartilage form

A

the lowest portion of the larynx

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18
Q

what is special about the cricoid cartilage

A

only circumferential ring of the trachea

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19
Q

which structure is more prominent in males?
which structure is more prominent in females?

A

laryngeal prominence in males
the cricoid ring in females

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20
Q

where are cricothyrotomies performed

A

the cricothyroid membrane

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21
Q

what is the narrowest protion of the adult airway

A

glottis

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22
Q

what is the leaf-shaped cartilaginous structure

A

epiglottis

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23
Q

what closes over the trachea during swallowing

A

epiglottis

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24
Q

what 3 things must be visualized before inserting ET tube

A

epiglottis, glottis, and vocal cords

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25
Q

physical act of moving air into and out of the lungs

A

ventilation

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26
Q

process of loading oxygen molecules onto hemoglobin molecules in the bloodstream

A

oxygenation

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27
Q

exchange of oxygen and carbon dioxide in the alveoli and tissues of the body

A

respiration

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28
Q

what is the active part of ventilation?
what is the passive part of ventilation?

A

active: inhalation
passive: exhalation

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29
Q

what is external respiration also called

A

pulmonary respiration

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30
Q

what is internal respiration also called

A

cellular respiration

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31
Q

what is external respiration

A

exchanging oxygen and carbon dioxide between alveoli and blood in pulmonary capillaries

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32
Q

what is internal respiration

A

exchanging of oxygen and carbon dioxide between systemic circulation and cells of the body

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33
Q

what type of problem is an overdose on CNS depressors

A

ventilation problem

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34
Q

what type of problem is a person trapped in a place devoid of oxygen

A

oxygenation problem

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35
Q

circulation of blood within an organ or tissue in adequate amounts to meet the current needs of the cells

A

perfusion

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36
Q

what is a dangerous condition in which the tissues and cells do not receive enough oxygen

A

hypoxia

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37
Q

early signs of hypoxia (5)

A

restlessness, irritability, apprehension, tachycardia, anxiety

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38
Q

late signs of hypoxia (3)

A

change in mental status, weak/thready pulse, cyanosis

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39
Q

how to assess cyanosis in dark skinned patients

A

mucous membranes (lips, gums, inner eyelids, and nailbeds)

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40
Q

what is dyspnea

A

shortness of breath

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41
Q

how does gas exchange occur

A

simple diffusion

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42
Q

what is a failure to match ventilation and perfusion called

A

V/Q mismatch

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43
Q

what contributes to most abnormalities in oxygen and carbon dioxide exchange

A

V/Q mismatch

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44
Q

what is normal resting minute ventilation

A

6L/min

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45
Q

what is normal resting alveolar volume

A

4L/min

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46
Q

what is normal pulmonary artery blood flow

A

5L/min

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47
Q

what is the ratio of ventilation to perfusion

A

4:5L/min or 0.8L/min

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48
Q

the ventilation-to-perfusion ratio is highest where? lowest where?

A

highest: apex of the lung
lowest: base of the lung

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49
Q

what is the most common airway obstruction in an unresponsive patient and what are the two indicators

A

tongue - improper head/neck position and snoring respirations

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50
Q

what two neuromuscular disorders can affect the ability of the CNS to control breathing

A

muscular dystrophy and poliomyelitis

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51
Q

how does muscular dystrophy affect the CNS’s ability to control breathing

A

degeneration of muscle and its contractility as well as curvature of the spine

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52
Q

how does poliomyelitis affect the CNS’s ability to control breathing

A

affects the nerves that regulate ventilation and result in paralysis

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53
Q

what three conditions are bronchoconstriction associated with

A

allergic reactions, asthma, and COPD

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54
Q

intrinsic factors that cause airway obstruction (3)

A

infection, allergic reactions, unresponsiveness

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55
Q

extrinsic reactions that cause airway obstruction (2)

A

trauma and foreign body airway obstruction

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56
Q

what is respiratory splinting

A

purposely breathing shallow to alleviate pain caused by injury such as flail chest

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57
Q

hypoventilation

A

CO2 production exceeds body’s ability to eliminate it or CO2 elimination is depressed and can’t keep up with normal metabolism

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58
Q

hyperventilation

A

CO2 elimination exceeds carbon dioxide production

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59
Q

if the pH of blood is too high, what happens to the patient’s breathing and why

A

shallow/slow breaths in attempt to retain carbon dioxide

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60
Q

if the pH of blood is too low, what happens to the patient’s breathing and why

A

hyperventilation to expel more carbon dioxide

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61
Q

what two examples can cause hyperventilation/pH acidity

A

hyperglycemic ketoacidosis and aspirin OD

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62
Q

decrease in minute volume leads to ____

A

hypercapnia

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63
Q

increase in minute volume leads to ____

A

hypocapnia

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64
Q

what is hypercapnia

A

buildup of CO2 in the blood

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65
Q

what is hypocapnia

A

decrease of CO2 in the blood

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66
Q

how does hypoventilation affect minute volume

A

goes down

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67
Q

how does hypoventilation affect CO2 elimination

A

goes down

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68
Q

how does hypoventilation affect CO2 levels

A

goes up (hypercapnia)

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69
Q

how does hyperventilation affect minute volume

A

goes up

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70
Q

how does hyperventilation affect CO2 elimination

A

goes up

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71
Q

how does hyperventilation affect CO2 levels

A

goes down (hypocapnia)

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72
Q

what two things have key roles in the process of respiration

A

atmospheric pressure and partial pressure of oxygen

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73
Q

what happens to percentage of oxygen, partial pressure, and total atmospheric pressure at higher altitudes

A

oxygen - stays the same
partial pressure - decreases
total atmospheric pressure - decreases

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74
Q

what is PaO2

A

partial pressure of oxygen

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75
Q

what makes it difficult to breathe at high altitudes

A

low PaO2

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76
Q

carbon monoxide has a ___x higher affinity for hemoglobin than oxygen

A

250

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77
Q

what is intrapulmonary shunting

A

blood entering the lungs from the right side of the heart bypasses the alveoli and returns to the left side of the heart in an unoxygenated state

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78
Q

what does fluid accumulation in the alveoli lead to

A

anaerobic respiration and increase in lactic acid accumulation

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79
Q

what is anemia

A

deficiency of red blood cells

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80
Q

hemorrhagic vs vasodilatory shock

A

hemorrhagic: decrease in blood volume caused by internal/external bleeding

vasodilatory: increase in size of blood vessels causing decrease in BP and blood flow

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81
Q

what is the fastest way the body can eliminate excess H+ ions

A

creating water and carbon dioxide

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82
Q

four main clinical presentations of acid-base disorders

A

respiratory acidosis and alkalosis
metabolic acidosis and alkalosis

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83
Q

side effect of positive pressure ventilation in patients

A

decreased cardiac output and preload, increased afterload, and hypotension

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84
Q

what draws air into the chest cavity

A

negative-pressure ventilation

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85
Q

normal adult resp rate

A

12-20

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86
Q

normal child resp rate

A

12-37

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87
Q

normal infant (1month-1year) resp rate

A

30-53

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88
Q

what is a clear indicator of a depressed or absent gag reflex

A

pooling of secretions in patient’s mouth

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89
Q

what is the gag reflex

A

spastic pharyngeal and esophageal reflex triggered by stimulating the uvula or posterior pharynx

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90
Q

low oxygen level in arterial blood

A

hypoxemia

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91
Q

deficiency of oxygen at the tissue and cellular levels

A

hypoxia

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92
Q

lack of oxygen that results in tissue and cellular death

A

anoxia

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93
Q

difference between hypoxemia and hypoxia treatment

A

hypoxemia can be reverse by administering supplemental oxygen and hypoxia require more aggressive oxygenation and ventilatory support

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94
Q

what is adventitious breath sounds

A

abnormal

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95
Q

what is the upright sniffing position

A

patient is sitting up with head moved forward until the earlobes are on the same vertical plane as the manubrium of the sternum

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96
Q

what is the tripod position

A

patient is sitting up and leaning forward with elbows bent

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97
Q

proper airway management order (4)

A

opening airway
clearing airway
assessing breathing
providing appropriate interventions

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98
Q

what is orthopnea

A

positional dyspnea

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99
Q

what is breathing retractions

A

skin pulling between and around the ribs during inhalation

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100
Q

what muscles are used during accessory muscle use breathing

A

sternocleidomastoid muscles, pectoralis major muscles, abdominal muscles

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101
Q

what are staccato speech patterns

A

one or two word dyspnea

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102
Q

what is paradoxical motion and what does it indicate

A

opposite of normal chest movements (inward movement of chest segment during inhalation and outward movement of chest segment during exhalation) indicating flail chest

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103
Q

what is pulsus paradoxus and what does it indicate

A

drop in systolic BP of more than 10, change in pulse quality, or disappearing of pulse during inhalation indicating decompensating COPD, pericardial tamponade, or other increase in intrathoracic pressure

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104
Q

what is sneezing caused by

A

irritation of the nasal cavity

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105
Q

what is hiccupping

A

sudden inhalation caused by spasmodic contraction of the diaphragm cut short by closure of the glottis

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106
Q

what creates breath sounds

A

air moving through the tracheobronchial tree

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107
Q

what type of respiratory pattern is gradual increasing rate and depth of respirations followed by gradual decrease of respirations with intermittent periods of apnea and what is it associated with

A

Cheyne-Stokes respirations

brainstem injury

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108
Q

what type of respiratory pattern is deep, rapid respirations and what is it associated with

A

Kussmaul respirations

diabetic ketoacidosis

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109
Q

what type of respiratory pattern is irregular pattern, rate, and depth of breathing with intermittent periods of apnea and what is it associated with

A

Biot (ataxic) respirations

intracranial pressure

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110
Q

what type of respiratory pattern is prolonged, gasping inhalation followed by extremely short, ineffective exhalation and what is it associated with

A

Apneustic respirations

increased intracranial pressure

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111
Q

what type of respiratory pattern is slow, shallow, irregular or occasional gasping breaths and what is it associated with

A

agonal gasps

cerebral anoxia (shortly after heart has stopped but brain is still sending signals to the muscles)

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112
Q

what type of respiratory pattern is tachypneic hyperpnea (rapid, deep respirations) and what is it associated with

A

central neurogenic hyperventilation

increased intracranial pressure or direct brain injury

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113
Q

what is the inspiratory/expiratory ratio

A

1:2 (expiration time is twice as long as inspiration)

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114
Q

the I/E in patients with lower airway obstruction or asthma may be what ratio

A

1:4 or 1:5

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115
Q

what is the I/E ratio in patients with tachypnea

A

1:1

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116
Q

wheezing is what pitch and represents what

A

continuous high-pitched

constricted lower airway (asthma)

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117
Q

rhonchi is what pitch and represents what

A

continuous low-pitched

mucus or fluid in larger lower airways (pulmonary edema)

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118
Q

what is crackles and represents what

A

also known as rales

discontinuous

airflow causes mucus or fluid into the smaller lower airways

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119
Q

what is stridor and represents what

A

high-pitched during inspiration
foreign body aspiration, infection, swelling or trauma immediately above the glottic opening

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120
Q

what causes pleural friction rub

A

inflammation causing pleurae to thicken, allowing visceral and parietal pleurae to rub together

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121
Q

what does a pulse oximeter measure

A

percentage of saturated hemoglobin in arterial blood and patient’s pulse

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122
Q

when auscultating breath sounds emergently, where do you auscultate

A

bilaterally at the third or fourth intercostal space in the midaxillary line

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123
Q

normal oxygenated patient should have what SpO2 level

A

greater than 95%

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124
Q

less than 95% SpO2 in nonsmoker suggests what

A

hypoxemia

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125
Q

SpO2 less than 90% accompanied with respiratory distress signals a need for what

A

aggressive oxygen therapy

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126
Q

hemoglobin loaded with oxygen

A

oxygemoglobin

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127
Q

hemoglobin from which oxygen has been released to the cells

A

reduced hemoglobin

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128
Q

compound formed by oxidation of iron on the hemoglobin

A

methemoglobin

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129
Q

hemoglobin loaded with carbon monoxide

A

carboxyhemoglobin

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130
Q

peak expiratory flow rate in healthy adults

A

350-750mL

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131
Q

what is used to evaluate bronchoconstriction and with what tool

A

peak rate of forceful exhalation with peak expiratory flowmeter

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132
Q

what ABG measurements are used to evaluate patient’s acid-base status and what is the normal range of both

A

pH and Hco3-

pH: 7.35-7.45
Hco3-: 21-28mEq/L

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133
Q

what ABG measurement is used to evaluate patient’s effectiveness of ventilation and what is the normal range

A

PaCO2

35-45mm Hg

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134
Q

what ABG measurements are used to evaluate patient’s oxygenation and what is the normal range of both

A

PaO2 and SaO2

PaO2: 80-100mm Hg
SaO2: above 95%

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135
Q

what is the “smoke of metabolism”

A

carbon dioxide

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136
Q

how many ATP does aerobic metabolism create from each glucose molecule

A

38

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137
Q

how many ATP does anaerobic metabolism create from each glucose molecule

A

2

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138
Q

what is the recommended method of monitoring placement of advanced airway device

A

capnography

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139
Q

what reading approximates the arterial PaCO2 level and by how close

A

ETCO2 level is usually 2-5mmHg lower than arterial PaCO2 levels

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140
Q

what happens to CO2 levels after ROSC

A

abrupt and sustained increase

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141
Q

colorimetric carbon dioxide detector function

A

treated paper turns from purple to yellow during exhalation signifying presence of carbon dioxide

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142
Q

Phase 1 (A-B) of capnography waveform

A

respiratory baseline
initial stage of exhalation (dead space gas free of CO2)

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143
Q

Phase II (B-C)

A

expiratory upslope
alveolar gas mixes with dead space gas

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144
Q

Phase III (C-D)

A

alveolar plateau
all alveolar ga, max CO2 level

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145
Q

Phase IV (D-E)

A

inspiratory downstroke
displaces CO2 causing waveform to return to base level

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146
Q

what happens to waveform during hypoventilation

A

high waveforms, prolonged alveolar plateau, and longer-than-normal intervals between waveforms

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147
Q

what happens to waveform during hyperventilation

A

small waveforms, short alveolar plateau, shorter-than-normal intervals between waveforms

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148
Q

what is “shark fin” waveform

A

caused by bronchospasms
gradual upsloping phase II (B-C)

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149
Q

how is rebreathing CO2 shown on waveform

A

waveforms elevate and never return to the baseline at the end of the inspiratory downstroke phase IV (D-E)

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150
Q

cause of too high CO2 in apneic with a pulse patient

A

positive-pressure ventilation is too slow

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151
Q

cause of too low CO2 in apneic with a pulse patient

A

positive-pressure ventilation is too fast

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152
Q

cause of too high CO2 in apneic and pulseless patient

A

positive-pressure ventilation is too slow or could indicate ROSC

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153
Q

cause of too low CO2 in apneic and pulseless patient

A

misplaced ET tube, prolonged arrest, inadequate chest compressions, positive-pressure ventilation is too fast

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154
Q

preferred technique for opening the airway of a patient without cervical spine trauma

A

head tilt-chin lift maneuver

155
Q

assessing breathing in an unresponsive patient should take no longer than ____

A

10 seconds

156
Q

preferred technique for opening the airway of a patient with suspected cervical spine trauma

A

jaw-thrust maneuver

157
Q

which maneuver to use on a jaw-fracture and why

A

jaw-thrust to keep tongue away from back of throat

158
Q

preferred technique for opening a patient’s airway for suctioning or inserting an airway

A

tongue-jaw lift maneuver

159
Q

mechanical or vacuum-powered suction units should be capable of at least ___ mm Hg with ___ seconds

A

300, 4

160
Q

tonsil-tip catheter and what they are good options for

A

large diameter and rigid

suctioning oropharynx in adults, kids, and infants
large volumes of fluid rapidly

161
Q

all names for rigid pharyngeal suction tips

A

tonsil-tip, Yankauer, DuCanto

162
Q

whistle-tip catheters and what they are good options for

A

smaller diameter, soft nonrigid catheters

suctioning oropharynx/nasopharynx, down an ET tube, or stomas

163
Q

all names for nonrigid plastic catheters

A

French or whistle-tip catheters

164
Q

be careful not to stimulate the back of the throat especially in young children/infants because

A

can induce a vagal response and cause bradycardia

165
Q

how to measure for proper sized catheter

A

from corner of the mouth to the earlobe or angle of the jaw

166
Q

apply suction in a ___ motion

A

circular

167
Q

an oropharyngeal (oral) airway is designed to do what

A

hold the tongue away from the posterior pharyngeal wall

168
Q

rough airway insertion can do what

A

injure the hard palate and cause oral bleeding

169
Q

nasopharyngeal (nasal) airway size range

A

12Fr-36Fr

170
Q

contraindication to nasopharyngeal airways

A

facial or skull fractures, can enter the cranial vault through the hole caused by the fracture

171
Q

in adults, sudden foreign body airway obstruction usually occurs ____
in children, it usually occurs ____

A

during a meal

while eating or playing with small toys

172
Q

typical foreign body obstruction patient

A

middle-aged or older
wears dentures
consumed alcohol or has a condition (stroke) that decreases airway reflexes

173
Q

dysphonia

A

difficulty speaking

174
Q

aphonia

A

inability to speak

175
Q

what is a laryngeal spasm and what is it usually caused by

A

spasmodic closure of the vocal cords, completely occluding the airway

usually caused by trauma during overly aggressive intubation attempt

176
Q

what is laryngeal edema and what is it usually caused by

A

causes glottic opening to become extremely narrow or totally closed

usually caused by epiglottitis, anaphylaxis, inhalation injury (burns to upper airway)

177
Q

most effective means of dislodging mild airway obstruction

A

forceful cough

178
Q

what is lung compliance

A

ability of alveoli to expand when air is drawn or pushed into the lungs during ventilation

179
Q

what is poor lung compliance characterized by

A

increased resistance during ventilation attempts

180
Q

at what oxygen level in the air can side effects start to occur

A

19%

181
Q

Heimlich maneuver aka ___

A

abdominal thrust maneuver

182
Q

what to do instead of Heimlich in patients with advanced stages of pregnancy or morbid obesity

A

chest thrusts

183
Q

what is a direct laryngoscopy and what do you use to remove the foreign body from the upper airway

A

visualization of the airway with a laryngoscope

Magill forceps

184
Q

what can giving a patient who does not need oxygen cause

A

oxidative stress and hyperoxic injury

185
Q

most common oxygen cylinder class and amount in field

A

D cylinder - 350L of oxygen

186
Q

most common oxygen cylinder class and amount stored on the ambulance

A

M cylinder - 3,000L of oxygen

187
Q

when to replace oxygen cylinder with new one (safe residual pressure)

A

200psi or lower

188
Q

formula for determining duration of flow for oxygen cylinder

A

(tank pressure PSI - 200PSI) x (cylinder constant/flow rate in L/min) = duration of flow in minutes

189
Q

do not subject oxygen cylinders to temperatures greater than ___ degrees (F/C)

A

125F / 50C

190
Q

have the oxygen cylinder hydrostatically tested every ____

A

10 years

191
Q

pressure of gas in a full oxygen cylinder

A

2,000psi

192
Q

what is a therapy regulator

A

reduces high pressure of gas in oxygen cylinder to a safe range of about 50psi

193
Q

which flowmeter, the pressure-compensated or the Bourdon-gage flowmeter, is affected by gravity and how do you have to treat it differently

A

pressure-compensated, must remain in upright position

194
Q

what usually causes hiccups

A

swallowed air which leads to spasming of the diaphragm

195
Q

where to listen for lung sounds

A

second, fifth, and seventh intercostal space

196
Q

nonrebreathing mask flow rate and FIO2

A

12-15L/min, 90%

197
Q

nasal cannula flow rate and FIO2

A

1-6LPM, 24-44%

198
Q

partial rebreathing mask flow rate and FIO2

A

6-10LPM, 35-60%

199
Q

tracheal normal breath sounds

A

inspiratory/expiratory are both loud

200
Q

bronchial normal breath sounds

A

inspiratory are shorter than expiratory, both are loud

201
Q

bronchovesicular normal breath sounds

A

inspiratory/expiratory are both medium intensity

202
Q

vesicular normal breath sounds

A

inspiratory sounds last longer than expiratory sounds, both are faint

203
Q

two treatment options for patients with severe respiratory distress or failure

A

positive-pressure ventilation with bas-mask device or CPAP

204
Q

what can aggressive positive-pressure ventilation do to patient

A

impair patient’s hemodynamics and push air into stomach

205
Q

formula for cardiac output

A

stroke volume x pulse rate

206
Q

what is gastric distention

A

air in the stomach

207
Q

what happens to air movement during PPV

A

air forced into lungs

208
Q

what happens to blood movement during PPV

A

intrathoracic pressure is increased, venous return/preload is impaired, stroke volume and cardiac output are reduced

209
Q

what happens to airway wall pressure during PPV

A

more volume is required to have same effects as normal breathing which results in walls being pushed out of their normal anatomic shapes

210
Q

what happens to esophageal opening pressure during PPV

A

air is forced into the stomach causing gastric distention resulting in vomiting and aspiration

211
Q

what happens to overventilation during PPV

A

forcing volume and rate results in increased intrathoracic pressure, gastric distention, and decreased cardiac output (hypotension)

212
Q

how much air can patient receive with mouth-to-mask technique

A

up to 55%

213
Q

max suctioning time for adults, children, and infants

A

adult: 15 seconds
child: 10 seconds
infant: 5 seconds

214
Q

ventilation rate for 12-14 (onset of puberty) and older

A

1 breath every 6 seconds for 10 breaths/min

215
Q

ventilation rate for infants/peds up to onset of puberty

A

1 breath every 2-3 seconds for 20-30 breaths/min

216
Q

adult bag-mask device reservoir bag volume

A

1200-1600mL

217
Q

pediatric bag-mask device reservoir bag volume

A

500-700mL

218
Q

infant bag-mask device reservoir bag volume

A

150-240mL

219
Q

how much tidal volume to deliver to adult via bag-mask to produce visible chest rise

A

500-600ml (6-7mL/kg)

220
Q

deliver each breath with bag-mask over what period of time

A

1 second

221
Q

when should you also wear a protective gown when managing airway

A

significant blood splashing or if the patient is suspected of having infection respiratory infection (SARS, TB, covid)

222
Q

what technique to use for single rescuer bag-mask ventilation

A

EC clamp technique

223
Q

what to do if the patient’s stomach rather than the chest is rising and falling

A

reposition the head, if spinal injury is present then reposition the jaw

224
Q

what does the automatic transport ventilator AC mode do

A

assist/control - controls work of breathing but allows patient to set the respiratory rate

225
Q

what does the automatic transport ventilator SIMV mode do

A

synchronized intermittent mandatory ventilation - sets the respiratory rate and volume/pressure delivered and syncs with each patient-initiated breath

226
Q

what does the automatic transport ventilator pressure support mode do

A

uses positive pressure to overcome airway resistance to increase patient’s spontaneous breaths (requires patient to be able to initiate breath)

227
Q

ATV is set based on what and why

A

the patient’s ideal body weight, not actual body weight because adult lungs do not increase in size or hold more volume due to increased body weight

228
Q

how much oxygen does ATV consume

A

5 L/min

229
Q

what can happen if the ATV’s pressure relief valve fails or if ventilation is too fast/too forceful

A

barotrauma

230
Q

atelectasis

A

alveolar collapse

231
Q

what about pediatrics makes it more difficult to achieve effective mask-to-face seal compared to adults

A

flat nasal bridge

232
Q

length-based resuscitation tape can be used to estimate appropriate size of bag-mask valve for patients up to what weight

A

75lbs/34kgs

233
Q

accidentally placing pressure on pediatrics’ eyes while ventilating can do what

A

stimulate oculocardiac reflex which can decrease HR and BP

234
Q

contraindications for CPAP

A

unable to protect airway, hypoventilation, hypotension, pneumothorax, head/facial injury, cardiogenic shock, tracheostomy, GI bleeding, nausea/vomiting, recent GI surgery

235
Q

what generates PEEP and what is PEEP

A

patient exhaling against resistance (expiratory positive airway pressure) generates PEEP

PEEP: positive end-expiratory pressure

236
Q

therapeutic PEEP range

A

5-10cm H2O

237
Q

CPAP units can empty a D cylinder in ___ minutes

A

5-10

238
Q

CPAP FIO2 level

A

30-35%

239
Q

possible effects of CPAP

A

pneumothorax from barotrauma, increased pressure in chest cavity leading to hypotension, gastric distention

240
Q

who should get humidified O2

A

burn patients

241
Q

how is BPAP different from CPAP

A

bilevel positive airway pressure - delivers two pressures
1. inspiratory positive airway pressure to open lower airways
2. lower expiratory positive airway pressure to help keep lower airways open

242
Q

how to perform assisted ventilation

A

match the first 5-10 breaths then slowly adjust the rate

243
Q

how is invasive gastric decompression performed

A

inserting gastric tube through mouth or nose into patient’s stomach and removing contents with suction

244
Q

use caution when inserting NG/OG tubes on which patients and never use NG/OG tubes on which patients

A

caution: esophageal disease (tumors, varices, strictures)
never: non-patent esophagus

245
Q

how to confirm proper placement of NG/OG tube

A

auscultate over epigastrium while injecting 20-30mL of air into the tube and/or observe for gastric contents in tube (no reflux around tube)

246
Q

what is gastric lavage

A

cleaning out the stomach’s contents (usually patients who ingested toxins)

247
Q

laryngectomy

A

surgical removal of larynx

248
Q

tracheostomy

A

surgical opening of trachea

249
Q

stoma

A

orifice that connects trachea to outside air

250
Q

limit suctioning of stoma to ___

A

10 seconds

251
Q

how to suction a stoma

A

inject 3mL of sterile saline through stoma into trachea, tell patient to exhale, insert catheter without providing suction until resistance is felt (no more than 12cm), suction while withdrawing catheter

252
Q

what adapter size must be on tracheostomy tube to be compatible with ventilatory devices

A

15/22mm

253
Q

if a tracheostomy tube becomes dislodged, what can occur

A

stenosis (narrowing) of the stoma

254
Q

which dental appliances to leave in and which to remove

A

leave in place: well-fitted ones maintain facial structure

remove: loose-fitted ones could become an airway obstruction

255
Q

what obstruction often contain sharp metal ends that can easily lacerate the pharynx or larynx

A

bridges

256
Q

facial injuries should increase your index of suspicion for ____

A

cervical spine injury

257
Q

do not proceed to advanced airway management too early, do it only for two reasons:

A

failure to maintain patent airway and/or failure to adequately oxygenate and ventilate

258
Q

mnemonic to guide assessment of difficult airway

A

LEMON
Look externally
Evaluate 3-3-2
Mallampati classification
Obstruction
Neck mobility

259
Q

difficulties for airway just by looking at patient

A

short, thick necks
morbid obesity
dental conditions like overbite or buck teeth

260
Q

what is the evaluate 3-3-2 of LEMON

A

3 - patient’s mouth should open at least 3 fingerbreadths
3 - length of mandible should be at least 3 fingerbreadths long (from tip of chin to hyoid bone)
2 - distance from hyoid bone to thyroid notch should be at least 2 fingerbreadths wide

261
Q

what is the Mallampati classification

A

oropharyngeal structures visible in an upright, seated position in full conscious, alert patient who is able to open mouth

262
Q

what is the Cormack-Lehane classification

A

classifies views obtained by laryngoscopy based on the structures seen

263
Q

Class I of Mallampati classification

A

entire posterior pharynx is fully exposed

264
Q

Class II of Mallampati classification

A

posterior pharynx is partially exposed

265
Q

Class III of Mallampati classification

A

posterior pharynx cannot be seen; base of uvula is exposed

266
Q

Class IV of Mallampati classification

A

no posterior pharyngeal structures can be seen

267
Q

Class I of Cormack-Lehane classification

A

full view of epiglottis, arytenoid cartilage, and vocal cords is available

268
Q

Class II of Cormack-Lehane classification

A

epiglottis is in full view but only a portion of the glottis or arytenoid cartilage can be seen

Class 2a: partial view of the glottis
Class 2b: arytenoids or posterior part of vocal cords barely visible

269
Q

Class III of Cormack-Lehane classification

A

only epiglottis can be seen - glottis nor arytenoid cartilage is visible

270
Q

Class IV of Cormack-Lehane classification

A

neither epiglottis nor glottis is visible

271
Q

ideal position for visualization and intubation

A

sniffing position - ears aligned with sternal notch

272
Q

what is endotracheal intubation

A

ET tube passed through glottic opening and tube is sealed with cuff inflated against tracheal wall

273
Q

disadvantage of ET intubation

A

bypasses warming, filtering, and humidifying functions of the upper airway

274
Q

what is the use of the ET tube’s pilot balloon

A

indicates whether distal cuff is inflated or deflated after the tube has been inserted

275
Q

what is the purpose of the ET tube’s Murphy eye

A

enables ventilation to occur even if the tip becomes occluded by blood, mucus, or tracheal wall

276
Q

ET tube diameter and length size range

A

diameter: 2-10mm
length: 12-32cm

277
Q

what ET sizes are equipped with distal cuff

A

5-10mm

278
Q

normal ET tube size for adult female and adult male

A

female: 7-7.5mm
male: 7.5-8mm

279
Q

what is the stylet used for

A

guides the tip of the tube over the arytenoid cartilage and through the vocal cords

280
Q

how should a stylet be formed and where should it be placed in ET tube

A

“hockey stick curve”
at least 0.5inch (1cm) back from the end of ET tube

281
Q

normal ET tube size for pediatrics

A

2.5-5mm

282
Q

why are distal cuffs not needed for pediatrics

A

the cricoid ring (narrowest part of peds airway) forms a seal with the ET tube

283
Q

good estimates of the diameter of the glottic opening

A

diameter of nostril or little finger
length-based tape for peds

284
Q

what is the laryngoscope straight and curved blade called

A

straight: Miller
curved: Macintosh

285
Q

what population is the straight laryngoscope blade used for and why

A

infants and small children because the tip directly lifts up the epiglottis

286
Q

where is the tip of the curved laryngoscope blade placed

A

vallecula (space between epiglottis and base of the tongue)

287
Q

blade sizes for laryngoscopes

A

0-4

288
Q

blade sizes for children and adults

A

children: 0, 1, 2
adults: 3(average size), 4 (larger people)

289
Q

how long to preoxygenate an apneic or hypoventilating patient before intubation

A

2-3 minutes to as close to 100% as possible

290
Q

what are the piriform fossae

A

pockets on both sides of laryngeal inlet

291
Q

what are the aryepiglottic folds

A

soft tissue separating larynx from piriform fossae

292
Q

three axes of the airway

A

oral, tracheal, pharyngeal

293
Q

in most supine patients, the sniffing position can be achieved by ____

A

elevating the occiput 1-2 inches

294
Q

what side to insert blade into patient’s mouth and why

A

right side to sweep the tongue to the left side of mouth

295
Q

what is the critical structure to identify during laryngoscopy

A

epiglottis

296
Q

bougie bend at the distal tip

A

30 degrees

297
Q

what is the bougie used for

A

epiglottis-only views to facilitate intubation

298
Q

when you meet resistance with the bougie, you know that it is where

A

at the level of the carina

299
Q

what is the purpose of the bend at the end of the distal tip of the bougie

A

enables you to feel the tracheal rings

300
Q

once the ET tube passes through the vocal cords, what do you do with the tube

A

rotate it to the right and direct the tip downward to follow the trachea

301
Q

how far to advance the ET tube

A

until proximal end of the cuff is 0.5 to 0.75inches past the vocal cords

302
Q

what is the most reliable method of confirming the tube has entered the trachea

A

visualizing the ET tube passing between the vocal cords

303
Q

how much air to inflate into the distal cuff

A

5-10mL

304
Q

what can overinflating the distal cuff cause

A

ischemia or necrosis of the tracheal wall which leads to tracheal stenosis (narrowing)

305
Q

how to determine if the tube migrated after placement

A

note the depth of the ET tube at patient’s teeth after placement

306
Q

if copious vomit is being emitted from the ET tube, ___

A

do NOT remove it

inflate distal cuff, turn tube to the side, and ventilate with bag-mask device

307
Q

what does breath sounds only on right side of chest indicate and how to correct it

A

tube was advanced too far and entered the right main stem of bronchus

deflate cuff, slowly retract tube while listening for breath sounds over left side of chest until bilateral breath sounds are present

308
Q

what is the most reliable method for confirming and monitoring placement of ET tube

A

waveform capnography

309
Q

with a firmly secured tube, the tip can move ____

A

2 inches

310
Q

if the patient’s head is hyperflexed, what happens to the tube? if the head is hyperextended?

A

ET tube can be pulled out of the trachea

Et tube could be pushed farther into the trachea and into a main stem bronchus

311
Q

what is nasotracheal intubation and what is the other term for it

A

insertion of ET tube into trachea through nose without directly visualizing the vocal cords

“blind” intubation

312
Q

nasotracheal intubation is only performed on what patients

A

patients with spontaneous breathing

313
Q

contraindications of nasotracheal intubation

A

head trauma, deviated septum, nasal polyps, frequent cocaine use, blood-clotting abnormalities

314
Q

standard ET tubes should be how much smaller when inserted nasally

A

1-1.5 mm smaller

315
Q

how to advance nasotracheal tube

A

advanced as patient inhales

316
Q

which nostril for nasotracheal intubation, how to adjust if you have to use other nostril

A

right nostril, if left nostril must be used, rotate tube 180 degrees

317
Q

devices used to determine maximum airflow during nasotracheal intubation

A

humid-vent 1, beck airway airflow monitor (BAAM), stethoscope with head removed

318
Q

if you see a soft-tissue bulge on either side of the airway after inserting nasopharyngeal tube, what probably happened

A

the tube has probably been inserted into the piriform fossa

319
Q

what is the definition of a “failed airway”

A

failure to maintain adequate ventilation and oxygenation regardless of techniques of airway management being used

320
Q

tracheobronchial suctioning

A

passing a suction catheter into the ET tube to remove pulmonary secretions

321
Q

what can tracheobronchial suctioning cause

A

cardiac dysrhythmias and cardiac arrest

322
Q

what to do before tracheobronchial suctioning

A

preoxygenation and inject 3-5mL of sterile water down ET tube to loosen extremely thick pulmonary secretions

323
Q

what can happen when extubation is performed on responsive patients

A

high risk of laryngospasm and upper airway swelling

324
Q

complications with sedation in airway management are usually what

A

undersedation and oversedation

325
Q

examples of benzodiazepine sedative-hypnotics

A

diazepam (valium) and midazolam (versed)

326
Q

examples of dissociative anesthetics

A

ketamine (ketalar)

327
Q

examples of opioid sedative-analgesics

A

fentanyl (sublimaze) and alfentanil (alfenta)

328
Q

examples of non-opioid/nonbarbiturate sedative-hypnotics

A

etomidate (amidate)

329
Q

two major classes of sedatives commonly used in airway management and what they do

A

analgesics: decrease perception of pain
sedative-hypnotics: induce sleep and decrease anxiety (do not reduce pain)

330
Q

benzodiazepines produce what

A

anterograde amnesia

331
Q

midazolam vs diazepam

A

midazolam is 2-4x more potent than diazepam, faster acting, and shorter duration of action

332
Q

potential side effects of benzodiazepines

A

respiratory depression and hypotension

333
Q

what is a benzodiazepine antagonist

A

Flumazenil (Romazicon)

334
Q

what is a dissociative anesthetic

A

produces anesthesia by distorting patient’s perception of sights/sounds and inducing dissociation

335
Q

what is reemergence phenomenon

A

occurs during half-life of ketamine when patient is awakening - causes pleasant dreams, vivid nightmares, or delirium

336
Q

what are opioids

A

act as CNS depressant and produce insensibility or stupor

337
Q

how much more potent is fentanyl than morphine

A

70-150x

338
Q

alfentanil in comparison to fentanyl

A

alfentanil is less potent with faster onset of action, shorter duration of action, and eliminated from body quicker

339
Q

what sedative causes myoclonic muscle movement

A

Etomidate (Amidate)

340
Q

how long after receiving IV dose of paralytic will a patient become totally paralyzed

A

1-2 minutes

341
Q

how do depolarizing neuromuscular blockers work

A

competitively bind with ACh receptor sites - causes depolarization of muscle and prevents future signs for depolarization

342
Q

example of depolarizing neuromuscular blocker

A

succinylcholine chloride (anectine)

343
Q

what does succs cuase

A

fasciculations

344
Q

succs onset, duration, contraindications, and side effect

A

onset: 60-90 secs
duration: 5-10mins
contraindications: conditions that can result in hyperkalemia (burns, crush injuries, blunt trauma)
side effects: bradycardia

345
Q

how do nondepolarizing neuromuscular blockers work

A

bind to ACh receptor sites, do not cause depolarization of muscle fiber

346
Q

examples of nondepolarizing neuromuscular blockers

A

vecuronium, pancuronium, rocuronium

347
Q

glottic opening in infancy, age 7, and adult

A

infancy: C1
age 7: C3-4
adult: C4-5

348
Q

what should be avoided after administering a paralytic agent if possible

A

bag-mask ventilation

349
Q

if your choice of paralytic is succs, consider what two medication administrations

A

defasciculating dose of 10% of normal dose of nondepolarizing paralytic and atropine sulfate to decrease bradycardia risks

350
Q

ETT size for pediatric patient formula

A

(age/4) + 4

351
Q

if patient is hemodynamically unstable (systolic BP less than 90mm Hg) what should be considered over benzos

A

ketamine or etomidate

352
Q

two signs of adequate paralysis

A

apnea and laxity of mandible

353
Q

what to do with patient who requires ET intubation but cannot be preoxygenated due to mental status

A

DSI (delayed sequence intubation)

354
Q

how to perform DSI

A

administer dissociative dose of ketamine, administer 15LPM via nonrebreathing mask and NC, after maintaining oxygen for 3mins, administer paralytic

355
Q

what is denitrogenation

A

replacing alveolar nitrogen with oxygen

356
Q

what degree to have bed elevated to for RSI

A

15-30 degrees

357
Q

what is the single-lumen airway blindly inserted into the esophagus

A

King LT Airway

358
Q

main disadvantage of the LMA

A

does not protect against aspiration and may increase risk of it

359
Q

what size ET tube can be passed through a size 3 or 4 LMA

A

6mm

360
Q

i-gel allows for passage of what size gastric tube

A

10Fr

361
Q

iGel size 3 color and weight

A

yellow
30-60kgs

362
Q

iGel size 4 color and weight

A

green
50-90kgs

363
Q

iGel size 5 color and weight

A

orange
over 90kgs

364
Q

where are the superior cricothyroid vessels located

A

run at transverse angle across upper third of cricothyroid membrane

365
Q

where are the carotid arteries located

A

run vertically lateral to the cricothyroid membrane

366
Q

where does the ET tube or tracheostomy get inserted during cricothyrotomy

A

subglottic area (below vocal cords) of the trachea

367
Q

age contraindicated for surgical cricothyrotomy

A

under 8 years old (use needle cricothyrotomy)

368
Q

how to make your cut for a surgical cric

A

vertical 0.5-0.75inches

369
Q

crics on obese patients run a risk of what

A

false passage of the tube undermining the subcutaneous tissue

370
Q

what is subcutaneous emphysema

A

air infiltrates the subcutaneous (fatty) layers of the skin
characterized by “crackling” sensation when palpated

371
Q

what to use to cut for cric

A

number 10 scalpel

372
Q

what gauge needle for needle cric

A

12-16 gauge

373
Q

how to insert needle for needle cric

A

45 degrees caudally (towards feet)

374
Q

what is the cylinder constant for D

A

0.16

375
Q

what is the cylinder constant for M

A

1.56

376
Q

what age range is croup most common in

A

6 months - 6 years

377
Q

what time of year is croup more prominent in northern areas

A

October-March

378
Q

what two conditions are commonly mistaken for epiglottitis until an abscess is seen

A

peritonsillar abscess and retropharyngeal abscess

379
Q

what is diphtheria

A

bacterium attacks and kills epithelial tissue creating a pseudomembrane

380
Q

what is aspiration pneumonitis

A

gastric acid irritates the lung tissue after it is aspirated

381
Q

what increases risk of aspiration in patients with tube feedings

A

if they are placed supine immediately after a large feeding

382
Q

three most chronic obstructive lower airway diseases

A

emphysema, chronic bronchitis, asthma

383
Q

how is bronchospasm different from edema

A

bronchospasm: muscle contracts causing entire tube to narrow

edema: wall of tube swells causing only lumen to narrow

384
Q
A

PARAMEDIC SCHOOL (74 decks)

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