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Respiratory emergencies and management > BOOOOOOOOM > Flashcards

BOOOOOOOOM Flashcards

1
Q

What is airway management of a patient who is breathing fairly adequately?

A

Giving oxygen if needed

Positioning to maximize air exchange

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2
Q

What is airway management of a patient who has labored breathing?

A

Continuous Positive Airway Pressure (CPAP)

Bilevel Positive Airway Pressure (BiPAP)

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3
Q

A patient comes in with angioedema: what should be speculated as the causative agent?

A

ACE inhibitors

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4
Q

What is airway protection?

A

Airway is fine…but there are other factors that might cause the patient to quit breathing (decreased LOC, absence of protective reflexes, apnea)

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5
Q

What are three reasons NOT to intubate?

A

Airway is adequately protected
Oxygenation can be done less invasively
The patient is DNI

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6
Q

If possible, what should be done prior to intubation?

A

Pre-oxygenating

Giving succinylcholine

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7
Q

Why is succinylcholine given?

A

Ultra short-acting muscle relaxant

Paralysis lasts 8-12 minutes

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8
Q

What are three back-up plans to intubation?

A

Combitube
King Airway
Laryngeal Mask Airway (LMA)

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9
Q

When should intubation be given up on in favor of a back-up plan?

A

If intubating failed twice (even after repositioning after the first failure)

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10
Q

What is a back-up to the back-up plans?

A

Cricothyroidotomy–between Adam’s apple and cricoid cartilage

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11
Q

What are some side effects of succinylcholine?

A

Bradycardia (treated with atropine)
Increased pressures (intragastric, intracranial, intraocular)
Increased serum potassium
Increased temperature

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12
Q

Who shouldn’t be given succinylcholine?

A 
Burn patients (increases temp)
Renal failure patients (increased K+)
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13
Q

How can succinylcholine affect a person’s appearance?

A

Eyes like a mole, moist as a slug, weak as a kitten

Muscarinic receptors –> salivation, lacrimation, urination, and defecation (SLUD)

Nicotinic effects –> fasciculation and weakness

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14
Q

What are examples of non-depolarizing neuromuscular blockers?

A

Vecuronium

Rocuronium

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15
Q

What is the MOA of vecuronium?

A

Competes at motor endplate for cholinergic receptor –> initiating flaccid paralysis

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16
Q

How long after giving vecuronium should the patient be intubated?

A

2.5-3 minutes

17
Q

Where is vecuronium metabolized?

A

Liver and kidneys

18
Q

Does renal failure affect recovery time of vecuronium?

A

No

19
Q

Does liver failure affect recovery time of vecuronium?

A

Yes…may double recover time

20
Q

Does vecuronium cause hypotension or tachycardia?

A

No

21
Q

What is the rate of onset of rocuronium?

A

Close to succinylcholine

22
Q

Barbiturates, rapid acting sedatives, can be used prior to intubation: what is a possible side effect?

A

Hypotension

23
Q

What rapid-acting anesthetic that induces a disassociative state is used in kids, but is usually avoided in adults d/t a “bad trip”?

A

Ketamine

24
Q

Besides being anesthetic/disassociating, what are some other benefits of ketamine?

A

Useful in trauma and hypotensive states

Bronchodilatory

25
Q

Besides “bad trips”, what are some other negative side effects of ketamine?

A

HTN

Increased upper airway secretions (treated with atropine)

26
Q

Benzodiazepines (midazolam) is a short acting CNS depressant that causes adequate sedation in 2-2.5 minutes: what is a possible side effect of this drug?

A

Slight drop in MAP

27
Q

What are examples of rapid acting sedative hypnotics?

A

Propofol

Etomidate

28
Q

What is the MOA of propofol?

A

Inserts into nerve membrane bilayer –> disrupts nerve conduction

29
Q

What are some side effects of propofol?

A

Apnea

CV depressant –> hypotension

30
Q

What sedative drug is ideal for hypovolemic/hemorrhagic shock patients?

A

Etomidate

31
Q

What are some possible side effects of etomidate?

A

Vomiting

Myoclonus

32
Q

What are the steps of intubation?

A 
1- Pre-oxygenate/prepare
2- Pre-treat/prime
3- Paralyze
4- Intubate
5- Confirm tube placement
6- Medicate for long-term management
33
Q

What is important to remember during step 2 (pre-treat/prime)?

A

Give drugs (lidocaine, fentanyl, vecuronium/rocuronium, atropine) enough time to work…2-3 minutes

If there is not enough time to wait, skip step

34
Q

What is important to remember during step 6 (medicate for long-term management)?

A

Match long-acting paralytics to equally long-acting sedatives…make sure patient is not aware AND not in pain

Respiratory emergencies and management (1 decks)

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