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AFD Paramedic School > Chapter 14 Airway Management > Flashcards

Chapter 14 Airway Management Flashcards

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0
Q

Brian injury or death can happen in little as this time frame

A

4 to 6 minutes

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1
Q

When managing a Pts airway,your primary objective is optimal ____________.

A

Ventilation

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2
Q

The functional level of the respiration system is the

A

Alveoli.

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3
Q

Primary function of the respiratory system is

A

O2 in and CO2 out. A proper exchange of both gases

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4
Q

The nasal cavity and the mouth meet at the

A

Pharynx (throat)

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5
Q

The pharynx has three parts. Name

A

The nasopharynx, the oropharynx, and the laryngopharynx.

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6
Q

These cavities are prone to infection due to the fact that they trap particles as they enter the airway

A

Sinuses

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7
Q

Tubes from the inner ear that help drain and equalize it.

Are called

A

Eustachian tubes (Auditory tubes)

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8
Q

The oropharynx extends down to the

A

Epiglottis

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9
Q

For a unresponsive PT. What is the leading cause of airway obstruction

A

The tongue

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10
Q

The anchor of the tongue is the

A

Hyoid bone. It is a free floating bone not connected to any hard structure

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11
Q

At what structure does the nasopharynx end and the oropharynx start.

A

The uvula

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12
Q

The gag reflex comes for nerves stimulated where

A

The posterior of the pharynx

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13
Q

Name the two sets of tonsils and where there located

A

The Palestine tonsils are more prominent not he side of the throat
The Adenoids tonsils are located on the upper rear wall of the oral cavity.

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14
Q

Which tonsils can cause a ear infection when infected

A

The Adenoids

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15
Q

The laryngopharynx is also called. Where is located

A

Hypopharynx. Between the epiglottis and glottis

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16
Q

Two important landmarks for tracheal intubation.

A

The epiglottis and vallecula

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17
Q

The depression or “little valley between the bas of the tongue and the epiglottis is called

A

The valecula

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18
Q

When intubating With the strait laryngoscope what is a important landmark

A

Epiglottis

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19
Q

When intubating With the curved laryngoscope what is a important landmark

A

The vallecula

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20
Q

AKA. Voice box. It houses the vocal cords and keeps air to the trachea and food to the esophagus.

A

The larynx

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21
Q

The space between the true vocal cords is

A

The glottis

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22
Q

Patency of the glottis largely depends on what

A

Muscle tone

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23
Q

The _________ cartridge is the narrowest diameter of the airway for children younger then ten years old.

A

Cricoid

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24
Q

The fibrous membrane between the thyroid and cricoid cartridge is called. Why is it important.

A

The cricothyroid membrane. The place where we perform a cric at. (Cricthyroidotomy).

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25
Q

Stimulation of the Vagus nerves that run the length if the trachea can cause what physiological affects when stimulated, let’s say with a intubation blade or endotracheal tube. (HR, BP, RR)

A

Decreased HR, BP, and RR

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26
Q

Superior margin of T4 and the inferior margin if the xiphoid process mark the anatomical margins of what structure

A

The lower airway

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27
Q

Average length of a adult trachea is

A

10 to 12 cm

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28
Q

Foreign bodies tend to go into which lung most of the time. Why

A

The right. It’s main bronch mainstay is larger and makes less of a curve when it branches off the carina

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29
Q

The point of entry for the bronchioles.

A

The Hilum

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30
Q

Beta 2 receptor stimulation results in what response from the bronchioles.

A

Smooth muscle from the bronchioles relax

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31
Q

The stse of alveolar collapse due to no surfactant being present

A

Atelectasis

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32
Q

The cartilaginous rings of a human do not fully mature until what age

A

8 years

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33
Q

The adult larynx is located approx at what cervical vertebrae??
The Peds??

A

Adult C4-C5

Peds C1-C4

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34
Q

For a neonate at what age do oral respirations begin

A

5-6 months

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35
Q

The diaphragm of a neonate is ________ in shape

A

Horizontal

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36
Q

The diaphragm of a adult is ________ in shape

A

Oblique

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37
Q

Chest rise may be happening but try respirations may not be happening due to underlying injuries and less protection from the undeveloped rib cage. This type of movement is called

A

Paradoxic movement.

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38
Q

Major respiration stimulus comes from this part of the brain.

A

Medulla oblongata.

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39
Q

During inspiration a nervous impulse is transmitted to the diaphragm via what major nerve

A

The phrenic nerve

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40
Q

The Hering-Breuer reflex is designed to keep us from doing what.

A

Over inflation of the lungs in a conscious spontaneously breathing perso

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41
Q

Average tidal volumes for a adult and Ped is

A

Adult 500 ml

Ped 8ml/kg

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42
Q

The Hering-Bauer reflex is only active in adults for two reasons. Wen is it active for Peds

A

Adults 1. Exercise (increased tidal volume is needed)
2. The apneustic center of the brain is damaged or non functional.
Peds. It is always active

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43
Q

The pressure exerted by each individual gas in a mixture

A

Partial pressure.

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44
Q

1 mm Hg is equal to __ Torr

How many Torrs at sea level

A

1 mmHg =1 Torr

At sea level. 760 Torr

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45
Q

Four main gases in the Earths atmosphere

A

Oxygen O2, Nitrogen Na, Water vapor H20, Carbon Dioxide CO2

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46
Q

Normal levels of PaO2 are

Normal levels of PaCO2 are

A

80-100 torr

35-45torr

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47
Q

______ refers to a decreased amount of O2 saturated Hemoglobin in the blood stream.

A

Hypoxemia

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48
Q

Refers to a low level of O2 in the tissues.

A

Hypoxia

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49
Q

Most common cause of hypoxemia is

A

Hypoxia

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50
Q

What structure is directly behind the thyroid cartridge and is the narrowest portion of the adult airway.

A

The glottis opening

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51
Q

The point of attachment for the vocal cords

A

Arty enosis cartridges

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52
Q

Stimulation of the vagus nerves that run along the pharynx can result in what 3 major physiological responses.

A

Bradycardia
Hypotension
Decreased RR

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53
Q

When you right stem intubate someone how far should you back the tube out before reassessing.

A

A few centimeters

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54
Q

Stimulation of the Beta 2 receptor sites in the bronchioles results in what

A

Relaxation of bronchial smooth muscle

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55
Q

The medical term used to describe the actual functioning parts of a human lung

A

Parenchyma

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56
Q

To intubate a pediatric Pt., Where should padding be placed to help align the airway

A

Under the torso

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57
Q

For neonates. The connection of the epiglottis and soft palate can stay intact except for what two instances.

A

Crying and disease

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58
Q

Cuffed endo tubes are not needed for Peds younger then. Why

A

8 years old. Their cricoid ring is small enough to make a good seal.

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59
Q

In neonates and children what is the primary muscle of inspiration

A

The diaphragm.

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60
Q

Gas exchange from the alveoli and RBCs is called __________ respiration.

A

External respiration.

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61
Q

Gas exchange between the blood cells and the tissues is called __________ respiration.

A

Internal

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62
Q

At sea level what is O2s partial pressure in relation to the other 3 main gases in the atmosphere

A

160 torr

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63
Q

What percentage of venous hemoglobin is bound with CO2. Where is the rest located.

A

33%. The rest is located in the HCO3. (Bicarbonate ions)

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64
Q

What is the condition polycythemia Vera.

A

Too large amount of RBCs

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65
Q

Earliest physical signs of hypoxia is

A

Restlessness and anxiety

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66
Q

The bluing of a persons skin due to hypoxia is called

A

Cyanosis

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67
Q

Normal concentrations of O2 bound hemoglobin are __mg/dL. Cyanosis can occur at what concentration

A

15 mg/dL.

5mg/dL

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68
Q

Decreased elimination of CO2 secondary to airway disease is also called what and is normally present with patients with Emphasema

A

Air trapping

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69
Q

How is a patients lips going to present when having trouble breathing due to Emphysema .

A

Pursed in order to “trap” air into the lungs in order to keep the alveoli inflated

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70
Q

A Pulmonary embolus or a tension pneumothorax can cause which one. Hypocarbia or Hypercarbia

A

Hypocarbia. Decrease function and perfusion of the lung tissue.

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71
Q

The amount if air left over and not used in the gas exchange. How many ml’s does it consist of.

A

Dead air space. Approx 150 ml

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72
Q

The volume of gas inhaled or exhaled during a normal single respiratory cycle. It consists of how many ml’s.

A

Tidal volume. Approx 500 ml

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73
Q

The amount of air that dies reach the alveoli for gas exchange. It consists of how many ml’s.

A

Alveolar air volume. Approx 350 ml

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74
Q

What is the true measurement of a Pts Ventilatory status and is vital in assessing pulmonary function.

A

Minute volume

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75
Q

A minute volume ascertains what.

A

The Ventilatory rate and depth of each inhalation.

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76
Q

The volume of air remaining in the lungs after a NORMAL expiration.

A

Functional reserve capacity

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77
Q

After maximal forced exhalation, this is the amount of air in the lungs not able to be expelled

A

Residual volume

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78
Q

The amount of gas that can be forcefully inspired in addition to a normal breaths tidal volume.

A

Inspiratory reserve volume

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79
Q

The amount if gas that can be forcefully expired at the end of a normal expiration.

A

Expiratory reserve volume

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80
Q

The percentage of O2 in inspired air commonly documented as a decimal.

A

FiO2 = the 0.85

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81
Q

The greatest rate of air flow that can be achieved during forced expiration beginning with the lungs fully inflated.

A

Peak expiratory flow

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82
Q

Can hypothermia cause Hypocarbia.

A

Yes. It decreases metabolism and decreases CO2

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83
Q

The most effective care for hyperventilating Pts is to treat the ___________ cause.

A

Underlying

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84
Q

Total lung volume for a adult man is approx

A

6 liters

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85
Q

Primary control of respiration lies in what portion of the brain

A

The brain stem

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86
Q

What portion of the brain stem is responsible for involuntary respirations.

A

Medulla

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87
Q

If the phrenic nerve, which is a involuntary pathway is continually stimulated what happen physiologically.

A

RR increase

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88
Q

The phrenic nerves are directly connected to the

A

Diaphragm

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89
Q

If the medulla should fail what center in the secondary respiration portion of the brain stem can take over.

A

The apneustic center in the Pons

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90
Q

The apneustic center does what.

A

Prolongs inspiration and inhibiting expiration.

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91
Q

What other center in the Pons controls expiration.

A

Pneumotaxic center

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92
Q

The primary function of the pneumotaxic center is to do what

A

Inhibit inspiration

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93
Q

The impulses of what center in the Pons overrides the other

A

The pneumotaxic impulses override the apneustic center impulses normally.

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94
Q

Apneustic respirations consist of what.

A

Prolonged inhalation with brief exhalation

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95
Q

Where are chemoreceptors located and what do they do

A

The medulla, carotid arteries, and the Arch of the Aorta. They monitor the O2, CO2, and pH of the respiratory system.

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96
Q

What is principally responsible for respiratory center stimulation.

A

The pH of the CSF circulating in the brain

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97
Q

A pt with a decreased partial pressure of O2 in the BLOOD is in a state of

A

Hypoxemia

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98
Q

If the chemoreceptors of a COPD Pt becomes desensitized to the higher levels of pH what happens

A

O2 levels will now take over as the primary stimulus regulating respiration.

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99
Q

Excess O2 administration to a pt breathing as a result of hypoxia drive could cause what theoretically. How

A

Respiratory arrest. It slows the respiratory drive so much it could put the body in arrest. Since the respiratory drive is ran by O2 levels instead of CO2 as in a normal human.

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100
Q

A person compensating for a lower airway obstruction will be in what position.

A

Tripod position

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101
Q

Patients with an upper airway obstruction will be found in what position to compensate.

A

Sniffing position.

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102
Q

Infant (1-12months) RR

A

30-60 breaths/min

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103
Q

Toddler (1-3years) RR

A

24-40 breaths/min

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104
Q

Preschooler (4-5years) RR

A

22-34 breaths/min

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105
Q

School age (6-12 years) RR

A

18-30 breaths/min

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106
Q

Adolescent (13-18) RR

A

12-16 breaths/min

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107
Q

Adult (18 years or older) RR

A

12-20 breaths/min

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108
Q

What position unless contraindicated should we place people in respiratory distress.

A

45 degree or 90 degree semi fowlers

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109
Q

An uncomfortable awareness of one’s own breathing.

A

Dyspnea.

110
Q

A TOTAL lack of oxygen available to tissues is called

A

Anoxia

111
Q

Angulation of the sternum that indicates the point where the second rib joins with the sternum.

A

Angle of Louis

112
Q

What anatomical landmark is used as a starting point from which the ribs and intercostal spaces can be counted.

A

Angle of Louis

113
Q

The number of each intercostal space corresponds to that of the rib immediately above or below it.

A

Above it

114
Q

The angle formed by the MARGINS of the ribs at the sternum

A

Costal angle

115
Q

The presence of cyanosis is indicative of what serious physiological problem.

A

Serious gas exchange problem requiring immediate corrective action.

116
Q

Dyspnea relieved by a change in position (either sitting upright or standing) is called

A

Orthopnea

117
Q

Orthopnea indicates what major possible physiological problems.

A

Left ventricular failure or serious pulmonary complications (due to hypoxia and hypo ventilation)

118
Q

Chest movement that can occur when multiple adjacent ribs are broken is called

A

Paradoxic movement

119
Q

A barrel chest is common with what type of patient

A

Emphysema.

120
Q

This condition produces a snap crackle and pop sensation that feels like crisped rice cereal under the skin.

A

Subcutaneous emphysema

121
Q

A life threatening condition that produces poor bag compliance

A

Tension pneumothorax

122
Q

Snoring is indicative of what type of respiratory problem.

A

Physical obstruction

123
Q

If a person is unconscious what is the most probable obstruction to the airway if they are snoring

A

The tongue

124
Q

Gurgling is indicative of what respiratory blockage.

A

A large amount of secretions or vomitus

125
Q

Define stridor, what is it caused by

A

A high pitched shrill noise that is usually heard on inhalation caused by an upper airway compromise and possible impending airway obstruction.

126
Q

A cough that produces sputum is said to be a ___________ cough

A

Productive

127
Q

The primary goal of auscultation is to determine if lung sounds are

A

Present and equal bilaterally

128
Q

What lung sound is associated with asthma

A

Wheezes on inspiration and expiration

129
Q

When fluid accumulates in the smaller airway passages and is normally associated with pulmonary edema.

A

Crackles (rales)

130
Q

This act is thought to open atelactic (collapsed) alveoli and happens about once per minute

A

Sighing

131
Q

Secondary to inflammation and mucous or fluid in the LARGER airway passages, it is congestion heard on inspiration. It is associated with bronchitis or pneumonia.

A

Rattles (rhonchi)

132
Q

If a person has been intubated in the past what does that mean to a paramedic.

A

They will have a higher likelihood of needing another in the future.

133
Q

What is the main purpose of a primary survey.

A

Seek out and find all life threats.

134
Q

If their is any doubt over the adequacy of ventilation in addition to oxygenation of the patient we should do what

A

Use supplemental oxygen and positive pressure ventilation.

135
Q

Oxygen is available in two forms.

A

Liquid and gas

136
Q

What size cylinders are usually used by paramedic crews.

A

D and E.

137
Q

What are the capacities of D, Jumbo D, E, L, and M tanks

A

D 400L, Jumbo D 640L, E 680L, M 3450L.

138
Q

Which size tank is usually stored in the rescue itself and not portable.

A

Size M which holds 3450L

139
Q

What is the equation to figure the amount of Minutes left in a air cylinder.

A

Minutes remaining = Tank pressure (psi) X 0.28/ Flow (L/min)

140
Q

This device creates a anatomical reservoir in the naso pharynx for O2 administration

A

Nasal Cannula

141
Q

What O2 concentration does a nasal cannula create.

A

25-45% at 1-6L/min flow

142
Q

Which device is useful for people that are predisposed to CO2 retention.

A

Nasal cannula

143
Q

When using a simple face mask. What minimal flow rate must you have in order to not allow buildup of the Pts exhaled CO2 in the mask.

A

5L/min or higher

144
Q

What is the O2 concentration that a simple mask can deliver at what flow rate.

A

40-60% at 6-10 L/min

145
Q

What is the recommended flow rate for a simple face mask.

A

8-10 L/min

146
Q

Which mask has a reservoir bag that collects the Pts own dead space to mix with oxygen and allows it to be reused.

A

Partial rebreather mask

147
Q

If a person has poor respiratory effort and is apneic, do not use a mask or cannula, instead do what.

A

Bag with positive pressure ventilation

148
Q

What is the O2 concentration of a Partial Rebreather Mask.

A

35-60% at 6-10L/min

149
Q

Which mask is used when high flow O2 is called for

A

Nonrebreather Mask

150
Q

What is the O2 concentration of a Non Rebreather and it’s needed flow rate.

A

100% at 10-15L/min

151
Q

When using a nonrebreather or partial rebreather the reservoir bag must be how full

A

At least two thirds full.

152
Q

Which mask is precise in its delivery.

A

The Venturi mask

153
Q

Which mask is recommended for a person with a hypoxia respiratory drive such as with COPD

A

The Venturi mask system.

154
Q

What med can help with laryngospasms after extubation.

A

Bronchodilators

155
Q

What are the two manual maneuvers meant to do for an unconscious victim.

A

They both help get the tongue off the back of the Pharynx.

157
Q

Two type of suction catheters.

A

Hard (tonsil tip, Yankauer)

Soft (whistle tip, flexible, or French)

158
Q

How long should you oxygenate a pt after suctioning and before you suction again.

A

30 seconds to 1 minute before repeating suction.

159
Q

Suction should not be applied for more then how long in adults, Children, and Neonates.

A

Adults: no more then 10-15 seconds
Children: no longer then 10 seconds
Neonates: no more then 3-5 seconds.

160
Q

What type of suction catheter an be used blindly

A

Soft (French) catheter

161
Q

Which catheter is best used for secretions

A

The soft (French)

162
Q

When suctioning, if the Pt starts to cough or gag, what physiological effects can happen.

A

Increased HR and BP

163
Q

Devices that assist in either maintaining an open passageway, protect the airway from aspiration, or both are called

A

Airway adjuncts

164
Q

An oropharyngeal airway extends from where to where

A

The lips to the pharynx

165
Q

To suction the lower airway with a French catheter. How should you measure it.

A

Measure the distance from the nose to the ear and the nose to the sternal notch.

167
Q

What manual maneuver is needed when cervical spine injuries are suspected and the head tilt chin lift is contraindicated.

A

The modified jaw thrust.

168
Q

Suctioning times for
Adult
Child/Infant
Neonate

A

Adult. 10-15 secs
Child/Infant. 10 secs
Neonate. 3-5 secs

169
Q

An OPA is measured how.

A

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

170
Q

The NPA should not be used in anyone that may be on anticoagulants. Why

A

They may suffer from epistaxis (bloody noses) and create more of a problem with securing the integrity if the airway.

171
Q

How should a NPA be measured

A

The tip of the nose to the angle of the jaw or tip of the ear

172
Q

The Bevel of a NPA should be pointed where.

A

The septum.

173
Q

Expired air contains how much O2

A

16%

174
Q

Which device, a bag mask device or mouth mask device, can deliver a better tidal volume for the patient. Why

A

The mouth-mask device due the fact you can make a better seal with two hands while supporting. Better head position.

175
Q

What % of O2 delivered via
A bag mask device without supplemental O2.
A bag mask device with supplemental O2.
A bag mask device with supplemental O2 and reservoir

A

21%
40-60%
90-100%
All set at a flow rate of 15 L/min

176
Q

Cricoid pressure is done for what reason.

A

To pinch off the esophagus with the cricoid cartridge (full rigid ring) against the 5th or 6th vertebrae.

177
Q

Cricoid pressure in neonates should be done how

And in children

A

Neonates. Finger tip

Children thumb and index finger

178
Q

Three indications the the Pt is being well ventilated is

A

Improved color
Pulse oximetry
Responsiveness

179
Q

The most frequent problem with bag-mask ventilation is

A

Inability to deliver adequate Ventilatory volumes

180
Q

When using a ATV we should set the Tidal volume to what.
Also what Rate

What if Pt is in cardiac arrest. What rate

A

6-7 ml/kg (500-600ml)
10-12 breaths/min

Cardiac arrest. 8-10 breaths/min

181
Q

Some ATV should not be used on Pts younger then

A

5 yo

182
Q

Are Flow restricted, Oxygen-powered Vent devices indicated for children.

A

No. May create Barotrauma.

183
Q

A metal tracheostomy tube will require what to connect to a bag-mask device.

A

A adaptor.

184
Q

What type of tracheostomy tube helps the patient to learn to breath through the upper airway, expel secretions, and talk.

A

Fenestrated tracheostomy tubes

185
Q

The 3 most common complication with tracheostomy tubes is

A

Dislodgment. Obstruction. Infection

186
Q

If a tracheostomy tube is displaced and their is not a new one available what can we do.

A

We can drop a tracheal tube

187
Q

Extreme caution should be taken when placing a naso gastric tube when what is present

A

Major facial or head trauma.

188
Q

If esophageal trauma, verices, cancer, or any other issues are suspected where should a gastric tube be placed.

A

In the controlled environment of a hospital.

189
Q

What size bag-mask for Peds and neonates. What size should not be used for neonates

A

Peds and neonates. 450-500ml bag

Neonates should not be give the 250 ml bag because it does not provide the proper volume needed.

190
Q

Padding of the shoulders to align the airway should be used in patients younger then ___ yo.

A

3

191
Q

The cartilaginous rings of a human do not fully mature until what age.

A

8yo

192
Q

What are the 2 sizes of a Combi-tube.

A

37 Fr for Pts between 4 and 5 feet tall.

41 Fr for Pts taller then 5’feet tall.

193
Q

How much air is put into the Distal and Proximal cuffs of the 37 Fr and 41 Fr Combitubes

A
  1. 80ml distal and 15ml proximal

41. 100ml distal and 15ml proximal.

194
Q

What is the minimum height that we can use a Combitube.

A

They are not to be used an anyone less then 4 feet tall.

195
Q

For a PTL airway how tall do you have to be for it to be used. And how old.

A

5-7 feet tall.

At least 14 years old.

196
Q

The black line of the LmA should be aligned with what to ensure that it has been placed correctly.

A

The upper lip.

197
Q

An LMA cannot be used if the mouth cannot be opened at least how far.

A

0.6 inches

198
Q

Major disadvantage of an LMA.

A

Can’t protect from aspiration

199
Q

The King is designed to placed in the _______ ONLY.

A

Esophagus ONLY.

200
Q

What are the three sizes of the King device. How much air to inflate each sizes cuffs.

A

Size 3 for Pts 4-5 feet tall. 45-60 ml.
Size 4 for Pts 5-6 feet tall. 60-80 ml.
Size 5 for Pts 6 feet or taller. 70-90 ml.

201
Q

How far should you advance a King device.

A

Till the bag mask device connector is even with the lips or gums.

202
Q

If a person is less then 4 feet tall can you place a King device.

A

No

203
Q

What are two important conditions exist for placing an ET tube.

A

Pts who have inadequate oxygenation

Pts who cannot maintain their own airway.

204
Q

Easiest of all indications for the use of an ET tube is

A

Cardiac or respiratory arrest

205
Q

A person with a fast and reversible condition like hypoglycemia or a drug overdose should or should not be intubated.

A

Not. They can come out of their condition quickly as long as we make sure they do not aspirate.

206
Q

The greatest challenge when securing an airway is knowing ——

A

When to intervene

207
Q

What condition if present des not allow us to intubate unless imminent respiratory arrest is likely.

A

Epiglottis.

208
Q

When intubating. It is good practice to have what available especially if you suspect an airway that may be shutting due to inflammation.

A

An ET tube one half size smaller and one a half size larger.

209
Q

A proper blade should be sized how.

A

Between the Pts lips and larynx.

210
Q

The straight blend is called

The curved is called the

A

The miller, Wisconsin, or Flagg blade.

The Macintosh blade.

211
Q

What size blade is for infants and large adults.

A

Size 0 for infants and size 4 for large adults.

212
Q

What shape blade is preferred for infants.

A

The miller, Wisconsin, or Flagg

213
Q

What type of lubricant should be used on a ET tube. Which kind should never be used.

A

Water based is the only one used.

Petroleum can cause cuff damage and cause inflammation.

214
Q

A cuffed ET tube is not indicated in what age patients, why.

A

Pts younger then 8 yo. They have smaller cricoid cartilages that provide a good seal by themselves.

215
Q

ET tubes are available in what lengths.

A

12-32 cm

216
Q

Internal ET tube sizes range from what sizes.

A

2.5 -5.5mm uncuffed and 5.0-10.0mm cuffed

217
Q

Common ET tube sizes for an adult is

A

7.0-8.5 mm

218
Q

For an immediate placement on an an adult what sizeET tube is used.

A

7.5mm

219
Q

When an ET tube is placed properly the distal # markings should be recorded. They usually range between what cm markings.

A

19-23 cm to the front teeth.

220
Q

A stylet is usually how big in diameter.

A

4mm

221
Q

A stylet should be how far from the end if the ET tube.

A

One half inch

222
Q

To get a Proper and accurate reading from either a color device or capnography we should get at least how many full breaths from a patient.

A

6 full breaths are needed for accurate placement.

223
Q

When using a EDD. When should we inflate the cuff in an ET tube.

A

We should inflate after the EDD device has confirmed placement.

224
Q

Increased Vagal tone and gagging can result in what

A

Bradycardia and increased ICP.

225
Q

What else can we do, on top of using a securing device, to ensure the ET tube does not become displaced.

A

Secure a Neck Collar

226
Q

How long should we stop bagging for a ET tube placement attempt.

A

No longer then 30 seconds.

227
Q

How far should the cuff be advanced past the vocal cords.

A

1/2 - 1 inch past the cords (glottis)

228
Q

How long should we preoxygenate a person before placing a ET tube.

A

30 seconds - 1minute

229
Q

What position aligns the three axes (mouth, pharynx, and trachea) the best for intubation.

A

The sniffing if no C spine trauma is suspected.

230
Q

Describe the Acronym BURP and what isn’t used for.

A

Backward Upward Rightward Pressure technique

To aid in manipulating the Larynx in order to view the vocal cords

231
Q

In folate the distal cuff of a ET tube at least how much.

A

Between 6-10 ml of air depending on the size selected.

232
Q

A good rule of thumb for cuff inflation is

A

Inflate till it is full but easily compressed between your thumb and index finger

233
Q

A weakness in the lung parenchyma called a ______ can make the patient more susceptible to a pneumothorax secondary to positive-pressure ventilation.

A

Bleb

234
Q

You must use at least how many devices to confirm ET tube placement in the trachea.

A

At least 2 devices.

235
Q

How many CMs past the vocal cords should the cuff of the ET tube be placed.

A

1 or 2 cm’s past

236
Q

When possible what should be used for Peds that weigh less then 35 kg’s in order to size them for an ET tube.

A

A braslow tape.

237
Q

What are some formulas for tube sizing for Peds less then 10 years old. Uncuffed and cuffed.

A

Age / 4 + 4 = uncuffed

Age / 4 + 3 = cuffed

238
Q

For proper depth of ET tube placement for Peds older then 2 yo, what is the formula

A

Age / 2 + 12 = ET tube depth

239
Q

For EDD on a Ped how much should they weigh at least.

A

20 kg

240
Q

For a Nasotracheal placement what should their Glasgow Coma score be.

A

Less then 8 on the Glasgow Coma scale

241
Q

What is the age cut off door a Nasotracheal tube.

A

At least 10 yo

242
Q

A smaller tube for Nasotracheal placement is needed. How much smaller?

A

1/2 to 1 size smaller

243
Q

What type of jelly if approved can be placed on the distal end of the Nasotracheal tube to help with pain and bleeding.

A

Lidocaine

244
Q

What important step that is different from the rest is needed for digital placement of a ET tube.

A

A bite block must be placed in the Pts mouth

245
Q

For transillumination technique, what indication tells us that we are in the trachea

A

The light passing through the Adam’s apple (thyroid cartridge)

246
Q

What are the 7 P’s of RSI

A 
Preparation 0-10 min
Preoxygenate 0-5 min
Premedicate 0-3 min
Paralysis with sedation 0
Protect the airway 0-15 seconds
Pass the tube and proof of placement 0-45 seconds
Post intubation management 0-60 seconds
247
Q

What Mallampati Airway Classification should RSI be used on

A

Class 1 and 2

248
Q

To wash out nitrogen from the lungs of a patient for RSI. What mask is best

A

The non rebreather.

249
Q

To minimize bradycardia and limit secretions for RSI. What medication should be given and how long before the intubation procedure.

A

Atropine. Given at least 1-2 minutes before

250
Q

What is a great alternative to Atropine if MCEP approves

A

Glycopyrrolate (Robinul)

251
Q

If the Pt has ICP or a suspected head injury. What is a great medication for RSI. Why

A

Lidocaine. It diminishes cough and gag reflexes and does not increase and may diminish ICP

252
Q

The first medications for RSI are referred to as ________ agents.

A

Adjunctive meds or agents

253
Q

Which should be given first. The paralytic or sedative. Why

A

The sedative should be given first. Nothing worse then being paralyzed and being conscious. Put them out before you paralyze them.

254
Q

Sedation is also called ________ in RSI

A

Induction

255
Q

The cricoid thyroid membrane lies how far below the vocal cords.

A

1 cm

256
Q

How big of a needle is needed for a Cric in a Adult and a Ped

A

Adult 14 gauge

Ped 18 gauge

257
Q

What special piece of equipment is needed for a needle cric to ensure proper oxygenation.

A

A jet ventilator at 50 psi

258
Q

How long should you limit a needle cric to until better means are available.

A

30 to 45 minutes.

259
Q

What is the size range for a cric endotracheal tube

A

6 to 7 mm

260
Q

Never perform a surgical cric on a child younger then ____ yo.

A

5.

261
Q

O2 saturation of hemoglobin can be measured with what device.

A

Pulse ox

262
Q

SpO2 means

A

Saturation of peripheral oxygen

263
Q

Older Pts over 75 yo may have this range of SpO2

A

86 to 90%

264
Q

What is it called when you have a low amount of hemoglobin.

A

Hemocrit

265
Q

How big is you first incision with a scalpel when performing a surgical cric and what direction does it go.

A

1-2 cm. vertical to the neck

266
Q

Colorimetric capon meters have only been know to function how long.

A

15 minutes

267
Q

According to the book what is the normal level do exhaled CO2.

A

33 to 43 mm Hg

268
Q

Which phase according to the book represents inhalation on a capnography wave graph.

A

Phase 0

269
Q

Alveolar plateau is represented by what phase on a capnography wave graph.

A

Phase 3.

270
Q

End Tidal CO2 is a number acquired at what point during ventilation.

A

The point at which exhalation ends and inhalation begins

271
Q

PEEP stands for

A

Positive end-expiatory pressure

272
Q

CPAP and PEEP should not exceed ___ cm H2O.

A

10

273
Q

What is BiPAP

A

Two levels of positive pressure effect the patient. One on inhalation like CPAP but has another on exhalation also.

274
Q

When is BiPAP used.

A

On patients with chronic respiratory failure.

275
Q

CPAP should not be used on a patient younger then

A

14 yo

AFD Paramedic School (4 decks)

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