Chapter 2 Airway and Ventilatory Management Flashcards by Marialaina Tomolonis

Q

When preparing for an intubation what primary complication should be avoided by immediate suction

A

Aspiration

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Q

Acronym for difficult intubation assessment

A

LEMON

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Q

Define LEMON

A

L-Look externally E-Evaluate (332 rule) Distance between incisors ≥ 3 fingers Distance between hyoid and chin ≥ 3 fingers Distance between thyroid notch & floor of mouth ≥2 fingers M-Mouth/Millampati (hypopharynx classification) O-Obstruction N-Neck mobility

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Q

Objective signs of airway obstruction on inspection

A

Agitation Obtundation Cyanosis

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Q

Objective signs of airway obstruction on Auscultation

A

Noisy breathing Snoring, gurgling, crowing Hoarseness

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Q

Airway: Inspection

A

Pulse ox Head Chest Nails/circumoral skin (late sign) Retractions/accessory muscle use

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Q

Airway: Auscultation

A

Abnormal sounds Absent Sounds

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Q

Airway: Palpation

A

Trachea (midline)

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Q

Ventilation: Inspection

A

Asymmetry (Splinting/flail chest)

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Q

Ventilation: Auscultation

A

Tachypnea Absent BS

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Q

Types of Airway Techniques (2)

A

Chin-lift Jaw Thrust

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Q

Types of Airways

A

Oropharyngeal Nasopharyngeal Extraglottic + Supraglottic devices (LMA, ILMA, LTA, MEA)

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Q

Who should you not use an Oropharyngeal airway on?

A

Conscious patients

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Q

Who cannot have a Nasopharyngeal airway?

A

Pt’s w/ suspect cribiform plate fx

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Q

When is an Extraglottic/Supraglottic device used?

A

In pt’s who require adjunct airway but in whom intubation has failed or is unlikely to succeed

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Q

Do any of the Extraglottic/Supraglottic devices provide a definitive airway?

A

NO

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Q

What are the four types of Extraglottic/supraglottic devices?

A

Laryngeal Mask Airway Intubating Laryngeal Mask Airway Laryngeal Tube Airway Multilumen Esophageal Airway

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Q

What type of Airway is Demonstrated in this Photo

A

Oropharyngeal Airway

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Q

What type of Airway is Demonstrated in this photo?

A

Nasopharyngeal Airway

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Q

What type of Airway is Demonstrated in this photo?

A

Laryngeal Mask Airway

Q

What type of Airway is Demonstrated in this photo?

A

Intubating Laryngeal Mask Airway

Q

What type of Airway is Demonstrated in this photo?

A

Laryngeal tube Airway

Q

What type of Airway is Demonstrated in this photo?

A

Multilumen Esophageal Airway

Q

What is the Definition of a Definitive Airway?

A

Tube placed in the trachea w/ cuff inflated below the vocal coards. Tube connected to some sort of oxygen enriced ventilation and airway is secured with tape

What are the 3 types of Definitive Airway

1. Orotracheal Tube 2. Nasotracheal Tube 3. Surgical Airway (Cric/Trach)

What are the inidications for a Definitive Airway due to the need for Airway protection?

Severe maxillofacial fx Raisk of obstruction (Nack hematoma, laryngeal or tracheal injury, Stridor) Risk for aspiration (bleeding, vomiting) Unconscious

What are the indications for definitive airway due to the need for ventilation/oxygenation?

Inadequat resp status (tachypnea, hypoxia, hypercarbia, cyanosis) Massive blood loss and need for vol resusc Severe closed head injry w/ need for hyperventilation Apnea

GCS \< 8 You Must \_\_\_\_\_\_

Intubate

Whic definitive endotracheal intubation is preferred?

Orotracheal

When can Nasotracheal intubation be used?

only in pt's who are already spontaneously breathing

When is NT tube contraindicated?

Frontal sinus, basilar skull, and cribiform plate fx suspect Apnea

What CONFIRMS proper tube placement

X-ray

What SUGGESTS proper tube placement?

Lung sounds present bilaterally No borborygmi Presence of CO2 in exhaled air on capnography

What should be used if OT placement is unsuccessful on the first try?

GEB (Gum Elastic Bougie)

Steps for Rapid Sequence Intubation (10)

1. Plan for failure 2. Ensure suction + pos pressure vent are ready 3. Preoxygenation w/100% O2 4. Cric pressure 5. Admin Induction (etomidate 0.3mg/kg) or sedative 6. Admin Succsinylcholine (1-2mg/kg) 7. after pt relaxes intubate OT 8. Inflate cuff, confirm placement 9. releast Cric 10. ventilate

Why is etomidate preferred to other sedatives?

Does not have significant effect on BP/ICP while still sedating

Why does care need to be taken when using etomidate and other sedatives?

Can cause loss of the airway

What is the downside to using Etomidate?

can suppress adrenal function

What is the onset and duration of action of succinylcholine?

onset \< 1 min duration ≤ 5 min

What electrolyte imbalance can succinylcholine cause? Why does this matter?

Hyperkalemia Cution w/ pt's who have crush injury, burns, electrical injury

What are the 2 types of Surgica Airway?

Needle Cricothyroidotomy Surgical Cricothyroidotomy

When is a surgical Airway appropriate?

ET failure, LMA/ILMA failure Glottis Edema FX of larynx Seere orpharyngeal hemorrhage

How long can a needle cric be used for?

30-45 min

What size cannula is used in needle cric?

adults - 12-14g

Who should not get a surgical cric?

Children \< 12yo

When should the result of calorimetric tests be used?

After 6 breaths Gastric distension can cause increase in exhaled CO2 levels , but clears up in a few breaths.

What type of intubation is indicated in this photo?

Orotracheal Intubation

What type of intubation is indicated in this photo?

Nasotracheal intubation