Chapter 2 Airway and Ventilatory Management Flashcards
When preparing for an intubation what primary complication should be avoided by immediate suction
Aspiration
Acronym for difficult intubation assessment
LEMON
Define LEMON
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
Objective signs of airway obstruction on inspection
Agitation Obtundation Cyanosis
Objective signs of airway obstruction on Auscultation
Noisy breathing Snoring, gurgling, crowing Hoarseness
Airway: Inspection
Pulse ox Head Chest Nails/circumoral skin (late sign) Retractions/accessory muscle use
Airway: Auscultation
Abnormal sounds Absent Sounds
Airway: Palpation
Trachea (midline)
Ventilation: Inspection
Asymmetry (Splinting/flail chest)
Ventilation: Auscultation
Tachypnea Absent BS
Types of Airway Techniques (2)
Chin-lift Jaw Thrust
Types of Airways
Oropharyngeal Nasopharyngeal Extraglottic + Supraglottic devices (LMA, ILMA, LTA, MEA)
Who should you not use an Oropharyngeal airway on?
Conscious patients
Who cannot have a Nasopharyngeal airway?
Pt’s w/ suspect cribiform plate fx
When is an Extraglottic/Supraglottic device used?
In pt’s who require adjunct airway but in whom intubation has failed or is unlikely to succeed
Do any of the Extraglottic/Supraglottic devices provide a definitive airway?
NO
What are the four types of Extraglottic/supraglottic devices?
Laryngeal Mask Airway Intubating Laryngeal Mask Airway Laryngeal Tube Airway Multilumen Esophageal Airway
What type of Airway is Demonstrated in this Photo
Oropharyngeal Airway
What type of Airway is Demonstrated in this photo?
Nasopharyngeal Airway
What type of Airway is Demonstrated in this photo?
Laryngeal Mask Airway
What type of Airway is Demonstrated in this photo?
Intubating Laryngeal Mask Airway
What type of Airway is Demonstrated in this photo?
Laryngeal tube Airway
What type of Airway is Demonstrated in this photo?
Multilumen Esophageal Airway
What is the Definition of a Definitive Airway?
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
- Orotracheal Tube
- Nasotracheal Tube
- 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)
- Plan for failure
- Ensure suction + pos pressure vent are ready
- Preoxygenation w/100% O2
- Cric pressure
- Admin Induction (etomidate 0.3mg/kg) or sedative
- Admin Succsinylcholine (1-2mg/kg)
- after pt relaxes intubate OT
- Inflate cuff, confirm placement
- releast Cric
- 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
