Emergency Medicine Airway Management and CV Collapse Flashcards
For CONCIOUS patients healthcare providers should perform the ACLS survey. What is this?
Advanced Cardiac Life Support
ABC
- Airway
Is it open and clear?
- Breathing
Is ventilation and oxygenation adequate?
- Circulation
What is needed to support the pulse and blood pressure?
Airway Management
- If NO C spine concern what is the 1st step? If there is?
- 2nd step?
- If NO respiratory effort begin what?
- Insert what?
- OPEN AIRWAY → head tilt/chin lift (if no c-spine concerns)
* jaw thrust is adequate if c-spine issues - CLEAR the airway with suction (if available)
- NO RESPIRATORY EFFORT → begin ventilation with bag-mask (BMV) device
- INSERT → nasopharyngeal or oropharyngeal airway
Airway Management
In unconscious patient with respiratory effort?
- Administer high-flow oxygen
- Ensure no obstruction to upper airway
- Insert nasopharyngeal or oropharyngeal airway
- If suspected lower airway obstruction → perform heimlich maneuver
‘High-Flow’ Oxygen Options? (3)
- Nasal Cannula with flow rate at 6L/min provides about 40% FIO2
- ‘Dial-a-Concentration’ or Venturi-Masks can deliver from 24-40% FIO2
- Non-Rebreathing (NRB) Masks with reservoirs can deliver a little less than 100% FIO2 (litre flow needs to be at least 10)
Nasopharyngeal Airways (NPA)
- Usually better with what?
- Can be used when there is what? (can’t with an oral airway)
- Ensure what before placement? (2)
- Can lead to?
- usually better tolerated in conscious patients (compared w the oropharyngeal airways)
- can usually be used even with intact gag reflex
- ensure it is not too long or too big + lube with lidocaine jelly
- can lead to epistaxis
Nasopharyngeal Airway Placement
- Outer diameter of the NPA should be what size?
- Length should not be longer than what?
- Lubricate and place how?
- outer diameter of the NPA should not be larger than the inner diameter of the nares
- length should not be longer than from the tip of the patient’s nose to the earlobe
- lubricate with water-soluble lube and insert in a plane perpendicular to the face
Oropharyngeal Airways (OPA)
- For who?
- Will often lead to emesis if what?
- Needs to be inserted carefully because?
- Impossible to insert in who?
- Not as adequate in?
- for unconscious patients
- will often lead to emesis if gag reflex is intact
- needs to be inserted carefully so that tongue is not pushed back therefore blocking the airway
- difficult or impossible to insert with seizing patient
- not as adequate in edentulous (no teeth) patients
Proper size OPA stretches from where to where?
The mouth to the angle of the mandible.
Laryngeal Mask Airway (LMA) indications? (5)
- rescue device after failed intubation
- can be attempted quickly while another person is preparing for a cricothyroidotomy (an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations)
- pre-hospital setting
- plan for short term intubation
- good alternative to continued bag-mask ventilation
LMA can decrease aspiration risk (for which patients)?
Can not be intubated but can be ventilated
Laryngeal Mask Airway
- Allows isolation of what?
- It is designed to sit where in the patient?
- Used in what settings? (3)
- Advanatges?
- Success rate?
- allows relative isolation of the trachea
- it is designed to sit in the patient’s hypopharynx and cover the supraglottic structures
- used in many settings →
- operating room
- emergency department
- out-of-hospital care
- easy to use and quick to place, even for the inexperienced provider
- success rate for placement of a LMA of nearly 100% occurs in the operating room
LMA contraindications? (2)
- can not open mouth
- complete upper airway obstruction
What are the 7 steps of LMA insertion?
- select the proper size
- size 4 for females
- size 5 for males
- inflate then deflate the cuff
- lubricate the back of the mask
- patient placed in sniffing position
- may need to use sedation like versed or propofol
- slide the mask down the posterior pharyngeal wall until resistance is felt
- inflate the mask with the recommended amount of air
- confirm tube position
LMA complications? (3)
- any airway device with a cuff can cause necrosis if the cuff is overinflated
- mask tip can fold and can cause obstruction by pushing down on the epiglottis
- mask tip can fold back on itself
When could the LMA mask tip fold back on itself? (3)
- if mask is not pushed up against the hard palate
- if not adequately lubricated
- if cuff is not adequately deflated
Combitube
(oesophageal tracheal airway or oesophageal tracheal double-lumen airway)
- Functions when placed in either the what? (2)
- Does insertion require neck movement?
- Insert how?
- Check what for oesophageal intubation?
- Ventilate through the what?
- oesophagus or trachea
- no neck movement required
- insert blindly
- white port (oesophageal)
- blue port (ventilation)
Intubation ‘Rules’? (4)
- Oxygenate before and after you intubate
- Intubate early
- Intubate as soon as you think about it
- Make sure the patient is not a DNI/DNR prior to intubation