Extra Airway Stuff

Question 1

What does the OBESE pneumonic stand for? What is the criteria for using it?

Answer 1

O: Obesity (BMI > 30 kg/m2)
B: Beard
E: Edentulous
S: Snorer (OSA)
E: Elderly (Men specifically > 55yrs old)

Criteria for Difficult Mask Ventilation

Question 2

What does the BOOTS Pneumonic stand for? What does it predict?

Answer 2

B: Beard
O: Obese
O: Older
T: Toothless
S: Sounds (Snoring/Stridor)

Predicts a Difficult Airway and may show an inability to maintain O2 sat > 90% with BMV.

Question 3

What does the LEMON pneumonic stand for?

Answer 3

L: Look (Abnormal face, Trauma)
E: Evaluate (3-3-2 Rule)
M: Mallampati score
O: Obstruction/Obesity
N: Neck Mobility

Question 4

This type of intubation may be necessary if the patient has a suspected difficult Airway.

Answer 4

Awake Intubation

Question 5

What are three very important components to be mindful of when attempting to intubate a difficult airway?
What might you consider if you can’t intubate?

Answer 5

1. Optimize O2 throughout
2. Limit your attempts
3. Call for help if necessary.

Consider awakening the patient.

Question 6

What does it mean to have a dynamic airway?
What are some examples?

Answer 6

“Changing” airway
Bullets (Trauma), Bites (Angioedema), Burns (Swelling)

Question 7

When doing an awake intubation, what are the 4 steps for using local anesthesia?

Answer 7

1. Dry
2. Nebulize
3. Atomize
4. Topicalize

Question 8

What are the doses of glycopyrrolate, Atropine, and nebulized lidocaine for awake intubations?

Answer 8

Glyco: 0.2 mg
Atropine: 0.01 mg/kg
Nebulized Lido: Either 4ml of 4% or 8ml of 2%

Question 9

What are the 5 steps to laryngoscopy as discussed in lecture?

Answer 9

1. Set the table
2. Find the Epiglottis
3. Optimize the head
4. Seat the blade
5. Optimize the Larynx

Question 10

If you are not in a good position during laryngoscopy, ___ prior to trying again or use a ___.

Answer 10

Ventilate/ Bougie

Question 11

The black stripe on the bougie corresponds to what measurement at the lip and what anatomical position in a normal male airway?

Answer 11

25 cm @ the lip
mid-trachea in an adult male

Question 12

Based on a research article from the powerpoint, ___ is superior to BVM in morbidly obese patients.

Answer 12

LMA

Question 13

For induction, Ketamine could be beneficial for what patient population?

Answer 13

Asthmatics

Question 14

What 2 patient populations/physiological issues would we not want to give Etomidate to for induction?

Answer 14

1. Sepsis
2. Seizure pts

Question 15

What is the DOA of Roc?
Succs?

Answer 15

Roc: 30-90 mins
Succs: 5-10 mins

Question 16

What are the 3 “Physiologic Killers” as discussed in lecture?

Answer 16

1. Hypotension
2. Hypoxemia
3. Metabolic Acidosis

Question 17

True or False: We want to keep our sedatives low and paralytics high in Shock patients?
What two drugs are ideal for induction of shock patients?

Answer 17

True!

Ketamine/Roc (1.6 mg/kg)

Question 18

Which push-dose pressor is the ideal 1st choice?
Which one do we ALWAYS dilute?
Which one has a great effect in profound shock?

Answer 18

Epi

Neo

Vaso

Question 19

What is a DSI? Why would we use this technique?

Answer 19

Delayed Sequence Intubation

Uncooperative patients

Question 20

What does BUHE stand for?

Answer 20

Back - Up Head Elevated
(Patient doesn’t HAVE to be supine to Intubate)

Question 21

Which intervention for acidosis is “tenuous at best”?

Answer 21

Sodium Bicarb administration

Question 22

What are the vent settings for VAPOX therapy in acidotic patients?

Answer 22

NC @ 15LPM
Mode: SIM-V/PSV
Vt: 8ml/kg
FiO2: 100%
Pressure Support: 5-10 cmH2O
PEEP: 5 cm H2O
Low Resp Rate

Question 23

What are some aspiration risks discussed in lecture?
What are the treatments?

Answer 23

Upper GI Bleeds
Bowel Obstructions
Pre-induction vomiting

TX: NGT prior to intubation, intubate in a semi-upright position, bag early.

Question 24

What is the conversion of “French” to centimeters?

Answer 24

4 French = 1 cm