Management of the emergent airway Flashcards
Treat angioedema from allergy with ___.
Treat angioedema from ACE inhibitors with ___.
Treat angioedema from C1 esterase deficiency with ___.
Treat angioedema from allergy with epinephrine and methylprednisolone.
Treat angioedema from ACE inhibitors with icatibant.
Treat angioedema from C1 esterase deficiency with icatibant.
Icatibant is a synthetic bradykinin B2 receptor antagonist
Initial ventilator settings for an emergent airway
Assist control mode (AC)
14 breaths/minute, TV 6-8 mL/kg
100% FiO2, PEEP of 5 cm H2O
End-inspiratory and pleateau pressures < 30 cm H2O
Cutoffs of A-a gradient
A-aDO2 < 15-20 is normal
A-aDO2 > 300 is the definition of ARDS
Quick calculation of the A-aDO2
A-aDO2 = (FiO2 x 7) - PaO2 - (PaCO2 x 1.2)
Management of partial tracheal transsection
Direct laryngoscopy is contraindicated as this can result in complete airway loss.
Like laryngeal obstruction, this is a case where surgical airways are necessary.
Sellick maneuver
Compression of the cricoid cartilage
This results in flattening of the esophagus between the cricoid cartilage and cervical spine, reducing the risk of gastric aspiration during intubation.
Needless to say, this should not be performed in someone with possible cervical spine injury requiring cervical collar.
How can you confirm a successful intubation?
- Capnography. A CO2 sensor will always be attached to the ETT, which will show increased CO2 within ~6 breaths of intubation.
- CXR. This is slower and is done following capnography confirmation. Mostly this ensures that, in the setting of a normal capnograph, you are not in one of the mainstem bronchi.
Auscultation is NOT RELIABLE for determining proper placement of the ETT.
Cricothyrotomy steps
In a cricothyrotomy, you are inserting your catheter through the cricothyroid membrane between the thyroid cartilage (superior) and cricoid cartilage (inferior).
