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BioScience II > (Obesity) Emergency Airway management Article (josh) > Flashcards

(Obesity) Emergency Airway management Article (josh) Flashcards

Lets do some Fatties

1
Q

Calculation for BMI

A

BMI= weight (KG) / Height (meters squared)

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2
Q

BMI classification
Overweight
Class I Obesity
Cass II obesity (formerly Morbid obesity)
Class III obesity (formerly Severe obesity)

A

Overweight- 25.0-29.9
Class I Obesity- 30.0- 34.9
Cass II obesity- 35.0-39.9
Class III obesity- > or= to 40

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3
Q

Physiologic and Anatomic Changes:

Both __1___ consumption and __2____ production are increased

A

1-Oxygen consumption

2-CO2 production

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4
Q

Physiologic and Anatomic Changes:

both the increased O2 consumption and CO2 production are a result of what?

A

metabolic activity in excess adipose tissue and from increased work required of supportive tissue

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5
Q

Physiologic and Anatomic Changes:

do to the increased O2 consumption and CO@ production, what occurs to the “safe apnea period” in obese pts

A

decreases

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6
Q

Physiologic and Anatomic Changes:

what happens to Airway resistance?

A

increases

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7
Q

Physiologic and Anatomic Changes:

what is different about the diaphragm?

A

abnormally elevated

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8
Q

Physiologic and Anatomic Changes:

what happens to “work of breathing”?

A

Increases

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9
Q

Physiologic and Anatomic Changes:

Why do obese pt’s have an increased work of breathing?

A

secondary to abnormal chest wall elasticity and resistance to caudad excursion of diaphragm.

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10
Q

Physiologic and Anatomic Changes:
Due to the increased airway resistance, abnormally elevated diaphragm, and increased work of breathing in obese pt’s, what is the affect on there respiratory pattern? (AKA what do their respiration’s look like)

A

Shallow and rapid

with limited ventilatory capacity

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11
Q

Physiologic and Anatomic Changes:

what is a common upper airway anatomical problem with obese pts?

A

pharyngeal wall collapse

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12
Q

Physiologic and Anatomic Changes:

what causes Pharyngeal wall collapse?

A

increased fat deposition in pharyngeal tissues

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13
Q

Physiologic and Anatomic Changes:

Obesity puts pt’s at an increased risk for other health related complication. give ex of these health care issues

A 
atherosclerosis
HTN
DM
Cardiomyopathy
Arrhythmias
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14
Q

Physiologic and Anatomic Changes:

Obese pt’s have an increased risk for aspiration pneumonitis due to what?

A

Excess volume of gastric acid

increased intraabdominal pressures

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15
Q

Metabolism & Pharmacokinetics:

What type of drugs have a larger Vd

A

Lipophilic drugs (since Vd is dependent upon the amount of adipose tissue)

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16
Q

Metabolism & Pharmacokinetics:

what happens to GFR?

A

increases

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17
Q

Metabolism & Pharmacokinetics:

What happens to renaly excreted drugs in obese pt’s?

A

shorter 1/2 lives ( since their elimination is directly proportional to creatinine clearance)

18
Q

Metabolism & Pharmacokinetics:

What effect does obesity have on Heapaticly eliminated drugs?

A

none

19
Q

Airway Assessment:
the goal of airway assessment is to identify clinical features that predict difficulty in 3 main areas of emergency airway management. What are those 3 main areas?

A

1) Ventilation (w/bag mask pr extraglottic device)
2) Laryngoscopy & ETT intubation
3) Surgical Airway performance

20
Q

Airway Assessment:

Obesity my complicate all 3 areas/task, thus airway management in the obese pt’s should always be considered what?

A

Potentially difficult

21
Q

Airway Assessment: Bag Mask Ventilation

why is bag mask more difficult? (3 reasons)

A

Increased Airway resistance
Difficulty maintaining seal
Target O2 saturation difficult to obtain

22
Q

Airway Assessment: Bag Mask Ventilation

What causes the increased Airway resistance?

A

redundant airway soft tissue

Increased body mass

23
Q

Airway Assessment: Bag Mask Ventilation

what causes Difficulty in maintaining a seal?

A

requirement for higher pressures

24
Q

Airway Assessment: Bag Mask Ventilation

what causes the Target O2 saturation to become difficult to obtain?

A

O2 consumption is increased

25
Q

Airway Assessment: Tracheal intubation

what makes ETT placement difficult?

A

altered upper airway anatomy- resulting in poor view of glottis

26
Q

Airway Assessment: Surgical airway

What makes surgical airways difficult in the obese?

A

excessive soft tissue in the anterior neck

  • limits access to cricothyroid membrane
  • Difficult to identify anatomic landmarks
27
Q

Airway Management: Bag-Mask Ventilation

what is the best method for bag-mask ventilation w/ the obese pt?

A

two-person tech w/ oropharyngeal AND nasapharyngeal airways in place (yes it says AND nor or)

28
Q

Airway Management: Bag-Mask Ventilation

what position of bed is best for bag-mask ventilation?

A

angled w/ head uo and feet down (AKA reverse trendelenburg)

29
Q

Airway Management: Bag-Mask Ventilation

Why is reverse trendelenburg position good?

A
  • Reduces pressure from abdominal contents on diaphragm

- Shifts weight of chest wall INFERIORLY (thus improving chest wall diaphragm excursion)

30
Q

Airway Management: Tracheal Intubation

what position is best for ETT placement?

A
  • Reverse trendelenburg (upright position)
  • Ramped or head elevated position (extrenal auditory meatus and sternal notch horizontally aligned)

* traditionally sniffing position has been recommended to optimize glottic view during DL, but the ramped position appears to be more effective in obese pt’s*

31
Q

Airway Management: PreOxygenation

this is the essential aspect of _____ intubation

A

RSI

32
Q

Airway Management: PreOxygenation

what are some techniques to optimize preOxygenation?

A

1) Administer highest possible concentration of O2, via the best available means
2) remember NRB-mask gives 70% O2, a properly placed Bag-Mask unit gives 90-100% w/o assistance
3) Place in upright Position
4) use lubricated, BILATERAL nasal trumpets when needed

33
Q

Airway Management: PreOxygenation

how long should you pre-Oxygenate

A

3-5 min

34
Q

Airway Management: PreOxygenation

what is a way to aide in keeping O2 saturation up during the Apneic Phase of RSI

A

Nasal cannula in 5 LPM

thought this was cool

35
Q

Medication Dosing:

How should induction drugs be dosed?

A

LBW

36
Q

Medication Dosing:

how should rocuronium and Vecuronium be dosed?

A

IBW

37
Q

Medication Dosing:

How should SCh be dosed

A

TBW

38
Q

Medication Dosing:

What happens to Thiopental and Benzodiazepines effects?

A

prolonged (due to their lipophilicity and large Vd)

39
Q

Medication Dosing:

what happens to Propofol and Opiods effects?

A

no real changes very similar to non-obese

40
Q

Specific Equipment:

what type of equipment can make intubation easier

A

Short Laryngoscope handle
Larger Laryngoscope blades
ETT introducer (AKA bougie)

41
Q

Specific Equipment:

What are some devices for airway management?

A 
Optical or video Laryngoscope (glide scope)
LMA and Laryngeal tubes
Intubating LMAs
Combitube (i always think of dwayne w/this)
ETTI (bougie)
Lighted stylet
Fiberoptic stylet
Flexible Fiberoptic
42
Q

Thats it for fatties and airways article next slide is summary

A

FAT PEOPLE = Difficult airway

could have done this all in one slide

BioScience II (39 decks)

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