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R: Resource Manual for Airway Management in the Emergency Department > Preparation > Flashcards

Preparation Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

What mnemonic is used to anticipate a challenging intubation?

A

L
E
M
O
N

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2
Q

LEMON mnemonic for challenging intubation

A

Look externally
- obesity
- trauma
- short neck
- previous surgery/radiotherapy
- trismus

Evaluate 3:3:2 rule
- 3: interincisor distance less than 3 of patients own fingers
- 3: mental process to thyroid cartilage (hyomental distance) less than 3 fingers
- 2: thyrohyoid distance less than 2 fingers

Mallampati score

Obstruction
- stridor etc

Neck mobility
- spinal immobilisation
- impaired by chronic/acute medical condition

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3
Q

What is the Mallampati examination

A
  • Position patient sitting upright, head neutral, mouth fully open, tongue extended and not talking
  • Class 1: soft palate, fauces, uvula, anterior + posterior pillars
  • Class 2: soft palate, fauces, uvula
  • Class 3: soft palate and base of uvula
  • Class 4: hard palate only seen
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4
Q

For: nasal prongs: outline:
- FiO2
- Flow
- Considerations

A
  • FiO2: 0.24-0.4
  • Rates: 1-5L/min
  • Drying and uncomfortable with flow rates >2 in conscious patients
  • Can be used for apnoeic oxygenation
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5
Q

For: humidified high flow nasal prongs: outline:
- FiO2 + PEEP
- Flow
- Considerations

A
  • FiO2: 1.0, PEEP: 7.4
  • Flow: 60L/min
  • Warming and humidifying allow for greater comfort
  • Greater set up time required
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6
Q

For: oxygen mask: outline:
- FiO2
- Flow
- Considerations

A
  • FiO2: 0.35-0.6
  • Flow: 6-14L/min
  • Delivered O2 falls as RR, TV and peak inspiratory flow rate rise
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7
Q

For: non-rebreather mask: outline:
- FiO2
- Flow
- Considerations

A
  • FiO2: up to 0.9
  • Flow: 15L/min
  • O2 flow must be sufficient to keep reservoir bag inflated at all times to achieve higher FiO2
  • Higher FiO2 can only be achieved with spontaneously breathing patient
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8
Q

When is the NRBM used?

A
  • When RR or effort are/anticipated to be inadequate
  • Must be used to assist ventilations otherwise patient will not generate enough negative inspiratory pressure to open the one way valve in circuit and receive O2
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9
Q

How does OPA maintain patent airway?

A
  • Lifts tongue away from oropharynx and provides patent airway
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10
Q

What size OPAs are used for an adult?

A

4: small adult
5: large adult

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11
Q

What size OPA is used for a newborn?

A

00: small/premature newborn
0: newborn
1: Neonate up to 1 year (10kg)

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12
Q

What size OPA is used for a child?

A

2: 2-4 years (10-20kg)
3: 6-12 years (20-30kg)

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13
Q

Outline all OPA sizes for paediatric patients

A

00: small/premature newborn
0: newborn
1: neonate up to 1 year (10kg)
2: 2-4 years (10-20kg)
3: 6-12 years (20-30kg)

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14
Q

How do you measure OPA?

A

Angle of jaw to central incisors

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15
Q

What are the two insertion methods for an OPA?

A
  1. Direct
    - depress tongue with tongue depressor
  2. Rotation
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16
Q

How do you measure NPA?

A

Tip of nose to tragus of ear

17
Q

What size NPA is used in adults?

A

6-8

18
Q

How do you insert NPA?

A
  • Lubricate tip
  • Advance along floor of nose
19
Q

How does ETT maintain patent airway?

A
  • Maintains airway from mouth to trachea below vocal cords
20
Q

What does the murphys eye on the ETT do?

A
  • In case of mainstem bronchial intubation (tube too far in) side port distal to cuff allows some ventilation via non-intubated bronchus
21
Q

What does the pilot tube on the ETT do?

A
  • Cuff inflation
22
Q

What size ETT for adults?

A

Standard adult male: 7.5-9
Standard adult female: 7-8.5

23
Q

What is the general depth an ETT is inserted to?

A

~21-23cm at teeth

24
Q

When are uncuffed ETTs used

A
  • Paediatric patients
    –> Due to funnel shaped trachea a cuffed tube will cause ischaemia and necrosis due to high pressure of cuff at narrowest point of airway
25
Q

What issues arise from the use of uncuffed ETTs

A
  • Gas leak
26
Q

How does LMA maintain airway patency?

A
  • mouth to above laryngeal opening
27
Q

What size LMA is used for adults?

A

4: females
5: males

28
Q

What size LMAs are used for neonates?

A

Size 1 (up to 5kg/<6 months)

29
Q

What size LMAs are used for infants?

A

Size 1.5 - (5-10kg/ 6-12 months)

30
Q

What size LMAs are used for children?

A

Size 2 (10-20kg / 1-5 years)
Size 2.5 (20-30kg / 5-10 years)
Size 4 (30-50kg / (10-15 years)

31
Q

How is the LMA inserted?

A
  • Deflate cuff fully
  • Apply lube to outer surface of cuff
  • Hold LMA like pen
  • Insert until resistance is felt
  • Inflate cuff
32
Q

What is the direct laryngoscope used for?

A
  • Lifts tongue to allow visualisation of oropharynx/larynx
33
Q

What shape blades are available for laryngoscope?

A
  • Straight (miller): children <2
  • Curved (Mac): adults
  • Hyperangulated blade (d / mccoy): for difficult airways
34
Q

What is a stylet used for?

A
  • Rigid stick which is inserted into ETT and then allows for end of ETT distal to cuff to be moulded to desired shape

! Lubricate stylet prior to insertion into ETT

35
Q

What is a bougie used for?

A
  • Semi rigid tube that is passed into cords and allows ETT to be threaded over
  • Used when it is impossible to achieve direct intubation due to inability to see cords or difficulty directing ETT between cords
36
Q

What is video laryngoscope used for?

A
  • Laryngoscope blade with camera attached to distal end of blade

R: Resource Manual for Airway Management in the Emergency Department (2 decks)

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