Respiratory Emergencies Flashcards
If a patient is breathing fairly adequately, how should you manage their airway? In other words, what’s the first line of airway management?
give supplemental osygen with nasal cannula or a mask and reposition the patient to maximize air exchange
If the patient’s breathing is labored, but their airway is still intact, what’s the next step you can take beyond cannula or mask?
consider assisting their breathing with CPAP or BiPAP
How do CPAP and BiPAP differ?
CPAP is continuous positive airway pressure and bipap will have positive pressure during inspiration and then let up on the pressure during expiration
If you have to intubate someone, how can you assist oxygenation prior to doing so?
Using a bag-valve mask
What are four examples of trauma injuries that often require airway management?
facial traumas
neck injuries
flail check
burns
What are some illnesses leading to hypoxia requiring airway management?
pulmonary edema COPD aspiration infeciton drugs allergid reactions - anaphylaxis and angioedema
What is one class of drug that is particularly bad for causing angioedema - even years after stopping the drug?
ACE inhibitors
What are some mechanical reasons to manage an airwa?
- comrpession of the airway by infection
2. partial or complete obstruction secondary to foreign body or infections like epiglotitis or trachiitis
What are 4 signs that someone isn’t protecting their airways?
decreased LOC (GCS less than 8)
absence of protective reflexes (gag or cough)
apnea
hypoventilation leading to hypercapnia and hypoxia
What are 3 primary reasons not to intubate?
- patient is protecting their airway adequately
- oxygenation can occur by other less invasive means
- DNI
Where do you place an endotracheal tube? How do you know if it’s gone too far?
You want it to go down the trachea to above the carina.
if you pushed too far, it will go down the right main bronchus so you will only hear breath sounds on the right and not the left - just pull back a bit
When should you switch to the back-up plan?
if you fail intubation a second time
What are the “back-ups” to intubation?
combitube
king airway
laryngeal mask airway (LMA)
How does a combitube work?
same concept - there’s a distal cuff that will obstruct the esophagus and a proximal cuff that obstructs the mouth so the only place the air can go is down the trachea
Describe a king airway?
same concept as a combitube, but the actually tube used is less complex. cuffs are inflated afterward
Describe a laryngeal mask airway. Who uses it?
there’s a leaf-like thing that covers over the esophagus. you can do a blind insertion - doesn’t need to go past the vocal chords. Anesthesiologists like this.
If all else fails, what can you do?
cricothyroidotomy
Describe someone who is a potentially difficult intubation?
short neck prominent upper incisors receding mandible limited jaw opening limited cervical spine mobility
(an ape)
What is rapid sequential intubation?
basically a list of drugs you should use in intubation
What is the depolarizing neuromuscular blocker?
succinylcholine
Describe succinylcholine’s mechanism of action
it’s an ultrashort-acting skeletal muscle relaxant that combines with cholinergic receptors at the motor endplate to produce flaccid paralysis - binds even more firmly to the receptor than acetylcholine
How is succinylcholine broken down?
rapidly by pseudocholinesterases into succinylmonocholine
How can you see the depolarizing action at the muscle’s motor endplate?
clinically visible muscle fasiculations
How long does it take for succinylcholine to take effect? How long does it last?
takes effect in 30-60 seconds, so optimal intubating ocnditions occur at 60-90 seconds
paralysis usually lasts 8-12 minutes
