Week 3 advance airway Flashcards
Difficult airway→ “LEMONS”=
Looks externally
Evaluate 3-3-2 Rule,
Mallampati Score
Obstruction
Neck mobility
Saturation (preoxygenation % for reserve)
E in lemons
3-3-2 Rule=
3 fingers (Mouth opening): PT should be able to open their mouth wide enough to fit three fingers vertically.
3 fingers (Chin to hyoid): distance from the chin to the hyoid bone should be at least the width of three fingers.
2 fingers (Hyoid to thyroid notch): distance from hyoid bone to the thyroid notch should be at least the width of two fingers.
M in lemons
Mallampati Score classes=
Class I: Everything in the back of the mouth is easily seen.
Class II: Most structures are seen, but the back pillars are not.
Class III: Only the uvula and soft palate are seen.
Class IV: Only the roof of the mouth (hard palate) is seen.
L in lemons
looks externally
is there obvious trauma, is there obvious obstructions, ect
N in lemons=
neck mobility
S in lemons
Saturations=
what is the PT’s reserve,
100% after preoxygenation has an adequate reserve
90-100% after preoxygenation has a limited reserve
Less than 90% has no oxygen reserve
Cormack/LeHane Classification system=
Grade 1: entire glottic opening & vocal cords may be seen
Grade 2: epiglottis & posterior portion of glottic opening may be seen w/ a partial view of vocal cords
Grade 3: only epiglottis & (sometimes) posterior cartilages seen
Grade 4: neither epiglottis nor glottis seen
If PT pulled out their trach tube & didn’t have another use
6.0 ET Tube
French suction catheter=
small flexible catheter
Tonsil tip/yankauer tip suction catheter=
Larger & hard catheter
Suctioning time limits:
Adult= 15 secs max
Children= 10 secs max
Infants=5 secs max
ET/Trach tube= 5-10 secs max
To prevent & burp gastric distention use=
Awake PT= (NG) nasogastric tube
Unconscious PT= (OG) Orogastric tube
Measuring NG tube=
tip of nose, around ear, & down to xiphoid process (make a “?”)
Measuring OG tube=
corner of mouth, around ear, and down to xiphoid process (make a “?”)
Decompressing (burping) gastric distention steps:
- Lube tip of tube & gently insert it
- Check tube hasn’t curled in mouth
- Confirm placement by injecting 30-50mL of air while listening to epigastric region
4.Secure tube
BURP for neck pressure=
Backward: Apply pressure posteriorly (toward the back) on the thyroid cartilage.
Upward: Apply pressure superiorly (toward the head) on the thyroid cartilage.
Rightward: Apply pressure laterally (toward the right side) on the thyroid cartilage.
Pressure: Maintain steady pressure in directions to improve view
Nasotracheal Intubation=
Indications=
Contraindications=
blind intubation
requires a cooperative or unresponsive spontaneously breathing PT
S/S of basilar skull fracture, severely deviated nasal septum, Apneic PT
FBAO Removal tool name=
magill forceps
Epiglottoplasty=
identifying where the vocal cords are
amount of apnea time PT can withstand before becoming hypoxic factors:
age, obesity, pregnancy, lung disease, baseline saturations, & acute illness
Obese & pregnant PTs have less or more receive?
less reserve in large part b/c of limited functional residual capacity.
Indication of adequate denitrogenation=
Lvls above 85% (ETCO2) End-tidal carbon-dioxide
best practice for EMS “oxygen washout”=
increase the SpO2 to above 93% & keep it there for at least 3 mis prior to attempting intubation. Using a BVM w/ a good mask seal, max oxy/ flow, a reservoir, & PEEP is an effective preoxygenation
Apneic oxygenation method=
providing oxygen to apneic (non-breathing) PT during endotracheal intubation to minimize the possibility of hypoxia developing during the procedure. This can be done by placing a nasal cannula under the BiPAP/CPAP or BVM mask to augment preoxygenation
Delayed Sequence intubation(DSI)=
use of sedative w/o paralytic to allow effective mask seal & better pre oxygenation during intubation
One of the most common causes of peri-intubation hypotension=
decreased preload→can treat this by increasing preload w/ fluid.
1 way to predict PTs who aren’t already hypotensive but at high risk during intubation=
calculate shock index
Shock index=
the ratio of HR to systolic-BP. Values over 0.9 suggest impending hypotension.
way to assess Shock Index=
if the HR is higher than the systolic-BP, the shock index must be over 1 & you should anticipate peri-intubation hypotension.
The gold standard for ETT confirmation=
Use of 4-phase waveform end-tidal CO2 (capnography)
Needle Cricothyrotomy=
inserting 14-gauge needle into the trachea at the crico-thyroid membrane (small needle for small kids)
Open=
placing a ET/Trach tube directly into trachea through incision at crico-thyroid (open up that throat)
tracheal stenosis=
narrowing of the trachea, often from injury & scarring from a artificial airway or surgical procedure
Barotrauma=
trauma/ damage to the lungs from changes in pressure or increasing pressure. (can also occur from over ventilation)
Trimsmis=
Locked Jaw
mentim=
Tip of chin
Uvula function=
blocks food from nasopharynx
Controlled hyperventalion BVM only for =
Brainstem herniation
decorded position=
flexing forearms outwards
decortit position=
flexing forearms inwards
Grade 3 & 4 LeHane class use what
Bougee
Globit cells function=
produce mucus to catch foreign substances
phonate=
Make sounds orally/talk
Intubation ETT size # X 2 =
suction size
Depolarizing paralytics last=
3-15 mins
Nondepolarizing paralytics last=
60-90 mins
DOPE =
possible reason/s why capnography changed on intubated PT
Displacement/dislodged tube
Obstruction of tube
Placement/ pneumothorax
Equipment malfunction/failure
SPo2=
oxygen hemoglobin saturation
Takes 5mins to desaturate
Normal ETCO2=
35-45mmHg
What is considered the most common reason a patient with a trach tube summons the help of 911?
Clogged tube
As neuromuscular blocking agents start to wear off, what will you see on a patient’s waveform capnography?
Curare Cleft
If a patient was to hyperventilate, what would you anticipate their ETCO2 level to be at?
below 35mmHg
What is considered a good “rule of thumb” for estimating the proper depth of an ET tube?
Depth should be approximately three times the ET tube size
During what part of the capnography waveform does the monitor obtain the ETCO2 number from?
End of Phase III
CO2 basics=
produced by all living cells, diffused into bloodstream, transported to lungs, perfused into the aveoli, exhaled through airway
Use ETCO2 as guide during resuscitation
<20 slow down, >40 increase
Increased CO2 may=
ROSC
Max Lvl of <10mmHg during 1st 20 mins after intubation was never associated w/ ROSC=
call off
Qualitative Capnometry aka Colormetry
Measures the CO₂ by the quality of the color change between purple & yellow. Simple detection of CO₂ and is not a measurement.
Capnometry=
Is the measurement of expired CO₂.typically provides a numeric display of the partial pressure of CO₂ (in Torr or mmHg) or the % of CO₂ present
Capnography=
Capnography is a graphic recording or display of the capnometry reading over time
“Shark-fin” capnography waveforms indicate
Asthma and or COPD
Sudden loss of capnography waveforms indicate
ET Tube moved out of place or loss of circulatory
Huge increase of mmHg in waveform (suddenly 85mmHg) indicates-
ROSC
Phase I
Phase II
Phase III
Phase IV
respiratory baseline
respiratory upstroke
expiratory plateau
inspiratory downstroke
Hypocapnia=
Hypercapnia=
<35mmHg
>45mmHg
