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
