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PAAM > Week 3 advance airway > Flashcards

Week 3 advance airway Flashcards

1
Q

Difficult airway→ “LEMONS”=

A

Looks externally
Evaluate 3-3-2 Rule,
Mallampati Score
Obstruction
Neck mobility
Saturation (preoxygenation % for reserve)

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2
Q

E in lemons
3-3-2 Rule=

A

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.

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3
Q

M in lemons
Mallampati Score classes=

A

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.

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4
Q

L in lemons
looks externally

A

is there obvious trauma, is there obvious obstructions, ect

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5
Q

N in lemons=

A

neck mobility

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6
Q

S in lemons
Saturations=

A

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

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7
Q

Cormack/LeHane Classification system=

A

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

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8
Q

If PT pulled out their trach tube & didn’t have another use

A

6.0 ET Tube

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9
Q

French suction catheter=

A

small flexible catheter

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10
Q

Tonsil tip/yankauer tip suction catheter=

A

Larger & hard catheter

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11
Q

Suctioning time limits:

A

Adult= 15 secs max
Children= 10 secs max
Infants=5 secs max
ET/Trach tube= 5-10 secs max

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12
Q

To prevent & burp gastric distention use=

A

Awake PT= (NG) nasogastric tube
Unconscious PT= (OG) Orogastric tube

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13
Q

Measuring NG tube=

A

tip of nose, around ear, & down to xiphoid process (make a “?”)

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14
Q

Measuring OG tube=

A

corner of mouth, around ear, and down to xiphoid process (make a “?”)

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15
Q

Decompressing (burping) gastric distention steps:

A
  1. Lube tip of tube & gently insert it
  2. Check tube hasn’t curled in mouth
  3. Confirm placement by injecting 30-50mL of air while listening to epigastric region
    4.Secure tube
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16
Q

BURP for neck pressure=

A

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

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17
Q

Nasotracheal Intubation=
Indications=
Contraindications=

A

blind intubation
requires a cooperative or unresponsive spontaneously breathing PT
S/S of basilar skull fracture, severely deviated nasal septum, Apneic PT

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18
Q

FBAO Removal tool name=

A

magill forceps

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19
Q

Epiglottoplasty=

A

identifying where the vocal cords are

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20
Q

amount of apnea time PT can withstand before becoming hypoxic factors:

A

age, obesity, pregnancy, lung disease, baseline saturations, & acute illness

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21
Q

Obese & pregnant PTs have less or more receive?

A

less reserve in large part b/c of limited functional residual capacity.

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22
Q

Indication of adequate denitrogenation=

A

Lvls above 85% (ETCO2) End-tidal carbon-dioxide

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23
Q

best practice for EMS “oxygen washout”=

A

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

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24
Q

Apneic oxygenation method=

A

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

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25
Q

Delayed Sequence intubation(DSI)=

A

use of sedative w/o paralytic to allow effective mask seal & better pre oxygenation during intubation

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26
Q

One of the most common causes of peri-intubation hypotension=

A

decreased preload→can treat this by increasing preload w/ fluid.

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27
Q

1 way to predict PTs who aren’t already hypotensive but at high risk during intubation=

A

calculate shock index

28
Q

Shock index=

A

the ratio of HR to systolic-BP. Values over 0.9 suggest impending hypotension.

29
Q

way to assess Shock Index=

A

if the HR is higher than the systolic-BP, the shock index must be over 1 & you should anticipate peri-intubation hypotension.

30
Q

The gold standard for ETT confirmation=

A

Use of 4-phase waveform end-tidal CO2 (capnography)

31
Q

Needle Cricothyrotomy=

A

inserting 14-gauge needle into the trachea at the crico-thyroid membrane (small needle for small kids)

32
Q

Open=

A

placing a ET/Trach tube directly into trachea through incision at crico-thyroid (open up that throat)

33
Q

tracheal stenosis=

A

narrowing of the trachea, often from injury & scarring from a artificial airway or surgical procedure

34
Q

Barotrauma=

A

trauma/ damage to the lungs from changes in pressure or increasing pressure. (can also occur from over ventilation)

35
Q

Trimsmis=

A

Locked Jaw

36
Q

mentim=

A

Tip of chin

37
Q

Uvula function=

A

blocks food from nasopharynx

38
Q

Controlled hyperventalion BVM only for =

A

Brainstem herniation

39
Q

decorded position=

A

flexing forearms outwards

40
Q

decortit position=

A

flexing forearms inwards

41
Q

Grade 3 & 4 LeHane class use what

A

Bougee

42
Q

Globit cells function=

A

produce mucus to catch foreign substances

43
Q

phonate=

A

Make sounds orally/talk

44
Q

Intubation ETT size # X 2 =

A

suction size

45
Q

Depolarizing paralytics last=

A

3-15 mins

46
Q

Nondepolarizing paralytics last=

A

60-90 mins

47
Q

DOPE =
possible reason/s why capnography changed on intubated PT

A

Displacement/dislodged tube
Obstruction of tube
Placement/ pneumothorax
Equipment malfunction/failure

48
Q

SPo2=

A

oxygen hemoglobin saturation
Takes 5mins to desaturate

49
Q

Normal ETCO2=

A

35-45mmHg

50
Q

What is considered the most common reason a patient with a trach tube summons the help of 911?

A

Clogged tube

51
Q

As neuromuscular blocking agents start to wear off, what will you see on a patient’s waveform capnography?

A

Curare Cleft

52
Q

If a patient was to hyperventilate, what would you anticipate their ETCO2 level to be at?

A

below 35mmHg

53
Q

What is considered a good “rule of thumb” for estimating the proper depth of an ET tube?

A

Depth should be approximately three times the ET tube size

54
Q

During what part of the capnography waveform does the monitor obtain the ETCO2 number from?

A

End of Phase III

55
Q

CO2 basics=

A

produced by all living cells, diffused into bloodstream, transported to lungs, perfused into the aveoli, exhaled through airway

56
Q

Use ETCO2 as guide during resuscitation

A

<20 slow down, >40 increase

57
Q

Increased CO2 may=

A

ROSC

58
Q

Max Lvl of <10mmHg during 1st 20 mins after intubation was never associated w/ ROSC=

A

call off

59
Q

Qualitative Capnometry aka Colormetry

A

Measures the CO₂ by the quality of the color change between purple & yellow. Simple detection of CO₂ and is not a measurement.

60
Q

Capnometry=

A

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

61
Q

Capnography=

A

Capnography is a graphic recording or display of the capnometry reading over time

62
Q

“Shark-fin” capnography waveforms indicate

A

Asthma and or COPD

63
Q

Sudden loss of capnography waveforms indicate

A

ET Tube moved out of place or loss of circulatory

64
Q

Huge increase of mmHg in waveform (suddenly 85mmHg) indicates-

A

ROSC

65
Q

Phase I
Phase II
Phase III
Phase IV

A

respiratory baseline
respiratory upstroke
expiratory plateau
inspiratory downstroke

66
Q

Hypocapnia=
Hypercapnia=

A

<35mmHg
>45mmHg

67
Q
A

PAAM (6 decks)

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