Week 4 "scary" airway Flashcards
ELM= external Laryngeal Manipulation→ BURP
Backwards Upwards Rightwards pressure for better glottic visual
Needle cricothyrotomy=
surgical airway inserting a 14-gauge needle into the trachea at the crico-thyroid membrane
Easier but less airway
Open Cricothyrotomy=
surgical airway that places a ETT or trach tube directly into the trachea through an incision at the crico-thyroid membrane
Harder but effective airway (50% have complications)
Tracheal stenosis
narrowing of trachea from injury/ scarring often caused by Cricothyrotomy
How to estimate PEDI ET tube size:
Uncuffed ET: (Age /4) + 4 OR (Age + 16) /4
Cuffed ET = (Age /4) + 3.5
How to estimate childs weight:
(Age + 4) x 2 = Approximate weight in kg (Old Way)
(Age x 3) + 7 = Approximate weight in kg (New Way
Cricothyrotomy Indications:
Contraindications
Inability to establish an airway by any other method!!!
None if the procedure is indicated
Needle Cricothyrotomy Potential Complications:
Barotrauma, Pneumothorax, Hypercarbia
Tidal volume in kids=
5-7mL/Kg
With kids ETT have tube sizes:
size you want, a size larger, & smaller
WHALE emblem on kid seat=
We Have A Little Emergency
Bottom of sticker with ALL of kids info
Epiglottis shape in adult=
Epiglottis shape in kids=
Domed & firm
flimsy & floppy “wet donut w/ a bite”
location of lungs in kids=
armpit to armpit for auscultation
Diaphragms in kids location &–>
straight across & sometimes “belly breath” to put more neg/ pressure on diaphragm
kids if to fight bronchoconstriction with intubation use which ETT
cuffed ETT to create resistance against constriction
Narrowest part of kid’s airway
Cricoid
Pedi ETT location
2-3 cm below cords when intubating
Pedi uncuffed sizing=
(age/4) +4 or (age +16)/4
Pedi cuffed sizing=
(age/4) +3.5
Estimate pedi weight:
(age +4) x2=Kg <Old>
(age X 3) +7=Kg <New></New></Old>
Handtevy=
your hand 1,3,5,7,9 10,15,20,25,30→ weight (Kg) in kids
Broselow tape=
tape rolled out to measure kids weight “red to head” heel to color for weight category
if kid is on the line of a weight category=
give a lil more drugs (need to be aggressive with care)
Kids have prominent Crane #10 reflex
can go bradycardic acutely
Most common cause of cric/s
Facial trauma
setting up needle cric/
End off of 3.5 et tube into 18-gauge catheter
Best way= 3mL plunger out 8.0 et tube and middle of the barrel
Less than age of 8
can only needle cric/ & 18-gauge catheter
Bleps=
weak spots in lung tissue → can pop a bleb
setting tools for surgical cric/
Surgical cric/ ~6.0 tube, scalpel, & bougie
Marfan=
stretched weak spots of tissues/skins
Paper bag syndrome=
inhaling before wrecking thus lung pops from hitting steering wheel w/ full of air
¾ inch in open pneumo
sucking chest wound
Tension pneumo only crushes
Right atrium
Kussmaul sign
increased JVD during inhalation
Hyperresonant percussion note=
direct, indirect, blunt→
Hypoperresonant= got a hemothorax
Signs in hemothorax you dont see in tension pneumo
JVD b/c blood loss
Anterior site for pneumo decompression b/c
Air is always up/rising
needle size for for decompressing pneumo
3 inches at least
Digital thoracostomy=
1-2in incision between 4th & 5th intercostal space, ( “cut finger tube” )
The diaphragm receives its stimulus from the medulla via
phrenic nerve
The anatomical landmark for the insertion of a surgical airway is
cricothyroid membrane
A surgical cricothyrotomy is contraindicated in patients less than
less than 8 years old
