Advanced Airway Management

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Author:
readyreg29
ID:
258859
Filename:
Advanced Airway Management
Updated:
2014-02-06 08:27:03
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Advanced Airway Management
Folders:
MEDIC 2013
Description:
MEDIC 2013
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  1. The most definitive means of achieving complete control of the airway
    Intubation of the trachea
  2. Advantages of ET intubation
    • Secure airway
    • Protects against aspirations
    • Alt. route to IV/IO for certain medications
  3. Disadvantages of ET intubation
    • Special equipment
    • Physiologic functions of airway:
    • (warming, filtering, humidifying)
  4. Complications of ET intubation
    • Bleeding
    • Hypoxia
    • Laryngeal swelling
    • Laryngospasm
    • Vocal cord damage
    • Mucosal necrosis
    • Baratrauma
  5. Equipment for intubation
    • Ventilation equipment
    • ET Tube
    • Laryngoscope & blades
    • Towels
    • Suction
    • Magill forceps
    • Stethoscope and end-tidal CO2 detector
    • ET tube securing device
  6. The mnemonic for assessment of a difficult airway
    • LEMON
    • L-look externally
    • E-evaluate
    • M-mallampati (class I-IV)
    • O-obstruction
    • N-neck mobility
  7. Usual ET tube size for: 
    Men
    Women
    Pediatrics
    • Men: 7.5 to 8.5 mm
    • Women: 7.0 to 8.0 mm
    • Pediatrics: 2.5 to 4.5 mm
  8. Anatomic clues  that can help determine the proper size of a ET tube
    • Diameter of the:
    • Nostril
    • Little finger
    • Thumbnail
    • ** have 3 tubes ready
    • (size you think, larger, smaller)
  9. The two most common laryngoscope blades
    • Miller (strait)
    • Macintosh (curved)
  10. Laryngoscope blade sizes
    Adult 
    Pediatrics
    • Adults:3-4
    • Pediatrics: 0-2 (Based on age or height)
  11. Furosemide (Lasix)
    Loop diuretic
    Indications
    Dosages
    • Indications
    • Pulmonary edema
    • Congestive heart failure

    • Adult Dosages
    • IV slowly: 0.5 - 2 mg/kg max.
    • (usually 20-40mg)
  12. Nitroglycerin (Nitrostat, Tridil)
    Vasodilator, Organic nitrate, antianginal
    Indications
    Dosages
    • Indications
    • Angina
    • Myocardial infarction
    • Congestive heart failure w/ pulmonary edema

    • Adult dosage
    • SL chest pain: 1/150 gr (0.4mg) tablet or one spray (repeat x3)

    • SL pulmonary edema: 1-2 1/150 gr (0.4mg) tablets 
    • (5-10 mins as long as systolic BP >90-100
  13. Morphine Sulfate
    Narcotic agonist
    Indications
    Dosage
    • Indictions
    • Analgesia pt's: burns, myocardial infarction, renal colic
    • Pulmonary edema

    • Adult Dosage
    • 1-3mg increments slow IV push
    • (1-5 mins) until desired effect
  14. Orotracheal intubation by
    Direct Laryngoscopy
    INDICATIONS
    • Airway control needed: coma, respiratory arrest, cardiac arrest
    • Impending respiratory failure
    • Prolonged ventilatory support required
    • No gag reflex
    • Traumatic brain injury
    • Unresponsiveness
    • Airway compromise: burns or trauma
    • Medication administration (last resort)
  15. Orotracheal intubation by
    Direct Laryngoscopy
    CONTRINDICATIONS
    • Gag reflex
    • Inability to open mouth: trauma, dislocated jaw, patholoigic condition
    • Unseen glottic opening
    • Copious secretions, vomitus, blood in airway
  16. Injury to your body because of changes in barometric (air) or water pressure
    Baratrauma
  17. If a patient collapses unconscious to the ground after choking; what are the first four steps you should take:
    • Position on the ground
    • Chest compressions (30)
    • Open airway, look, remove, ventilate
    • * if no air past object, chest compress until expelled
  18. Your 1st and most reliable method of confirming that the tube has entered the trachea
    Visualizing the ET tube passing between the vocal cords
  19. Unequal or absent breath sounds when confirming tube placement suggest:
    • Esophageal placement
    • Right mainstem bronchus placement
    • Pneumothorax
    • Bronchail obstruction
  20. Indicated for patients who are breathing spontaneously but require definitive airway management to prevent further deterioration
    Nasotracheal intubation
  21. Conditions such as what are excellent candidates for nasotracheal intubation
    • COPD
    • Asthma
    • Pulmonary edema
    • Responsive pt's with altered mental status 
    • Intact gag reflex
  22. A potential complication of endotracheal intubation
    Intubation of the esophagus
  23. Administration of ___________ prevents succinylcholine-induced bradycardia in pediatric patients
    Atropine sulfate
  24. Succinylcholine should be used with caution in patients with:
    • Burns
    • Crush injuries
    • Blunt trauma
    • ** conditions resulting in hyperkalemia (high potassium)
  25. Needle cricothyrotomy involves inserting a______________ through the______________
    • 14 to 16 gauge over-the-needle catheter
    • Cricothyroid membrane
  26. Alternative airway devices, which may be used if ET intubation is not possible or is unsuccessful
    • Combitube
    • Laryngeal mask airway
    • King LT airway
    • Cobra perilaryngeal airway
  27. Combitube
  28. Laryngeal mask airway
  29. King LT airway
  30. Drugs used for RSI include
    • Sedatives
    • Diazepam (valium)
    • Midazolam (versed)
    • Neuromuscular blocking agents (succinylcholine)
  31. Using pharmacologic agents to sedate and paralyze a patient to facilitate placement of an ET tube
    Rapid-sequence intubation (RSI)
  32. Methods of providing artifical ventilations in order of preference
    • Two-person bag-mask device
    • Mouth to mask w/ supplemental O2
    • Flow-restricted oxygen-powered ventilation device
    • One-person bag-mask w/ O2
  33. ETOMIDATE
    Sedative/hypnotic agent
    Indications
    Dosages
    Induction of anesthesia for rapid sequence intubation (RSI)

    0.3 mg/kg IV over 30-60 seconds
  34. MIDAZOLAM HYDROCHLORIDE (Versed)
    Central nervous system depressant Benzodiazepine
    Indications
    • Anti-convulsant

    • Sedation 
Management of acute agitation / excited delirium 
    • Induction for intubation
  35. MIDAZOLAM HYDROCHLORIDE (Versed)
    Dosage
    Patients 14 to 60 years of age:
    IM: 2 to 5mg 

    • IV/IO: 1 to 10mg titrate to effect 
    • (2.5mg over 2 minutes)

    *Total dose: 
Should not exceed 20 mg
  36. MIDAZOLAM HYDROCHLORIDE (Versed)
    Dosage
    Patients over 60 years of age:
    IM: 1 to 5mg 

    • IV/IO: 1 to 3.5 mg IV/IO, titrate to effect
    • (1.5 mg over at least 2 minutes

    *Total dose: 
Should not exceed 20 mg
  37. MIDAZOLAM HYDROCHLORIDE (Versed)
    Dosage
    For emergency intubation:
    • 0.1mg/kg to 0.3 mg/kg
    • (limit of 20 mg)
  38. MIDAZOLAM HYDROCHLORIDE (Versed)
    Dosage
    Seizures:
    IM: 0.2 mg/kg

    IN: 0.3mg/kg (if no IV/IO access)
  39. SUCCINYLCHOLINE
    Ultra-short-acting depolarizing-type skeletal muscle relaxant
    Indications
    Dosage
    Endotracheal intubation requiring paralysis (RSI)

    • IV: 1.5mg/kg
    • (repeat 2-3 minutes to achieve paralysis)

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