Chp 8

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Author:
johnnyb0y488
ID:
77325
Filename:
Chp 8
Updated:
2011-04-04 20:46:31
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medic2011
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Description:
basic airway management /advance airway management
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  1. applies gentle pressure posteriorly on the anterior cricoid cartilage
    sellick maneuver
  2. sellick maneuver closes the esophagus to pressure as high as
    100 cm/h20
  3. complications of the sellick maneuver include
    • esophageal rupture
    • unrelieved gastric pressure
    • obstruction of the trachea
    • laryngeal trauma from excessive manual pressure

    (euol)
  4. nasopharyngeal airway varies from________long and its diameter ranges from _______
    • 17 to 20 cm long
    • 20 to 36 F
  5. oropharyngeal airway is designed to follow the
    palates curvature
  6. oropharyngeal sizes
    #0? to #6 ?
    • 0=neonates
    • 6=large adults
  7. when intubation what important physiologic functions of the upper airway are you bypassing
    • warming
    • filtering
    • humidifying

    (wfh)
  8. instrument for lifting the tongue and epiglottis out of the way so you can see the vocal cords
    laryngoscope
  9. curve blade
    macintosh
  10. straight blade
    miller
  11. straight blade is better for intubation ?
    infants
  12. endotracheal tubes range in sizes from
    12 to 32 cm
  13. uncuffed tube diameter ranges from
    2.5 to 4.5 mm
  14. cuffed tube diameter ranges from
    • 5.0 to 9.0mm
    • holds 5 to 10 ml
  15. tube size for adults is
    • 7 to 9 mm
    • 7.5 average
  16. what is used to facilitate endotracheal intubations when intubation is difficult
    gum elastic bougie
  17. gum elastic bougie should not be used on
    children less then 14 years old
  18. ETT movement can cause
    • cardiovascular stimulation
    • elevation in intracranial pressure
    • injury to the tracheal mucosa

    (cei)
  19. redirect the endotracheal tube during nasotracheal intubation
    magill forceps
  20. do not use what kind of lubricants
    petroleum based
  21. indications for endotracheal intubation include
    • resp/ cardiac arrest
    • unresponsiveness without gag reflex
    • inability to protect airway
    • increased risk of aspiration
    • obstruction

    (ruiio)
  22. lower airway indications include
    • severe resp distress due to
    • asthma
    • COPD
    • CHF
    • pneumonia

    (saccp)
  23. endotracheal intubation permits administration of what meds
    • lidocaine
    • epinephrine
    • atropine
    • naloxone

    (lean)
  24. only fulcrums available in the your patient mouth will be his
    upper incisors
  25. phonation
    noise made by vocal cords

    esophageal intubation
  26. which bronchus mainstem angles away more
    left
  27. ETT depth for the average male and female
    • 21cm=for women
    • 23cm=men
  28. any tear in the lung parenchyma can cause a
    pneumothorax
  29. accumulation of air or gas in the pleural cavity
    tension pneumothorax
  30. tension pneumothorax is marked by
    • worsening compliance
    • diminished breathe sounds
    • hypoxia with hypotension
    • distended neck veins

    (wdhd)
  31. trachea will deviate________from the side of the chest with the pneumothorax
    away
  32. if you suspect tension pneumothorax what is indicated
    needle decompression
  33. the best way to monitor endotracheal tube placement and ventilation
    continuous waveform capnography
  34. different indicators of proper placement
    • tube passing thro the cords
    • bilateral breathe sounds
    • no breathe sounds over the epigastrium
    • + change in c02 on ETC02
    • +capnogram
    • EDD(esophageal detector device)
    • condensation
    • no vomit in tube
    • no phonation once tube is in place
  35. maneuver that help visualize the cords during intubation
    BURP maneuver

    • backward
    • upward
    • rightward pressure
  36. bright light lateral and superior to the adams apple indicates the it has moved into the
    right or left pyriform fossa
  37. advance tube off of stylet into the larynx
    1 to 2cm
  38. digital
    tactile
    • finger
    • touch
  39. when would you do digital intubation
    • patient is deeply comatose
    • cardiac arrest
    • when proper positioning is difficult

    (pcw)
  40. giving meds to sedate and temporarily paralyze a patient and the performing orotracheal intubation
    • rapid sequence intubation
    • RSI
  41. indication for RSI
    glasgow coma score of 8 or less
  42. ______is the primary neurotransmitter and blocking its action results in relaxation of the
    • acetylcholine
    • skeletal muscle(voluntary)
  43. generalized involuntary muscle twitching
    fasciculations
  44. most commonly used depolarizing agent used paralytic agent for RSI
    succinylcholine
  45. nondepolarizing agents block the uptake of
    • acetylocholine
    • and do not allow the stimulation of the muscles

    • vencuronium
    • atracurium
    • pancuronium

    (vap)
  46. fasciculations may increase the tendency
    to vomit and may increase intracranial pressure
  47. contraindications for succinycholine
    • penetrating eye injury
    • burns greater than 8 hours duration
    • massive crush injuries
    • neurologic injuries greater than 1 week out

    (pbmn)
  48. what drug is second line therapy when succinycholine is contraindicated
    vecuronium

    giving two minutes before paralytic agent
  49. onset and duration of vecuronium and succinycholilne
    • onset
    • 2 to 3 min
    • 60 to90 sec
    • duration
    • 45 min
    • 3 to 5 mins
  50. paralytic used for patients with kidney or liver disease
    atracurium(tracruim)
  51. has long duration (60 mins) what drug?
    pancuronium
  52. surgical airway
    cricothyrotomy
  53. alternative sedatives
    • atropine
    • indication=peds and bradycardia
    • lidocaine
    • indication=head injury
  54. narrowest part of the airway in peds is
    • cricoid cartilage
    • not the glottic opening as in adults
  55. formula for ETT size
    age+16/4
  56. use what kind of ETT with infants and children under the age of 8
    noncuffed
  57. premature ETT
    size
    type
    depth
    blade size
    • 2.5-3
    • uncuffed
    • 8cm
    • 0 straight
  58. full term infant ETT
    size,type, depth,blade size
    • 3-3.5
    • uncuffed
    • 8-9.5cm
    • 1 straight
  59. infant to 1 year
    size,type, depth,blade size
    • 3.5-4
    • uncuffed
    • 9.5-11cm
    • 1 straight
  60. toddler
    size,type, depth,blade size
    • 4-5
    • uncuffed
    • 11-12.5cm
    • 1-2 straight
  61. preschool
    size,type, depth,blade size
    • 5-5.5
    • uncuffed
    • 12.5-14cm
    • 2 straight
  62. school age
    size,type, depth,blade size
    • 5.5-6.5
    • uncuffed
    • 14-20cm
    • 2 straight
  63. adolescent
    size,type, depth,blade size
    • 7-8
    • cuffed
    • 20-23cm
    • 3 straight or curved
  64. ped endotracheal tubes should be how many centimeter below vocal cords
    2 to 3 cm
  65. infants and small children have greater______that adult
    vagal tone
  66. vagal response will
    • slow child HR
    • decrease cardiac output and Bp
  67. facial and airway swelling
    angioedema
  68. blind nasotracheal intubation requires the pt to be?
    breathing
  69. king lt airway allows up to how much ventilation pressure
    30cm/h20
  70. esophageal obturator airway is a hollow tube with a closed end and a distal cuff intended to block air from the
    esophagus
  71. contraindication for EOA
    • less than 16
    • shorter than 5 ft or taller than 6'7''
    • caustic poisons
    • esophageal disease or alcoholism

    (lsce)
  72. needle criocthyromtomy is also called
    translaryngeal cannula ventilation
  73. differnces in needle circothyomtomy and open cricothyrotomy
    • needle is easier but harder to ventilate
    • open is harder but easier to ventilate
  74. narrowing or constriction
    stenosis
  75. contraindications to performing surgical airways
    • unable to identify anatomical landmarks
    • crush injury to the larynx
    • tracheal transection
    • trauma
    • tumor
    • subglottic stenosis

    (uctts)
  76. what gauge needle would you use for a needle cricothyrotomy
    14 gauge
  77. when is needle cricothyrotomy not indicated
    if high pressure ventilation equipment is not available
  78. contraindication in open cricothyrotomy
    children under 12 cricothyroid membrane is small and underdeveloped
  79. removal of the larynx
    laryngectomy
  80. surgical opening into the trachea
    tracheostomy
  81. how many mls of sterile saline do you use during suctioning a stoma
    3 mls down the trachea
  82. to suit the prehospital environment suctioning should be at least __________mmhg when occluded and a flow rate of_____liters per minute when tube is open
    • 300
    • 30
  83. stimulating the vagus nerves causes what
    • bradycardia
    • hypotension
  84. coughing causes an increases ___and reduces _____
    • intracranial pressure
    • cerebral blood flow
  85. impulse to breathe is triggered by a low Pa02 or hypoxia
    hypoxia drive
  86. default pressure for therapy regulators is
    50 psi
  87. transfer pressure from tank to tank
    high pressure regulator
  88. delivering 02 to pt
    therapy regulator
  89. indicated for low to moderate oxygen requirements
    • nasal cannula
    • 40 % 02 at 6 l
  90. particularly useful for COPD pt
    concentrations of
    24
    28
    35
    40%
    venturi mask
  91. indicated for moderate to high oxygen requirements
    • simple face mask
    • 40 to 60 % at 6 to 10l
  92. indicated for moderate to high oxygen requirements with max flow rate of 10 l/min
    partial rebreather mask
  93. highest oxygen concentration of all
    nonrebreather mask

    80 to 95% at 15 lmin
  94. what pt does humidified oxygen benefit
    • croup
    • epiglottis
    • bronchiolitis
    • patients receiving long term oxygen therapy

    (cebp)
  95. effective ventilatory support requires a tidal volume of at least
    800 ml at 10-12 breath a min
  96. rescuers expired air will contain only
    17% 02
  97. mouth to mask ventilation combined with 10 lmin can deliver an inspired 02 concentration of
    50%
  98. bvm without 02 can deliver
    21%
  99. bvm with 02 can deliver
    60 to 70 %
  100. should bvm's for adults have pop off valves
    no just peds
  101. you can best achieve a mask seal with a __________person technique using a __________to maintain an open airway
    • 2
    • jaw thrust
  102. bvm with a capacity of 450ml is for
    neonates and infants
  103. peds bvm for children up to
    8 years
  104. adult bvm has a capacity of
    1500 ml
  105. to assess adequacy of ventilations
    • look for chest rise
    • listen for lung sounds at third intercostal space on midaxillary line
    • clinical improvement
  106. demand valve mask is not recommended for pt under the age of
    16
  107. in a demand valve mask pressure exceeds______the valve opens
    60 cm h20
  108. you should never use mechanical ventilators in
    • children less than 5
    • awake pt
    • pt with obstructed airway

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