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49 Cards in this Set
- Front
- Back
Adequate mask ventilation
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NBCx3
NEG gas sounds BBS Condensation CO2 Chest rise |
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Adv to masking
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SCAR
SORE THROAT, cost, anesthetic depth, relaxants not needed |
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CI for nasal intubation
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BICE
Basal skull fracture, infection, coags, epistaxis |
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Hazards of mask ventilation
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Dermatitis/necrosis
Aspiration Eye edema Conjunctiva Blindness Nerve injury -buccal facial nerve Corneal abrasion + environmental pollution, cervical spine immobility, fatigue |
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Disadv to mask
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HH DIOR
Hands not free Higher gas flows Difficult to maintain airway Intraop manipulation O2 desat Remote access |
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Comps for oral/nasal
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Airway obstruction or trauma- tongue damage/edema, epistaxis, aspiration, LARYNGOSPASM
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Indication for ETT and aspiration
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FITO PEG
Full stomach Intestinal obstruction Trauma Obesity Preggo Esophageal reflux Gastric paresis - diabetes |
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Preop interview
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FAM - food, anesthesia hx, med hx
ACP-HIDEP AIRWAY, cardio-pulm Handicap-physical abnormalities IV access Diagnostic tests Eval Proceed? |
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Equipment
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ML SLOTS
M forceps Laryngoscopes Suction Lube Oxygen/mask/circuit Tape Stylet |
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Steps for laryngospasm treatment
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PLS
Positive pressure w 100% fio2 with mask- check gastric inflation Larson maneuver at laryngospasm notch - mandible and mastoid process Succ 0.1 mg/kg Intubate only if severe hypoxemia or edema |
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Treatment for obstruction
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CJOP
Call their name Chin lift Jaw thrust - lift angle of mandible Reposition head Oral airway Remove foreign body Mask with positive pressure ventilation Intubate |
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Deep extubation
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For those who cant have coughing after procedure.. Asthma, plastic surgeries, hernia repairs
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CI for LMA
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HAPS
High pressure requirements Aspiration risk Pathology Surgical field interference |
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Hemodynamic response to intubation
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Dysrhythmias, htn, tachy, bronchospasm
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* advan to LMA
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Less Sore throat, invasive, coughing, trauma, drug needed
Smoother process |
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Intubation disadvantages
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Perforation, trauma, sore throat, nosebleeds, vocal cord injury, obstruction, dental trauma, aspiration
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Mendelsons syndrome
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Gastric content aspiration during induction
ph <2.5 n >25 cc |
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BURP
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Method to help visualize vocal cords ...
Backward upward rightward pressure of thyroid cartilage |
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Distance from teeth to vocal cords and VC to carina
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10-15 cm
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Formula to find depth of tube insertion
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Age/2 +12 under 12
7-8-9 for babies 23 male 21 female |
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Cuffed and uncuffed tube size
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Age/4+4 for un cuffed
Age/4+3 cuffed Kids usually get cuffed now over age 1 |
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Reduce gastric volume and increase pH
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NG tube
Reglan H2 blocker- ranitidine Proton pump inhibitor- omeprazole Anticholinergic- glyco Antacids-bicitra |
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Me delusions trx
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Suction
Lateral head down position Beta agonist- to help mucocilliary fx and clear secretions No lavage, abx or steroids Chest xray Fluids for SIRS / pressors Bronch |
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Reduce gastric volume and increase pH
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NG tube
Reglan H2 blocker- ranitidine Proton pump inhibitor- omeprazole Anticholinergic- glyco Antacids-bicitra |
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Mendelsons trx
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Suction
Lateral head down position Beta agonist- to help mucocilliary fx and clear secretions No lavage, abx or steroids Chest xray Fluids for SIRS / pressors Bronch |
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Causes of laryngospasm
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IBF2rectum
1. Irritant gases 2. Secretions/blood 3. Foreign bodies 4. Stimulate periosteum, dilation of rectum, celiac plexus 5. Manipulating airway during stage 2 6. Light anesthesia- before or after extubation |
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Cough 3 events
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1. Deep inspiration
2. Right Glottic closure 3. Expiratory phase |
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Cough 3 events
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1. Deep inspiration - to build high lung volumes
2. Right Glottic closure - to build pressure of over 100 cm H2O 3. Expiratory phase |
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Laryngospasm is sensed by this nerve
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Superior laryngeal nerve which innervates vocal cords
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5 important steps to airway management
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1. H&P
2. Consider ease of rapid intubation 3. Risk of aspiration 4. Plan for supraglottic ventilation 5. Risk to pt of failed airway maneuvers HARF |
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Temporary blindness from masking affects this nerve
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Central retinal artery
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Tight masks can affect these nerves
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Buccal branch facial nerve -affects orbicularis oris muscle
Supraorbital Supratrochlear |
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Purpose of airways
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Lift tongue and epiglottis away from posterior pharynx
- protect tongue - prevent biting - provide path for inserting tubes into esophagus - help sxning - obtain better mask fit |
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Causes of airway obstruction
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Soft tissue
Foreign body Tumor laryngospasm |
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Awake extubation is mandatory if
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DEAD
Difficult to mask Edema Aspiration risk Difficult to mask ventilate |
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Awake extubation criteria
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THORN CORM
TV > 5cc/kg Hands grasp head lift O2 sat RR NIF >25 cm H2O CO2 < 50mmHg Responsive Muscle relaxants |
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Awake extubation is mandatory if
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DEAD
Difficult to mask Edema Aspiration risk Difficult to mask ventilate |
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Awake extubation criteria
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THORN CORM
TV > 5cc/kg Hands grasp head lift O2 sat RR NIF >25 cm H2O CO2 < 50mmHg Responsive Muscle relaxants |
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Awake Extubation steps
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1. Correct plane -Responsive pt with spontaneous breaths adequate rate and TV
2. Insert oral airway 3. 100% O2 4. Suction 5. Deflate cuff 6. Remove during inspiration 7. Mask ventilate 8. Check for adequate air exchange 9. Assist in ventilation 10. Monitor for laryngospasm |
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Nasal intubation steps
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1. Sniffing position
2. Preoxygenate with mask 3. Prepare tube with warm saline and lube 4. Induce general anesthesia 5. Hyperextend neck 6. Insert tube into nares 7. Advance posteriorly 8. Open mouth with scissor technique 9. Insert laryngoscopes into right side of mouth and sweep tongue to the left, locate vallecula, insert tip into vallecula and lift up and away 10. Locate vocal cords 11. Ask for forceps and align ETT up to glottis 12 have assistant advance ETT past the vocal cords 13. Check placement 14. Secure tube |
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Nasal intubation steps
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1. Sniffing position
2. Preoxygenate with mask 3. Prepare tube with warm saline and lube 4. Induce general anesthesia Spray 5. Hyperextend neck 6. Insert tube into nares 7. Advance posteriorly 8. Open mouth with scissor technique 9. Insert laryngoscopes into right side of mouth and sweep tongue to the left, locate vallecula, insert tip into vallecula and lift up and away 10. Locate vocal cords 11. Ask for forceps and align ETT up to glottis 12 have assistant advance ETT past the vocal cords 13. Check placement 14. Secure tube |
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Floor intubation steps
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1. Assess pt, gather info, ventilate, monitors, suction, develop a plan, maybe give sedation
2. Gather supplies - bougie, difficult airway cart and assistant 3. Consider - sedation, topical anesthetic or NMB 4. Intubate and check placement- can use bulb and easy cap 2, o2 sats, get an X-ray Ballotment |
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Awake fiberoptic intubation steps
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1. Inform pt of why and procedure, get consent, medicate
2. Gather supplies -suction 3. Nebulizer 4% lidocaine, cetacaine spray or nerve block 4. Place Williams airway 5. Slide Parker flex tip tube over scope and insert into airway 6. Find vocal cords and advance until u see tracheal rings and carina 7. Advance ETT into vocal cords 8. Remove scope 9. Inflate cuff check placement 10. Induce general anesthesia |
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LMA INSERTION
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1. Deflate cuff
2. Lube on the back 3. Sniffing position 4. Open mouth 5. Hold LMA like a pencil 6. Slide firmly along the hard palate 7. Advance into pharynx until resistance is met 8. Inflate cuff without holding the tube 9. Watch outward neck movement 10. Connect to circuit and check placement 11. Place bite block and secure tube |
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Difficulty in LMA INSERTION
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1. C spine immobility
2. Limited mouth opening |
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Benefits of masking
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Minimally invasive
Universal Requires no sophisticated equipment Critical to managing airway |
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Components of lar cavity
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Cords
Rima Cricoid |
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3 benefits of adult ETT cuffs
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1. Positive pressure
2. Aspiration prevention 3. Leak proof inhalation of anesthesia |
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Benefits of LMA over intubation
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CDIF
C Difficult intubation Invasive F |