-
applies gentle pressure posteriorly on the anterior cricoid cartilage
sellick maneuver
-
sellick maneuver closes the esophagus to pressure as high as
100 cm/h20
-
complications of the sellick maneuver include
- esophageal rupture
- unrelieved gastric pressure
- obstruction of the trachea
- laryngeal trauma from excessive manual pressure
(euol)
-
nasopharyngeal airway varies from________long and its diameter ranges from _______
- 17 to 20 cm long
- 20 to 36 F
-
oropharyngeal airway is designed to follow the
palates curvature
-
oropharyngeal sizes
#0? to #6 ?
-
when intubation what important physiologic functions of the upper airway are you bypassing
- warming
- filtering
- humidifying
(wfh)
-
instrument for lifting the tongue and epiglottis out of the way so you can see the vocal cords
laryngoscope
-
-
-
straight blade is better for intubation ?
infants
-
endotracheal tubes range in sizes from
12 to 32 cm
-
uncuffed tube diameter ranges from
2.5 to 4.5 mm
-
cuffed tube diameter ranges from
- 5.0 to 9.0mm
- holds 5 to 10 ml
-
-
what is used to facilitate endotracheal intubations when intubation is difficult
gum elastic bougie
-
gum elastic bougie should not be used on
children less then 14 years old
-
ETT movement can cause
- cardiovascular stimulation
- elevation in intracranial pressure
- injury to the tracheal mucosa
(cei)
-
redirect the endotracheal tube during nasotracheal intubation
magill forceps
-
do not use what kind of lubricants
petroleum based
-
indications for endotracheal intubation include
- resp/ cardiac arrest
- unresponsiveness without gag reflex
- inability to protect airway
- increased risk of aspiration
- obstruction
(ruiio)
-
lower airway indications include
- severe resp distress due to
- asthma
- COPD
- CHF
- pneumonia
(saccp)
-
endotracheal intubation permits administration of what meds
- lidocaine
- epinephrine
- atropine
- naloxone
(lean)
-
only fulcrums available in the your patient mouth will be his
upper incisors
-
phonation
noise made by vocal cords
esophageal intubation
-
which bronchus mainstem angles away more
left
-
ETT depth for the average male and female
-
any tear in the lung parenchyma can cause a
pneumothorax
-
accumulation of air or gas in the pleural cavity
tension pneumothorax
-
tension pneumothorax is marked by
- worsening compliance
- diminished breathe sounds
- hypoxia with hypotension
- distended neck veins
(wdhd)
-
trachea will deviate________from the side of the chest with the pneumothorax
away
-
if you suspect tension pneumothorax what is indicated
needle decompression
-
the best way to monitor endotracheal tube placement and ventilation
continuous waveform capnography
-
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
-
maneuver that help visualize the cords during intubation
BURP maneuver
- backward
- upward
- rightward pressure
-
bright light lateral and superior to the adams apple indicates the it has moved into the
right or left pyriform fossa
-
advance tube off of stylet into the larynx
1 to 2cm
-
-
when would you do digital intubation
- patient is deeply comatose
- cardiac arrest
- when proper positioning is difficult
(pcw)
-
giving meds to sedate and temporarily paralyze a patient and the performing orotracheal intubation
- rapid sequence intubation
- RSI
-
indication for RSI
glasgow coma score of 8 or less
-
______is the primary neurotransmitter and blocking its action results in relaxation of the
- acetylcholine
- skeletal muscle(voluntary)
-
generalized involuntary muscle twitching
fasciculations
-
most commonly used depolarizing agent used paralytic agent for RSI
succinylcholine
-
nondepolarizing agents block the uptake of
- acetylocholine
- and do not allow the stimulation of the muscles
- vencuronium
- atracurium
- pancuronium
(vap)
-
fasciculations may increase the tendency
to vomit and may increase intracranial pressure
-
contraindications for succinycholine
- penetrating eye injury
- burns greater than 8 hours duration
- massive crush injuries
- neurologic injuries greater than 1 week out
(pbmn)
-
what drug is second line therapy when succinycholine is contraindicated
vecuronium
giving two minutes before paralytic agent
-
onset and duration of vecuronium and succinycholilne
- onset
- 2 to 3 min
- 60 to90 sec
- duration
- 45 min
- 3 to 5 mins
-
paralytic used for patients with kidney or liver disease
atracurium(tracruim)
-
has long duration (60 mins) what drug?
pancuronium
-
surgical airway
cricothyrotomy
-
alternative sedatives
- atropine
- indication=peds and bradycardia
- lidocaine
- indication=head injury
-
narrowest part of the airway in peds is
- cricoid cartilage
- not the glottic opening as in adults
-
formula for ETT size
age+16/4
-
use what kind of ETT with infants and children under the age of 8
noncuffed
-
premature ETT
size
type
depth
blade size
- 2.5-3
- uncuffed
- 8cm
- 0 straight
-
full term infant ETT
size,type, depth,blade size
- 3-3.5
- uncuffed
- 8-9.5cm
- 1 straight
-
infant to 1 year
size,type, depth,blade size
- 3.5-4
- uncuffed
- 9.5-11cm
- 1 straight
-
toddler
size,type, depth,blade size
- 4-5
- uncuffed
- 11-12.5cm
- 1-2 straight
-
preschool
size,type, depth,blade size
- 5-5.5
- uncuffed
- 12.5-14cm
- 2 straight
-
school age
size,type, depth,blade size
- 5.5-6.5
- uncuffed
- 14-20cm
- 2 straight
-
adolescent
size,type, depth,blade size
- 7-8
- cuffed
- 20-23cm
- 3 straight or curved
-
ped endotracheal tubes should be how many centimeter below vocal cords
2 to 3 cm
-
infants and small children have greater______that adult
vagal tone
-
vagal response will
- slow child HR
- decrease cardiac output and Bp
-
facial and airway swelling
angioedema
-
blind nasotracheal intubation requires the pt to be?
breathing
-
king lt airway allows up to how much ventilation pressure
30cm/h20
-
esophageal obturator airway is a hollow tube with a closed end and a distal cuff intended to block air from the
esophagus
-
contraindication for EOA
- less than 16
- shorter than 5 ft or taller than 6'7''
- caustic poisons
- esophageal disease or alcoholism
(lsce)
-
needle criocthyromtomy is also called
translaryngeal cannula ventilation
-
differnces in needle circothyomtomy and open cricothyrotomy
- needle is easier but harder to ventilate
- open is harder but easier to ventilate
-
narrowing or constriction
stenosis
-
contraindications to performing surgical airways
- unable to identify anatomical landmarks
- crush injury to the larynx
- tracheal transection
- trauma
- tumor
- subglottic stenosis
(uctts)
-
what gauge needle would you use for a needle cricothyrotomy
14 gauge
-
when is needle cricothyrotomy not indicated
if high pressure ventilation equipment is not available
-
contraindication in open cricothyrotomy
children under 12 cricothyroid membrane is small and underdeveloped
-
removal of the larynx
laryngectomy
-
surgical opening into the trachea
tracheostomy
-
how many mls of sterile saline do you use during suctioning a stoma
3 mls down the trachea
-
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
-
stimulating the vagus nerves causes what
-
coughing causes an increases ___and reduces _____
- intracranial pressure
- cerebral blood flow
-
impulse to breathe is triggered by a low Pa02 or hypoxia
hypoxia drive
-
default pressure for therapy regulators is
50 psi
-
transfer pressure from tank to tank
high pressure regulator
-
delivering 02 to pt
therapy regulator
-
indicated for low to moderate oxygen requirements
- nasal cannula
- 40 % 02 at 6 l
-
particularly useful for COPD pt
concentrations of
24
28
35
40%
venturi mask
-
indicated for moderate to high oxygen requirements
- simple face mask
- 40 to 60 % at 6 to 10l
-
indicated for moderate to high oxygen requirements with max flow rate of 10 l/min
partial rebreather mask
-
highest oxygen concentration of all
nonrebreather mask
80 to 95% at 15 lmin
-
what pt does humidified oxygen benefit
- croup
- epiglottis
- bronchiolitis
- patients receiving long term oxygen therapy
(cebp)
-
effective ventilatory support requires a tidal volume of at least
800 ml at 10-12 breath a min
-
rescuers expired air will contain only
17% 02
-
mouth to mask ventilation combined with 10 lmin can deliver an inspired 02 concentration of
50%
-
bvm without 02 can deliver
21%
-
bvm with 02 can deliver
60 to 70 %
-
should bvm's for adults have pop off valves
no just peds
-
you can best achieve a mask seal with a __________person technique using a __________to maintain an open airway
-
bvm with a capacity of 450ml is for
neonates and infants
-
peds bvm for children up to
8 years
-
adult bvm has a capacity of
1500 ml
-
to assess adequacy of ventilations
- look for chest rise
- listen for lung sounds at third intercostal space on midaxillary line
- clinical improvement
-
demand valve mask is not recommended for pt under the age of
16
-
in a demand valve mask pressure exceeds______the valve opens
60 cm h20
-
you should never use mechanical ventilators in
- children less than 5
- awake pt
- pt with obstructed airway
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