Term
| What is the normal ventilation rate when using a BVM? |
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Definition
| 10-15/min, or one ventilation every 5-6 seconds |
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Term
| Hyperventilation is defined as: |
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Definition
| 20 ventilation a per minute, or one every 3 seconds |
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Term
| Tidal volume is the amount of air we move with each ventilation. How can we tell if we are delivering sufficient tidal volume with each ventilation? |
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Definition
| Typically, we should deliver 6-10 mL/kg. this is based on ideal body weight. However, ensuring normal chest rise and fall is more important that any formula. |
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Term
| Each ventilation we give to our patient should be delivered over what time frame. |
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Definition
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Term
| When assessing the possible difficulty in using a BVM, we use the acronym MOANS. Which stands for: |
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Definition
Mask/seal
Obesity/obstruction
Age
No teeth
Stiff |
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Term
| Some complications of using a BVM with a BLS airway include: |
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Definition
| Gastric insufflation, barotrauma, increased intrathoracic pressure, decreased venous return, hypotension, vomiting, development of ARDS. |
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Term
| For which reason should all Pt's who have received basic BVM receive an NG tube? |
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Definition
| Decompression of gastric insufflation allows for greater diaphragm mobility. |
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Term
| List several alternative airway devices available for endotracheal intubation. |
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Definition
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Term
| According to the 2010 AHA guidelines, Sellick's Maneuver is: |
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Definition
| No longer recommended, as it increases the risk of failed intubation, and does not allow for a better view of the glottis. It is currently a class IIIB procedure, listed as being potentially harmful. |
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Term
| BURP, when used for intubation stands for: |
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Definition
| Backwards, Upwards, Rightward Pressure. This mnemonic is used for laryngeal manipulation during ETI attempts to improve the view of the airway. |
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Term
| The SHORT mnemonic is used to identify a difficult chrycothyrotomy, and stands for: |
|
Definition
Surgery
Hematoma
Obesity
Radiation distortion
Tumor |
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Term
| Indications for a surgical cricothyrotomy include: |
|
Definition
| Can't intubation, can't ventilate |
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Term
| Contraindications for surgical cricothyrotomy include: |
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Definition
| All contraindications are relative. Airway obstruction below the chrycothyroid membrane, less than 12 years of age, pre existing laryngeal or tracheal pathology, tracheal transection, destruction or deformity of landmarks. |
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Term
| Disadvantages of a surgical cricothyrotomy include: |
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Definition
| Requires extensive training and retraining to maintain proficiency, time intensive, hypoxia will develop, severe bleeding, laryngeal, tracheal, or cricoid ring injury, unidentified misplaced tube, pneumothorax, pneumomediastinum, infection. All complications are minor when compared to failed airway. |
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Term
| Methods of confirming ET placement include:, |
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Definition
| Visualization of the tube passing through the chords, condensation in the tube (both are unreliable), esophageal detector device (EDD), ETCO2 capnography/capnometry (this is the gold standard), colemetric ETCO2 detector, symmetrical chest rise, bilateral lung sounds, negative epigastric sounds |
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Term
| Advantages/uses of capnography in the intubation/ventilated patient include: |
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Definition
| Confirmation of tube placement, predicts survivability/effectiveness of CPR, immediately identifies disconnect of the ventilator or extubation, identifies the patient trying to breathe while on ventilator, control hyperventilation during head injury. |
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Term
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Definition
| Induction of sedation in a patient, followed by fast acting neuromuscular blocking agent to allow for ETI. |
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Term
| What are the 7 P's of RSI? |
|
Definition
Preparation
Pre oxygenation
Pretreatment
Paralysis with induction
Protection and positioning
Placement with proof
Post intubation management |
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Term
| During the preparation phase of RSI, we use the SOAP ME mnemonic, which means: |
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Definition
Suction (on and functioning)
Oxygen (high flow on Pt)
Airway equipment (stylets, ET's, laryngoscope, back-ups)
Pharmacology (all drugs)
Monitoring Equipment (confirmation devices, pulse ox, capnography, cardiac monitor) |
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Term
| While evaluating our patient for RSI, we should consider the LEMON mnemonic, which stands for: |
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Definition
Look
Evaluate 3-3-2
Mallampati
Obstruction
Neck motility |
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Term
| Premedication mnemonic is LOAD, and stands for: |
|
Definition
Lidocaine
Opiates
Atropine
Defasiculating agent |
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Term
| Lidocaine during RSi is given: |
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Definition
| To decrease the risk of ICP increase (effectiveness is controversial). Dose is 1.5 mg/kg, given 3 minutes prior to airway manipulation. |
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Term
| Opiates during RSI are given: |
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Definition
| To blunt sympathetic response, analgesic effects. Dose for Fentanyl is 3 mcg/kg, given 3 minutes prior to airway manipulation. |
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Term
| Atropine during RSI is given: |
|
Definition
| To decrease vagal response, and given to all children under 10. Dose is 0.02 mg/kg given 3 minutes prior to induction. |
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Term
| Defasiculating doses are: |
|
Definition
Succinylcholine: 0.15 mg/kg
10% of normal paralyzingly dose for vecuronium, pancuronium, and rocuronium. |
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Term
| Induction agents, and their dosing are: |
|
Definition
Etomidate (preferred): 0.3 mg/kg
Midazolam: 0.2-0.3 mg/kg to max of 5 mg
Ketamine: 1-2 mg/kg
Propofol: 1.5-3 mg/kg |
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Term
| Succinylcholine is the depolarizing neuromuscular blocking agent most preferred due to its fast onset and short duration for RSI. It is dosed at: |
|
Definition
Adult: 1-2 mg/kg
Child: 2 mg/kg
Newborn: 3 mg/kg |
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Term
| Alternate nondepolarizing NMBA agents for RSI, and their dosing are: |
|
Definition
Vecuronium: 0.1-0.15 mg/kg
Pancuronium: 0.1 mg/kg
Rocuronium: 1 mg/kg |
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Term
| At what SPO2 reading, should an ETI attempt be discontinued? |
|
Definition
| When the SPO2 decreases to 90% |
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Term
| Post intubation management includes: |
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Definition
| Sedation with benzodiazepines at 1/2 - 1/3 of the intial dosing, propofol infusions titrated to effect, and/or long term paralysis. |
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Term
| Contraindications for RSI include: |
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Definition
| All contraindications are relative. Anticipated difficult airway, contraindications to specific RSI medications |
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