ALS airway

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  • Created by: Louisa
  • Created on: 17-09-20 10:43
why does the anatomy of the nose and the mouth make it difficult for advanced life support
nasal- easily obstructed, vasular and infants are nose breathers mouth - obstructed esily by tongue foreign body, teeth and tonsils. also highly vascualar
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the right lung has how many lobes compared to the left lung
3 to 2
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when assessing the airway what are obvious signs to look for
trauma, tumours, swelling, and skeletal features.
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when masnaging air way what approach do we take
step wise
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what does moans stand for
mask seal, obesity/obstruction, age, no teeth and sniffing/snoring in referece to using a bag valve mask
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what does RODs stand for?
Restricted mouth opening, obstruction/obesity, disrupted/distorted anatomy, stiff
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what does rods refer to
the sub glotic air way (IGEL)
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what does LEMON stand for?
Look external, evaluate 3-3-2, mallampati score, obstruction/obesity, neck mobility
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what does LEMON in reference to?
Laryngoscopy
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what is the 3-3-2 rule?
3 fingers in the mouth, 3 finger from tip of chin to hyoid bone, 2 fingers from hyoid bone to the thyroid carticlage
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what is the mallampati score on what scale?
1 to 4, where 1 you can see all the way to the back of the throat and 4 the tongue is blocking the thraot and can only see the hard palet
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what does SHORT stand for?
Surgery to neck, haematoma/infection, obesity, radiation therapy or tumor.
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what is short in reference to
needle cricothyrotomy
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what is the most important message during ALS
Used a structured approach and when nothing is working go back to basics
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when doing incubtion what steps would you take
do lemon first, then plan a back up plan and get your team ready, as soon as you seethe vocal cords you don;t take your eyes off them.
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in what order would you do ALS
head tilt chin lift, check air way, suction??, OP airway and bag valve mask, Igel (subglotic airway), then a larynscopy to do an incubation. if all else fails needle cric
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between each stage, if the igel fails what would you do
go back to BVM to prepare for a incubation
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what is the most important part of performing ALS
communication
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what oxygen levels do we want to achieve
no less than 92%
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what is useful to add onto equiment to assess when doing an ALD
End tidal CO2
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what are the 7 Ps in intubation
preparation, pre oxygenation, plan for failure, postion, protection, placement, post intubation care
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what are the four most important things to communicate when doing ALS
pre oxygenate, montior, iv access, equipemnt
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forpreoxygenation what oxygen levels do we use with BVM
100%
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what do we need to check for with the chest with BVM
rise and fall
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how many emergancy vital breaths are there
8
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what do you need to achieve in your plan
communicate plan for procedure, ensure theres a mutual understnaidn, equipemnt is in place
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what postion do you want your PT in for ALS
supine, head tilt chin lift (smelling the morning air) 180' access, a pillow may help achieve this
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for protection what do you need to check
working suction, and how to do BURP
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what is BURP
backward, upward, rightward, pressure (often we don't need to do this, kind of dated and can cuase damage so be super careful)
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what is important to communicate
visuals, bougie, correct length at teeth 22 to 24 cm, secrured, rise and fall of chest, airway entry bilateral, any ait entering stomach, end tidal co2 attached and value
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postintubation what is the procedure
confirm ET tube secure, attach ventilator, monitor
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what is important to socument post intubation
pre intubation assessment, procedure, and observation
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what is daltons law of partial pressures
pt = p1 +p2 + p3
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diffusion is the ability of a gas to
diffuse across a membrane
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what factors affect diffusion
solubility, concentration, amount of SA avalible and temp of fluid
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what disorders have problems with diffusion
COPD, fibrosis,tumor, and pulmonary odemea
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Pressures - oxygen moves out of haemoglobin into
cells at lungs and vic versa in the cells
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what is the bohr effect
describes heamoglobins affinity to oxygen
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where the pH is more alkaline
Hb has a higher ffinity to oxygen so won't give oxygen to tissues easily
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what pH is more acidic
Hb is weakened and has a lower affinity so oxygen is given up to tissues easily
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what is the oxygen dissociation curve
oxygen binds to haemoglobin by confirmational change, once one binds so does the rest
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lower oxygen concentrations means its
difficult for heamoglobin to absorb oxygen
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an increase in the hydrogen ions makes it more acidic this moves the curve to the.. and therefore oxygen doesn't bond
right, doesn't bond as easily in lungs but does release easily in tissues
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what can cause this effect to also take place
an increase in temperature
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a decrease in hydrogen ions causes a reduction in
partial pressure of CO2, measn more alkaline
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this moves the curve to the and this means oxygens binds
up and left. more easily in the lungs but is not released from HB at the tissues as easily.
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what also has this affect
lowering the temperature
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what are the 4 types of hypoxia
hypoxic, hypemic, stagnant, and histotoxic
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hypoxic - 4 causes - breathing gas ... decreased ... abnormal... and a heartcondition..
breathing gas lower than normal oxygen levels, decerased ventilation eg. a confined space, abnornal lung function e.g. asthma. Arteriovenous shunting e.g. congenital heart disease
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hypermic - reduced or altered .. .causing...
pH blood levels, therefore not normal oygen carrying capacity e.g. anemia or poisoning
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stagnant - this is a ... state that causes
shocked state that causes widespread inadequate perfusion
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examples of stagnant
hypovolemic, cardiogenic shcok, embolism and thrombus
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istotoxic is the bloods inability to ... e.g.
pick up and transport oxygen, eg. cyanide poisioning
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signs of tissue hypoxia
CNS impairment, restless/ confusion, unsteady gait.. tachycardia, and tachypnea
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what gas stimulates our breathing
CO2 stimulates Resp.
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1% increase in Co2 means a
increase in minute volume
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what receptors are important to detection of pH and co2 and found where?
central chemorecptors on surface of medulla
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if the chemoreceptors are stimualted by increase in h+ ions then
resp is increased to rid of the co2 at the lungs
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subjective oxygen signs
dizziness, headache, restless, air hunger, visual changes, tingling
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objective ocygen signs
increased ventialtion function, unsteady gait, tachycardia, cyanosis, hypertension, unconciuosness
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what can we use to identify poor oxygen levels
o2 sats prob, end tidal co2, and lung sounds.
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oxygen sats are an indicator of...
percentage of haemoglobin sat with oxygen at the time of measurement
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accuract of sp02 is dependent on
HB levels, arterial blood flow, temp of digit, % of inspired oxygen, amount of light seen by snesor
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what is end tidal co2
partial pressure of co2 on exhale
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normal capnography reading
35 to45 mmHg
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inceased ETco2 could mean
increased muscular activity, magnilant hyperthermia, and increased cardiac output
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decreased ETco2 could mean
decreased muscular activity, hypothermia, decerased cardiac output, PE and bonchospasm
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what are the 4 basics in managing resp failure
postition, supplemental oxygen, medication and ventilation
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how to check if its been effective managament
equal bilateral rise and fall of the chest, increase in saturations, colour improves, ETco2 in normal range, and neurological status inproves
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Other cards in this set

Card 2

Front

the right lung has how many lobes compared to the left lung

Back

3 to 2

Card 3

Front

when assessing the airway what are obvious signs to look for

Back

Preview of the front of card 3

Card 4

Front

when masnaging air way what approach do we take

Back

Preview of the front of card 4

Card 5

Front

what does moans stand for

Back

Preview of the front of card 5
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