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131 Cards in this Set
- Front
- Back
T or F: Airway and ventilation are the first most critical steps in every pt?
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True
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Presence of gas or air in pleural cavity
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Pneumothorax
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5 Types of airway obstruction:
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1. Tongue
2. Foreign bodies 3. Trauma 4. Laryngeal spasm and edema 5. Aspiration |
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What is the most common type of airway obstruction?
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Tongue
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Foreign bodies obstructing the hypopharynx are often caused by ___, involve ___ consumption or ___ dislodgement.
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Food
Alcohol Dentures |
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Choking in restaurants that looks like a heart attack is often called:
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Cafe Coronaries
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T or F: Children do not aspirate things they swallow because their airway is relatively small.
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False (they aspirate a lot because they put so many things in their mouths)
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T or F: The glottis is the narrowest part of an adult's airway, therefore edema or spasm of the vocal cords is potentially lethal.
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True
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Removing a tube from a body opening:
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Extubation
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Trauma, anaphylaxis, epiglottitis, and inhalation of hot gases can cause:
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Laryngeal spasm and edema
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The most common cause of laryngeal spasm is:
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Over aggressive intubation
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__ is the most commonly aspirated material.
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Vomitus
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Obtunded is another word for:
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Drowsy
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Damage to the lungs or infection occur in __ to __ % of PTs that aspirate foreign matter.
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50 - 80
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Inadequate ventilation can lead to ___ and ___.
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Hypercarbia and hypoxia
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___ is the key to airway management in every PT.
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Viligance
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___ is to identify any immediate threats to the PT's life.
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Primary assessment
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3 primary problems you are looking at during primary assessment:
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Airway
Breathing Circulation |
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Normal adult respiration rate:
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12 - 20
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_ should be spontaneous, effortless and regular.
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Breathing
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Assymetrical chest wall movement that lessens respiratory efficiency.
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Paradoxical breathing
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Defect in chest wall that allows a segment to move freely, causing paradoxical chest wall motion.
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Flail Chest
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___ includes focused history and physical exam.
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Secondary assessment
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Focused history may include:
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Time of onset
What was PT doing Allergies Medications Past Med Hx |
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Physical exam will include:
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Inspection
Auscultation Palpation |
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Bluish discoloration
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cyanosis
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An abnormality of breathing rate, pattern or effort
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Dyspnea
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Oxygen deficiency
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Hypoxia
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The absence or oxygen
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Anoxia
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Modified respirations include:
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Coughing
Sneezing Hiccoughing Sighing Grunting |
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Drop in blood pressure of greater than 10 torr during inspiration.
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Pulsus paradoxus
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5 common abnormal respiratory patterens:
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1. Kussmaul's
2. Cheyne-Stokes 3. Biot's 4 Central neurogenic hyperventilation 5. Agonal |
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Deep, slow or rapid, gasping breathing, commonly found in DIABETIC KETOACIDOSIS
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Kussmaul's respirations
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Progressively deeper, faster breathing alternating gradually with shallow, slower breathing indicating BRAINSTEM INJURY.
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Cheyne-Stokes
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Irregular rate and depth with sudden, periodic episodes of apnea, indicating increased INTRACRANIAL PRESSURE.
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Biot's
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Deep, rapid respirations, indicating INTRACRANIAL PRESSURE.
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Central neurogenic hyperventilation
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Shallow, slow or infrequent breathing indicationg BRAIN ANOXIA.
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Agonal
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Results from partial obstruction of the upper airway by tongue.
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Snoring
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Results from accumulation of bloo, vomit or other secretions in upper airway.
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Gurgling
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Harsh, high pitched heard on inhalation. Associated with laryngeal edema or constriction.
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Stridor
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Musical, squeaking or whistling on inspiration or expiration. Associated with broncho constriction.
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Wheezing
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Lack of sound indicating problem with airway and or breathing.
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Quiet
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Sounds that may indicate compromise of gas echange:
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Crackles
Rhonchi |
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Bubbling sound heard on inspiration. Associated with fluid in the smaller bronchi.
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Crackles
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Rattling noise heard on inspiration. Associated with inflammation, mucus or fluid bronchi.
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Rhonchi
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Stiffness or flexibility of the lung tissue.
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Compliance
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T or F: A fall in teh pulse rate in a PT with airway compromise is not an immediate concern.
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False
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Measurement of hemogloblin oxygen sat in the peripheral tissues.
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Pulse oximetry
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Saturation of arterial blood with oxygen as measured by pulse oximetry, expressed as a %.
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Oxygen sat % (SpO2)
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PaO2
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Partial pressure of oxygen in blood.
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What's known as the 5th vital sign?
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Pulse Ox
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Normal SpO2
Mild hypoxia Moderate hypoxia |
95 - 100%
91 -94% 86 - 90% |
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Measurement of exhaled CO2 concentration.
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Capnography
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Disposable ETCO2 detector that contains pH-sensitive, chemically impregnated paper encased within a plastic chamber.
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Colorimetric Device
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Detectors that use infrared thechique to detect CO2 in exhaled breath are __?
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Electronic devices
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___ reflects CO2 concentrations over time, usually in 4 phases.
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Capnogram
1. Flatline 2. Upstroke 3. Respiratory Plateau 4. Downstroke |
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4 manual airway maneuvers:
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1. Head Tilt/Chin Lift
2. Jaw Thrust 3. Jaw Thrus w/o head extension 4. Celleck Maneuver |
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2 basic mechanical airways:
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1. Nasopharyngeal airway (NPA)
2. Oropharyngeal airway (OPA) |
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4 advanced airway devices that could be used to establish an airway:
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1. Endotracheal Tube (ET Tube)
2. Esophageal Tracheal CombiTube (ETC) 3. Laryngeal Mask Airway (LMA) 4. Pharyngo-tracheal lumen (PtL) King Tube not mentioned in book. |
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Instrument for lifting the tongue and epiglottis in order to see the vocal cords.
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Laryngoscope
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2 Types of laryngoscope blades:
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1. MacIntosh blade (Mac-curved)
2. Miller blade (straight) |
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Mac blade is designed to go into the __.
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Vallecula
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Miller blade is desgned to go under the ___.
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Epiglottis
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An endotracheal tube (ETT) is a flexible, translucent tube ranging from __ to __.
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12 -32 cm
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Plastic covered metal wire used to bend teh ETT into a J or hockey-stick shape.
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Stylet
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Scissor-style clamps with circular tips.
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Magill forceps
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What is a dual-lumen airway with ventilation port for each lumen?
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ETC or Combitube
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I hope this works
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I don't want to do this again
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What is a tunnel through a tube?
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Lumen
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Name some indicators for Endotracheal Intudation
(6) |
*Respiratory/Cardiac arrest
*Unconsciousness *Risk of Aspiration *Obstruction due to foreign bodies, burns, trauma, of anaphylaxis *Resp. extremis due to diseases *Pneumothorax, Hemothorax, or Hemopneumothorax w/ resp. difficulty |
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List of Intubation devices
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Endotracheal Tube(ETT)
Esophageal CombiTube(ETC) Pharyngo-tracheal lumen airway (PtL) Laryngeal Mask Airway(LMA) Esophageal Gastric Tube (EGTA) Esophageal Obturator Airway (EOA) |
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Do not intubate in the prehospital setting if _____ is present, instead rapid transport to the operating room.
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Epiglottitis
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A PtL or pharyngo-trachael lumen airway has how many lumen?
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Two
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True or False
Bypassing the upper airway's function of warming, filtering, and humidifying the inhaled air is an advantage of Endotrachael Intubation |
False
The statement is a disadvanatage |
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A Cobra perilaryngeal airway (PLA) holds soft tissue and what out of the way?
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The epiglottis
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The only fulcrum in the a Pt's mouth are _______, which is why you want to lift instead of flexing the wrist while using the laryngoscope blade.
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Upper incisors
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Needle cricothyrotomy inserts what gauge needle into the trachea at the cricothyroid membrane?
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14 gauge
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To avoid hypoxia during intubation, limit each intubation attempt to no more than ____ seconds.
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30 seconds
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What does a open cricothyrotomy insert into the trachea?
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either an endotracheal tube or tracheostomy tube through an incision in the cricothyroid membrane.
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*Absence of chest rise
*Absence of breath sounds *Gurgling sounds over epigastrium *Distention of Abdomen *Absence of condensation in tube *Persistence of air leak *Cyanosis *Phonation (noise made by vocal cords) * No color change w/colormetric CO2 detector *falling pulse ox are all indicators of ______ |
Esophageal Intubation
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What is barotrauma?
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injury caused by pressure within an enclosed space.
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If you inserted ETT to far, most likely the tube will enter the _____ mainstem
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Right
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What does stenosis mean?
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narrowing or constriction
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The average depth of ETT for men is ____ cm and for women is ____ cm
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men: 23cm
women: 21 cm |
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What is the only indication for a surgical airway?
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The inability to establish an airway by any other method.
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Any tear in the lung parenchyma can cause a _____.
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Pneumothorax
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What is the opening in anterior neck that connects the trachea with ambient air?
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Stoma
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*more difficulty in ventilating
* diminished unilateral breath sounds * hypoxia w/hypotension * distended neck veins *deviated trachea these are all signs/markings of |
Tension Pneumothorax
(the trachea will deviate away from the side of the pneumothorax) |
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Suction means?
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To remove with a vacuum type device
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The most widely preferred and most commonly used path for endotracheal intubation is ______?
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Orotracheal Intubation
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Two types of suctioning catheters are?
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Hard and Soft
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During Orotracheal Intubation, what are the landmarks for the blades Mac vs Miller
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Mac Blade- distal end at the base of the tongue in the vallecula
Miller Blade- distal end is under the epiglottis |
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A high pressure regulator is used to transfer oxygen from what?
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Tank to Tank
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The most reliable method of confirming correct ETT placement is ?
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Direct visualization of the ETT passing through the vocal cords
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A pressure regulator used for delivering oxygen to the patients?
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Therapy regulator
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When using a Check ball to confirm ETT placement, resistance to air withdrawl or the creation of a vacumn is a sign of _____
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Esophageal Intubation
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A nasal cannula is placed at the?
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nares
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It is ideal to verify and document at least ____ different indicators of proper tube replacement
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3 different indicators
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A venturi mask is a high flow mask that uses a venturi system to deliver what kind of oxygen concentrations?
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relatively precise oxygen concentrations
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BURP is a maneuver to enhance visualization of the vocal cords, BURP is an acronym for?
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B- backward
U- upward R- rightward P- pressure |
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A venturi mask is useful with what kind of patients?
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COPD
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What is an advantage and a limitation for Transillumination Intubation
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Advantage- you can perform ET intubation w/out manipulating a trauma PT's head/neck
Limitation- Bright ambient light makes the transillumination difficult to see |
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On a simple face mask, what percentage of oxygen do you get?
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40 to 60% usually flow at 6-10 lpm
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What are some advantages of digital intubation
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*does not require manipulation of head or neck
* does not require visualization * helpful when facial injuries distort Pt's anatomy *helpful when you can't suction blood/vomitus for a proper view of airway |
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A simple face mask has what on the sides of mask?
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side ports allow room air to enter the mask and dillute the oxygen concentration during inspiration.
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What is your most immediate concern with every patient?
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Maintaining a patent airway and adequate oxygenation and ventilation
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Partial rebreather mask has side ports that are covered by what?
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One way discs, these masks are used for moderate to high oxygen concentrations.
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Glasgow Coma Score of ___ or less is a sign of Altered Mental Status and an indication for ?
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RSI
Rapid-sequence Intubation |
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Maximum flow rate on a partial rebreather mask is?
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10 lpm
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The most preferred neuromuscular blocking agent (paralytic) for emergenc RSI is
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Succinylcholine
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Nonrebreather mask has a reservoir bag with what in it?
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oxygen ready to inhale
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Application of the Sellick maneuver will help to prevent
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Aspiration
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What provides the highest concentration of oxygen?
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Non rebreather at 80 to 95% at 15lpm
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Ture of False
During RSI you want to paralyze the PT before you administer a sedative. |
False
Sedate then paralyze |
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Effective ventilatory support requires a tidal volume of what?
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800 ml over 10 to 12 breaths per minute
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The preferred laryngoscope blade for most pediatric PT's is
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Straight (Miller) blade
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If doing mouth to mouth ventilations, what percentage of oxygen is the pt getting?
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17%
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What are 2 ways to measure an ETT for pediatrics
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1- (Age in years+16) / 4
2- match diameter to the child's smallest finger |
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BVM is a self inflating bag with how many valves?
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2 one way valves
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Do you want to use a cuffed or uncuffed ETT with infants and children under 8 yoa, and why?
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Uncuffed because the narrowing of the child's cricoid cartilage forms a suitable cuff
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What percentage of oxygen does a BVM give when not hooked up to oxygen?
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21% and 60-70% hooked up to oxygen. 90-95% when BVM has an adjunct oxygen reservoir or corrugated tubing
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The depth of insertion of the distal tip for pediatric ETT should be ___ to ___ cm below the vocal cords.
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2-3 cm below
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What device uses a push button or lever?
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Demand valve device
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Laryngoscopy and passage of ETT are likely to cause a vagal response. What are signs of a vagal response
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Dramatic slowing of heart rate
Decrease cardiac output Decrease in Blood Pressure |
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What age is the pediatric BVM preferred?
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8 years old
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What are some situations whereNasotracheal Intubation are not recommended
(6) |
*suspected nasal fractures
* suspected basilar skull fracture * significant deviated nasal septum or nasal obstruction * cardiac/respiratory arrest * unresponsive PT |
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Adult BVM capacity is how many mL.
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1500 and pediatric is 450 mL
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True or False
Blind Nasotrachael Intubation requires the PT to be breathing |
True
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A demand valve device can operate at what highest flow rate?
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40 lpm maximum.
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What are some high risks of Extubation in the field
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Laryngospasm
Involuntary closure of the epiglottis may prohibit successful reintubation |
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What is the most important part of documentation?
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Documenting your airway management
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