Airway Management and Advanced Airways
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Questions and Answers

What is the primary goal of the IV fluid challenges in anaphylaxis management?

  • MAP ≥ 65
  • SBP ≥ 80
  • SBP ≥ 90 (correct)
  • MAP ≥ 75

    • What is the maximum total dose of epinephrine that can be administered in anaphylaxis management?

  • 2 mg (correct)
  • 1 mg
  • 3 mg
  • 4 mg

    • What medication is recommended for patients on beta blockers who do not respond to epinephrine?

  • Albuterol
  • Ipratropium
  • Glucagon (correct)
  • Diphenhydramine

    • What is the recommended dose of diphenhydramine for anaphylaxis management?

    <p>50 mg</p> Signup and view all the answers

    What is the primary concern in patients with asthma or COPD experiencing respiratory distress?

    <p>Ventilation and oxygenation</p> Signup and view all the answers

    What is the recommended treatment for cardiac arrest in a patient with anaphylaxis?

    <p>Begin quality CPR and administer epinephrine per cardiac arrest SOP</p> Signup and view all the answers

    What is the recommended dose of albuterol for wheezing in anaphylaxis management?

    <p>2.5 mg</p> Signup and view all the answers

    What is the recommended flow rate for oxygen administration in anaphylaxis management?

    <p>6 L/min</p> Signup and view all the answers

    Which of the following patient groups is at a high risk for serious complications from sepsis?

    <p>Adults 65 years and older</p> Signup and view all the answers

    What is a key factor in determining the signs and symptoms of a pulmonary embolism?

    <p>Location and size of the embolism</p> Signup and view all the answers

    Which of the following is a risk factor for pulmonary embolism?

    <p>Recent trauma or damage to the lining of vessels</p> Signup and view all the answers

    Which of the following conditions is a risk factor for sepsis?

    <p>Asthma</p> Signup and view all the answers

    What is an important consideration when assessing a patient for pulmonary embolism?

    <p>The patient's medical history, including previous VTE or PE</p> Signup and view all the answers

    Which of the following is a consideration when determining if a patient is at risk for serious complications from sepsis?

    <p>The patient's immunocompromised state</p> Signup and view all the answers

    What is an important factor in the diagnosis of pulmonary embolism?

    <p>The patient's history of recent venous stasis</p> Signup and view all the answers

    Which of the following is a risk factor for both sepsis and pulmonary embolism?

    <p>All of the above</p> Signup and view all the answers

    What is indicated for a patient with tension pneumothorax who exhibits decreased blood pressure and unilaterally absent lung sounds?

    <p>Needle pleural decompression on the affected side</p> Signup and view all the answers

    What is the appropriate respiratory rate for assisting a patient with COPD in an acute ventilatory failure state?

    <p>6-8 BPM</p> Signup and view all the answers

    Which of the following symptoms is NOT indicative of critical (severe) respiratory distress?

    <p>Speaks in complete sentences</p> Signup and view all the answers

    When managing hypercapnia in a patient with chronic hypercarbic state, how should the PaCO2 be manipulated?

    <p>Gradually reduce above chronic norms</p> Signup and view all the answers

    What is the target SpO2 level for a patient with COPD receiving treatment?

    <p>92%</p> Signup and view all the answers

    What should be done for a patient experiencing acute respiratory acidosis due to ventilatory failure?

    <p>Only eliminate excess CO2 above chronic hypercapnia</p> Signup and view all the answers

    If a patient is bradycardic during respiratory distress, what does this indicate?

    <p>Possible severe respiratory failure</p> Signup and view all the answers

    When conducting nebulizer therapy for an asthma patient, which action should be taken after starting the treatment?

    <p>Add oxygen if SpO2 is below the threshold</p> Signup and view all the answers

    What should be done if the patient's systolic blood pressure (SBP) falls below 90 mmHg?

    <p>Titrate PEEP values downward to 5 cm</p> Signup and view all the answers

    In the case of a patient experiencing severe asthma distress, how should epinephrine be administered?

    <p>0.3 mg IM, repeat once in 10 minutes</p> Signup and view all the answers

    What is the appropriate action if a patient is on beta blockers and requires albuterol treatment?

    <p>Proceed with caution due to potential side effects</p> Signup and view all the answers

    For patients with COPD experiencing respiratory distress, what should be done immediately after starting nebulizer treatment?

    <p>Begin transport immediately</p> Signup and view all the answers

    What is the maximum administration rate for magnesium sulfate in patients with severe distress?

    <p>1 g over 5 minutes</p> Signup and view all the answers

    If a patient's MAP falls below 60 mmHg, which intervention is recommended?

    <p>Remove CPAP as it is contraindicated</p> Signup and view all the answers

    What should be done for a patient with a tracheostomy experiencing respiratory distress?

    <p>Provide high-flow oxygen via the tracheostomy</p> Signup and view all the answers

    What is the first medication to follow epinephrine in the treatment of severe asthma distress?

    <p>Albuterol</p> Signup and view all the answers

    Based on the provided information, which age group can be considered for a surgical cricothyrotomy according to the OLMC but not the SOP?

    <p>8-12 years old</p> Signup and view all the answers

    In which scenario is a drug-assisted intubation (DAI) NOT recommended?

    <p>A patient with a history of drug overdose who is in a coma with absent airway reflexes</p> Signup and view all the answers

    What is the primary purpose of drug-assisted intubation?

    <p>To facilitate intubation in patients with intact airway reflexes</p> Signup and view all the answers

    Which of the following scenarios would NOT be considered an indication for advanced airway placement?

    <p>A patient with a GCS score of 10 due to a stroke</p> Signup and view all the answers

    Which of the following is a contraindication or restriction for the use of sedatives in DAI?

    <p>A patient with a known allergy to the sedative</p> Signup and view all the answers

    What is the recommended oxygen delivery method when attempting to ventilate a patient after a cricothyrotomy?

    <p>Bag-valve mask with 15 L O2</p> Signup and view all the answers

    Which of the following is NOT a recommended step in the initial management of airway impairment?

    <p>Administering medications to relax the airway</p> Signup and view all the answers

    Which of the following conditions is NOT considered a potential indication for DAI?

    <p>Acute pancreatitis</p> Signup and view all the answers

    Study Notes

    Airway Management

    • If still obstructed and unable to intubate or ventilate adequately, consider cricothyrotomy
    • For patients ≥13 years, use needle or surgical cricothyrotomy; for patients ≤12 years, use needle cricothyrotomy, except for OLMC only, where surgical cricothyrotomy is used for 8-12 years old
    • During transport, attempt to ventilate with 15 L O2/BVM

    Advanced Airways | Drug-Assisted Intubation (DAI)

    • Purpose of DAI: Achieve rapid ETI in patients with intact airway reflexes via use of medications that facilitate intubation
    • Consider indications for ADV airway placement, including:
      • Actual or potential airway impairment or aspiration risk that cannot be mitigated by other interventions
      • Actual/impending ventilatory failure (e.g., HF, pulmonary edema, COPD, asthma, anaphylaxis)
      • Increased WOB resulting in severe fatigue
      • GCS ≤ 8 due to an acute condition unlikely to be self-limited
      • Self-limiting conditions (e.g., seizures, hypoglycemia, postictal state, select drug OD)
      • Unable to ventilate/oxygenate effectively with BLS airways and BVM
      • Need for ↑ inspiratory pressure or PEEP to maintain gas exchange & CPAP contraindicated
      • Need for sedation to control ventilations
    • Contraindications/restrictions:
      • Coma with absent airway reflexes or known hypersensitivity/allergy to sedatives
      • Use in pregnancy could be potentially harmful to fetus; consider risk/benefit

    Intubation Procedure

    • IMC: SpO2 & EtCO2 before and after airway intervention | Confirm patent IV / IO; ECG monitor
    • Prepare patient: Position for optimal view and access (head up to 45° unless contraindicated) | Assess for difficult intubation
    • IV NS consecutive 200 mL IVF challenges up to 20 mL/kg; Goal: SBP ≥ 90 (MAP ≥ 65); reassess after each 200 mL
    • Medications:
      • EPINEPHRINE (1 mg/10 mL) titrate in 0.1 mg IVP/IO doses q. 1 min prn to a max total dose [all routes] of 2 mg
      • GLUCAGON 1 mg IVP / IO [ALS] IN / IM [BLS] if on beta blockers & not responding to EPI
      • ALBUTEROL 2.5 mg & IPRATROPIUM 0.5 mg via HHN/mask if wheezing
      • DIPHENHYDRAMINE 50 mg IVP/IO; if no IV / IO give IM

    Asthma | COPD

    • Assess ventilation/oxygenation, WOB, accessory muscle use, degree of airway obstruction/resistance, speech, cough, cerebral function, fatigue, hypoxia, CO2 narcosis, and cardiac status
    • If wheezing without Hx of COPD/Asthma: Consider FB aspiration, pulmonary embolus, vocal cord spasm, HF/pulmonary edema
    • If probable cardiac cause (PMH: CVD): Rx per Cardiac SOPs
    • If tension pneumothorax: Needle pleural decompress affected side
    • Airway/Gas exchange: Assess need for DAI/BIAD if near apnea, coma/depressed mental status, exhaustion, severe hypoxia (SpO2 < 90); hypercapnia (EtCO2 ≥ 60) | CR instability | Impending respiratory failure/arrest
    • If chronic hypercarbic state (COPD): Rx ventilatory failure w/ acute resp.acidosis carefully
    • Eliminate only extra CO2 (above chronic hypercarbic norms) causing acute ventilatory failure
    • Do not hyperventilate and do not over-correct: If rapidly ventilated to EtCO2 of 35-45, pt may suffer lethal dysrhythmias from Ca binding | Slowly reduce PaCO2

    Lower Acuity to Emergent

    • Mild to Moderate distress with wheezing and/or cough variant asthma:
      • ALBUTEROL 2.5 mg & IPRATROPIUM 0.5 mg via HHN or mask
      • Add O2 6 L/NC if patient is hypoxic (Asthma: SpO2 < 94%; COPD: SpO2 < 92%) & using a HHN
      • Begin transport as soon as neb is started - do not wait for a response
      • Continue nebulizer therapy enroute | May repeat X 1

    Critical (Severe distress)

    • Severe SOB, orthopnea, accessory muscle use, speaks in syllables, tachypnea, lung sounds diminished or absent; exhausted; HR & BP may be dropping
    • IMC special considerations:
      • Prepare resuscitation equipment; anticipate rapid patient deterioration
      • If immediate intubation not needed: O2 /C-PAP 5-10 cm PEEP; use 15 L/NRM or assist w/ 15 L/BVM if CPAP unavailable or contraindicated
      • If SBP falls < 90 (MAP < 65): Titrate PEEP values downward to 5 cm; remove C-PAP if MAP < 60

    History of ASTHMA | History of COPD

    • EPINEPHRINE (1 mg/1 mL) 0.3 mg IM [BLS] or ALBUTEROL 2.5 mg & IPRATROPIUM 0.5 mg /HHN/ mask/ BVM
    • Follow immediately with ALBUTEROL 2.5 mg & IPRATROPIUM 0.5 mg via HHN, mask or BVM; continue enroute [BLS]
    • May repeat X 1 as needed
    • If severe distress persists: MAGNESIUM (50%) 2 g in 16 mL NS (slow IVP/IO) or in 50 mL NS (IVPB) | Give over 10 min - Max 1 g / 5 min

    Tracheostomy | Laryngectomy

    • Give 15 L O2 / NRM or CPAP as indicated for ventilatory distress; acute lung injury or ARDS | Assist with BVM if ventilatory failure
    • Consider need for ALBUTEROL / IPRATROPIUM standard dose / HHN or in-line neb

    SEPSIS

    • Risk factors for serious complications:
      • Asthma; COPD; cystic fibrosis; pulm.fibrosis
      • Heart disease (CAD, HF, cardiomyopathies)
      • Endocrine disorders (diabetes mellitus)
      • Obesity with a BMI of 30 or higher
      • Immunocompromised state
      • Coagulation disorders

    Pulmonary Embolism

    • Difficult to diagnose, and potentially lethal if missed
    • Consider possible PE if:
      • Hx: Previous venous thromboembolism (VTE) or pulmonary embolism
      • Venous stasis (obesity, surgery or prolonged immobilization w/in last 30 days)
      • Recent trauma/damage to lining of vessels (CV disease: atherosclerotic changes; HTN, injected drug use; central line; or other IV medical device, inflammation from direct infection, diabetes; smoking)
      • Hypercoagulable state (malignant: cancer currently active or considered cured w/in last year; hematologic (pregnant), or medication induced (oral hormone use))

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    Adult Airway Management PDF

    Description

    Learn about airway management techniques, including cricothyrotomy and drug-assisted intubation, for patients of different ages and in various situations.

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