EXAM HINTS FOR TMC CSE EXAM QUESTIONS AND ANSWERS

EXAM HINTS FOR TMC CSE EXAM QUESTIONS AND ANSWERS Jaw Thrust /Modified Jaw Thrust - ANSWER-Allows for establishing patent airway in pt's with suspected neck fracture. head tilt-chin lift maneuver - ANSWER-a technique used to open the airway of a patient with no suspected neck or spine injury (preferred method of establishing airway during CPR. Flow inflating resuscitation bag - ANSWER-Used for resucitation and manual ventilation of neonates. Should always be used with a pressure manometer to monitor PIP and PEEP. Oral and Nasal Intubation Indications: - ANSWER-Provide a patent airway Access for suctioning Means for MV Protect the airway (aspiration, obstruction). Direct instillation of medication (when IV is unavailable) V-Valium/versed used as a (sedative) A-Atropine for (Bradycardia) N-Narcan for (Narcotic Overdose) E-Epinephrine for (Asystole) when administering medication through the ET Tube double the normal IV dose, flush with 10 ml saline, and hyperventilate for 30 seconds. laryngospasm - ANSWER-spasm of the laryngeal muscles, causing a constriction Evidence of difficult airway - ANSWER-Tracheal shift/deviation Enlarged Thyroid Short receding mandible Enlarged Tongue (macroglossia) Bull neck Limited range-of-motion of the neck or cervical spine. Small mouth opening. Mallampati Class III or IV Complications of Intubation - ANSWER-Infection-Fever, secretions, etc. Cuff pressure is directly related to capillary pressures. Maintain cuff inflation at 20-25 mm Hg (25-35 cm H20) Laryngospasm-most serious complication. Right mainstem bronchus intubation (oral ET tube inserted >25 cm). Risk of Ventilator Acquired/Associated Pneumonia (VAP). Flexion or extension of the head will change the position of the ET tube. Intubation Procedure - ANSWER-1.Prepare and Check Equipment 2.Recommend neuromuscular blocking agent as needed (succinylcholine). 3.Position pt.'s head in a sniffing position (slight hyperextension). 4.Adequately hyperoxygenate (resuscitation bag with 100% O2 for 2 minutes). 5.Hold laryngoscope in left hand, Et tube in right hand. 6.Insert blade down right side of mouth, sweep tongue to left. 7.Advance blade, lift epiglottis, visualize cords a. Insert tip of curved blade in Vallecula. b. Insert tip of straight blade under epiglottis. 8.Cricoid Pressure (Sellick maneuver) is indicated if the larynx is in an anterior location or pt. is at risk of aspiration. 9. Insert tube, inflate cuff, assess tube position, ventilate and oxygenate. 10. Inflate cuff to 20-25 mm Hg (25-35 cm H2O).