1
Q
How is the patient placed in the recovery position?
A
Left lateral recumbent position.
2
Q
Describe how the Head Tilt/Chin Lift is done.
A
- With pt in supine position
- One hand on forehead and one hand under the jaw
- Lift the chin upward, lifting the entire mandible with it
3
Q
Indications:
Head Tilt Chin Lift
A
Opening the airway for someone that has not sustained trauma.
4
Q
What are the procedures for Jaw Thrust Maneuver?
A
- Stand at the head of the stretcher, while pt is in supine position.
- Place your thumbs on the cheeks over the zygomatic arches.
- Hook your fingers under the angle of the mandible.
- Pull the jaw upward.
5
Q
Indications:
Jaw Thrust Maneuver
A
Opening the airway with suspected trauma present.
6
Q
Fill in the blank:
Suction canisters should generate ____ mmHg when clamped for 4 seconds.
A
300
7
Q
When should you use a Yankauer catheter versus a French catheter?
A
- Yankauer: large volumes of fluid
- French: ET/LMA/King/Stoma
8
Q
What are the maximum allowed suctioning times for adult, child, and infant?
A
- Adult: 15 seconds
- Child: 10 seconds
- Infant: 5 seconds
9
Q
How do you measure the suction tip for proper depth during suctioning?
A
corner of the mouth to the earlobe
10
Q
List the steps for proper airway suctioning.
A
- Measure the catheter appropriately.
- Turn the patient’s head to the side before suctioning.
- Do not suction while inserting.
- Suction in a circular motion as the catheter is withdrawn.
- Do not suction for more than 15 seconds (adult).
11
Q
Define:
OPA
A
Oropharyngeal airway
Used to hold the tongue from the posterior pharyngeal wall.
12
Q
Indications:
OPA
A
- unresponsive patient
- no gag reflex
13
Q
How do you measure an OPA?
A
Patient’s earlobe to the corner of the mouth.
14
Q
List the steps for inserting an OPA.
A
- Measure appropriately.
- Open the mouth with the cross-finger technique.
- Insert OPA with the tip at the roof of the mouth.
- Rotate the OPA 180 degrees, flipping it over the tongue.
15
Q
Define:
NPA
A
Nasopharyngeal Airway
A rubber tube is inserted through the nose into the posterior pharynx behind the tongue and allows air to pass through.
16
Q
Contraindications:
NPA
A
- facial trauma
- skull fracture
- patient intolerance
17
Q
How do you measure an NPA?
A
Patients earlobe to the tip of the nose.
18
Q
List the steps for inserting an NPA.
A
- Measure appropriately.
- Lubricate the NPA.
- Place in the largest nostril, bevel towards the septum (if left nostril, rotate 180 degrees while inserting).
- Insert gently.
19
Q
What are the causes of an airway obstruction?
A
- tongue
- foreign body
- laryngeal spasm/edema
- laryngeal injury
- aspiration
20
Q
Treatment:
Mild airway obstruction
A
Leave it alone and instruct to cough.
21
Q
Treatment:
Severe airway obstruction of foreign body.
Patient is unable to talk/breathe.
A
Abdominal thrusts
22
Q
When do you stop doing abdominal thrusts in a choking patient?
A
When they become unresponsive.
23
Q
How do you perform the Heimlich on a pregnant patient?
A
chest thrusts
24
Q
What do you do if your choking patient becomes unresponsive?
A
- Lay the patient down and begin chest compressions.
- After 30 compressions, look inside the mouth.
- If there is a visible obstruction, attempt to remove it.
25
If you cannot see the obstruction in a choking patient while doing CPR, what is an **advanced technique** to try to visualize and remove the obstruction?
Direct laryngoscopy
## Footnote
Remove obstruction with _Magill Forceps_ if able.
26
What is the most common oxygen cylinder used **on scene**?
## Footnote
Contains 350L of oxygen.
D cylinder
27
What is the typical oxygen cylinder used on the **ambulance**?
## Footnote
Contains 3000L of oxygen.
M cylinder
28
# Fill in the blank:
You should **replace** your oxygen cylinder when it reaches \_\_\_\_ psi or lower.
200
## Footnote
Some systems are \< 500.
29
What is the **formula** for calculating the remaining oxygen in a tank?
(Tank pressure – 200) * Cylinder constant / Flow rate (L/min)
30
How much oxygen can a **non-rebreathing mask** deliver at 15 L/min?
| NRB
90-100%
31
What is the flow rate and oxygen percentage delivered by a **nasal cannula**?
**1-6 L/min**
24-44%
32
What is the flow rate and oxygen percentage delivered by a **partial NRB**?
**6-10 L/min**
35-60%
33
What is the **venturi mask** useful for?
It delivers **highly specific amounts of oxygen** concentrations.
34
# Fill in the blank:
The **BVM ventilation rate** for an adult who is **apneic** but has a pulse is typically \_\_\_\_\_ breathe/min.
10-12
35
List the steps in performing **BVM**.
1. Select the proper size.
2. Perform Head-Tilt/Chin-Lift, or jaw thrusts.
3. Suction as needed.
4. Insert OPA/NPA.
5. Position the mask's top edge over the bridge of the nose and the bottom edge in the groove between the lower lip and chin.
6. Use an EC clamp.
7. Ventilate every 5–6 seconds.
8. Assess for chest rise and fall.
36
# Define:
CPAP
Continuous Positive Airway Pressure
## Footnote
Opens collapsed alveoli and increases pressure within the lungs.
37
# Indications:
CPAP
* Alert and able to follow commands.
* Moderate to severe respiratory distress.
* COPD, Pulmonary Edema, Asthma, or CHF.
* SpO2 levels \< 90%.
38
# Contraindications:
CPAP
* Respiratory arrest
* Hypoventilation
* Pneumothorax/chest trauma
* Active GI bleed/vomiting
* Unable to follow commands
* Hypotension
39
# Define:
gastric distention
Occurs when air enters the **stomach** during ventilation.
40
What are the complications of **gastric distention**?
* regurgitation/aspiration
* pushes the diaphragm upward
41
When should an **NG/OG** tube be placed?
When any **positive pressure ventilations** will occur.
42
How do you measure an **OG/NG** tube?
* OG: Mouth → Ear → Xiphoid process
* NG: Nose → Ear → Xiphoid process
43
How do you ventilate a **stoma**?
* **Mouth-to-stoma** - barrier device
* **Infant/child BVM** - over stoma
## Footnote
Make sure to seal the mouth and nose during ventilations.
44
List the steps in **suctioning a stoma**.
1. Don PPE.
2. Pre-oxygenate via BVM: 100% oxygen.
3. Inject 3 ml of normal saline through the stoma.
4. Insert soft-tip suction during exhalation.
5. Suction while withdrawing the catheter.
6. Resume BVM and ventilation.
45
What is the concern with a **tracheostomy tube** becoming **dislodged**?
**stenosis** of the stoma
46
In assessing a difficult airway, **LEMON** is a mnemonic that stands for:
**L**ook
**E**valuate 3-3-2
**M**allampati
**O**bstruction
**N**eck mobility
47
What is the **3-3-2 rule** for difficult airways?
* **3** fingers fit into the opening of the mouth.
* **3** fingers in space from the chin to the hyoid bone.
* **2** fingers in space from the thyroid notch to the hyoid bone.
48
What is a **Mallampati classification**?
An evaluation of the posterior pharynx and structures to **determine the difficulty of intubation**.
49
# Define:
Murphy's Eye
Opening on the side of the tube that **allows ventilation** even if the tip is occluded.
50
What is the formula for **pediatric tube size**?
* Uncuffed: ETT size (mm) = (Age in years / 4) + 4
* Cuffed: ETT size (mm) = (Age in years / 4) + 3.5
## Footnote
Example:
For a 4-year-old child:
* Uncuffed tube: (4 / 4) + 4 = 5.0 mm
* Cuffed tube: (4 / 4) + 3.5 = 4.5 mm
51
What **structures** are the Mac and Miller blades aiming for?
* **Mac**: Sits inside the vallecula to lift the epiglottis.
* **Miller**: Directly lifts the epiglottis with the blade.
52
What **position** should the head be in for intubation?
sniffing
53
How far do you advance the proximal cuff once it is inserted through the vocal cords?
**1-2** cm
54
# Define:
**BURP** maneuver
**B**ackwards
**U**pwards
**R**ightward
**P**ressure
55
# Fill in the blank:
The **first** and **most reliable** method of confirming tube placement is \_\_\_\_\_ the tube passing through the vocal cords.
visualizing
56
How do you fix a **right main stem intubation**?
**Slowly back the tube up** while auscultating and ventilating.
57
How **deep** should a tube be placed at the teeth?
Multiply the tube's internal diameter (in mm) by 3 to estimate depth at teeth.
58
# Indications:
nasotracheal intubation
* The patient has to be **spontaneously breathing**.
* **AMS and respiratory failure** with intact gag reflex.
59
List the differences of **pediatric airways** versus **adults**.
* larger head - flexes downward
* larger tongue - airway obstruction
* floppy epiglottis - require lifting
* smaller trachea
60
What is the **smallest portion** of a pediatric's airway?
cricoid ring
61
What should be placed during a pediatric intubation to **ensure proper positioning**?
**Towels** under the back.
62
Name the **sedatives** used in RSI.
* Valium, Ativan, Versed
* Ketamine
* Etomidate
63
# Define:
Non-depolarizing Neuromuscular blockers
They **bind to acetylcholine**, similar to depolarizing agents. However, they **block ACh receptors** without causing fasciculations
## Footnote
Eg. Rocuronium, Vecuronium, and Pancuronium.
64
# Define:
Depolarizing Neuromuscular blockers
Competitively binds with ACh receptors, **causing fasciculations**
## Footnote
Eg. Succinylcholine
65
What are the **onset and duration** time of **succinylcholine**?
* onset: **60-90 secs.**
* duration: **5-10 mins.**
66
What are the **onset and duration** time of **rocuronium** and **vecuronium**?
_Rocuronium_:
* onset: **\< 2 mins.**
* duration: **45-60 mins.**
_Vecuronium_:
* onset: **2 mins.**
* duration: **45 mins.**
67
# Define
RSI
Rapid-Sequence Intubation
68
What is the **lidocaine dose** for RSI of a _head injury_?
1.5 mg/kg
## Footnote
Stops the increase of ICP from laryngeal stimulation.
69
What is the pediatric **atropine** premedication **dose** for RSI?
0.02 mg/kg
70
When using a **combitube**, which tube should be ventilated first?
blue tube
## Footnote
If chest rise, continue to ventilate.
71
When inserting an **LMA**, where should the **tip** sit in the airway?
Just above the **upper esophageal sphincter**, resting in the **hypopharynx**.
72
How are **king airways** sized per height?
Size:
* 3 → **4'-5'**
* 4 → **5'-6'**
* 5 → **\> 6'**
73
When doing a **surgical cric**, what landmarks do you cut **between**?
| Cricothyroidotomy
Thyroid cartilage and cricoid ring.
## Footnote
Cricothyroid membrane
74
What type of ventilator can be used on a **needle cric**?
Jet ventilator
