Airway Management and Intubation Lecture Notes

Flashcards covering airway adjuncts (OPA, NPA), RSI medications (sedatives/paralytics), intubation equipment (ET tubes, laryngoscopes), and placement verification methods.

Oropharyngeal airway (OPA)

An airway adjunct used to displace the tongue and keep the airway open in patients without a gag reflex.

Tongue

The most common cause of airway obstruction.

Nasopharyngeal airway (NPA)

Also known as a nasal trumpet, this adjunct is measured from the nare to the tip of the earlobe and can remain in a patient for up to $48$ hours.

Water-based lubricant

The specific type of lubrication required for NPA insertion because oil-based alternatives are flammable in the presence of oxygen.

Deviated septum

A condition where the bridge in the middle of the nose is off to one side; when present, clinicians should always use the larger nair for airway insertion.

Preoxygenation

The process of using $100\%$ oxygen or an Ambu bag to increase $SpO_2$ and $PaO_2$ before intubation to provide more time for safe airway placement.

$$90\%$$

The approximate $SpO_2$ level that corresponds to a $PaO_2$ of $60\,mm\,Hg$ on the oxygen-hemoglobin dissociation curve, marking a significant drop-off point for oxygen saturation.

PEEP valve

An attachment on a manual resuscitator bag used to force oxygen in and improve recruitment, essential for raising oxygen saturation levels in difficult cases.

Propofol

A white, hypnotic sedative known as "milk of amnesia" that has a half-life of approximately $2.5\,\text{minutes}$ and can cause hypotension and bradycardia.

Etomidate

The NBRC gold standard sedative for intubation that has a short half-life and no significant contraindications but cannot be used as a continuous drip.

Ketamine

A sedative used for intubating asthmatics due to its bronchodilation effects; it does not cause respiratory depression but may cause emergence phenomena.

Succinylcholine

Known as "sucks," this is the gold standard paralytic for intubation with the shortest half-life, though it is contraindicated in patients with hyperkalemia.

Hyperkalemia

A condition of high potassium that is a major contraindication for succinylcholine because the drug causes a potassium spike that could lead to cardiac arrest.

Rocuronium

An intermediate-acting paralytic used when a patient has high potassium because it does not cause potassium levels to spike.

Murphy's eye

A safety side-hole on an endotracheal tube that allows for ventilation even if the main tip of the tube becomes occluded.

Radiopaque line

A white or blue line on an endotracheal tube visible on X-rays; its tip should be positioned $3-5\,cm$ above the carina.

Pilot balloon

The external component used to inflate and monitor the integrity of the internal cuff of an endotracheal tube.

$$20-25\,mm\,Hg$$

The recommended cuff pressure range measured in millimeters of mercury to ensure a seal without causing tracheal tissue death.

$$20-30\,cm\,H_{2}O$$

The recommended cuff pressure range measured in centimeters of water, often monitored using a cuff manometer.

Subglottic port

A suction port located above the ET tube cuff used to remove oral secretions and drastically reduce the risk of Ventilator-Associated Pneumonia (VAP).

Macintosh blade

A curved laryngoscope blade that is inserted into the vallecula to indirectly lift the epiglottis for visualization of the vocal cords.

Miller blade

A straight laryngoscope blade used to directly lift the epiglottis, often preferred for use in pediatric patients with floppy airways.

Yankauer

A rigid suction tool used specifically for cleaning secretions, vomit, or blood from the patient's mouth and upper airway.

McGill forceps

Curved tools with grippy teeth used to remove foreign bodies like dentures or food from the airway during intubation.

Stylet

A malleable rod inserted into an endotracheal tube to provide the rigidity and shape needed to guide the tube into the trachea.

Colorimetric $CO_2$ detector

A device used for fast verification of tube placement; it turns yellow if $CO_2$ is present and remains purple if the tube is in the esophagus.