1 Airway Mgmt Flashcards
Inter incisor gap: shows what, small means what, nml cm
Ability to align axis, more acute angle b/w oral and glottic. 4
TMD: cm difficulty
<6 or >9 cm.
Mandibular protrusion, which classes good or not
I good, III bad
Normal AO flexion
90-165 degrees
Normal AO extension, difficult when
35 degrees. <23 degrees
Conditions that impair AO mobility
Klippel feil, downs
Grade IIa v IIb view
A= only posterior glottic opening. B= only corniculates and posterior VC, no opening view
RF for difficult mask
BONES BMI >26 age >55
RSI cricoid p before and after LOC
2kg/20 newtons before, 4/40 after
Causes of angioedema and tx of each
ACEI: epi, antihistamines, steroids. C1 esterase deficiency: FFP or C1 esterase, epi/antihistamine wont work
Ludwig’s angina: what it is, best way to do airway or not to do it
Infec roof of mouth. Do awake nasal or trach. Dont do retrograde in infec above trachea
Syndromes w large tongue
BT big tongue; beckwith, trisomy 21
Small mandible syndromes
Please get that chin: Pierre robin, goldenhaur, treacher Collins, cri du chat
Cervical anomaly syndromes: kids try gold
Klippel fail, trisomy 21, goldenhaur
Pierre robin dev from nml how
Small mandible (micrognathia/hypoplasia), tongue falls back (glossoptosis), cleft palate
Treacher Collins deviations
Small mouth and mandible, nasal a/w blockage (Chantal atresia)
Trisomy 21 deviations
Small mouth large tongue AO instab, small subglottic diam (subglottic stenosis)
Klippel feil dev
Neck rigidity
Cri du chat abn
Small mandible, laryngomalacia, stridor
ETT goes where what goes
Nose. Nose to chest= tip to carina, nose away- tip away
Contraindic to nasal airway
Lefort II or III, basilar frac, prev transphenoidal hypophysectomy or Caldwell luc procedure
Why low vol high p cuffs good vs bad
Good: better aspiration risk. Bad: tracheal ischemia and cant measure pressure
What most ett cuffs are
Low pressure high vol
LMA cuff: max PPV pressure, max cuff pressure
PPV 20 cm h20, cuff 40-60 target range
LMA 1: size, cliff, largest ett/bronnch
<5 kg, 4 ml, 3.5, 2.7
LMA 1.5: size, cliff, largest ett/bronnch
5-10 kg, 7 ml, 4 ett, 3
LMA 2: size, cliff, largest ett/bronnch
10-20 kg,10 ml, 4.5 ett 3.5 bronch
LMA 2.5: size, cliff, largest ett/bronnch
20-30 KG, 14 ML, 5 ETT 4 BRONCH
LMA 3: size, cliff, largest ett/bronnch
30-50 kg, 20 ml, 6 ett 5 bronch
LMA 4: size, cliff, largest ett/bronnch
50-70 kg, 30 ml, 6 ett 5 bronch
LMA 5: size, cliff, largest ett/bronnch
70-100 kg, 40 ml, 7 ett, 5.5 scope
LMA proseal features
Gastric drain tube, larger mask, bite block, max PPV <30
LMA that is disposable and sim to proseal
LMA supreme
Intubation LMA, cant use where
Fasttrach, MRI
LMA flexible: features, good when, bad where
Wire reinforced, longer and narrow than classic, good in head and neck sx cant use in mri
Steps if aspiration after LMA in
Leave it in, tburg and deepen anes, 100% 02, low fgf and tv, suction through lma, FOB to eval if need ett
Most to least stimulating airway devices
Combitude, dvl, FO ett, LMA
Rules for LMA in lap
<15 degree tilt, <15 cm h20 abd p, <15 min insufflation
Combitude: placed where, sizing
Hypopharynx. 4-6 ft 37, >6 ft 41
Combitude: which cuff occluded hypopharynx vs esophagus
Proximal= hypo, distal= esoph
Combitude: cuff vol, attempt vent where if in esophagus
37- oro 60 ml, 41- oro 70-80. Distal cuff both 5-10 ml
FO scope: hand placement, lever movement
Non dom on level, dom on scope. Lever down to point tip up, level up to point tip down
When to use Bullard
Mouth opening 7mm minimum (use if small), cervical instab, treacher or Pierre, adult and peds versions
EI: where trachea and carina should be reached
Trachea 24 cm carina 35-40
When lighted stylet useful
Ant airway, small mouth open, unstable neck, oral or nasal ett, Pierre robin, burns
Trachlight angle in adults vs peds
Adults 90 degrees, peds 60-80
Contraindications to TTJV
Upper airway obstruc or laryngeal injury
When cric is contrainficated
<6 years kid
Where trach is inserted
2nd and 3rd tracheal rings
