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BB APA & Found > 2 Airway Management > Flashcards

2 Airway Management Flashcards

1
Q

Goals of Airway Management

A

Ventilation - if you can ventilate, it’s not an emergency

Oxygenation

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2
Q

7 P’s

A 
Preparation
Pre-oxygenation
Pre-treatment
Paralysis w/ induction
Positioning
Placement w/ proof
Post-Intubation management
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3
Q

Pharynx

A

oro-, naso-, hypo-

  • glossopharyngeal nerve innervates posterior wall of pharynx
  • vagus nerve for gag reflex
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4
Q

Hypopharynx location & innervation

A

C5-6, vagus nerve, RLV, SLN

epiglottis to inferior cricoid cartilage

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5
Q

Larynx Functions

A
  • protects lower airway
  • patency
  • gag & cough reflex
  • phonation
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6
Q

3 single cartilages of Larynx

A

Epiglottis
Thyroid
Cricoid

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7
Q

3 unpaired cartilages of Larynx

A

Arytenoid
Cuneiform
Carniculate

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8
Q

Intrinsic & Extrinsic Muscles of Larynx control…

A

Extrinsic control - move entire larynx, elevators & depressors
Intrinsic control -

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9
Q

Lower Respiratory Tract

A

structures below cricoid cartilage

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10
Q

Trachea

A

inferior cricoid cartilage down to carina (10-20cm)

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11
Q

Only full ring of cartilage in trachea…

A

cricoid, then 16-20 c-shaped rings

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12
Q

Airway Evaluation

A
  • central to any plan, must be thorough

- consider equipment, staff experience

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13
Q

Potential causes of difficult intubation

A
  • inadequate pre-op assessment
  • anesthetist
  • equipment
  • inexperience
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14
Q

ASA definition of difficult to ventilate

A

when signs of inadequate ventilation cannot be reversed by mask ventilation
OR
the pts oxygen saturation cannot be maintained above 90% with mask ventilation

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15
Q

ASA definition of difficult to intubate

A

a trained anesthetist provider, using conventional laryngoscopy, requires more than 3 attempts or more than 10 minutes to complete tracheal intubation

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16
Q

ASA definition of difficult airway

A

a trained anesthetist experiences difficulty with facemask ventilation, laryngoscopy, intubation or all of the above

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17
Q

LEMON

A 
Look externally
Evaluate 3-3-2 rule
Mallampati
Obstruction/Obesity 
Neck mobility--> atlanto-occipital range
18
Q

BONES

A

*mnemonic for if mask ventilation will be difficult
Beard
Obesity
No teeth
Elderly (>55y/o, loose airway elasticity)
Snoring

19
Q

4 D’s

A 
*predict how difficult laryngeal visualization may be
Disproportion
Distortion
Dismobility
Dentition
20
Q

Anticipated Difficult Airway…

A

-cricothyroid membrane should be identified and marked prior to surgery

21
Q

Anticipated Difficult Airway…

A

-cricothyroid membrane should be identified and marked prior to surgery

22
Q

Cricothyrotomy

A
  • cricothyroid membrane
  • 14F angiocath, 3.0 ETT adapter + bag
  • needle vs surgical
23
Q

3 options for airway management…

A
  1. ) awake intubation
  2. ) quick look - sedated, no paralytic, decreased risk of failed BVM
  3. ) induction & paralysis - classic
24
Q

Pre-oxygenation technique

A
  1. ) tidal volume breathing for 3-5 min
  2. ) deep breaths x4 within 30 seconds (preferred)

**increase arterial oxygen tension, good for pts with limited FRC

25
Q

Initial intubation attempts after GA unsuccessful –>

A
  1. ) call for help
  2. ) return of spontaneous ventilation - sux, prop, LMA
  3. ) awakening patient
26
Q

Initial intubation attempts after GA unsuccessful –>

A
  1. ) call for help
  2. ) return of spontaneous ventilation - sux, prop, LMA
  3. ) awakening patient
27
Q

LMA/SGA

A
  • intubation conduit

- size based on ideal weight, typically sz 4

28
Q

Laryngeal Scope Blades

A

Mac
Miller
Wis
Heine

29
Q

Fiberoptic Intubation

A
  • nasal or oral

- useful for tricky intubation or when putting in double lumen tube

30
Q

Video Assits

A

glidescope

McGrath

31
Q

Tube Changer

A

bougie- helpful if you can’t see cords at all - feel tracheal cartilage

32
Q

Light wand

A

Eschmann stylet

33
Q

Invasive Airway Access

A

Jet ventilation
percutaneous intubation
retrograde intubation
surgical airway

34
Q

Plan A

A

Initial Strategy
elective intubation
RSI
-bougie, blade, video scope

35
Q

Plan B

A

Secondary intubation strategy

  • NOT appropriate for elective RSI
  • classic LMA
  • fiberoptic intubation through LMA
36
Q

Plan C

A

Maintain oxygenation & ventilation

  • attempt to wake pt up, consider suggamedex if available
  • facemask, NP airway, LMA
37
Q

Plan D

A

rescue techniques –> can’t intubate, can’t ventilate

-needle cricothyroidotomy

38
Q

Upper Airway Obstruction

A
  • emergent

- s/s hoarse, muffled voice, difficulty swallowing, secretions, stridor, dyspnea

39
Q

Lower Airway Obstruction

A

management- optimize ventilation & oxygenation

-high peak pressure, low TV, impaired ventilation

40
Q

Pts with OSA…

A

bring CPAP to PACU

41
Q

Obese pts…

A
  • position
  • pre-oxygenate (limited FRC)
  • have alternate plans
  • will desat quicker, limit delays
42
Q

Extubation Criteria

A
  • hemodynamic stability
  • normothermia
  • ability to maintain airway (TOF >0.9, lift head for 5 sec) capacity >15ml/kg
  • ability to oxygenate
  • acceptable analgesia

BB APA & Found (5 decks)

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