2025 Airway Management Exam 2 Flashcards

Question

NPA: Insertion

Answer 1

Lubricate with water soluble lubricant or anesthetic jelly (not required) Gently insert into nostril Along floor of nostril, perpendicular to face Parallel to turbinates If resistance occurs Try slight tube rotation Try other nostril Check for respirations following placement

Answer 2

Esophageal intubation (if too long) Laryngospasm (if too long) Vomiting (less likely than with OPA) Nasal mucosa injury (turbinates specifically) and secondary blood aspiration Epistaxis Tissue Necrosis (if left in too long)

Answer 3

Positive-pressure ventilation Bag-mask ventilation Laryngeal mask airway (LMA) Endotracheal tube (ETT) Spontaneous ventilation (Negative Pressure) Bag-mask ventilation Laryngeal mask airway (LMA) Most common use... commonly called a glorified oral airway... very useful for a spontaneous breathing patient Endotracheal tube (ETT)

Answer 4

Every Anesthesia Machine needs an Ambu bag with the machine

Answer 5

Resuscitation Malleable, transparent body 22 mm connection Air-cushion seal No retaining ring Anesthesia Opaque body or Transparent body 22 mm connection Air-filled seal Retaining ring

Answer 6

Mask is pressed against nasal bridge with thumb. Ensure that there is no pressure on the eyes Index finger exerts downward pressure on the base of the mask over the chin. Little finger should engage the angle of the mandible.

Answer 7

Suction Saves Lives Oral secretions Bloody secretions Yankauer suction tips Gentle curve to fit airway Multiple holes at tip

Answer 8

Conscious patient – talking, swallowing, … Unconscious patient – breathing with patent airway O2 Unconscious patient – attempting to breath but airway obstructed O2 Airway support Physical maneuver – jaw thrust maneuver Adjunct for physical support – OPA, NPA Assistance for breathing – positive-pressure ventilation Unconscious patient with neuromuscular blockade O2 Positive-pressure ventilation – BVM, LMA*, ETT

Answer 9

To determine ease or difficulty of airway manipulation (intubation, mask ventilation) To prepare the anesthetist... Selection of airway devices, techniques, and procedures ... generally want to secure airway with patient awake Minimize harm during subsequent airway management Determine airway-related risks in order to: discuss them with the patient avoid risk-related problems

Answer 10

Establish correct anatomic position for the patient Obtain correct position for laryngoscopist Establish alignment of axes Secure the airway Choose safest anesthesia technique

Answer 11

Airway techniques: Patient maintains own airway Oral and nasal airways Bag-mask ventilation Direct laryngoscopy (tracheal intubation)... see with your two eyes Indirect laryngoscopy (glidescope)... see through a video monitor Blind Airway Techniques (LMA, Combitube, etc.) Fiberoptic bronchoscopy Cricothyrotomy/cricothyroidotomy Tracheostomy

Answer 12

Previous intubations (previous difficult airway) Dental problems (loose, chipped, broken, removable) Arthritis (TMJ and neck mobility) Diabetes (gastric motility->delayed emptying) NPO status (aspiration risk) Heartburn/GERD (aspiration risk)

Answer 13

Ability to ventilate Ability to intubate Risk of aspiration

Answer 14

Interincisor distance (mouth opening) >4 cm or two finger-breadths Mallampati Class 1 or 2 Thyromental distance >6 cm – three finger breadths from tip of mandible to thyroid notch w/neck fully extended At least 9 cm from symphysis of mandible to mandibular angle Slender neck without masses, full range of motion Ability to extend atlantooccipital joint (normal extension is 35 degrees)

Answer 15

In a general adult population, DMV was reported in 5% of the patients. Maintenance of airway patency and oxygenation are the main objectives of face-mask ventilation. Difficult mask ventilation was defined as the inability of an unassisted anesthesiologist to maintain the measured oxygen saturation as measured by pulse oximetry > 92% or to prevent or reverse signs of inadequate ventilation during positive-pressure mask ventilation under general anesthesia.

Answer 16

Prepare for mask ventilation difficulty if: Beard Facial scars Facial injuries/dressings Edentulous (IF have dentures, ask to remove them so don't fall out) Any airway obstruction – (e.g. after multiple DL’s)

Answer 17

Mouth opening less than 4cm Thyromental distance less than 6cm Mallampati class 3 or 4 Neck movement less than 80 degrees Inability to advance the mandible (prognathism) Obese Positive history of difficult intubation

Answer 18

Those with Rheumatoid Arthritis need to be careful with

Answer 19

Used when someone is really obese

Answer 20

Size/Obesity Neck size and ROM Face Lips Mouth/Tongue/Teeth

Answer 21

Mouth must open (at least a little) Three axes (tracheal, pharyngeal, oral) must be at least somewhat aligned in the sniffing position There must be a place big enough to put the tongue, and space to see The amount of the posterior pharynx you can visualize is important and correlates with the difficulty of intubation. Visualization of the pharynx is obscured by a large tongue (relative to the size of the mouth), which also interferes with visualization of the larynx on laryngoscopy.

Answer 22

Mandible – length and subluxation Opening – Measure mouth opening Uvula – can you see it Teeth – Dentition – large or loose teeth Head – flex, extension, rotation Silhouette – Upper body abnormalities: kyphosis, large breast

Answer 23

Open Mouth as wide as can and push tongue out... it DOES NOT include a say "ahhh"

Answer 24

Pharyngitis - severe Going to be rubbing up against tissue so might want to give Decadron on the 8-12 mg range

Answer 25

Gingival hyperplasia

Answer 26

GINGIVITIS

Answer 27

Periodontitis

Answer 28

Important to note Pain and/or Paresthesia prior to the surgery... also need to note motor weakness

Answer 29

Will be indicative of join immobility on other parts of the body

Answer 30

Grade 1: Full view of the glottis Grade 2: Only the posterior commissure is visible Grade 3: Only the epiglottis is seen Grade 4: No epiglottis or glottic structure visible, only soft palate

Answer 31

LMA Development: Dr Archie Brain, British anesthesiologist, London Hospital, 1981 Cadaveric specimens The laryngeal mask airway: a new concept in airway management. AIJ Brain. Br J Anaesth 55: 801, 1983. Alternative to face mask and to endotracheal tube Developed from the Goldman Dental Nose Piece – used for airway maintenance during dental extractions Commercial product in United Kingdom: 1988 Ubiquitous in United Kingdom: 1990 FDA approval in US: 1991 World-wide use: 2000

Answer 32

Specially designed airway that seats over the larynx to allow ventilation in normal patients. The LMA may be a useful adjunct in patients who are inadequately ventilated by mask. The Laryngeal Mask Airway is an alternative airway device used for anesthesia and airway support It consists of an inflatable silicone mask and rubber connecting tube It is inserted blindly into the pharynx, forming a low-pressure seal around the laryngeal inlet and permitting gentle positive pressure ventilation All parts are latex-free Construction Silicone 30o between airway tube and body of mask Basic components 15 mm connector Airway tube Cuff Inflation system Valve Pilot balloon Pilot tube

Answer 33

The Laryngeal Mask Airway is an appropriate airway choice when: Mask ventilation can be used (except in the Difficult Airway Algorithm) ... can take the place of Mask Ventilation Endotracheal intubation is not necessary (when they do not have to be paralyzed is a big indicator) MAC procedures are good with LMA

Answer 34

Establishes airway with supraglottic seal (above the vocal cords)

Answer 35

Indications Administration of general anesthesia Establish unsecured airway emergently Facilitate endotracheal intubation Adjunct to FOB airway management Decadron is a drug to be used to help with swelling and bleeding in the airway

Answer 36

Advantages: Allows rapid access Does not require laryngoscope Does not require neuromuscular blockade for placement or maintenance (just need Propofol, and some lidocaine for the sting of the Propofol) Provides airway for spontaneous or controlled ventilation (can be used PPV, but not a first choice) Tolerated at lighter anesthetic planes Advantages (compared to): Less stimulating during use (ETT) Less ↑ in intrathoracic and intraabdominal pressures during emergence (ETT) Less cardiovascular response (ETT) Less ↑ in IOP (ETT) Frees practitioner’s hands (mask) Provides seal for PPV (OAW or NAW)

Answer 37

Does not protect against aspiration in the non-fasted patient Standard LMA not recommended for use with ventilator... though it is used all the time Requires re-sterilization if Original LMA Learning curve for insertion Over-estimated ease of use (can be harder to correctly insert and seat compared to an ETT) Not a Secure Airway

Answer 38

Non-fasted patients (the only true absolute contraindications) Risks of aspiration (GERD, not NPO, hiatal hernia, obesity, pregnancy, bowel obstruction, acute pancreatitis, ....) Morbidly obese patients Obstructive or abnormal lesions of the oropharynx Maxillofacial Trauma Respiratory disease with low compliance and/or high resistance Patient position or surgery limiting airway access Upper airway pathology (infection, hematoma, cyst, ....)

Answer 39

LMA Management Preparation Deflate* (those with cuff) Lubricate* (never put on anterior side) Induction of general anesthesia Preoxygenate IV induction with minimum apneic period (lidocaine, may or may not use Fentanyl, Propofol) Insertion Oral cavity Oropharynx Hypopharynx Inflation After seating Volume per LMA size Observe pilot balloon rise Confirmation Observe chest rise Auscultation Capnography Securing Tape to zygomatic region* Prevent torque on the tube (by having circuit go back behind head) Maintenance Observe airway integrity Prevent torque Removal Patient breathing, awake & cooperative OR Patient breathing and asleep may have to revert to bag-and-mask ventilation if they obstruct Extubating Criteria 1) Spontaneous breathing (breathing on own) 2) Taking adequate tidal volumes *** so can absolutely have a sleeping patient that is meeting those criteria

Answer 40

Insertion Finger(s) Tongue depressor Introducer

Answer 41

Jam into vallecula (pull out start over) Push epiglottis down over glottic opening (pull out start over) Get caught on glottic opening (adjust with little pull back, might have to pull out and start over)

Answer 42

Good Seal: EtCO2 Bi lat rise and fall of chest Misting in tube Adequate inspiratory pressures No weird sounds

Answer 43

Special Features: Suction gastric contents Basic components Cuff Drainage system External drain tube with connector Internal drain tube Drain tube orifice Integral bite block Introducer strap

Answer 44

Special Features: May be used as a rescue airway and fiberoptic conduit when intubation is difficult, hazardous or unsuccessful It can be used for bronchoscopy in the awake or asleep patient

Answer 45

Video screen used to visualize glottis Same as Fast-trach with added video screen

Answer 46

Ambu AuraOnce

Answer 47

A LMA you could intubate through Can suction through it *** KNOW WHICH ONES YOU CAN DO THIS WITH FOR TESTS

Answer 48

Nothing to inflate Technically can suction through it Has a bite block Most woman - 4 Most men - 5

Answer 49

Tips for Success: Begin with ASA I & II patients Learn and use standard insertion technique Use appropriate size and do NOT overinflate Maintain adequate anesthetic depth May consider using a bite block to prevent kinking of the tube when the patient bites down Use PSV if PPV needed w/LMAs

Answer 50

What is the risk of aspiration with the LMA™ airway? The incidence of clinically detectable regurgitation with the LMA™ airway into the pharynx has been reported in various publications at approximately 0.1%. The incidence of aspiration with the LMA™ airway is low and is comparable to the incidence of aspiration associated with outpatient general anesthesia with the face mask or endotracheal tube.

Answer 51

The following are practical guidelines to minimize risk of aspiration: Carefully select the patient and surgical procedure according to approved indications and contraindications Avoid inadequate anesthesia upon insertion of the LMA™ airway and during surgery (Test papillary reflex of eye) Avoid lubrication of anterior surface, excessive lubrication, or use of lidocaine gels containing non-aqueous solvents or silicones*

Answer 52

Why do I have trouble inserting the LMA™ device? Some of the most common mistakes made while inserting the LMA™ airway include : Inadequate anesthesia may cause coughing or breath-holding Immediately deepen anesthesia and manually ventilate the patient Suboptimal head/neck position When inserting the LMA-ProSeal™, LMA-Unique™, LMA-Classic™, and LMA-Flexible™, keep the patient's head in the sniff position... just try to get best sniffing as possible When inserting the LMA-Fastrach™, keep the patient's head in the neutral position Incorrect mask deflation - Attempting to insert the LMA™ airway with the cuff partially inflated increases the chances of a down-folded epiglottis Failure to press the LMA™ airway into the palatopharyngeal curve during insertion Follow the recommended insertion techniques described in the LMA literature Lack of water-soluble lubricant on the posterior surface of the LMA™ cuff Using a mask that has surpassed its useful life of 40 insertions The cuff and airway tubes of the reusable LMA™ devices are manufactured from silicone. With each use, the silicone degrades and loses flexibility. Prior to use, be sure to perform the manufacturer recommended Pre- Use Performance Tests listed in the product instruction manuals

Answer 53

How do I use the LMA™ device with positive pressure ventilation? Positive pressure ventilation (PPV) via the LMA™ device is an established technique, effective in both children and adults Use Pressure Control over Volume Control Before attempting PPV with the LMA™ airway, the clinician should be experienced using the LMA™ airway with spontaneously-breathing patients The following are practical points to review when using the LMA™ airways with PPV: Use tidal volumes of approximately 6-8 ml/kg Maintain peak inspiratory pressures within the maximum airway seal pressure, on average, 30 cm H2O or less with the LMA-ProSeal™ and 20 cm H2O or less with the other LMA™ airways... 20 is kind of the limit generally Control end-tidal CO2 by altering respiratory rate Leaks during PPV may be attributable to light anesthesia, inadequate muscle relaxant (if used), use of too small an LMA™ airway, a reduction in lung compliance related to the surgical or diagnostic procedure, patient factors, or displacement of the LMA™ airway by head turning or traction. During the recovery period, reverse the muscle relaxant or allow it to wear off before switching off the anesthetic agents at the end of the procedure. With gentle, assisted ventilation, the patient should be allowed to start breathing

Answer 54

How do I manage an air leak with the LMA™ airway? An air leak may have several causes. Prior to insertion, be sure the LMA™ device is in proper working order, doesn't have a hole in the mask or inflation line, and has passed all the recommended Pre-Use Tests. Inadequate anesthesia can cause an air leak around the mask of the LMA™ device. Deepen the level of anesthesia to see if the leak subsides. Air Leaks can be caused by: An improperly placed LMA™ airway a mask with too little or too much air in the cuff an LMA™ cuff that has folded back on itself and/or too small an LMA™ device for size of the patient Check the position of the LMA™ cuff and reinsert or replace, as necessary Do not simply add more air to the cuff as adding air may increase tension in the cuff, pushing it away from the laryngeal opening When using assisted or positive pressure ventilation with the LMA™ device, high airway pressures can cause the mask to leak Reduce the airway pressure by: lowering the tidal volume lowering the inspiratory flow rate increasing muscle relaxation or treating bronchospasm if present

Answer 55

How long can I leave the LMA™ airway in place? The maximum duration for which an LMA™ airway can safely be used is not yet known; however, there is increasing evidence that the LMA™ airway may be safe for elective procedures in healthy patients lasting 4 to 8 hours in the hands of experienced users (8 hours is way too long, Professor Chrobak would say 4 is the most) If the LMA™ airway is used for prolonged periods the respiratory function must be closely monitored use a heat and moisture exchanger (HME)

Answer 56

Can I remove the LMA™ airway with the cuff inflated? Provided the patient is awake and airway reflexes have returned, cuff deflation prior to removal is not essential However, it is preferable to remove the LMA™ airway deflated to prevent damage to the cuff from sharp teeth In most situations, clinicians prefer to remove the LMA™ with cuff inflated, primarily to remove secretions that collect on top of the cuff (this is a personal preference) This is particularly true of patients undergoing nasal/throat surgery where bleeding from above the airway has collected on the LMA™ cuff Rarely it may be difficult to remove the LMA™ airway inflated due to the cuff becoming caught under the base of the tongue It should also be noted that if intubation has been performed using the LMA- Classic™, LMA-Unique™, or LMA-Fastrach™ as a conduit, removal of the LMA™ airway with the cuff inflated may inadvertently dislodge or move the endotracheal tube

Answer 57

Is the LMA™ device safe in the MRI environment? The LMA-ProSeal™, i-Gel, LMA-Classic™, and LMA- Flexible™, and LMA-Fastrach™ endotracheal tube are MRI safe when properly positioned and secured with tape

Answer 58

The LMA-Classic™, LMA-Flexible™, and LMA- Unique™ have been studied in vitro with various types of lasers and clinical reports have appeared in the literature; however, there are no recommendations for use of the LMA™ airways in laser surgery.

Answer 59

1 = Neonates/Infants up to 5 kg 1½ = Infants 5-10 kg 2 = Infants/children 10-20 kg 2½ = Children 20-30 kg 3 = Children 30-50 kg 4 =Adults 50-70 kg 5 = Adults 70-100 kg 6 = Large Adults over 100 kg *** Know these for test questions

Answer 60

APPROPRIATELY SIZED LARYNGOSCOPE APPROPRIATELY SIZED ETT 7.0/6.5 - most woman 8.0/7.5 - most men *** But can change based on patients size/height *** Also can change on the procedure being done (bronchoscopy maybe 8.5/9.0) MEDICATIONS 1st - Fentanyl... dose doesn't really matter in the beginning (for the stimulation to come) 2nd - Lidocaine... for sting of Propofol 3rd - Propofol 4th - Muscle Relaxant... choice based on circumstances *** LMAs just need Propofol, maybe Lidocaine for the Propofol sting O2 METHOD FOR VENTILATION Minimum Ambu Bag

Answer 61

DESIGNED TO: ENTER THE MOUTH DISPLACE SOFT TISSUE ELEVATE THE EPIGLOTTIS DIRECTLY OR INDIRECTLY

Answer 62

WHAT EQUIPMENT WILL YOU NEED? Don't Forget the STYLET 8 years and under consider using an uncuffed tube

Answer 63

Laryngoscopes Handles (where the batteries are) Blades Light Source (always double check when getting equipment) With a Big Tongue consider Mac due to the bigger Web

Answer 64

ETT COMPONENTS TUBE DISTAL (PATIENT) END PROXIMAL (MACHINE) END At Distal End BEVEL MURPHY EYE CUFF CUFF PERMANENTLY ATTACHED PERMEABLE TO GASES AND VAPORS CUFF INFLATION SYSTEM (See Picture) CONNECTOR Always make to tighten after opening bag MACHINE END 15 MM OD MACHINE TAPERED FLANGE PATIENT END STRAIGHT OR CURVED (curved you would see with ENT surgeons and very specific)

Answer 65

OETT - Oral Endotracheal Tube NETT - Nasal Endotracheal Tube

Answer 66

Top pic is Oral RAE without a cuff Bottom pic is Nasal RAE Oral surgery, ophthalmology, ent, facial Right angle endotracheal tube

Answer 67

Uncuffed is only in Peds Leak Test Below 20, it is too small Above 20, have to figure out where the point is it leaks with the pressure

Answer 68

Sized in French Higher the number, bigger the tube

Answer 69

MATERIAL COPPER, ALUMINUM (REGULAR) STAINLESS STEEL (GLIDESCOPE) NO LOOSE COMPONENTS RETAIN SHAPE REMOVE EASILY WITH THUMB ACTION DISTAL SHAPE HOCKEY STICK ARCUATE PROXIMAL SHAPE LOOP AT 90O TO LONG AXIS

Answer 70

DONT FORGET TO SEAT CONNECTOR WHEN REMOVING TUBE FROM PACKAGING

Answer 71

MAKE SURE THAT YOU HAVE ALL OF YOUR EQUIPMENT PREPARED, IN THE ROOM AND READY MAKE SURE THAT YOU CAN PROVIDE YOUR PATIENT WITH BAG-MASK VENTILATION MAKE SURE PATIENT POSITION IS OPTIMIZED HAVE A BACK-UP PLAN B AND PLAN C

Answer 72

O2 SOURCE AND SELF INFLATING VENTILATION BAG FACE MASK ORAL AND NASAL AIRWAYS TRACHEAL TUBES STYLET SYRINGE FOR CUFF INFLATION SUCTION LARYNGOSCOPE HANDLES LARYNGOSCOPE BLADES PILLOW, TOWEL, BLANKET, OR FOAM FOR HEAD POSITIONING STETHOSCOPE

Answer 73

ACCOMPLISH INTUBATION WITHIN 30 SECONDS PROTECT THE PATIENT AGAINST HYPOXIA ASPIRATION OF GASTRIC CONTENTS (Have Suction on the Ready) TRAUMA MEMORY OF THE INTUBATION

Answer 74

ETCO2 we want over 85% is the indicator have a good Preoxygenation Always a Pulse Ox on, minimum 88%

Answer 75

THE VOLUME OF ACIDIC ASPIRATES THAT WILL IMMEDIATELY CAUSE ALVEOLAR CAPILLARY BREAKDOWN: PH LESS THAN 2.5 AND VOLUMES GREATER THAN 25 ML (0.4 ML/KG)

Answer 76

HOW TO INTUBATE: FLEX THE CERVICAL SPINE (SNIFFING POSITION) EXTEND THE ATLANTO- OCCIPITAL JOINT OPEN THE MOUTH SCISSOR TECHNIQUE NATURAL OPENING UPON POSITIONING INSERT LARYNGOSCOPE RIGHT SIDE OF THE MOUTH DISPLACE THE TONGUE RIGHT TO LEFT ELEVATE THE EPIGLOTTIS FORWARD AND UPWARD MOTION EXPOSE THE VOCAL CORDS GUIDE THE ENDOTRACHEAL TUBE THROUGH THE VOCAL CORDS UNDER DIRECT VISION (I.E. YOUR EYES SEE IT PASS THROUGH THE VOCAL CORDS) NEVER TAKE YOUR EYES OFF THE PRIZE!

Answer 77

MOST COMMON METHOD PATIENT IS PUT INTO THE SNIFFING POSITION TO ALIGN THE AXES LARYNGOSCOPY IS PERFORMED INTRODUCE THE BLADE RIGHT SIDE OF MOUTH BLADE REMAINS LATERAL TO THE TONGUE ELEVATE THE EPIGLOTTIS CONFIRMATION OF ENDOTRACHEAL TUBE IN TRACHEA CONFIRMATION OF ENDOTRACHEAL TUBE IN TRACHEA

Answer 78

END- TIDAL CO2 MONITORING CAPNOGRAPHY/CAPNOMETRY ETCO2 DETECTOR (CHANGES FROM PURPLE TO YELLOW) AUSCULTATION – MOST “PRACTICAL” MOVEMENT OF CHEST AND EPIGASTRIUM DIRECT VISION VITAL SIGNS CONDENSATION IN THE TUBE PULSE OXIMETRY TUBE MARKING - 21-23 CM AT INCISORS CUFF PALPATION CHEST X-RAY

Answer 79

If after induction, you have a sudden drop to say 22 with good waveform... you know might have hypoperfusion - RUN A PRESSURE

Answer 80

TUBE NOT IN TRACHEA, CAPNOGRAM SUGGESTS TUBE IS IN TRACHEA BAG/MASK VENTILATION PRIOR TO INTUBATION ANTACIDS IN STOMACH RECENT INGESTION OF CARBONATED BEVERAGES TUBE IN PHARYNX

Answer 81

INDICATIONS FOR EXTUBATION POOR OR NO CHEST MOVEMENTS CYANOSIS DEVELOPING WITHIN 10 MINUTES FAILURE TO OXYGENATE ANOMALOUS TUBE LENGTH TACHYCARDIA AND HYPERTENSION INCREASING ABDOMINAL DISTENSION NO CO2 DETECTED BY CAPNOGRAPH ABSENCE OF CONDENSATION IN THE TRACHEAL TUBE

Answer 82

INDICATIONS: RESPIRATORY FAILURE WITH TRISMUS (lockjaw) TRAUMA PATIENTS WITHOUT SIGNIFICANT MIDFACIAL TRAUMA OR MIDFACE INSTABILITY (BLIND TECHNIQUE) SURGICAL NECESSITY OR SURGEON’S PREFERENCE

Answer 83

EQUIPMENT THE SAME AS OROTRACHEAL INTUBATION, WITH THE ADDITION OF MAGILL FORCEPS. WATER SOLUBLE LUBRICANT (K-Y JELLY) ALWAYS HAVE OXYGEN AND SUCTION IMMEDIATELY AVAILABLE WARM BOTTLE OF STERILE WATER SEDATION MAY OR MAY NOT BE REQUIRED SELECT AN ENDOTRACHEAL TUBE WHOSE INTERNAL DIAMETER IS A HALF-SIZE SMALLER THAN YOU WOULD NORMALLY USE FOR ORAL INTUBATION. LUBRICATE THE TUBE AND SELECTED NOSTRIL WITH K-Y JELLY. APPLY AFRIN OR PHENLEPHRINE TO CONSTRICT NASAL VASCULATURE CONSIDER SERIAL DILITATION WITH NASAL AIRWAYS

Answer 84

DIRECT VISION: INSERT TUBE INTO NARE WITH BEVEL POINTING TOWARD THE SEPTUM DIRECT IT VERTICALLY DOWNWARD, AT A RIGHT ANGLE UNTIL IT REACHES THE OROPHARYNX WITH STEADY, CONSTANT PRESSURE EXPOSURE OPEN THE MOUTH AS YOU WOULD WHEN PERFORMING AN OROTRACHEAL INTUBATION. VISUALIZATION VISUALIZE THE VOCAL CORDS WITH A LARYNGOSCOPE BLADE TUBE PLACEMENT YOU MAY BE ABLE TO DIRECT NASOTRACHEAL TUBE DIRECTLY PAST THE VOCAL CORDS; IF NOT MAGILL FORCEPS WILL LIKELY BE REQUIRED TO DIRECT THE TUBE INTO THE VOCAL CORDS.

Answer 85

TECHNIQUE: PERFORMED ON AN AWAKE, SEDATED, OR ANESTHETIZED PATIENT THE PATIENT MUST BE BREATHING SPONTANEOUSLY PREPARE THE NOSTRILS PLACE THE TUBE IN THE NOSTRIL AND THEN ADVANCE THE TUBE INTO THE OROPHARYNX Performing Technique FLEX THE CERVICAL SPINE LISTEN AND FEEL FOR BREATH SOUNDS SLOWLY ADVANCE THE TUBE, WHEN IT ENTERS THE AIRWAY, THE PATIENT WILL COUGH

Answer 86

NASAL BLEEDING--USUALLY CONTROLLED BY PINCHING NOSTRILS TOGETHER ESOPHAGEAL INTUBATION--TUBE POSITION MUST BE CONFIRMED USING THE SAME TECHNIQUES AS FOR ORAL INTUBATION. VERIFY TUBE POSITION FREQUENTLY. TRAUMA TO NASO AND OROPHARYNX, ESOPHAGUS--SOME BLEEDING MAY OCCUR. SUCTION IF NEEDED. THIS IS A GENTLE PROCEDURE, DO NOT FORCE THE TUBE. NASAL STRUCTURAL DAMAGE MAY RESULT IF TUBE IS REMOVED WITH BALLOON INFLATED RIGHT OR LEFT MAINSTEM INTUBATION ASPIRATION VAGAL STIMULATION LARYNGOSPASM VOCAL CORD DAMAGE PNEUMOTHORAX ANOXIA

Answer 87

ABSOLUTE 1. APNEA (IF BLIND TECHNIQUE) 2. SUSPECTED EPIGLOTTITIS 3. MIDFACE INSTABILITY 4. BLEEDING DISORDERS OR THOSE ON ANTICOAGULATION THERAPY RELATIVE 1. SUSPECTED BASILAR SKULL FRACTURE 2. NASAL FOREIGN BODIES OR LARGE NASAL POLYPS 3. RECENT NASAL SURGERY OR A HISTORY OF FREQUENT EPISODES OF EPISTAXIS 4. UPPER NECK HEMATOMAS OR INFECTIONS

Answer 88

MANUAL AIRWAY MANIPULATIONS USUALLY DONE BY AN ASSISTANT AND USED TO FACILITATE INTUBATION OR TO PROTECT PATIENTS AGAINST ASPIRATION

Answer 89

USED TO IMPROVE VISUALIZATION OF THE AIRWAY DURING ROUTINE AND DIFFICULT INTUBATION THE ‘BURP’ MANEUVER (CONSISTING OF BACKWARD, UPWARD AND RIGHT-SIDED PRESSURE ON THE THYROID AND CRICOID CARTILAGES) WAS INTRODUCED BY KNILL IN 1993 TO IMPROVE THE GLOTTIC VIEW DURING ENDOTRACHEAL INTUBATION. THREE DISTINCT COMPONENTS: POSTERIOR PRESSURE ON THE LARYNX AGAINST THE CERVICAL VERTEBRAE (BACKWARD) SUPERIOR PRESSURE ON THE LARYNX AS FAR AS POSSIBLE (UPWARD) LATERAL PRESSURE ON THE LARYNX TO THE RIGHT (RIGHT) *BY ADDING PRESSURE TO THE PRECEDING TERMS, THE ACRONYM BECOMES BURP

Answer 90

OPTIMAL EXTERNAL LARYNGEAL MANIPULATION IMPLIES THAT ONE SHOULD EXPERIMENT WITH THE OPTIMAL MANEUVER ON THE LARYNX TO IMPROVE VISUALIZATION.

Answer 91

THE APPLICATION OF CRICOID PRESSURE IN THE PRESENCE OF NECK EXTENSION FREQUENTLY IMPEDED THE LARYNGOSCOPIST’S VIEW OF THE LARYNX DURING ATTEMPTS AT INTUBATION THE "SNIFFING” POSITION WAS ADOPTED AS THE STANDARD DURING CRICOID PRESSURE APPLIED BY PLACING THE THUMB AND MIDDLE FINGER ON EITHER SIDE OF THE CRICOID CARTILAGE AND THE INDEX FINGER ABOVE TO PREVENT MOVEMENT OF THE CRICOID

Answer 92

Steps to take if not properly ventilating someone Less invasive to more invasive

Answer 93

Controlled GERD vs Uncontrolled GERD

2025 Airway Management Exam 2 Flashcards

Lectures 3-6: Airway Management and Equipment, Airway Evaluation, LMAs, Intubation