Advanced Airway Management Flashcards
Laryngeal Structures
Hyoid Bone
Thyrohyoid Membrane
Thyroid Cartilage
Cricothyroid Ligament
Cricoid Cartilage
Trachea
Pharyngeal tonsil
Adenoids
Epiglottis
Flap of elastic cartilage tissue
Guards entrance of the glottis, opening between vocal cords
Vocal Cords
Twin in-foldings of mucous membranes stretched across the larynx
CATHE
Inferior to superior of larynx
Cricoid cartilage
Arytenoid Cartilage
Thyroid Cartilage
Hyoid Bone
Epiglottis
Innervation of Larynx
Vagus Nerve
Vagus Nerve Stimulation
Decreases HR, BP, RR
Risk of stimulation with intubation/overinflation of king LT
Indications King LT
Need for ventilatory assistance/airway control
Other airways ineffective
Conditions King LT
GCS 3 w/o gag reflex
Contraindications King LT
Active vomiting
Inability to clear airway
Airway edema
Stridor
Caustic Ingestion
Medications which can go down King LT
Ventolin
Advantages of LMA
Minimal soft tissue trauma
Lower tidal volumes
Decreased gastric insufflation
Unaffected anatomical factors
Less coughing and laryngospasm
Decreased sympathetic response
Better tolerated
Disadvantages of LMA
No protection for aspiration/bleeding
Mouth required to be opened >0.6”
Difficult to adequately ventilate if needing high airway pressure
Not effective if airway anatomy abnormal
Contraindications of King LT
Risk of aspiration
High airway resistance
Presence of tumours, abscess, hematoma
Considerations for ETT
Failure to protect airway, failure of ventilation/oxygenation
Indications for ETT
Need for ventilatory assistance or airway control, other airways ineffective
LEMON
Look Externally
Evaluate 3-3-2
Mallampati
Obstruction
Neck Mobility
Look Externally
Beard
Moustache
Abnormal facial shape
Facial disruption by trauma
buck teeth
Obesity
Craniofacial abnormality
Neck mass
Large tongue
Trauma
3-3-2 Rule
3 Fingers between teeth
3 fingers from mentum to hyoid
2 fingers between hyoid and thyroid notch
Mallampati 1
Uvula, soft palate, faucial pillars visible
Mallampati 2
Uvula partially blocked by tongue, soft palate + faucial pillars visible
Mallampati 3
Soft palate visible, base of uvula may be visible, no other structures visible
Mallampati 4
Hard palate only visible
Obstruction
Laryngeal tumour
Evidence of airway obstruction
Epiglottitis
Peritonsillar abscess
Foreign body
Airway trauma
Noisy breathing
Inflammation
Neck Mobility
Reduced in elderly, arthritis, immobilization
BONES
BVM assessment
Beard
Obese
No teeth
Elderly
Snores
MOANS
BVM assessment
Mask seal
Obesity
Age
No teeth
Stiff
SLOPES
Suction, stylet
Laryngoscope, lube, lidocaine
Oxygen, OPA, Otrivin
Pillow/Positioning
ETT/ETCO2
Stethoscope, syringe, securing device
ETT tube sizing children
Age/4 + 4
ETT Depth to teeth child >2
Age/2 + 12
ETT Depth
Tube size x 3
Cormack and Lehane Scale
Grade 1: Full view
Grade 2: Epiglottis and arytenoids only
Grade 3: Epiglottis only
Grade 4: cannot see epiglottis
Sellick’s Maneuver
Protect from regurgitation/aspiration
10lbs pressure
Release if vomiting occurs to prevent esophageal rupture
Maintain until cuff inflated
Controversial if effective
Awake Intubation
GCS <8
Lidocaine 10mg/spray
Max 5mg/kg to 20 sprays
Confirmation of ETT Placement
ETCO2
Visualization
Auscultation
Chest rise
Misting
Syringe aspiration
SpO2
ETT Attempt
Insertion of laryngoscope for purpose of intubation
ETT Need For Sedation
Monitor HR and BP
Gagging
ETCO2
Indications for Procedural Sedation
Post-intubation, transcutaneous pacing
Conditions Procedural Sedation
> 18
RR >10 (non-intubated)
Normotension
Treatment Procedural Sedation
Midazolam
2.5-5mg
Max 5mg/dose
Total 10mg
2 doses 5 min apart
ETT Complications
Esophageal intubation
Vomiting
Aspiration
Right mainstream intubation
Inability to intubate
Loss of adaptor
Torn cuff
Dysrhythmias
Laryngospasm
Increased ICP
Hypoxia
Trauma
Flooded airway
Trouble Shooting ETT Compliance
DOPE BP
Displacement
Obstruction
Pneumothorax
Equipment
Bronchospasm
Pulmonary Edema
Esophageal obstruction
Treat with 1.0mg glucagon IV
Laryngospasm
Involuntary closure of glottic opening resulting in partial or complete airway obstruction
Causes of Laryngospasm
Extubation
Intubation/airway manipulation
ENT procedures
Fluids
Foreign body
Aspiration
Reflux
Near drowning
Larson’s Point
Laryngospasm notch
Break laryngospasm by applying painful anterior pressure at larson’s point bilaterally while performing jaw thrust
Indications Digital Intubation
Trauma
Obese or short necked pts
Secretions or bleeding obscures visualization
Pros of Digital Intubation
Fast
No requirement for positioning
Minimal C-spine movements for trauma pts
Ideal for those predicted to be difficulty airways
Used for copious secretions/blood and cannot visualize
Cons of Digital Intubation
Requires training
Being bit by pt
Airway trauma
Pt must be paralyzed or comatose/dead
Benefits those with long, slender fingers
Pickaxe/Tomahawk method
For trauma scenarios
In awkward situation
Times for Blind nasal intubation
C-spine injury
Airway control in conscious pt
Trismus
Significant head injury
Advantages nasal intubation
Better tolerated
No laryngoscope
Easier positioning
Awake pt
Pt cannot bite tube or manipulate with tongue
Disadvantages nasal intubation
Increased airway pressure
Limited compatibility
Epistaxis
Vocal cord trauma
Infection
Contraindications Nasal Intubation
<50 and asthma exacerbation not in or near cardiac arrest
Basal skull fracture
Uncontrolled epistaxis
Bleeding disorders
Complications of nasal intubation
Epistaxis
Damage to nasal cavity
Aspiration
Vagal stimulation
Laryngospasm
Vocal cord damage
Reasons for Tracheostomy
Bypass obstruction
Remove secretions
Oxygen delivery
Trauma/airway complications
Cricothyrotomy
Emergency airway procedure
Between cricoid and thyroid cartilages through the cricothyroid membrane
DOPES trach emergency
Displacement of tube
Obstruction of tube
Patient
Equipment
Stacked breaths
