Air management

Question 1

Gag reflex nerve

Answer 1

Vagus

Question 2

3 unpaired carilages

Answer 2

Thyroid, cricoid, epliglottis

Question 3

3 paired cartilages

Answer 3

Arytenoid, cuneiform, corniculate

Question 4

Difficult to ventilate def (ASA)

Answer 4

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

Question 5

Difficult to intubate definition

Answer 5

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

Question 6

Difficult airway definition

Answer 6

A trained anesthetist experiences difficulty with facemask ventilation, laryngoscopy, intubation, or all of these.

Question 7

Lemon Law

Answer 7

Look externally, Evaluate the 3-3-2 rule, Mallampati, Obstruction?/Obesity, Neck mobility

Question 8

3-3-2 rule

Answer 8

3 fingers fit in mouth-inter incisor distance, 3 fingers fit from mentum to hyoid cartilage, 2 fingers fit from the floor of the mouth to the top of the thyroid cartilage

Question 9

Thyro-mental distance

Answer 9

Measure from upper edge of thyroid cartilage to chin with head fully extended. Short is an anterior larynx, >7cm is easy intubation <6cm difficult airway

Question 10

Mallampati classification (PUSH)

Answer 10

1- Pillars, uvula, soft, hard palate, 2-Uvula base, soft, hard palate, 3-soft/hard palate 4- hard palate only

Question 11

Possible obstructions

Answer 11

blood, vomitus, teeth, epiglottis, dentures, tumors, impacted objects.

Question 12

Atlanto-Occipital angle

Answer 12

35 degrees.

Question 13

Mask ventilation difficult? BONES

Answer 13

Beard, Obesity, No teeth, Elderly, Snoring

Question 14

Laryngeal visualization difficult? 4 D’s

Answer 14

Disproportion, Distortion, Dismobility, Dentition,

Question 15

Difficulty with SGA (LMA)

Answer 15

Restricted mouth opening, Obstruction, Distortion of airway, Stiff lungs,

Question 16

Difficulty with cricothyrotomy

Answer 16

Distorition of neck anatomy, Obesity or short neck, Trauma in or around neck, Impediments limiting access to neck (halo, fixed flexion) Surgery

Question 17

Maneuvers for airway/intubation

Answer 17

Positioning-Sniffing position, Neck positioning, Ramping-elevate shoulders, neck, and head, Apneic oxygenation, Cricoid pressure

Question 18

Options for airway

Answer 18

Awake intubation,

quick look,

Induction and paralysis

Question 19

Quick look without

Answer 19

Muscle relaxation, includes sedation

Question 20

Tidal volume breathing for pre-oxygentaiton time

Answer 20

3-5min

Question 21

Pre-oxygenation Deep breaths

Answer 21

4 times within 0.5 minutes

Question 22

Plan A for intubation

Answer 22

Elective (4 attempts) or RSI (3 attempts),

Optimise position,

use bougie or stylet,

alternative blade/scope,

alternative operator

Question 23

Plan B intubation

Answer 23

Classic LMA, Intubating LMS,

Fibreoptic intubation trough LMA, malleable fibreoptic stylet, fibreoptic scope,

Not appropriate in elective RSI

Question 24

Plan C for intubation

Answer 24

Maintain oxygenation and ventilation,

Attempt to wake patient up,

Consider suggamadex if available,

face mask, nasopharyngeal airway, guedel airway, classic LMA, Intubating LMA

Question 25

Plan D intubation

Answer 25

Rescue Technique,

Needle cricothyroidotomy (pediatric or easy anatomy),

Scalpel-bougie-ETT (adult or easy anatomy)

Scalpel-finger-needle (impossible anatomy)

Question 26

Only full ring of cartilage in trachea

Answer 26

Cricoid

Question 27

Number of C-shaped rings in tracha

Answer 27

16-20

Question 28

Even with proper eval, what percentage of difficult airways are picked up

Answer 28

15-50%

Question 29

What is the Thyro-mental distance

Answer 29

Measure from upper edge of thryoid cartilage to chin with the head fully extended.

Short disance= an anterior larynx

>7cm is usually easy intubation

<6cm= difficult airway

Question 30

Eschmann Stylet

Answer 30

Bougie

Question 31

Common LMA size in adults

Answer 31

4 (50-70kg) 30cc cuff

5 (70-100kg) 40cc cuff

6 (>100kg) 50cc cuff

Question 32

Upper Airway Obstruction s/s

Answer 32

Hoarse,

muffled voice,

difficulty swallowing,

secretions,

STRIDOR,

DYSPNEA,

EMERGENCY

Question 33

Lower Airway Obstruction signs

Answer 33

high peak pressures, low tidal volumes, impaired ventilation

Question 34

Considerations for obese airway

Answer 34

position, preoxygenate, 2nd plan, alternate adjuncts, assistants, desaturate much quicker(limit time delay)

Question 35

Age consideration for dentures

Answer 35

Endentulous (leave dentures in place for masking and lma)

Question 36

Tracheal Extubation Criteria Global

Answer 36

Acceptable hemodynamic status,

Normothermia,

Ability to maintain patent airway,

Adequate muscle strength,

Acceptable metabolic indicators,

Accpetable hematologic indicators

Adquate respiratory mechanics

Ability to maintain adequate oxygenation

Adequate analgeisa for optimal resp effort,

Question 37

Criteria to maintain patent airway

Answer 37

Laryngeal and cough reflex

Appropriate level of consciousness

Question 38

Criteria for adequate muscle strength (extubation)

Answer 38

head lift >5sec with constant hand grip,

Reversal of neuromuscular blockade( TOF>.9, tetanic response to 100Hz 5 seconds, and double burst stimulation without fade.)

Question 40

Criteria for acceptable metabolic indicators (extubation)

Answer 40

Electrolytes within acceptable limits,

acid-base balance within accept

Question 41

Vital capacity for extubation

Answer 41

>15mL/kg

Question 42

Maximal negative inspiratory force(NIF)

Answer 42

> -20cm H2O

Question 43

Tidal volume for extubation

Answer 43

at least 4-5mL/kg

Question 44

PaCO2 for extubation

Answer 44

<50mmHg