Airway Flashcards
Name 2 indications cricothyroidotomy
- Inability to provide other emergency airway control eg orotracheal intubation
- Severe airway obstruction eg severe tbi, maxillo-facial injuries , penetrating neck injuries etc
Name 3 indications tracheostomy
- patients undergoing prolonged use of endotracheal tube (long ventilation)
- After cricothyrodotomy
- Severe maxillo facial trauma: “primary” tracheostomy
Name 3 differences between cricothyroidotomy and tracheostomy procedures and techniques
1 Crycothyroidotomy is emergency procedure, tracheostomy is elective
2. Cricothyroidotomy keep neck immobilised in-line neutral, tracheostomy extend
3. Cricothyroidotomy no anaesthesia; tracheostomy in the theater under general anaesthesia
Name 2 types tracheostomies
Open and percutaneous
Name 6 complications tracheostomy
- local haemorrhage (minor vessels)
- Oesophageal injury, tracheo-oesophageal fistula
- Injury to carotid arteries and jugular veins
- Injure thyroid
5-loss of airway - Pneumothorax
What is the triple airway manoeuvre?
Head tilt-chin lift, then jaw thrust, then maintain mouth in open position
Indications for oropharyngeal (guedel) airway? (2)
- Unresponsive pt with absent gag reflex. (tongue causing obstruction)
- During bag mask ventilation typically, before intubation
Contraindication for oropharyngeal airway?
Intact gag reflex because can cause laryngospasm
Label picture 2
See picture 3
Name 5 predictors of difficult BVM ventilation
BOOTS
Beard (solution: ky jelly, opsite, 2-person BVM)
Obesity bmi >26 (solution:ramp)
Old age >55
Toothless
Snoring
Name 4 indications for intubation and give 3 examples of each
- Ventilation during anaesthetic for surgery eg if muscle relaxant required, long case, abdo surgery, head positioning may be required in head head and neck surgery
- Pt can’t protect airway eg gcs <8, high aspiration risk, given muscle relaxation
- Potential airway obstruction eg airway burns, epiglottitis, neck haematoma
- Inadequate ventilation or oxygenation eg copd, head injury, ards
Label picture 4 and indication
Rigid yankauer suction for mouth, visible pieces of food, hard items etc
Label picture 5 and indication
Soft catheter suction for suction inside endotracheal tube
How measure size of orophanyngeal airway?
Distance between middle of lip and angle of mandible
Nasopharyngeal airway indication?
Reduced gcs and intact gag reflex.
Name 2 contraindications nasopharyngeal airway
• base of skull fracture
• Nasal polyps
How to measure size of nasopharyngeal airway?
Distance between tragus of ear and tip of nose. Little finger for diameter
Usually 7 for male, 6 for female
Name 5 predictors difficult intubation
• Oropharyngeal burns
• previous surgical airway
• previous neck surgery
• facial injury
• c spine injury
Inability to open mouth properly, high bmi, short neck
Name 5 complications intubation
• Trauma to lips and teeth
• bleeding
• esophageal intubation
• barotrauma to lungs by hyperventilation/ too high pressure. Can cause tension pneumo
• tracheal stenosis if >10 days
Where should incision be made for cricothyrodotomy?
Crico-thyroid membrane
Which conditions push trachea away to opposite side? (5)
• Massive pleural effusion
• tension pneumothorax.
• neck or thyroid mass
• large mediastinal mass
• upper lung tumours
( any thing that increase pressure or volume in hemithorax will push away)
Which conditions pull trachea toward same side? (5)
•Atelectasis (collapse lung) !
• pneumonectomy
• diaphragmatic paralysis
• pleural Fibrosis
• agenesis of lung
• spontaneous pneumothorax : non-tension or open.
Name 6 complications of mechanical ventilation
• Barotrauma
• air trapping
• Infection
• cardiovascular effects - decreased co
• oxygen toxicity
• Diaphragmatic dysfunction
Name 7 risk factors and signs post-trauma for airway obstruction
• Low GCS <8
• maxillo-facial trauma and mid- face fractures
. Penetrating neck injury (haematoma compress trachea)
• SBP < 60 - poor brain perfusion
• Burns to face and neck, especially inhalation injury
• high C spine cord injury above c5
• hanging
Which type of intubation is contraindicated in trauma?
Nasal
How assess patients for difficult intubation?
Lemon
Look for known factors that cause difficult intubation: beard, short neck, obese, receding mandible, advanced age
Evaluate the 3-3-2 rule.
Mallampati test - class 3 difficulty, class 4 very difficult
Obstruction trauma is a major cause of obstructed airway
Neck mobility -majority should not move necks, nb to immobilize.
What is the 3-3-2 rule of intubation?
• Distance between incisors should be at least 3 finger breadths
• distance between hyoid and chin at least 3 finger breadths
• distance between thyroid notch and floor mouth at least 2
Name the 4 classes of the mallampati test and what they indicate
• Class 1: see entire hypopharynx- easy intubation
• class 2: soft palate, uvula and fauces only visible - normal
• class 3: soft palate and base uvula visible - difficult
• class 4: hard palate only-very difficult
Name 6 alternatives to rescue airway during difficult intubation
•video laryngoscope
• Gum elastic bougie
• Laryngeal mask airway
• intubating bronchoscope
• needle cricothyroidotomy
• Surgical cricothyroidotomy
Why is tension pneumo dangerous? (4)
Displacement of mediastinal structures away from injured side cause:
• compression superior and inferior vena cava heart and contralat lung
. Drop venous return (preload) to heart
• reduced ventricular end diastolic filling pressures
. Drop cardiac output-cardiac compressive shock
Name 10 clinical manifestations of tension pneumothorax
• Respiratory distress- tachypnoea, nasal flare, use accessory muscles
. No chest movement affected side!
• hypotension
• reduced or absent breath sounds affected side!
• tracheal deviation contralateral side!
. Hyper-resonant percussion!
. Significant surgical emphysema
• tachycardia and hypoxia
• speak in short interrupted sentences-gasping for air
• decreasing GCS
• chest wound may be present
The maximum length of time spent attempting to intubate patient should not exceed?
5 minutes
