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N928 - Basic Principles > Airway Adjuncts > Flashcards

Airway Adjuncts Flashcards

1
Q

Supraglottic devices:

function, 3 types

A

provide ventilation above glottic opening
LMA
combitube
king laryngeal tube

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2
Q

Intubation stylet types (3)

A

Light
Bougie
Airway exchange catheter

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3
Q

using Flexible Fiberoptic Scope

type of intubation & set up

A

Most likely awake intubation.
Topical Lidocaine or nebulizer to tongue, pharynx, cords
- Sniffing position [use ramp or rolled blanket]
- have ETT on scope first

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4
Q

4 sites of regional airway blocks

A
  • Glossopharyngeal Nerve
  • Recurrent Laryngeal Nerve (RLN)
  • Superior Laryngeal Nerve (SLN)
  • Translaryngeal Block
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5
Q

Rigid Fiberoptic Scope is used..

A

when large/immobile tongue or head/neck cannot be extended

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6
Q

Retrograde Intubation is for situations in which you ____ ventilate; ______ intubated

A

you CAN ventilate; you CANNOT intubate

  1. Needle through cricothyroid membrane
  2. Guide wire placed
  3. ETT placed through mouth
  4. ETT positioned through cords into trachea
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7
Q

Submental intubation location & indication

A

ETT inserted at inferior border of mandible

facial trauma

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8
Q

Needle Cricothyrotomy is for situations in which you ____ ventilate; ______ intubated

A

you CANNOT ventilate; you CANNOT intubate

→ only use for a very short amount of time

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9
Q

Transtracheal Jet Ventilation is for situations in which you ____ ventilate; ______ intubated

indications or risk factors (5)

A

can’t intubate; can’t ventilate
- facial trauma, bleeding, swelling, edema, burns

  • O2 supply with at least 50psi of pressure
  • ensure upper airway is patent for air movement
  • TV dependent upon I:E ratio, chest wall & lung compliance

Catheter size
14g catheter ~1600mL/s
16g catheter ~500mL/s
^poiseuille’s law

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10
Q

Transtracheal Jet Ventilation contraindications (2)

A

FULL obstruction of upper airway

damage to trachea or tracheal rupture

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11
Q

Transtracheal Jet Ventilation complication considerations (4)

A
  1. Barotrauma
  2. Pneumothorax
  3. Subcutaneous Emphysema
  4. Equipment Failure
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12
Q

Supraglottic device indication (4)

A

failed intubation
rescue ventilation
alternative to ETT
conduit to facilitate ETT intubation

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13
Q

Supraglottic device contraindication (5)

A 
Poor pulmonary compliance
High airway resistance
Pharyngeal pathology
Risk for aspiration
Airway obstruction BELOW the larynx
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14
Q

Aperture Bars

A

on LMA, used to hold back epiglottis

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15
Q

LMA Size 1

weight
cuff volume
test volume
largest ETT size

A

<5kg

cuff volume: 4cc
test volume: 6cc
largest ETT: 3.5

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16
Q

LMA Size 2

weight
cuff volume
test volume
largest ETT size

A

10-20kg

cuff volume: 10cc
test volume: 15cc
largest ETT: 4.5

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17
Q

LMA Size 1.5

weight
cuff volume
test volume
largest ETT size

A

5-10kg

cuff volume: 7cc
test volume: 10cc
largest ETT: 4.0

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18
Q

LMA Size 2.5

weight
cuff volume
test volume
largest ETT size

A

20-30kg

cuff volume: 14cc
test volume: 21cc
largest ETT: 5.0

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19
Q

LMA Size 3

weight
cuff volume
test volume
largest ETT size

A

30-50kg

cuff volume: 20cc
test volume: 30cc
largest ETT: 6.0 cuffed

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20
Q

LMA Size 4

weight
cuff volume
test volume
largest ETT size

A

50-70kg

cuff volume: 30cc
test volume: 45cc
largest ETT: 6.0 cuffed

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21
Q

LMA Size 5

weight
cuff volume
test volume
largest ETT size

A

70-100kg

cuff volume: 40cc
test volume: 60cc
largest ETT: 7.0 cuffed

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22
Q

Where does the LMA sit?

A

Distal tip @ upper esophageal sphincter
Lateral edges rest in the pyriform sinus
Proximal edge seats under the base of the tongue

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23
Q

LMA Complications (3)

A

*aspiration
trauma
nerve injuries

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24
Q

LMA ProSeal

A

Reusable with gastric drain orifice

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25
Q

LMA Supreme

A

Single-use with gastric drain orifice

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26
Q

Bite block use with LMA:
always use ___
consider ___

A

always use during wake up.

consider length of case and necessity during the procedure

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27
Q

Fastrach LMA

A

CAN intubate through, handle to lift epiglottis

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28
Q

Air-Q Masked laryngeal airways

A

NO aperture bars
→ can place ETT through

Peds / Infant sizing

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29
Q

When do you use a bougie?

A

Grade III or Grade IV view

30
Q

sizes of oral airways (3)

A

Small 80mm
Medium 90mm
Large 100mm

31
Q

adverse events of oral airways (7)

A 
pressure ulcer
trauma to teeth/tissue
gagging
coughing
vomiting
laryngospasm
bronchospasm
32
Q

types of oral airways (4)

A

Guedel
Berman
Ovassapian
COPA (cuff)

33
Q

end of nasal airway should rest

A

just above epiglottis

34
Q

clinical uses of nasal airway (4)

A
  1. relieve obstruction
  2. facilitation of pharyngeal suctioning
  3. nasal dilation
  4. fiberoptic guide
35
Q

nasal airway sizing

A

internal diameter in mm

36
Q

nasal airway contraindications (6)

A
  • coagulopathy / anticoagulant therapy
  • pregnancy
  • basilar skull fx / trauma
  • nasal infection
  • deformities of face
  • Hx nosebleeds requiring treatment
37
Q

Oral & Nasal airway complications (8)

A
  • airway obstruction
  • tongue/tissue damage
  • central nervous system damage
  • uvula edema
  • dental damage
  • laryngospasm, coughing
  • ulceration/necrosis
  • latex allergy
38
Q

Face Mask parts (3)

A

body
seal (rim or flap)
connector [with 22mm internal diameter]

39
Q

face mask complications (8)

A
  • skin problems (necrosis, dermatitis)
  • nerve injury
  • aspiration of gastric contents
  • eye injury
  • movement of cervical spine
  • latex allergy
  • high FGF = no correlation between PaCO2 & ETCO2
  • environmental pollution
40
Q

lateral or prone emergency airway

A

LMA

41
Q

LMA components (5)

A
  • 15mm connector
  • curved airway tube
  • elliptical spoon shaped cuffed mask
  • inflation pilot balloon and valve
  • aperture bars
42
Q

maximum # use on reusable LMA

A

40 uses

43
Q

LMA size 6

weight
cuff volume
test volume
largest ETT size

A

> 100kg

cuff volume: 50cc
test volume: 75cc
largest ETT: 7.0 cuffed

44
Q

ensure LMA cuff pressure maintains for ____ minutes

A

2 minutes

45
Q

good indicator of anesthetic level for LMA placement

A

jaw thrust

46
Q

how to assess adequacy of LMA placement (2)

A
  • air leak?

- ETCO2?

47
Q

LMA removal timing; 2 options

A
  1. deep

2. awake

48
Q

LMA contraindications (8)

A
  1. aspiration risk [obese, hiatal hernia, delayed gastric emptying, >14wks preg, trauma, acute abdomen]
  2. glottic or subglottic obstruction
  3. supraglottic pathology
  4. limited mouth opening
  5. thoracic injury
  6. pts with low pulmonary compliance [ie. fibrosis]
  7. Peak airway pressure >20cmH2O
  8. patients who cannot report medical history
49
Q

which nerve can be injured d/t LMA

A

hypoglossal nerve injury

50
Q

Endotracheal intubation indications [physiological & surgery] (8)

A
  • aspiration risk
  • head/neck procedures
  • intracranial procedures
  • intrathoracic procedures
  • intraabdominal procedures
  • procedures requiring mechanical ventilation
  • airway anomalies
  • positioning where airway is unavailable to anesthesia
51
Q

ETT sized by the ___

A

internal diameter

2.5mm - 9.0mm

52
Q

ETT material

A

polyvinyl chloride (PVC)

American Society for Testing Materials (ASTM) Standard 21 applied to ETT construction

marking F-29, Z-79, I.T.
means it has been tested & no toxicity

53
Q

Size & Depth

A

Men: 8.0 or 9.0 @ 24-26cm at lip
Women: 7.0 or 8.0 @ 20-22 cm at lip

Children:
Size- (4 + age) / 4
Depth- (12 + age) / 2

54
Q

recommended cuff inflation pressure & tracheal perfusion pressure

A

20-25mmHg

25-30mmHg

55
Q

Uncuffed ETT used:

A

in children <8yr old

airleak @ 15-20cmH2O

56
Q

Prep of ETT (3)
secure ____
place & shape ____
check ____

A

15mm adaptor connection
stylet
check cuff

57
Q

Laryngoscope blades:

A

MacIntosh (valleculae) [size 1-4]

Miller (lifts epiglottis) [size 0-4]

58
Q

Glidescope uses (4)

A

video laryngoscope

Use:

  • known difficult airway
  • “Rescue”
  • Anterior larynx
  • Poor neck mobility
59
Q

Fiberoptic intubation indication (4)

A
  • difficult airway
  • C-spine precautions
  • assessment of double lumen ETT placement
  • airway evaluation
60
Q

Bullard Scope is a _____

Useful for ____

Not used because ____

A
  • rigid laryngoscope anatomically shaped with fiberoptic bundle and eyepiece extending at 45 degree angle from handle
  • useful in difficult airways
  • expensive; slow learning curve
61
Q

Wu Scope is a _____

Used because ______

Not used because ______

A
  • rigid anatomically shaped blade with separate flexible fiberoptic scope
  • allows for O2 and suctioning during intubation
  • slow learning curve; parts must be assembled
62
Q

UpsherScope is a ______

Not used because ______

A
  • rigid blade shaped in form of oropharynx with attached eye piece
  • slow learning curve
63
Q

Lightwand is ___ and functions by _____

A
  • lighted intubation wand
  • transillumination of neck to guide ETT

*larynx not directly visualized

64
Q

Eschmann Introducer (Bougie)
size
length
special end

useful for ____

A

15Fr 60cm long, angled 40 degrees at the tip

useful in Grade III and Grade IV Cormak Laryngoscope views

65
Q

Combitube is a ____

Used for ____

A

Supraglottic airway device

  • used in emergency
  • TWO lumens; can be used whether it is placed in esophagus or trachea
66
Q

Transtracheal Jet Ventilation Complications:
2 most common ____ & _____

also (5)

A

*tracheal mucosal damage & thickened secretions blocking the airway d/t inadequate humidification of inspired gases** MOST COMMON

  • Pneumothorax, pneumomediastinum, subcutaneous emphysema, barotrauma
  • tracheal/esophageal rupture
  • Hematoma
  • Failure to adequately ventilate
  • Inadequate delivery of anesthetic gases
67
Q

Retrograde Intubation location

size of catheter

technique

A

18g through cricothyroid membrane → cephalad at 45 degree angle

  • thread J-wire through needle & out through mouth
  • follow ETT over guidewire & into trachea
68
Q

Cricothyrotomy supplies (6)

A
  1. 12-14g needle
  2. 3mL syringe, no plunger
  3. 15mm ETT adapter from 4. 7.0 ETT
  4. breathing circuit
  5. TTJV
69
Q

Cricothyrotomy complications (6)

A
  • pneumothorax
  • subQ emphysema
  • bleeding
  • esophageal puncture
  • aspiration
  • respiratory acidosis
70
Q

AIRWAY MANAGEMENT PEARLS (8)

A
  1. take a careful history
  2. perform detailed assessment
  3. carefully plan for intubation, extubation & backup plans
  4. learn & repeatedly practice ALL airway management skills
  5. YOU CANNOT BEAT A GOOD VIEW
  6. Do not give wakefulness, spontaneous ventilation, or muscle tone away lightly
  7. New techniques should demonstrate superiority over existing options – sometimes the old way is better
  8. Don’t be afraid to stop and come back another day.
  9. If time runs out, be definitive and oxygenate
  10. Be aware of your own skills, be willing to call for help!

N928 - Basic Principles (22 decks)

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