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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
LMA Supreme
Single-use with gastric drain orifice
26
Bite block use with LMA: always use ___ consider ___
always use during wake up. | consider length of case and necessity during the procedure
27
Fastrach LMA
CAN intubate through, handle to lift epiglottis
28
Air-Q Masked laryngeal airways
NO aperture bars → can place ETT through Peds / Infant sizing
29
When do you use a bougie?
Grade III or Grade IV view
30
sizes of oral airways (3)
Small 80mm Medium 90mm Large 100mm
31
adverse events of oral airways (7)
``` pressure ulcer trauma to teeth/tissue gagging coughing vomiting laryngospasm bronchospasm ```
32
types of oral airways (4)
Guedel Berman Ovassapian COPA (cuff)
33
end of nasal airway should rest
just above epiglottis
34
clinical uses of nasal airway (4)
1. relieve obstruction 2. facilitation of pharyngeal suctioning 3. nasal dilation 4. fiberoptic guide
35
nasal airway sizing
internal diameter in mm
36
nasal airway contraindications (6)
- coagulopathy / anticoagulant therapy - pregnancy - basilar skull fx / trauma - nasal infection - deformities of face - Hx nosebleeds requiring treatment
37
Oral & Nasal airway complications (8)
- airway obstruction - tongue/tissue damage - central nervous system damage - uvula edema - dental damage - laryngospasm, coughing - ulceration/necrosis - latex allergy
38
Face Mask parts (3)
body seal (rim or flap) connector [with 22mm internal diameter]
39
face mask complications (8)
- 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
lateral or prone emergency airway
LMA
41
LMA components (5)
- 15mm connector - curved airway tube - elliptical spoon shaped cuffed mask - inflation pilot balloon and valve - aperture bars
42
maximum # use on reusable LMA
40 uses
43
LMA size 6 weight cuff volume test volume largest ETT size
>100kg cuff volume: 50cc test volume: 75cc largest ETT: 7.0 cuffed
44
ensure LMA cuff pressure maintains for ____ minutes
2 minutes
45
good indicator of anesthetic level for LMA placement
jaw thrust
46
how to assess adequacy of LMA placement (2)
- air leak? | - ETCO2?
47
LMA removal timing; 2 options
1. deep | 2. awake
48
LMA contraindications (8)
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
which nerve can be injured d/t LMA
hypoglossal nerve injury
50
Endotracheal intubation indications [physiological & surgery] (8)
- 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
ETT sized by the ___
internal diameter | 2.5mm - 9.0mm
52
ETT material
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
Size & Depth
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
recommended cuff inflation pressure & tracheal perfusion pressure
20-25mmHg 25-30mmHg
55
Uncuffed ETT used:
in children <8yr old | airleak @ 15-20cmH2O
56
Prep of ETT (3) secure ____ place & shape ____ check ____
15mm adaptor connection stylet check cuff
57
Laryngoscope blades:
MacIntosh (valleculae) [size 1-4] | Miller (lifts epiglottis) [size 0-4]
58
Glidescope uses (4)
video laryngoscope Use: - known difficult airway - "Rescue" - Anterior larynx - Poor neck mobility
59
Fiberoptic intubation indication (4)
- difficult airway - C-spine precautions - assessment of double lumen ETT placement - airway evaluation
60
Bullard Scope is a _____ Useful for ____ Not used because ____
- 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
Wu Scope is a _____ Used because ______ Not used because ______
- rigid anatomically shaped blade with separate flexible fiberoptic scope - allows for O2 and suctioning during intubation - slow learning curve; parts must be assembled
62
UpsherScope is a ______ Not used because ______
- rigid blade shaped in form of oropharynx with attached eye piece - slow learning curve
63
Lightwand is ___ and functions by _____
- lighted intubation wand - transillumination of neck to guide ETT *larynx not directly visualized
64
Eschmann Introducer (Bougie) size length special end useful for ____
15Fr 60cm long, angled 40 degrees at the tip useful in Grade III and Grade IV Cormak Laryngoscope views
65
Combitube is a ____ Used for ____
Supraglottic airway device - used in emergency * TWO lumens; can be used whether it is placed in esophagus or trachea
66
Transtracheal Jet Ventilation Complications: 2 most common ____ & _____ also (5)
*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
Retrograde Intubation location size of catheter technique
18g through cricothyroid membrane → cephalad at 45 degree angle - thread J-wire through needle & out through mouth - follow ETT over guidewire & into trachea
68
Cricothyrotomy supplies (6)
1. 12-14g needle 2. 3mL syringe, no plunger 3. 15mm ETT adapter from 4. 7.0 ETT 5. breathing circuit 6. TTJV
69
Cricothyrotomy complications (6)
- pneumothorax - subQ emphysema - bleeding - esophageal puncture - aspiration - respiratory acidosis
70
AIRWAY MANAGEMENT PEARLS (8)
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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