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TAS Emergencies and Critical Care ✅ > Airway and Intubation ✅ > Flashcards

Airway and Intubation ✅ Flashcards

1
Q

What is true of the airways in children compared to adults?

A

There are many anatomical airway differences between infants, children, and adults, and the younger the child, the more pronounced the difference

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2
Q

What is the importance of the difference in childrens airways?

A

It has relevance to emergency care, particularly airway opening manoeuvres, airway adjuncts, and endotracheal intubation

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3
Q

Why can life threatening airway obstruction develop rapidly in children?

A

As the airway is already narrow, and further airway narrowing from any cause increases resistance according to Pouseuille’s law

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4
Q

How is Pouseuille’s law applied to airways?

A

As resistance is inversely proportional to the fourth power of the radius, a small reduction in an already small airway radius will result in a large increase in resistance

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5
Q

What can neck flexion or overextension lea to in infants?

A

Airway obstruction by tracheal compression

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6
Q

Why can neck flexion or overextension lead to airway obstruction in infants?

A

Due to the relatively large head and short neck in infants

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7
Q

What else can cause airway obstruction in infants?

A

The relatively large tongue

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8
Q

When in particular can an infants tongue cause airway obstruction?

A

If there is a reduced level of consciousness

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9
Q

What other problem might the tongue cause?

A

May impede the view at laryngoscopy

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10
Q

What manoeuvres are used to open the airway in children?

A
  • Head tilt/chin lift

- Jaw thrust

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11
Q

How do airway manoeuvres used in children work?

A

They apply anterior tension to the hyoid bone and draw the epiglottis away from the posterior pharyngeal wall, opening the pharynx

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12
Q

In addition to drawing the epiglottis away from the pharyngeal wall, how else does jaw-thrust improve airway potency?

A

It pulls the tongue, which may cause airway obstruction, away from the palate and opens the oropharynx

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13
Q

What care must be taken when performing airway opening manoeuvres in children?

A

When positioning the fingers, as the floor of an infants mouth is easily compressible

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14
Q

What is it important to do when performing head tilt/chin lift in an infant?

A

Control the degree of head tilt to avoid airway narrowing due to overextension of the head and neck

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15
Q

What head position is preferred when opening the airway in an infant?

A

Neutral position

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16
Q

Why is a neutral position preferred when opening the airway in an infant?

A

Due to the large head and short neck

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17
Q

What head position is used when opening the airway in a child?

A

The sniffing position

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18
Q

When is the head tilt/chin lift manoeuvre contraindicated?

A

If there is a history of trauma

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19
Q

Why is the head tilt/chin lift manoeuvre contraindicated if there is history of trauma?

A

It may exacerbate cervical spine injury

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20
Q

What is the purpose of an oropharyngeal airway, or Guedel airway?

A

It creates an open channel between the mouth to the posterior pharyngeal wall

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21
Q

When are oropharyngeal airways used?

A

Only in infants and children with reduced level of consciousness

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22
Q

Why are oropharyngeal airways only used in infants and children with reduced level of consciousness?

A

As they may cause choking or vomiting if the gag reflex is present

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23
Q

How are oropharyngeal airways sized?

A

Measuring distance between anterior nares and tragus of ear

24
Q

What is the problem with airway adjuncts that are too small?

A

May be ineffective

25
Q

What is the problem with airway adjuncts that are too large?

A

May cause laryngospasm

26
Q

What is often tolerated better than an oropharyngeal airway?

A

A nasopharyngeal airway

27
Q

What complication may arise from insertion of a nasopharyngeal airway?

A

Haemorrhage from the vascular nasal mucosa

28
Q

What is the effect of haemorrhage from vascular nasal mucosa caused by nasopharyngeal airway?

A

Worsens airway obstruction

29
Q

When is a nasopharyngeal airway contraindicated?

A

Basal skull fracture

30
Q

What is a laryngeal mask airway?

A

A device for supporting and maintaining the airway without tracheal intubation

31
Q

Where does a laryngeal mask airway sit?

A

In the hypopharynx, covering the supraglottic structures

32
Q

What is the result of a laryngeal mask airway covering the supraglottic structures?

A

It allows relaxation of the trachea

33
Q

What is a laryngeal mask airway helpful for in the emergency setting?

A

Airway obstruction caused by supra-glottic airway abnormalities, or if bag-mask ventilation is not possible

34
Q

What is the limitation of a laryngeal mask airway?

A

It does not totally protect the airway from aspiration of the stomach contents, and with high pressure ventilation, gastric distention may occur

35
Q

In who might endotracheal intubation be difficult?

A

Infants

36
Q

What should endotracheal intubation be preceded by?

A

Induction of anaesthesia (unless child unconscious)

37
Q

What is involved in induction of anaesthesia before endotracheal intubation?

A

Drugs for sedation and neuromuscular blockade

38
Q

What clues might suggest a child has a difficult airway?

A
  • Presentation with airway obstruction or stridor
  • Airway swelling or oedema
  • History of obstructive sleep apnoea
  • Syndromes with facial malformations
  • History of previous difficult endotracheal intubation
39
Q

Give 2 causes of airway swelling or oedema

A
  • Burns

- Anaphylaxis

40
Q

Give 3 facial malformations that might indicate a difficult airway

A
  • Short mandible
  • Ear deformity
  • Pierre Robin syndrome
41
Q

Who should be present during intubation when a difficult airway is suspected?

A

Senior anaesthetist and ENT surgeon

42
Q

Describe the epiglottis in infants?

A

It is horse shoe shaped and relatively large

43
Q

How does the larynx in infants differ to in older children?

A

In infants it is high anterior, at C2/3 compared to C5/6 in older children

44
Q

What kind of laryngoscope is more commonly used in infants?

A

Straight blade (Miller blade)

45
Q

Where is the laryngoscope positioned in infants?

A

Posterior to the epiglottis

46
Q

What is done to the epiglottis when intubating an infant?

A

The epiglottis is lifted to allow visualisation of the glottis and vocal folds

47
Q

What kind of laryngoscope is used in children and adults?

A

Curved blade (Macintosh)

48
Q

Where is the laryngoscope positioned in children?

A

In the vallecula, anterior to the epiglottis

49
Q

What is done to the epiglottis when intubating a child?

A

It is lifted to visualise the larynx

50
Q

How are endotracheal tubes sized?

A

By internal diameter in mm

51
Q

What is the narrowest party of the airway until age 12?

A

The level of the cricoid cartilage

52
Q

What is the relevance of the cricoid cartilage being the narrowest part of the airway until age 12?

A

An endotracheal tube that passes easily through the vocal cords may still be too large to pass through the cricoid ring

53
Q

What might the consequence be of an endotracheal tube that is too tight at the level of the cricoid?

A

May damage the mucosa

54
Q

What might result from mucosal damage at the cricoid ring from a ET tube that is too late?

A

Airway oedema and post-extubation stridor

Rarely, tracheal scaring and stenosis

55
Q

Can ET tubes with cuffs be safely used in infants and young children?

A

Yes, providing correct tube size is used, tube position verified, and cuff inflation pressure checked and limited

56
Q

What is the result of ET tubes with cuffs now being confirmed to be safe to use in infants and young children?

A

They are first choice in paediatric critical care, and preferred in children with poor lung compliance or high airway resistance, or when precise ventilation and/or CO2 control is needed

57
Q

When are uncuffed ET tubes used?

A

In newborn infants

TAS Emergencies and Critical Care ✅ (8 decks)

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