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AFN Assessment > Airway Assessment 2 > Flashcards

Airway Assessment 2 Flashcards

1
Q

What is the most favorable test for difficult INTUBATION?

A

Mallampati

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2
Q

Mallampati Classifications (KNOW!!!!)

A

Class I: soft palate, fauces (arched opening) uvula, & anterior/posterior pillars
Class II: Everything except tonsillar pillars
Class III: Just base of uvula & hard palate
Class IV: hard palate only

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3
Q

Mallampati pt instructions

A

Instruct pt to open mouth and stick out tongue maximally while in the SITTING position.

No PHONATION!

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4
Q

12-pt Airway Assessment (KNOW!!!!)

A
  1. Length of upper incisors
  2. Involuntary: Maxillary teeth anterior to mandibular teeth.
  3. Voluntary: Protrusion of the mandibular teeth anterior to the maxillary teeth
  4. Intercisor distance
  5. Oropharyngeal Class (Mallampatti exam)
  6. Narrowness of palate
  7. Mandibular space length (Thyromental distance)
  8. Mandibular space compliance
  9. Length of neck
  10. Thickness of neck
  11. Palpation of cricoid membrane
  12. Cervical range of motion
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5
Q

LEMON Airway Assessment (KNOW!!!!!)

A

Look externally
Evaluate 3-3-2 rule
Mallampati
Obstruction
Neck mobility

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6
Q

What should you anticipate if abnormal findings during the LEMON airway assessment?

A

Inc potential for difficult airway, direct laryngoscopy

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7
Q

4 D’s (KNOW!!!!)

A

Dentition
Distortion
Disproportion
Dysmobility

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8
Q

Dentition Examples

A

Prominent upper incisors
Receding chin

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9
Q

Distortion Examples

A

Edema
Blood
Vomitus
Tumor
Infection

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10
Q

Disproportion Examples

A

Dec TMD (thyromental distance)
Inc neck circ
Mallampati >3

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11
Q

Dysmobility Examples

A

TMJ dz
Limited c-spine mobility

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12
Q

What are considered Thick Neck Measurements in females and males

A

Female >37cm
Male >42 cm

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13
Q

Inter-incisor gap/TMJ fxn

A

Distance of 4 cm or less is normal

Distance of <2 cm assist with difficult direct layngoscopy

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14
Q

How to test Thyromental Distance and what is the average length?

A

Lower border of mandible and thyroid notch

Approx 3 fingerbreadths, normally > 6.5 cm

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15
Q

Cranio-cervical mobility

A

Turn head and touch chin to shoulders

Touch chin to chest

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16
Q

Limitation of what joint will impair direct laryngoscopy

A

Atlanto-occipital joint

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17
Q

Which test assesses mobility of TMJ function and will determine if the jaw can be pulled forward for DL or jaw thrust for obstruction?

A

Mandibular Protrusion test or Upper lip bite test (ULBT)

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18
Q

Which test is most favorable test for difficult laryngoscopy?

A

Mandibular Protrusion test or Upper lip bite test (ULBT)

The most sensitive test of all was the upper lip bite test.

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19
Q

What determines if a pt is a difficult to mask ventilate?

A

Inability of an unassisted experienced anesthesia provider to maintain an SaO2>=92%

Or inability to prevent or reverse signs of inadequate vent at any point during the anesthetic

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20
Q

Risks for difficult mask ventilation

A

Age >55
Beard
No teeth
Hx of snoring
BMI >26
Mallampati >2
Macroglossia
Small TMD
Stiff lungs

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21
Q

Complications from difficult mask ventilation

A

Injury to buccal branch of the facial nerve
Injury to eye (corneal abrasion)
Bruising
Inflation of stomach (vomiting, aspiration)

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22
Q

What reflex is triggered during a difficult mask airway that results in apnea and bradycardia?

A

Oculo-cardiac reflex

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23
Q

Vent parameter that helps lower complications from difficult mask airway

A

Keep PIPs under 20

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24
Q

Chest rise, fogging in the mask, CO2 waveform, a good seal, quietness, and ability to feel air in the bag are signs of what?

A

Effective mask ventilation! Whooo hooo!!

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25
Q

Preoxygenation/Denitrogenation Methods

A

FGF of 5-8L/min
FiO2 100%
Tidal volume breath: 3-5 mins for max preoxy
Goal: ETO2>90%, ETN2<5% or
8 deep breaths in 2 mins, 4 deep breaths in 30 secs
Good capnography waveform, good seal around mask

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26
Q

Issues with Preoxygenation/Denitrogenation

A

Obesity
Claustrophobia
RSI

Caution with excessive sedation

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27
Q

________ is noisy inspiration from turbulent gas flow in upper airways (usually obstruction)

A

Stridor

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28
Q

Causes of stridor

A

Objects
Swelling
Fx
Thyroid
Neck Trauma

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29
Q

What is the upper airway infection that causes a barking noise and airway diameter to potentially be cut in half or to be 4.5mm in children?

A

Croup

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30
Q

Always address/correct Slide 94!

A

Go to the slide

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31
Q

Consider ________ for airway complications

A

Intubation

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32
Q

Heliox (____% helium with ____% oxygen)

A

70; 30

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33
Q

T/F: Heliox is less dense than air, able to flow through turbulent airways, and can help with CO2 elimination

A

True

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34
Q

Diffusion rate of O2 with the assistance of heliox

A

Diffusion of O2 happens from alveoli to blood at a much faster rate than O2.

200-250ml/min compared to CO2 at 8-20ml/min

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35
Q

What is “stiff joint syndrome”?

A

Glycosylation of tissue proteins from chronic hyperglycemia

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36
Q

Stiff joint syndrome is associated with _______.

A

Diabetes

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37
Q

During which complication is food and material settled into a “pouch”?

A

Zenker’s Diverticulum

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38
Q

T/F: It is preferred that cricoid pressure is utilized with Zenker’s Diverticulum.

A

False. Cricoid pressure can dislodge food particles

39
Q

Should antacids be used with Zenker’s?

A

No, the pH in the diverticulum is alkalotic (same as saliva). Usually doesn’t cause aspiration PNA.

40
Q

Zenker’s Diverticulum considerations

A

View with endoscopy
Awake intubation
DO NOT blindly place NGT d/t risk of perforation of pouch
Keep head up 20 degrees

41
Q

Obesity Implications for airway management

A

Preop eval significantly r/t difficult intubation
Judicious admin of sedative/narcotics
Optimal positioning with padding
Masking, oral, & nasal airways
Consider RA when applicable
Extubate fully awake after NMB reversal

42
Q

T/F: OSA is only a partial obstruction of lower airway during sleep.

A

False: OSA can be periodic, partial, or complete obstruction of the UPPER airway during sleep

43
Q

S&S of OSA

A

Episodic O2 desat & inc CO2
Variations in HR & BP
inc intrathoracic pressure

44
Q

What pre-op assessment is used to help diagnose OSA?

A

STOP-BANG

45
Q

STOP-BANG

A

Snoring
Tiredness
Observed Apnea
High bP

BMI >35
Age>50
Neck size >43male, >41 female
Gender (males)

46
Q

Risk scores for STOP-BANG

A

0-2 Low risk
3-8 High risk

47
Q

What medication is given in preop to help eliminate bleeding from the insertion of nasal trumpets?

A

Afrin, placed in both nares

48
Q

Which nare is typically used for nasal trumpet insertion?

A

Right nare

49
Q

What type of pt should be evaluated for aspiration d/t increased gastric volumes, more acidic pH, and may be recommended for preop meds?

A

Obese patient

50
Q

What acronym is used for airway prep/setup?

A

MAIDENS

51
Q

MAIDENS

A

M: Machine check, including O2 tank
A: Airways, oral, nasal, tongue depressor
I: Intubation, handles, blades, tubes, stylets, magill forceps
D: Drugs, Emergency drugs
E: Emergency-ambu, bougie, LMA
N: Nerve stimulator
S: Sucton-yankaur, catheters, stethoscope

52
Q

What position lines up the axis and improves the ability to ventilate and intubate?

A

Sniffing-position

53
Q

What are the 2 methods to accomplish the sniffing position?

A

Manual Method: Pulling jaw forward, moves tongue and epiglottis off pharynx

Pillow Method: Used often in obese patients

54
Q

Airway equipment

A

Oral/Nasal airways, ETTs, Laryngoscope/blade, LMA

55
Q

Where is the MAC blade placed?

A

In the vallecula (To elevate the epiglottis)

56
Q

Where is the Miller blade placed?

A

Blade tip under epiglottis to directly elevate

57
Q

___________ blade advantages: decrease in damage teeth, space avail in oropharynx for ETT

A

MAC blade

58
Q

_________ blade advantages: good in small cross-sectional dimensions. Useful in pts w/ narrow oral cavities. Prominent upper teeth ankylosis

A

Miller blade

59
Q

Pt hx

A

Loose/false teeth
GERD
Prior dif airway
NPO status
Hoarseness/dysphagia
Masking issues
Heavy beard
Short neck (muscular)
Thick Neck (W>37, M>42 cm)
Tracheal deviation

60
Q

Oral Cavity Exam

A

Protruding teeth
Length of incisors
loose/broken, chipped teeth,
Crowns/caps/dentures

If you see it, chart it!

61
Q

Inter-incisor gap/TMJ fxn

A

Measures the degree of mouth opening, trismus, spasm of jaw popping

62
Q

Inter-incisor gap values

A

4 cm=normal

<2cm= difficult direct laryngoscopy

63
Q

What assesses the ability to displace the tongue?

A

Thyromental distance

64
Q

The Mandible/Protrusion Test/Upper Lip Bite Test is the most favorable/most sensitive test for ___________?

A

Difficult LARYNGOSCOPY

Looks at incisor length & mobility of TMJ

65
Q

Mandible Protrusion Test/ULBT Classifications

A

Class I: Over vermillion border
Class II: Barely touching
Class III: Cannot get to the border

66
Q

Neck Circumference >_____ is a predictor for difficult airway

A

40cm

67
Q

T/F: What to do if you can’t get a good seal for mask ventilation?…..Freak out!

A

False:

Reposition using 2 handed mask
Use mask straps
Get help

68
Q

How would you know if airway management is required?

A

Blunting or removal of pts own protective ventilatory drive?

Regional use?

69
Q

Who should complete the airway exam if a pt’s airway is manipulated?

A

YOU or who ever is manipulating the airway!

This should ALWAYS occur

70
Q

Supralaryngeal ventilation?

A

Face mask or LMA
Could be challenging if someone has dec pulm compliance

71
Q

Ways to minimize the risk of aspiration?

A

NGT to sxn prior to induction
NPO status
Hx of vomiting
Bicitra for pH
Reglan
H2 blocks

72
Q

An adequately preoxygenated, healthy adult should maintain oxyhemoglobin saturation for _________ mins and child _______ mins

A

5-9; 2-4

73
Q

Stridor management

A

Heliox
Nebulized epi
Decadron 4-8mg q 8-12hrs

74
Q

What is the 1st consideration for a patient with stridor?

A

Should the pt be intubated or can it be delayed?

75
Q

Which types of pts cannot tolerate an apneic period?

A

Restrictive disease (intrinsic & extrinsic)
Obesity
Other Acute processes

76
Q

Chronic kyphotic, spine disorders, ankylosing spondylitis, neuromuscular diseases (MS), muscular dystrophy, and fibrosis are considered what type of diseases?

A

Restrictive Diseases

77
Q

Why are obese patients unable to tolerate and apneic period?

A

Dec FRC (esp supine/prone)
Abdominal contents pushing on lungs
Vt dec when supine (Atelectasis, inc intrapulm shunting, impaired oxygenation)

78
Q

Other acute processes that may dec the apneic period

A

Pulm edema
ARDS,
Pneumothorax
Pleural effusions
PNA

79
Q

Preoxygenation goal

A

ETO2>90%

80
Q

Denitrogenation goal

A

ETN2 <5%

81
Q

What complication is related to Juvenile DM?

A

Stiff Joint Syndrome

82
Q

T/F: Stiff joint syndrome is the glycosylation of tissue proteins from chronic hyperglycemia

A

True

Abnormal sugar/protein metabolism changes collagen and elastin fibers in dermis

83
Q

Is the atlanto-axial joint motion improved or limited with a diabetic pt?

A

Limited

84
Q

What hand sign is used to determine if a diabetic pt might have airway complications?

A

Prayer sign vs palmar test

85
Q

Airway/Resp issues for obese pts?

A

Dec FRC
Inc O2 consumption
Inc CO2 production
Higher min volume required to maintain normocarbia
Dec chest wall compliance
Chronic hypoxemia
Polycythemia
Pulm HTN
Diff surgical if necessary, visualize cricoid

86
Q

Considerations for potential airway complications

A

Preop eval
Judicious use of sedatives/narcotics
Optimal positioning
Masking/oral/nasal airways
Consider regional anesthesia
Extubate fully aware after reversal

87
Q

Long term consequences of OSA:

A

HTN
CV changes
RVH
Afib
Increased stroke risk
Declining cognition
Resp Failure

88
Q

Cardiac complications, cardiac arrest, and shock are increased ____fold in OSA pts

A

3

89
Q

The collapsing of what tissue causes OSA pts to awake a lot?

A

Pharyngeal tissue

Get adrenergic surge-pressure builds up

90
Q

A sleep study is recommended when over ____ events/hr over ____ secs

A

15;10

91
Q

Pre-op recommendations for pts with OSA

A

Eval @ risk pts prior to DOS
Thorough H&P
Inform pt for potential airway
Inpt instead of Outpt sx
Nasal trumpet
CPAP/BIPAP use
Eval for potential diff airway

92
Q

Post-op recommendation for pts with OSA?

A

Poss keep for observation to ensure pain is managed adequately w/o them going home and stop breathing d/t medication

93
Q

Even after corrective sx the pt should be assumed to remain at risk for OSA complications unless a _______ sleep study has been obtained.

A

Normal

AFN Assessment (7 decks)

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