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AFN Assessment > Airway Assessment 3 > Flashcards

Airway Assessment 3 Flashcards

1
Q

What is the goal of the sniffing position?

A

Improves the ability to intubate and ventilate
Draw a line from anterior ear to sternum

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2
Q

What are the axis that should be aligned for the sniffing position?

A

Oropharyngeal
Pharyngeal
Laryngeal

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3
Q

What are the 2 methods used to place the pt in the sniffing position?

A

Manual Method and Pillow method

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4
Q

Manual Method

A

Pulling jaw forward moves tongue and epiglottis off pharynx

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5
Q

Pillow method

A

Used most often in obese pts

Be sure to pad under arms

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6
Q

Signs of airway obstruction

A

Snoring
Grunting
Stridor (around larynx)
Loss of breath sounds
Climbing or absent CO2
Loss of fog in mask or ETT
Nasal flaring
Desaturation
Retractions/rocking

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7
Q

What is described as rocking motion of the tracheal or thoracic areas and is considered a compensatory mechanism to overcome an obstruction?

A

Retractions

SUPRAsternal retractions (tracheal tugging) vs SUBsternal/intercoastal retractions

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8
Q

Causes of Airway obstruction

A

OSA
Soft tissue relaxation
Foreign body/trauma
Vocal cord issues
Polyps
Infections
Swelling
Laryngospasm

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9
Q

Use caution when giving pre-op sedation to high risk patients

A

Something to keep in mind

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10
Q

Interventions for airway obstruction

A

Jaw thrust
Head repositioning
Oral/nasal airway
Mask ventilate if apneic
Determine underlying cause

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11
Q

Effects of airway obstruction

A

Inc WOB/fatigue
Interference of O2 supply and CO2 elimination
Difficulty in obtaining/maintaining adequate inhalation anesthesia

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12
Q

Oral airways are measured from the corner of the _____ to the tip of the earlobe.

A

Mouth

Most adults 9cm (large pts 10cm)

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13
Q

If sedation is too light with the insertion of an oral airway, what will happen?

A

Pts w/ intact gag reflex will not tolerate it

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14
Q

Advantages of an oral airway

A

Larger tube
Inserted quickly w/ little trauma
Easier suctioning
Less airflow resistance
Reduced risk of tube kinking

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15
Q

Disadvantages of an oral airway

A

Gagging/coughing/salivation/irritation can be induced
Tube fixation is difficult
Gastric distention from frequent swallowing
Mucosal irritation/ulcerations of mouth

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16
Q

Nasal airways are measured from the tip of the ______ to the tip of the earlobe.

A

Nose

30Fr small adults
34Fr Large adults

Sizes range from 26-34Fr

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17
Q

T/F Pts semi-wide awake will tolerate nasal airway

A

True

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18
Q

Contraindications for nasal airways

A

Hemorrhagic d/o
Pts on anticoagulants
Deformity
Basilar skull fx

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19
Q

Advantages of nasal airways

A

Long-term comfort
Decreased gagging/salivation
Improved mouth care
Better tube fixation
Improved communications

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20
Q

Disadvantages of nasal airways

A

Pain/discomfort
Nasal/Paranasal complications (epistaxis, sinusitis, otitis)
Difficult placement, smaller tube
Difficult suctioning
Increased resistance

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21
Q

What is the Gold Standard for airway management

A

ETTs

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22
Q

What ways can you achieve ETT intubation?

A

Awake vs asleep
Oral vs nasal
Blind vs Direct

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23
Q

ETT sizing

A

according to INTERNAL diameter in mm

Adult male: 7.5-8
Adult female: 6.5-7
Peds 16+age/4 or diameter of little finger

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24
Q

ETT average distance teeth to larnyx

A

Women: 20-21 cm
Men 22-23 cm

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25
Q

ETT positioning

A

21 is fun
22 will do
23 should not be

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26
Q

What happens when the tube is moved with repositioning?

A

EXTENSION head movement WITHDRAWS tube 1.9cm

FLEXION head movement ADVANCES tube 1.9cm

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27
Q

Recommended ETT cuff pressure

A

20-30mmHg

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28
Q

High volume/Low pressure cuff (Hi/Lo) or tapered cuffs prevents what?

A

VAP

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29
Q

Prevention of excessive pressure on trachea from cuff

A

Diffuse intra-cuff pressure over a large area
Tracheal wall pressure is 15-30mmHg
Cap Perfusion pressure is tracheal mucosa is 32mmHg ->cannot go above this, no perfusion= low sores/skin breakdown

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30
Q

Diffusion of Nitrous Oxide is 34x more soluble in blood than ______?

A

Nitrogen

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31
Q

Where does Nitrous oxide move into an enclosed space surrounded by a COMPLIANT wall which allows GAS to EXPAND?

A

Intestine
Chest
Gas embolism

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32
Q

Where does Nitrous oxide move into an enclosed space surrounded by a NON-COMPLIANT wall which causes an INC in PRESSURE?

A

Middle ear
nasal sinus

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33
Q

T/F: Transfer of N2O to inside ETT cuff may cause considerably decrease in cuff volume and pressure.

A

False: It will INCREASE volume and pressure

34
Q

What type of surgeries should you not use N2O?

A

Trauma
Abdominal cases
Pneumothorax
Middle ear issues/surgeries

35
Q

All types of ETTs have a _____mm connection piece

A

15mm

36
Q

Cuff with pilot balloon ETT

A

Cuff pressure 20-20mmHg

37
Q

Cuffless ETT

A

Infants & Children

38
Q

Radio-opaque ETT

A

Line from top to bottom for CXR

39
Q

Tip of ETT

A

Bevel on left side of visualization/placement

40
Q

Murphy Eye on ETT

A

Alternate gas passing area

41
Q

Laser ETT

A

Fire retardant
Cuff filled with sterile water

42
Q

Reinforced Wire Tubes

A

Used for mouth sx, insert w/ fiberoptic

Metal; need mobility in tube not for ICU/transport resist kinking

43
Q

NIMS ETT

A

used with thyroid surgery, has electrodes that alarm if they’re close to hitting a nerve

44
Q

Oral & nasal rae tubes

A

Has a bend for ENT procedures

45
Q

Endotrol tube

A

finger loop to control the end of the ETT

46
Q

Stylets

A

Should not extend past tip of ETT
Should be removed just after the tip of the ETT is beyond the glottis
Lubricate the stylet for easy removal (water soluble jelly)

47
Q

Laryngoscope/blade Handle

A

Light source “C” batteries or fiberoptic

48
Q

What are the 2 types of blades?

A

Straight (Miller, Wisconsin, Phillips) or
Curved (Macintosh)

49
Q

Blade sizing

A

Sizing range from 0-4, size denotes length of blade, smaller the #, shorter the blade

50
Q

Macintosh Blade

A

Tip of blade is curved-placed in the VALLECULA (to elevate the epiglottis)

Advance tip into vallecula, lift along axis of handle, tip of blade indirectly elevates epiglottis

51
Q

Advantages of Macintosh blades

A
52
Q

Miller Blade

A

Straight blade with a curved tip-tip under EPIGLOTTIS to directly elevate it (“pushes on epiglottis”)

Advance tip to underside of epiglottis, lift at 45 degree angle, tip of blade picks up epiglottis

53
Q

Advantages of Miller Blade

A

Good in small cross-sectional dimensions

Useful for narrow oral cavities or prominent upper teeth

Ankylosis

54
Q

Wisconsin Blade

A

straight blade with larger cross-sectional dimension, squared tip

55
Q

Phillips Blade

A

straight blade with wider surface, tip more upturned than miller

56
Q

Preparation for Laryngoscopy

A

Test the tube’s cuff inflation system (inflate/remove syringe, assure valve works)

Lock desired blade onto handle & test the light

Position pt/laryngoscopist (pt in comfortable position on OR table; height of table to position best for the person going to intubate-pt’s head at your XIPHOID process)

Preoxygenation/Denitrogenation (issues with obesity-maximize FRC, claustrophobia-allow pt to hold mask, RSI-not bagging…caution with excess sedation)

Final Step → assure an adequate depth of anesthesia!! (lash test)

57
Q

_________ is used to open the mouth (1st & 3rd fingers) - fingers removed after blade insertion and ID of epiglottis edge

A

Scissoring

58
Q

Blade Insertion

A

Laryngoscope held in left hand; open mouth with right hand; insert blade from right side of mouth & move into midline (be careful of teeth, do not pinch lips, deflect tongue left) NO ROCKING →LIFT TOWARD BELLY, NOT TOWARD FRONT TEETH

59
Q

Techniques to visualize Epiglottis

A

Slow advance inward & toward midline, right hand keeps lips from rolling between teeth & blade (avoid pressing on pt eye), advance until epiglottis seen –may only see arytenoids

If blade is too deep in pharynx may mistake esophagus (the goose!) for the glottis – back out

60
Q

What can you achieve with LMA?

A

PPV
Seal around the laryngeal opening

61
Q

Why is a LMA indicated?

A

Routine airway
Rescue airway
Resuscitation airway

62
Q

Contraindicated for LMA

A

Full stomach
Pregnancy > 14 weeks
Acute abd/thorax case
Decreased pulmonary compliance
Gross obesity
Hiatal hernia
Pharyngeal pathology (must sit correctly)
Obstruction below larynx

63
Q

Potential Problems with LMAs

A

Inadequate level of anesthesia (coughing, aspiration, laryngospasm)
Nitrous oxide diffusion (cuff under 60 mmHg)
Incorrect position of LMA

64
Q

Sizing of LMA

A

Based on gender, weight, anatomy → use a large size with less air – do not exceed maximum amount of air

65
Q

Aspiration Risk regarding LMA use

A

DO NOT USE with increase aspiration risk
Avoid inadequate anesthesia
Avoid gastric distention
No lubrication on anterior surface (no lido gel)

66
Q

Mask Ventilation Techniques

A

can be 1 person or 2 people
Requires a good mask fit and adequate volume of oxygen/air delivered
Rests on patient’s bridge of nose, maxillary bones, & mandible
Be careful of eyes → no direct pressure or air flow → risk of corneal abrasion
Keep dentures in for masking

67
Q

Purpose of mask ventilation

A

Denitrogenation & Pre-Oxygenation (O2 in FRC)

68
Q

How to properly hold mask

A

Held in left hand with thumb & first finger around the mask (C), middle & ring fingers on ramus of mandible, little finger maintains anterior displacement of the mandible (E)

69
Q

What is the most common reason for not getting maximum O2?

A

Loose fitting mask

70
Q

Endotracheal intubation indication

A

Compromise or inaccessibility of the airway
Long surgical procedure needing relaxation
Surgical procedure on the head/neck/abdomen
Need for controlled or PPV
Inability to maintain patent airway with mask/airway
Disease process involving the airway
Risk of aspiration from a full stomach

71
Q

ETT placement confirmation

A

onnect to source of ventilation & verify by at least 2 methods

End-tidal CO2 (6 breaths required to confirm in lungs)

Auscultation: 3 areas (epigastric, left lung, right lung)

Tube # placement → deep tube # = most sensitive detector of Esophageal intubation detection

ONCE CONFIRMED, SECURE THE TUBE

72
Q

ETT tube verification OUTSIDE the OR

A

CO2 colorimetry
Auscultation
Esophageal detection device
CXR

73
Q

What should you chart after intubation?

A

induction meds
Ability to mask ventilate
# times DL
Grade view of intubation
Verification of placement
# at teeth or lip

74
Q

Nasotracheal Intubation indications

A

Intraoral operations
Oral tube would interfere with surgeon access
Long-term ventilation anticipated

75
Q

Hx needed for nasotracheal intubations

A

Unexplained nosebleeds
Hx broken nose
Hx deviated septum
Nasally inhaled substance abuse

76
Q

Prep for nasotracheal intubations

A

Nasal tube should be 0.5 - 1 size smaller than orotracheal tube
Let sit in warm NS/sterile water to soften tip
Nasal trumpet well lubed

77
Q

What forceps are used to guide nasotracheal tubes in place?

A

Magill forceps

78
Q

When are nasotracheal intubations contraindications?

A

LaForte fx

79
Q

Steps for Nasotracheal Intubation

A

Evaluate patency of nares
Prepare nares (Afrin or neo, lido gel)
Dilate with nasal airways
Insert ETT like a nasal airway
Perform laryngoscopy, find end of ETT & use Magill forceps to put in glottis

80
Q

How to blindly insert nasotracheal tube?

A

Best with endotrol tube (finger loop) …only used with spontaneously breathing patients, prep normally, listen for breathing & advance with inspiration

81
Q

Cormack-Lehane classification/grade

A

Class 1: see top where cords meet
Class 2: See arytenoids, some cords
Class 3: See epiglottis only
Class 4: See nothing
Anterior Larynx (misnomer): d/t limited head extension

AFN Assessment (7 decks)

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