Airway Assessment 4 Flashcards
Key points regarding Direct Laryngoscopy
Requires direct line of sight
Requires increased lifting force
Increased stress response
Cervical instability
The following are reasons to use what type of technique for intubation?
Failed intubation
Initial attempt at the predicted difficult intubation
Instruction of the novice on normal airway
Video-assisted
Advantages of video-assisted
Eliminates need for line of sight, requires less lifting force, less stress response, less cervical instability, less dental/pharyngeal trauma, less need for mouth opening
Disadvantages of video-assisted
expensive, not always easier to pass tube, loose depth perception, overconfidence, loose skills on DL
Administration of what medication should be given 15-20 mins prior to fiberoptic intubations to dry up secretions?
Glycopyrrolate
Fiberoptic intubation indications
Previous difficult airway
Suspected difficult airway
Unstable neck fractures/limited motion
Halo/stabilization devices
Small mouth opening/Minimal jaw movement
Post airway evaluations/diagnostic
Common failures with fiberoptic intubations
Rushed technique (inadequate sedation, inadequate secretion drying)
Lack of experience (be careful with bending of scope) Failure to adequately anesthetize the airway
Nasal cavity bleeding/inadequate lubrication
Scope too large
Fogging
Normal Induction Sequence (Peri-induction Sequence)
All airways should ALWAYS be ready to go
Suction ready and on high
Pre-oxygenate with 100% FiO2 for 3-5 minutes
Administer induction agents (evaluate LOC, lash test-if blink then still light). Negative Lash test - lash doesn’t move at all (what you want)
Attempt mask ventilation (reposition head if needed) - need to see lungs inflate. Ensure that you can ventilate them before administering muscle relaxant.
Administer muscle relaxant - wait for medication to work
Intubate
Confirm breath sounds
Continue anesthetic
Secure the ETT
Rapid Sequence Intubation description
the simultaneous administration of a potent sedative agent & a NMB to induce unconsciousness and motor paralysis for tracheal intubation
Advantages of RSI
Prevent aspiration, rapid control of airway
Indications for RSI
full stomach, trauma, pregnancy, bowel obstruction, risk of aspiration
Technique for RSI
(end tidal O2 > 90% prior to push drugs)
Pre-oxygenate well
Administer induction agents → be aware of timing of muscle relaxants
Cricoid pressure (increased with drug pushes)
DO NOT ventilate (no masking…apneic period waiting for succ)
Perform direct laryngoscopy
Confirm placement
Continue anesthetic
Secure the ETT
Modified RSI
give a few gentle breaths prior to intubation
Maintain cricoid pressure
For those unable to tolerate an apneic period → reactive airway disease, increased ICP, not able to tolerate apnea
Cricoid pressure is also called ________ maneuver
Sellicks
Cricoid pressure: Stabilizing the cricoid cartilage with thumb & middle finger, apply anterior to posterior pressure (about ? lbs) with index finger
5
Purpose of utilizing Cricoid pressure
To shut the epiglottis so no stomach material coming in
Cricoid Pressure contraindications
cricotracheal injury
active vomiting
unstable C-spine
BURP
Backward, Upward, Rightward Pressure
Upward pressure may increase visibility of glottis; esophagus slightly left of trachea
Physiologic response to intubation
May become complications
Cardiovascular responses to intubation
tachycardia, dysrhythmias, HTN
Attenuation of Cardio response to intubation
appropriate anesthesia depth
Local anesthesia (IV lidocaine, lido spray on cords during induction)
Adjunct medications (fentanyl, esmolol, Neo prepared for BP drop)
Respiratory responses to intubation
hypoxia, hypercarbia, increased resistance to ventilation, laryngospasm, bronchospasm
Attenuation of Resp response to intubation
pre-O2, adequate mask ventilation, sympathomimetic inhalers, NMB, inhalation agents deepened
CNS response to intubation
Inc ICP
