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AFN Assessment > Airway Assessment 4 > Flashcards

Airway Assessment 4 Flashcards

1
Q

Key points regarding Direct Laryngoscopy

A

Requires direct line of sight
Requires increased lifting force
Increased stress response
Cervical instability

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2
Q

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

A

Video-assisted

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3
Q

Advantages of video-assisted

A

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

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4
Q

Disadvantages of video-assisted

A

expensive, not always easier to pass tube, loose depth perception, overconfidence, loose skills on DL

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5
Q

Administration of what medication should be given 15-20 mins prior to fiberoptic intubations to dry up secretions?

A

Glycopyrrolate

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6
Q

Fiberoptic intubation indications

A

Previous difficult airway
Suspected difficult airway
Unstable neck fractures/limited motion
Halo/stabilization devices
Small mouth opening/Minimal jaw movement
Post airway evaluations/diagnostic

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7
Q

Common failures with fiberoptic intubations

A

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

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8
Q

Normal Induction Sequence (Peri-induction Sequence)

A

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

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9
Q

Rapid Sequence Intubation description

A

the simultaneous administration of a potent sedative agent & a NMB to induce unconsciousness and motor paralysis for tracheal intubation

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10
Q

Advantages of RSI

A

Prevent aspiration, rapid control of airway

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11
Q

Indications for RSI

A

full stomach, trauma, pregnancy, bowel obstruction, risk of aspiration

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12
Q

Technique for RSI

A

(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

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13
Q

Modified RSI

A

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

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14
Q

Cricoid pressure is also called ________ maneuver

A

Sellicks

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15
Q

Cricoid pressure: Stabilizing the cricoid cartilage with thumb & middle finger, apply anterior to posterior pressure (about ? lbs) with index finger

A

5

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16
Q

Purpose of utilizing Cricoid pressure

A

To shut the epiglottis so no stomach material coming in

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17
Q

Cricoid Pressure contraindications

A

cricotracheal injury
active vomiting
unstable C-spine

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18
Q

BURP

A

Backward, Upward, Rightward Pressure

Upward pressure may increase visibility of glottis; esophagus slightly left of trachea

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19
Q

Physiologic response to intubation

A

May become complications

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20
Q

Cardiovascular responses to intubation

A

tachycardia, dysrhythmias, HTN

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21
Q

Attenuation of Cardio response to intubation

A

appropriate anesthesia depth
Local anesthesia (IV lidocaine, lido spray on cords during induction)
Adjunct medications (fentanyl, esmolol, Neo prepared for BP drop)

22
Q

Respiratory responses to intubation

A

hypoxia, hypercarbia, increased resistance to ventilation, laryngospasm, bronchospasm

23
Q

Attenuation of Resp response to intubation

A

pre-O2, adequate mask ventilation, sympathomimetic inhalers, NMB, inhalation agents deepened

24
Q

CNS response to intubation

A

Inc ICP

25
Q

Ocular response to intubation

A

Inc IOP

26
Q

Intubation Complications

A

Vocal cord damage, trauma or ischemia to mucosa (high cuff pressure)
Damage to arytenoid cartilage (voice changes)
Dental damage
Hoarseness or sore throat (most common postoperative complaint)
Injury to lips, gums, tongue, pharyngeal tissue
TMJ damage
HTN, Tachycardia, hypotension, bradycardia, arrhythmias, spinal column injury (in line stabilization, DL vs VL vs fiberoptic)
Tracheal Stenosis, Esophageal perforation (traumatic intubation, dysphagia, neck pain, subcutaneous emphysema)

27
Q

Extubation complications

A

Patient doesn’t “fly” → unable to keep SaO2 up, CO2 normal, or continues to need assistance to not obstruct, and to maintain good TV/RR

28
Q

Airway edema/macroglossia post-extubation

A

(may not be immediate) → causes: aggressive blood & fluid resuscitation & trendelenburg or prone position

Increased ICP, IOP
Bleeding from surgical site (coughing & increased BP)

29
Q

Spasm involving vocal cord closure & aryepiglottic folds folding over glottis is called?

A

Laryngospasm

30
Q

Which CN nerve is involved with laryngospasms?

A

Sensory stimulation of Vagus N via the RLN & SLN

31
Q

S&S of Larygospasms

A

Decreased SaO2, HTN

32
Q

Signs of Negative pressure pulmonary edema (NPPE)

A

acute respiratory failure, dyspnea, tachypnea, pink frothy sputum, stridor, severe agitation

33
Q

Pulm changes with NPPE

A

Inc in negative intrathoracic pressure
Inc in PVR (& volume)
Inc in pulm capillary transmural pressure (>32mmHg)

Disruption in pulm cap-alveolar membrane –edema remains even after obstruction is relieved

34
Q

Early detection of NPPE

A

diagnosis based on precipitating event, may be immediate or delayed, more often in patients with cardiac anomalies

35
Q

Types of early detection of NPPE

A

Type 1: immediately after acute onset of airway obstruction (laryngospasm, epiglottitis, coup, LMA/ETT blockage, laryngeal tumor, post op vocal cord paralysis, strangulation, drowning)

Type 2: occurs after relief of chronic airway obstruction (post tonsillectomy, post adenoidectomy, choanal stenosis, post removal of upper airway tumor, hypertrophic redundant uvula)

36
Q

Tx of NPPE

A

PEEP + diuretic and steroids (controversial)

37
Q

Tx of Laryngospasms

A

Positive pressure (MASK!), Succinylcholine, Larson Maneuver (vigorous jaw thrust, pulls false cords/folds away)

38
Q

Reflex spasm in bronchial smooth muscle is called what?

A

Bronchospasm

39
Q

Bronchospasms can be from tracheal irritation and stimulation of the ________ nerve.

A

Vagus

40
Q

T/F:Bronchospasm can be allergenic (histamine related)

A

True

41
Q

Bronchospasm Symptoms

A

wheezing, increased CO2, hypoxia, high PIP

42
Q

Tx of Bronchospasms

A

Deepen anesthetic w inhalation agents (bronchodilators), Albuterol, Beta2 agonists (epi, terbutaline)

43
Q

Tracheal perforation vs tear

A

most often with routine or difficult intubation

44
Q

What is the most sensitive indicator of endobronchial intubation?

A

Tube depth

Women 20cm
Men 22cm

45
Q

What should you do if you think that you did a esophageal intubation?

A

Take it out

Relies on clinical assessment

46
Q

Airway Fire 3 Key Factors

A

Fuel source
Ignition
Oxidizer

47
Q

Airway fires

A

Communication is a must! Esp w/ laser cases

48
Q

What is filled in laser tube cuffs to help extinguish fire and used for notification of ETT fire?

A

Sterile water or
NS + methylene glue

49
Q

Do you stop drop and roll if airway fire occurs?

A

Nah

Yell out for help/fire
Remove ETT immediately
Shut off airway gas
Remove drapes, gauze
Sterile water in the airway
Mask ventilate

50
Q

Aspiration Pneumonitis is considered to be what?

A

aspiration of acidic gastric contents (volume & pH dependent)

51
Q

Giving what makes pH more favorable that helps prevent Asp Pneumonitis?

A

Bicitra

52
Q

Wide spectrum of lung injury and high mortality rate occurs with what complication?

A

Asp Pneumonitis

AFN Assessment (7 decks)

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