Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Airway Management > Airway Basic > Flashcards

Airway Basic Flashcards

1
Q

What are the common components of airway examination?

A

Lemon is recommended but think about emergency or comatose patients.

Common are- Pts mouth opening, dental examination, cervical range of motion, and thyromental distance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the two model of pre operative airway physical examination and to define classes…

A

LEMON, and Mallampati classification of airway classes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Areas of concern for pre operative airway physical examination….some main ones which i may not remember

A

Prominent overbite- also explained as relation of maxillary and ,mandibular incisors during normal jaw closure.
Tip of chin should touch chest
Patient should be sitting upright and the individual should not be asked to phonate (because it can elevate palate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the predictors of difficult intubation

A

Mallampati class of 3 or 4
Thyromental distance of less than 6cm (3 finger=6cm, 2 finger= 4cm)
Mouth opening of less than 4cm (2 finger)….but Deidre said 3
Reduced atlantoocipal neck extension
Increased BMI
Large neck circumference (thick neck)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sniffing position aligns what three things

A

Long axes of Mouth, pharynx and larynx…helps in a tighter fit for a BVM as well as ETT intubation.

Sniffing position is head elevated and and neck extended advance the jaw.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

With jaw thrust the tongue…..

A

Is moved farther from hard and soft palates and patent upper airway is achieved.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

…….. is a non invasive means of ventilating and ……. A pt

A

Anesthesia face mask…..oxygenation…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is th standard attachment size for BVM or ventilator tubing,

A

15-mm (the whole size )

Around 6-8 sizes

3, 4 and 5 typically for adults.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The anesthesia mask should not be…..

A

Pushed on the pts face, rather the pts mandible should be pulled up into the mask. Two hand technique can be used if patient obese, difficult airway or bearded pt.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the ventilator pressure used for BVM the pt?

A

<20cmH2O…to prevent gas into the patients stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What facilitates in FMV?

A

Jaw thrust, maximized sniffing position, two handed mask technique, OPA,NPA all facilitates in successful FMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do we know the effective ventilation being performed on the patient?

A

Condensation, ETCO2, Taut, refilling bag in case of Non-inflating bag, bilateral breath sounds, symmetric chest rise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

True or false,
Even if the patient is not intubated, providing FMV allows for adequate oxygenation and ventilation(CO2 removal) and is effective until a definitive a/w is established

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

True or false, beard is the only modifiable risk factor

A

True…but either occlusive adhesive dressing or applying water soluble lubricant .

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lack of teeth is considered a factor which reduces the seal of the mask during ventilation

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What should be done with patient with reduced lung and chest wall compliance?

A

Increase ventilator pressure >20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How much tidal volume is recommended for BVM?

A

8 ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

LMA can be used as a conduit for blind intubation…true or false

A

True, blind or fiber optic intubation with a cuffed ETT can be performed though LMA to establish a definitive or secure airway.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is alternative to BVM?

A

LMA. Particularly benefit obese, pregnant and difficult airway patients.

20
Q

what is gold standard for airway management?

A

ETT, as
~it allows ventilation with high levels of positive pressure,
~direct route for drug delivery and suctioning in the lower airway for secretion removal,
~prevent foreign body aspiration into the lung,
~provide bronchoscopic examination of the peripheral airway

21
Q

What are the risk when placing Ett?

A

Hypoxia
Hyper carbia
Cardiovascular changes

22
Q

If airway latency and gas exchange cannot be established by simple means then…

A

Go for invasive procedures such needle or surgical cricothyrotomy, dnt waste time on Ett insertion from mouth or nose

23
Q

What’s the standard connector size of ETT

A

15 mm, to connect BVM, Or anything else like ETCO2 or ventilator

24
Q

A cuff attached to a pilot balloon with a …….valve

A

Spring loaded.

25
Q

Ett that lacks Murphy eyes are called……

A

Magill-type tubes.

26
Q

Ett are sized by….

A

Internal diameter..ID

27
Q

Why is uncuffed Ett used for children?

A

Becuz if we think about inflating it..then we need to opt for a smaller Ett ID keeping in mind the airway size(diameter), so if we go for uncuffed we can select a higher ID and instead not inflate it and provide more and better ventilation.
It inflate cuff—> smaller ID of Ett—> airway lumen already smaller in diameter.
As well as cricoid is the narrowest part of children until age 6, where placing the Ett snug fits below larynx and provides Positive pressure ventilation.

28
Q

What are the indications of intubation?

A

1)Airway compromise/obstruction—>due to retained secretion, foreign body, structural changes from edema, tumors or trauma, anaphylaxis
2) airway protection—> general anesthesia, accidental extubation, lack of cough or gag, risk of aspiration.
3)respiratory failure- ventilation failure(cannot remove CO2), oxygenation failure, apnea.(we need to breath for pt.

29
Q

What are the contraindication of intubation?

A

Absolute-
patient refusal
Medically futile
Medical directives

Relative-
No specific, benefits vs harm…but check for cardiac history as stimulation of a gal nerve can lead to reduced bp, reduced heart rate, hypotension and in worse case cardiac arrest.

30
Q

So two things to keep in mind while intubating the pt.

A

If the sedation and paralytic are insufficient, it can increase patients heart rate indicating he can still feel but not that much that he could respond. May be sedation is enuf but not the paralytic. In this scenario we may not necessarily be stimulating his vagal nerve.
The other thing is stimulation of vagal nerve…if you see a drop in pts bp, heart rate, could be due to stimulation of vagal nerve, and in this scenario we give epinephrine to increase the heart rate. May be the sedative was too much that’s why dropped the heart rate

31
Q

How many attempts for the first intubation?

A

2

32
Q

The two lines in the Ett should be how?

A

One line below the vocal cords and one line above

33
Q

If not chest rise when using Ett

A

Either the tube is not in trachea
Either it is in the right main stem(if not bilateral)
Either the the patient has a baro trauma, or pneumothorax that’s why no chest rise!!

34
Q

What happens if no chest rise when OPA is inserted

A

Means the patient is having pneumothorax….which can be due to flow inflating bag or self inflating bag….even if noticed it too quickly. Becuz with OPA it is impossible it is in the main right main stem or to be in the esophagus…so what’s left?? The size…if short it can obstruct and be of no benefit!!

So think about the reasons quickly…no chest rise!! Why?? Is the OPA too short?? Or is it because I am blowing the air too fast and caused a barotrauma or pneumothorax.

35
Q

Benefit of cricoid pressure?

A

2 benefits

To prevent aspiration
To prevent from air entering esophagus and stomach from BVM

36
Q

From when to when the cricoid pressure should be applied

A

From the time pt is unconscious until Ett is in place…..sometimes the intubator will say to release pressure

37
Q

True or false.
Cricoid pressure blocks vomits

A

False, it doesnot prevent vomit from occuring. If that happens, let it go means release the pressure and log roll the patient to avoid vomiting from entering into stomach and then suction immediately.

38
Q

What is BURP?

A

Cricoid pressure is just pushing down with thumb and middle finger,
But BURP is applying pressure backwards, upwards and towards right and pressure of the thyroid cartilage or larynx by the assistant and the operator.
Burp is for better visualization of glottis opening, where as cricoid is for preventing aspiration

39
Q

Signs of difficult intubation when you look externally

A

C-spine- positioning due to limited mobility for sniffing position
Beard- BVM, we cannot form a seal.
Denture or tooth too long or loose teeth- laryngoscopy and Ett
Scar tissue from previously trach/cric/ thyroid surgery patient- ett is difficult to pass.

Sometimes a patients trachea is stitched to the skin and that patient always breathes through the hole which is opening from the outside—> tracheostomy stoma.

40
Q

LEMON

A

LEMON- to rule out if we can see the glottis? Is it going to be difficult intubation or not? Alll before intubation!!!

Look- BVM(beard), laryngoscopy(scarring), difficult airway(c-spine)

Evaluate- 3-3-2- for ease of laryngoscopy
3-mouth opening
3- thyromental space
2- thyroid cartilage to hyoid bone(start of the neck)
Tip—> when u evaluate the 3-3-2 rule, same time see Mallampati classification for uvula.

Mallampati- to check the size of the mouth opening, tongue and oropharynx, class 1 and 2 accepted, 3 and 4 difficult intubation

O- obstruction of upper airway is an indicator of difficult airway.
Signs such as stridor, drooling, kneeling forward—>immediately it is epiglotitis (need to go to OR), difficult swallowing, muffled voice—. All these are signs of epiglottitis and are under difficult intubation due to upper airway obstruction
FBO, Laryngeal trauma, airway burns/swelling and tumor are other examples of obstruction. If patient met an accident, assume difficult intubation

N- neck mobility is the ability to place in sniffing position and optimal visualization of glottis. Such as, degenerative cervical arithritis, morbid obesity, facial or neck burn scarring, cervical trauma, fractures, thoracic kyphosis, hydrocephalus…..pt with c-spine issues, kyphoscholosis and hydrocephalus we can never put them in neutral position.

41
Q

True or false,

Orotracheal intubation is preferred route due to ease and speed of compared to nasal route.

A

True

42
Q

Can we place a pillow or towel to obtain a sniffing position?

A

Yes, you just have to make sure that the oral, pharyngeal and laryngeal axes are aligned.

43
Q

The blade should never touch the upper teeth and the lips aswell….true or false?

A

True

44
Q

How much volume should we inflate the cuff with?

A

7ml, 7cc….and pressure is <20cmh2o

45
Q

When is cricoid pressure recommended?

A

Only if the patient has had a positive pressure ventilation prior to intubation and applied correctly.

Airway Management (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions