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Principles of the Airway & Taxonomy > Airway Equipment > Flashcards

Airway Equipment Flashcards

1
Q

What is Ludwig’s Angina?

A

A skin infection that occurs on the floor of the mouth, under the tongue

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2
Q

Why might you utilize ramping on an obese patient?

A

To line up the three axes determined by aligning the meatus of the ear with the sternal notch

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3
Q

How is FRC affected by obesity?

A

Decreased FRC, make sure to pre oxygenate these patients well prior to intubation will desaturate quickly

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4
Q

What position may be helpful to intubate an obese patient?

A

Reverse trendelenburg, gravity helps pull everything down

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5
Q

What is a consideration with severe facial burns?

A

Scar tissue that is contracted, difficult to open patients mouth

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6
Q

What airway equipment must be ready and available in the OR?

A 
Suction 
Oral/Nasal Airway
Face Mask
Laryngoscope handle and blade
ETT with balloon checked
O2 supply and Ambu bag
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7
Q

How should an oral airway be inserted?

A

Follows the curvature of the tongue and lifts tongue and epiglottis away from the posterior pharyngeal wall

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8
Q

Where should the phalange of the oral airway be located?

A

Outside of lips

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9
Q

What injuries may result if an oral airway is left in a patient in the prone position?

A

Pressure causes tissue necrosis and severe tongue swelling

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10
Q

How should we measure the proper size of an oral airway to use?

A

Lips to mandible

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11
Q

What sizes of oral airways are available?

A

Small: 80mm
Medium: 90mm
Large: 100mm

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12
Q

Why wouldn’t you want to use an oral airway in a lightly sedated patient?

A

May provoke gag reflex, cough, vomit, laryngospasm, or bronchospasm

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13
Q

What is the purpose of a nasal airway?

A

Artificial airway that passes through the nose, goes behind the tongue and rests just above the epiglottis

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14
Q

What can a nasal airway be used for?

A

Relieve upper airway obstruction
Facilitation of pharyngeal suctioning
Nasal dilation for nasal intubation
Fiberoptic guide

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15
Q

What population usually tolerates a nasal airway?

A

Lightly anesthetized patient, provokes less airway stimulation

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16
Q

What is the size of a nasal airway indicate?

A

Internal diameter in millimeters

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17
Q

What are some contraindication to a nasal airway?

A 
Coagulopathy disorders
Anticoagulant therapy
Pregnancy (blood volume increased, engorged vessels)
Basilar skull fracture
Nasal infections
Deformities of the nose
HX nosebleeds
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18
Q

What are some complications to both nasal and oral airways?

A 
Airway obstruction
Tongue/soft tissue damage
CNS trauma
Uvula edema
Dental damage
Laryngospasm
Ulceration/necrosis
Latex allergy
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19
Q

What is the internal diameter of a face mask connector?

A

22mm

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20
Q

What is the correct size face mask for a patient?

A

Smallest mask that works, less dead space, easier to hold and less risk for eye injury

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21
Q

Why isn’t a head tilt chin lift great to use in pediatric populations?

A

Hyperextension pushed posterior pharyngeal wall up against the tongue and epiglottis

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22
Q

Why should we lift the jaw into the mask?

A

This motion will lift the tongue off the back of the airway

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23
Q

What is the proper technique for a face mask seal?

A

Downward displacement of the mask with the tub and first finger
Upward displacement of the mandible with the other three fingers, with pinkie at the angle of mandible

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24
Q

How should two handed mask ventilation be performed?

A

Use thumbs for downward displacement of mask and fingers on both hands to provide upward displacement of mandible
Assistant will need to provide ventilation

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25
Q

Why might mask ventilation not be effective?

A

Obstruction, laryngospasm, foreign body, or poor technique

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26
Q

Who might be a difficult mask ventilation?

A

Facial edema, prominent nares, receding jaw, obesity, beards, drainage tubes, tumors, infections, edentulous

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27
Q

What are some advantage of face mask anesthesia?

A

Low incidence of sore throat
less anesthetic depth needed
No muscle relaxants
Cost efficient for short cases

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28
Q

What are some disadvantage of face mask anesthesia?

A 
Hands "tied up"
User fatigue
Higher FGF
More difficult to maintain airway
Unprotected airway
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29
Q

What type of airway device is a LMA?

A

Supraglottic airway device

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30
Q

How does the LMA ventilate and oxygenate?

A

Designed to secure the airway by providing a circumferential seal around the laryngeal inlet with an inflatable cuff

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31
Q

What type of ventilation should be used with a LAM?

A

Spontaneous or assisted ventilation

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32
Q

What is the diameter of the LMA connector?

A

15mm

33
Q

What structures on the LMA prevent the epiglottis from obstructing the mask?

A

Aperture bars

34
Q

If you have a reusable LMA what should not be used to clean it and why?

A

Germicides, disinfectants or chemical agents. They can be absorbed into the LMA and cause pharyngitis and laryngitis

35
Q

What is typically the maximum use per reusable LMA?

A

40 times

36
Q

What should be used to clean a reusable LMA?

A

Endozime cleaner prior to steam autoclave

37
Q

How long should a LMA hold cuff pressure while testing prior to use?

A

Two minutes

38
Q

After inflating a LMA, what should the pilot balloon look like?

A

It should remain elliptical, a spherical balloon indicates loss of integrity

39
Q

What is the diameter of the LMA connecter?

A

15mm

40
Q

What airway protective device should always be used with a LMA?

A

Bite block, to prevent negative pressure pulmonary edema

41
Q

Where should the lubricant be place on a LMA?

A

posterior surface of the cuff

42
Q

How should the patient’s airway reflexes be prior to inserting a LMA?

A

Obtunded

43
Q

What is a good indicator to anesthetic depth prior to inserting a LMA?

A

Absence of motor response to jaw thrust

44
Q

What anatomic structure is used as a guideline for inserting a LMA?

A

Hard palate to soft palate

45
Q

What may occur after inflating the LMA?

A

The mask will rise slightly as it fits properly into the hypopharynx

46
Q

When ventilating with a LMA in place what pressures must not be exceeded and why?

A

20cmH2O can open the LES and cause gastric contents to be released, aspiration may occur

47
Q

What two factors may cause the tip of the LMA mask to fold over on itself?

A

Failure to press the mask against the hard palate or inadequate lubrication

48
Q

How might a LMA cause an airway obstruction?

A

If the tip is folded over, cause the epiglottis to a down-folded position

49
Q

How stimulating is inserting a LMA versus inserting an endotracheal tube?

A

LMA is much less stimulating with more stable vital signs

50
Q

What is the endotracheal tube made out of?

A

Polyvinyl chloride (flammable)

51
Q

What does the size of the tube indicate?

A

The internal diameter in millimeters

52
Q

What American Society for Testing Material applies to ETT construction?

A

ASTM Standard 21

53
Q

What size ETT should be used on a male?

A

8.0 or 9.0 at 24-26 at lip

54
Q

What size ETT should be used on a female?

A

7.0-8.0 at 20-22 at lip

55
Q

How do we determine the appropriate size ETT to place on a child?

A

4 + (age/4)

56
Q

What is the rule of thumb for the depth of inserting an ETT on a child?

A

12+(age/2) = depth in cm

57
Q

How large is the glottic opening of an adult?

A

6-9mm but can be stretched to 12mm

58
Q

What law can describe the increased WOB with an ETT?

A

Poiseuille’s Law, length and diameter impact resistance

59
Q

What is the purpose of Murphy’s eye?

A

If the bevel is occluded then air is still able to pass though the tube into the trachea

60
Q

If a patient doesn’t have to be paralyzed, why shouldn’t they be?

A

Respiratory rate can tell us depth of anesthesia, by taking away RR we are “giving up a piece of information”

61
Q

What is the purpose of the cuff of a ETT?

A

To provide a seal between ETT and tracheal wall

62
Q

What type of cuffs do most ETT we use have?

A

Low volume, high pressure cuffs

63
Q

What is the recommended cuff pressure in a ETT?

A

20-25mmHg (tracheal mucosa perfusion pressure 25-30mmHg)

64
Q

When might you hear an air leak with an uncuffed ETT?

A

15-20cmH2O

65
Q

What is the name of the curved blade and how does it work?

A

Macintosh, tip advanced to valleculae

66
Q

What is the name of the straight blade and how does it function?

A

Miller, lifts epiglottis

67
Q

What speciality blade is wide with a slight curve at the tip giving the user tighter control of the tongue?

A

Phillips blade

68
Q

What speciality blade is wider and typically seen in pediatrics?

A

Robert shaw blade

69
Q

What scale should we use to grade the airway during DVL?

A

Cormack Laryngoscopy Views

70
Q

Where should the cuff of the ETT sit?

A

Between the vocal cords and carina

71
Q

How many cm should be added to placement of nasal intubation?

A

3-4cm

72
Q

What is the distance from the teeth to the vocal cords?

A

12-15cm

73
Q

What is the distance from the vocal cords to the carina?

A

10-15cm

74
Q

How much can the ETT move with extension or flexion of the neck?

A

ETT can advance 1.9cm with head flexion and withdraw 1.9cm with head extension. ETT can move 0.7cm with rotation of head

75
Q

What type of drugs can be given to prevent physiologic effects of DVL?

A

Narcotics, antihypertensives, deepen anesthetic, topical prior to DVL

76
Q

What should the MAC of an anesthetic be prior to intubation if using mask induction?

A

30% higher than surgical MAC

77
Q

What patients is deep extubation contraindicated?

A

Patients with a difficult airway
Risk of aspiration
Airway edema

78
Q

What would you like the patients SpO2, RR, Co2 and tidal volume to be prior to extubation?

A

SpO2: >90%
RR < 45
Tidal volume >mL/kg

79
Q

What can occur if the arytenoid cartilage is dislocated during DVL?

A

Leads to flaccid cords and airway edema

Principles of the Airway & Taxonomy (5 decks)

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