Airway Equipment Flashcards
What is Ludwig’s Angina?
A skin infection that occurs on the floor of the mouth, under the tongue
Why might you utilize ramping on an obese patient?
To line up the three axes determined by aligning the meatus of the ear with the sternal notch
How is FRC affected by obesity?
Decreased FRC, make sure to pre oxygenate these patients well prior to intubation will desaturate quickly
What position may be helpful to intubate an obese patient?
Reverse trendelenburg, gravity helps pull everything down
What is a consideration with severe facial burns?
Scar tissue that is contracted, difficult to open patients mouth
What airway equipment must be ready and available in the OR?
Suction Oral/Nasal Airway Face Mask Laryngoscope handle and blade ETT with balloon checked O2 supply and Ambu bag
How should an oral airway be inserted?
Follows the curvature of the tongue and lifts tongue and epiglottis away from the posterior pharyngeal wall
Where should the phalange of the oral airway be located?
Outside of lips
What injuries may result if an oral airway is left in a patient in the prone position?
Pressure causes tissue necrosis and severe tongue swelling
How should we measure the proper size of an oral airway to use?
Lips to mandible
What sizes of oral airways are available?
Small: 80mm
Medium: 90mm
Large: 100mm
Why wouldn’t you want to use an oral airway in a lightly sedated patient?
May provoke gag reflex, cough, vomit, laryngospasm, or bronchospasm
What is the purpose of a nasal airway?
Artificial airway that passes through the nose, goes behind the tongue and rests just above the epiglottis
What can a nasal airway be used for?
Relieve upper airway obstruction
Facilitation of pharyngeal suctioning
Nasal dilation for nasal intubation
Fiberoptic guide
What population usually tolerates a nasal airway?
Lightly anesthetized patient, provokes less airway stimulation
What is the size of a nasal airway indicate?
Internal diameter in millimeters
What are some contraindication to a nasal airway?
Coagulopathy disorders Anticoagulant therapy Pregnancy (blood volume increased, engorged vessels) Basilar skull fracture Nasal infections Deformities of the nose HX nosebleeds
What are some complications to both nasal and oral airways?
Airway obstruction Tongue/soft tissue damage CNS trauma Uvula edema Dental damage Laryngospasm Ulceration/necrosis Latex allergy
What is the internal diameter of a face mask connector?
22mm
What is the correct size face mask for a patient?
Smallest mask that works, less dead space, easier to hold and less risk for eye injury
Why isn’t a head tilt chin lift great to use in pediatric populations?
Hyperextension pushed posterior pharyngeal wall up against the tongue and epiglottis
Why should we lift the jaw into the mask?
This motion will lift the tongue off the back of the airway
What is the proper technique for a face mask seal?
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
How should two handed mask ventilation be performed?
Use thumbs for downward displacement of mask and fingers on both hands to provide upward displacement of mandible
Assistant will need to provide ventilation
Why might mask ventilation not be effective?
Obstruction, laryngospasm, foreign body, or poor technique
Who might be a difficult mask ventilation?
Facial edema, prominent nares, receding jaw, obesity, beards, drainage tubes, tumors, infections, edentulous
What are some advantage of face mask anesthesia?
Low incidence of sore throat
less anesthetic depth needed
No muscle relaxants
Cost efficient for short cases
What are some disadvantage of face mask anesthesia?
Hands "tied up" User fatigue Higher FGF More difficult to maintain airway Unprotected airway
What type of airway device is a LMA?
Supraglottic airway device
How does the LMA ventilate and oxygenate?
Designed to secure the airway by providing a circumferential seal around the laryngeal inlet with an inflatable cuff
What type of ventilation should be used with a LAM?
Spontaneous or assisted ventilation
What is the diameter of the LMA connector?
15mm
What structures on the LMA prevent the epiglottis from obstructing the mask?
Aperture bars
If you have a reusable LMA what should not be used to clean it and why?
Germicides, disinfectants or chemical agents. They can be absorbed into the LMA and cause pharyngitis and laryngitis
What is typically the maximum use per reusable LMA?
40 times
What should be used to clean a reusable LMA?
Endozime cleaner prior to steam autoclave
How long should a LMA hold cuff pressure while testing prior to use?
Two minutes
After inflating a LMA, what should the pilot balloon look like?
It should remain elliptical, a spherical balloon indicates loss of integrity
What is the diameter of the LMA connecter?
15mm
What airway protective device should always be used with a LMA?
Bite block, to prevent negative pressure pulmonary edema
Where should the lubricant be place on a LMA?
posterior surface of the cuff
How should the patient’s airway reflexes be prior to inserting a LMA?
Obtunded
What is a good indicator to anesthetic depth prior to inserting a LMA?
Absence of motor response to jaw thrust
What anatomic structure is used as a guideline for inserting a LMA?
Hard palate to soft palate
What may occur after inflating the LMA?
The mask will rise slightly as it fits properly into the hypopharynx
When ventilating with a LMA in place what pressures must not be exceeded and why?
20cmH2O can open the LES and cause gastric contents to be released, aspiration may occur
What two factors may cause the tip of the LMA mask to fold over on itself?
Failure to press the mask against the hard palate or inadequate lubrication
How might a LMA cause an airway obstruction?
If the tip is folded over, cause the epiglottis to a down-folded position
How stimulating is inserting a LMA versus inserting an endotracheal tube?
LMA is much less stimulating with more stable vital signs
What is the endotracheal tube made out of?
Polyvinyl chloride (flammable)
What does the size of the tube indicate?
The internal diameter in millimeters
What American Society for Testing Material applies to ETT construction?
ASTM Standard 21
What size ETT should be used on a male?
8.0 or 9.0 at 24-26 at lip
What size ETT should be used on a female?
7.0-8.0 at 20-22 at lip
How do we determine the appropriate size ETT to place on a child?
4 + (age/4)
What is the rule of thumb for the depth of inserting an ETT on a child?
12+(age/2) = depth in cm
How large is the glottic opening of an adult?
6-9mm but can be stretched to 12mm
What law can describe the increased WOB with an ETT?
Poiseuille’s Law, length and diameter impact resistance
What is the purpose of Murphy’s eye?
If the bevel is occluded then air is still able to pass though the tube into the trachea
If a patient doesn’t have to be paralyzed, why shouldn’t they be?
Respiratory rate can tell us depth of anesthesia, by taking away RR we are “giving up a piece of information”
What is the purpose of the cuff of a ETT?
To provide a seal between ETT and tracheal wall
What type of cuffs do most ETT we use have?
Low volume, high pressure cuffs
What is the recommended cuff pressure in a ETT?
20-25mmHg (tracheal mucosa perfusion pressure 25-30mmHg)
When might you hear an air leak with an uncuffed ETT?
15-20cmH2O
What is the name of the curved blade and how does it work?
Macintosh, tip advanced to valleculae
What is the name of the straight blade and how does it function?
Miller, lifts epiglottis
What speciality blade is wide with a slight curve at the tip giving the user tighter control of the tongue?
Phillips blade
What speciality blade is wider and typically seen in pediatrics?
Robert shaw blade
What scale should we use to grade the airway during DVL?
Cormack Laryngoscopy Views
Where should the cuff of the ETT sit?
Between the vocal cords and carina
How many cm should be added to placement of nasal intubation?
3-4cm
What is the distance from the teeth to the vocal cords?
12-15cm
What is the distance from the vocal cords to the carina?
10-15cm
How much can the ETT move with extension or flexion of the neck?
ETT can advance 1.9cm with head flexion and withdraw 1.9cm with head extension. ETT can move 0.7cm with rotation of head
What type of drugs can be given to prevent physiologic effects of DVL?
Narcotics, antihypertensives, deepen anesthetic, topical prior to DVL
What should the MAC of an anesthetic be prior to intubation if using mask induction?
30% higher than surgical MAC
What patients is deep extubation contraindicated?
Patients with a difficult airway
Risk of aspiration
Airway edema
What would you like the patients SpO2, RR, Co2 and tidal volume to be prior to extubation?
SpO2: >90%
RR < 45
Tidal volume >mL/kg
What can occur if the arytenoid cartilage is dislocated during DVL?
Leads to flaccid cords and airway edema
