Airway Equipment Flashcards
1
Q
Basic Airway Equipment
A
- suction (functional and readily available)
- 2 oral and 2 nasal airways
- face mask
- laryngoscope handles and blades (functional)
- multiple sizes of ETT with stylets and pilot balloons checked
- O2 supply
- ambu bag
2
Q
oral airway
A
follows natural curvature of the tongue and lifts tongue and epiglottis away from posterior pharyngeal wall, thereby preventing obstruction
3
Q
oral airway sizing
A
- size specified by overall length
- multiple sizes available
- small = 80mm
- medium = 90mm
- large = 100mm
- determine proper size by measuring from corner of mouth to edge of mandible (around earlobe)
4
Q
Oral airway placement
A
- NOTE - only place when in deep sedation, not well tolerated in light sedation (gag, cough, vomit, laryngospasm, bronchospasm)
- tongue blade and proper sized oral airway
- use the tongue blade to push down on the tongue
- go in at 90 degrees in one corner of the mouth
- turn with the curve facing the roof of the mouth
- ensure tongue was not pushed further back and that you can mask ventilate
- avoid trauma to teeth and soft tissues
5
Q
common types of oral airways
A
- berman
- guedel
- ovassapian (used for fiberoptic intubation)
- COPA (cuffed)
6
Q
nasal airway
A
artificial airway that passes through the nose, goes behind the tongue, and rests just above the epiglottis
7
Q
clinical uses of nasal airway
A
- relieve upper airway obstruction
- facilitation of pharyngeal suctioning
- nasal dilation for nasal intubation
- fiberoptic guide
8
Q
nasal airway proper sizing
A
- size denoted by internal diameter in millimeters
- measure from patient nare to earlobe
9
Q
nasal airway proper placement
A
- use water soluble lube to lubricate outside of nasal airway
- better tolerated in awake or lightly anesthetized patients (versus an oral airway) - provokes less airway stimulation than hard oral airway
- be careful of bleeding - may be necessary to prep nares with vasoconstrictor
10
Q
relative contraindications for nasal airway
A
- coagulopathy or hemorrhagic disorder
- anticoagulant therapy
- pregnancy
- basilar skull fracture
- nasal infection
- deformities of nose
- history of nosebleeds requiring treatment
- septal defect
11
Q
oral/nasal airway complications
A
- airway obstruction
- tongue/soft tissue damage
- central nervous system trauma
- uvula edema
- dental damage
- laryngospasm, coughing
- ulceration/necrosis
- latex allergy
12
Q
face mask body
A
- rubber or plastic
- variety of shapes and sizes for adults and children
- transparent masks preferable over black or opaque
13
Q
face mask seal (aka rim or flap)
A
- part of face mask that comes into contact with patient’s face
- may be inflated or deflated to allow for better fit
14
Q
face mask connector
A
- fitting with a 22mm internal diameter
- ring with hooks may be present to fit mask straps
15
Q
face mask sizing
A
- use smallest mask that works
- least dead space
- easier to hold
- less risk for eye injury
16
Q
mask straps
A
- helps to hold mask firmly on the face, decreasing the presence of leaks
- avoid pressure damage - do not place on too tightly (can have facial nerve damage)
17
Q
mask ventilation
A
- head-tilt, chin-lift
- jaw thrust
18
Q
one-handed mask ventilation
A
- fingers kept on bone rather than soft tissue
- requires TIGHT seal
- downward displacement of the mask with the thumb and first finger
- upward displacement of the mandible with the other three fingers, with little finger at angle of mandible
- mandibular displacement combined with upper cervical extension and chin lift pull tongue soft tissues off posterior pharyngeal wall, relieving obstruction
19
Q
two-handed mask ventilation
A
- use thumbs for downward displacement of mask, and fingers on both hands to provide upward displacement of mandible
- requires assistant to provide manual ventilation
20
Q
causes of unsuccessful mask ventilation
A
- obstruction (like the tongue or other soft tissue)
- laryngospasm
- foreign body
- poor technique
21
Q
difficult mask ventilation
A
- facial edema
- prominent nares
- receding jaw
- obesity
- beards
- edentulous
- drainage tubes
- tumors/infections
22
Q
face mask advantages
A
- low incidence of sore throat
- less anesthetic depth needed
- no muscle relaxant necessary
- cost efficient for short cases
23
Q
face mask disadvantages
A
- hands are “tied up”
- user fatigue
- higher fresh gas flows often needed
- more difficulty in maintaining airway vs LMA
- unprotected airway
24
Q
face mask complications
A
- skin problems (dermatitis, necrosis)
- nerve injury (facial nerve CN VII)
- aspiration (no protection)
- eye injury (blindness from occlusion of retinal artery)
- movement of cervical spine
- latex allergy
- lack of correlation between PaCO2 and ETCO2 due to dilution from high FGF
- environmental pollution
25
Q
Laryngeal Mask Airway (LMA)
A
- supraglottic airway device designed to secure the airway by providing a circumferential seal around the laryngeal inlet with an inflatable cuff
- allows for spontaneous or assisted ventilation
26
Q
LMA components
A
- 15mm connector
- curved airway tube
- elliptical spoon shaped cuffed mask
- inflation pilot balloon and valve
- aperture bars that prevent epiglottis from obstructing mask
27
Q
reusable LMA
A
- made from medical grade silicone to withstand steam autoclaving for sterilization
- max use per LMA is 40 times
28
Q
LMA 1
A
- patient weight <5 kg
- max cuff vol - 4 cc
- cuff volume test - 6 cc
- largest ETT - 3.5
29
Q
LMA 1.5
A
- patient weight 5-10 kg
- max cuff vol - 7 cc
- cuff volume test - 10 cc
- largest ETT - 4.0
30
Q
LMA 2
A
- patient weight 10-20 kg
- max cuff vol - 10 cc
- cuff volume test - 15 cc
- largest ETT - 4.5
31
Q
LMA 2.5
A
- patient weight 20-30 kg
- max cuff vol - 14 cc
- cuff volume test - 21 cc
- largest ETT - 5.0
