Airway Equipment Flashcards
How do oral airways work?
Lift the tongue & epiglottis away from the posterior pharyngeal wall thereby preventing obstruction
What are the oral airway sizes?
Green = 80 mm Yellow = 90 mm Red = 100 mm
Contraindications to oral airways
prone, aspiration risk
How do you measure oral airways?
corner of mouth –> pt earlobe
What are the types of oral airways? (4)
Guedel, Berman, Ovassapian (fiberoptic int.), CPA
How do nasal airways work?
Relieve upper airway obstruction and rests just above epiglottis
How are nasal airways sized and measured?
Internal diameter in mm
Measured from nare to ear lobe
Nasal airway contraindications (6)
anticoag therapy or coagulopathy d/o basilar skull fracture deformities nasal infections nose bleed hx requiring tx pregnancy
How do you decrease dead space in a face mask?
choose the smallest appropriate size; increase FGF
Head-tilt chin lift c/i
C-Spine precautions
Pediatric population
Mandibular displacement + upper cervical extension + chin lift =
pull tongue soft tissues off posterior pharyngeal wall relieving the obstruction
Difficult mask ventilation RF: (9)
beard obesity > 26 kg/m2 age > 55 no teeth, no chin, nose is big s Others: edema, tumors
What are the advantages of a face mask?
low incidence of sore throat
less anesthesia
no relaxants
less $$
What are the disadvantages of a face mask?
no hands
fatigue
high FGF
unprotected airway
Complications of a face mask
skin problems nerve injury (VII) aspiration eye injury lack of correlationb tw PaCO2 and ETCO2 d/t FGF dilute environmental pollution
LMA
- do not exceed peak pressure 20 cm H2O
- airway reflexes must be obtunded before insertion
- never exceed cuff pressure of 60 cm H2O
what do the aperture bars do on the LMA?
prevent the epiglottis from obstructing the mask
Size 3
Weight: 30-50 kg
Test volume: 30cc
Maximum cuff volume: 20 cc
6.0 cuff
Size 4
Weight: 50-70 kg
Test volume: 45 cc
Maximum cuff volume: 30 cc
6.0 cuff
Size 5
Weight: 70-99 kg
Test volume: 60 cc
Maximum cuff volume: 40 cc
7.0 cuff
Size 6
> 100 kg
Test volume: 75 cc
Maximum cuff volume: 50 cc
7.0 cuff
LMA styles (3)
Proseal (gastric lumen to suction)
FasTrach (intubating LMA up to 8.0 ETT)
Regular
How long should the LMA hold its cuff volume?
2 minutes (50% more than its maximum)
What can cause the tip of the LMA mask to fold over on itself?
failure to press the mask against the hard palate or inadequate lubrication
LMA contraindications
- aspiration risk
- glottic/subglottic obstruction or pathology
- limited mouth opening
- trauma
- acute abdomen
- thoracic injury
- decreased pulmonary compliance
- peak airway pressures > 20 cm H2O
LDA ADR (4)
aspiration
sore throat (most common)
hypoglossal nerve injury, tongue cyanosis, VC paralysis
*laryngospasm if pt is light or in stage II
ETT indications (6)
- aspiration
- airway anomaly
- intracranial or intrathoracic or intraabdominal
- head/neck
- mechanical ventilation
- positioning where airway unavailable to CRNA
What is the ETT constructed of? Who monitors this?
polyvinylchloride
American Society for Testing Material (standard 21)
What does F-29, Z-79, or I.T. on an ETT mean
it has been tested and does not cause any toxicity
Tube length
measured in cm
Internal diameter
measured in mm (0.5 mm increments from 2.5-9)
Men size & insertion depth
8 or 9 at 24-26cm
Women size & insertion depth
7 or 8 at 20-22cm
Peds
size: 4 + age/4
depth: 12 + age/2
What is the cuff pressure?
Recommended: 20-25 mm Hg
Tracheal perfusion pressure: 25-30 mmHg
Air leak: 15-20 mm Hg
Head extension
8-10 cm
aligns p/l axes
Proper positioning for ETT
meatus of ear aligns w/sternal notch
Distance from teeth to vocal cords
12-15 cm
Distance from vocal cords to carina
10-15 cm
Distance from vocal cords to the carina
10-15 cm
Where should the cuff be located?
the midpoint between vocal cords and carina (T5)
Head flexion =
1.9 cm advance
Head extension =
1.9 cm withdrawal
Left or right head movment =
0.7cm
Left or right head movement =
0.7cm
Physiologic responses to DVL
CV: htn, tachy/bradycardia, arrhtymia, MI
IOP/ICP increased
bronchospasm, laryngospasm
Deep extubation
c/i if pt have difficult airway, aspiration risk, airway edema
no response to suctioning, but spontaneous breathing
Awake extubation
pt maintains & protects airway, purposeful movement, eyes open, reaction to suctioning
Subjective Criteria for Extubation (6)
follows commands clear oropharynx gag reflex head lift > 5s hand grasp minimal end expiratory % of IA
Objective criteria for extubation (7)
VC > 15 mL/kg peak voluntary negative insp. pressure > 25 cm H2O tidal volume > 6mL/kg sustained tetanic contraction spo2 > 90% and paO2> 60 mm Hg RR < 35 PaCO2 < 45
Extubation steps (5)
- 100% (maybe) O2
- suction oropharynx/hypopharynx
- close APL
- deflate cuff
- remove ETT w/positive pressure
Causes of compromise post-extubation
residual anesthetic poor central effort reduced tone reduced gag edema vocal cord paralysis laryngo/bronchospasm
Nasal intubation indications
maxillofacial surgery/oral surgery/dental
Nasal intubation c/i
coagulopathy basil skull fx intranasal d/o CSF leak extensive facial fractures
What are the causes of inability to ventilate?
- laryngospasm (nerve injury; light anesthesia)
- supraglottic soft tissue relaxation
- chest wall rigidity
- pathologic glottic/subglottic (edema, stenosis)
- equipment failure (insp/exp valves)
What is glidescope good for?
- difficult airway
- anterior larynx
- poor neck mobility
Fiberoptic intubation
- difficult airway
- C-spine precautions
Bullard scope
rigid, useful for difficult airway
$$$$
slow learning curve
attached eyepiece
Wu
rigid
O2 and suctioning
slow learning curve
Upsher
rigid
attached eyepiece
Bougie
eschmann introducer
15Fr, 60 cm long, angled @ 40 degrees
Combitube
supraglottic airway device; two lumens
TTJV
need high pressure source (50 PIS)
TV dependent on I:E ratio, compliance, catheter size
use 14g (1600mL/s) or 16g (500 mL/s)
TTJV complications
- thick secretions and tracheal mucosal damage blocking airway b/c inadequate humidification of gasses
- hematoma
- inadequate delivery of gases
- barotrauma*
Retrograde intubation
18G needle @ 45 degree angle
Cricothyrotomy components
12-14G needle + 3ml syringe 3 ml syringe-- no plunger 15 mm ETT adaptor from 7 ETT TTJV breathing circuit
Cricothyrotomy complications
pneumo emphysema sq bleeding esophageal puncture aspiration respiratory acidosis
