Airway Equipment (Exam III) Flashcards
1
Q
What pressure should the inflatable seal of a face mask be at?
A
20 - 25 cmH₂O
2
Q
What connector size does a face mask have?
A
22 mm internal diameter
3
Q
What risk factors are there for difficult mask ventilation?
A
- Male
- > 55 yo
- Beard
- Edentulous
- OSA
- BMI > 30 kg/m²
4
Q
What are some options for overcoming a difficult mask ventilation?
A
- Oral or nasopharyngeal airway
- Two-handed technique
- Cut the beard
- Tegaderm
- Difficult airway algorithm
5
Q
What are most oropharyngeal airways made of?
A
plastic
6
Q
How do oropharyngeal airways work?
A
Lift tongue & epiglottis away to ↓ work of breathing during SV (spontaneous ventilation)
7
Q
How is the correct oropharyngeal airway size checked?
A
Corner of mouth to angle of jaw or earlobe
8
Q
When inserting oropharyngeal airways, what reflexes should be depressed?
A
Pharyngeal and laryngeal reflexes
9
Q
Where are bite blocks placed?
A
Between upper and lower teeth and gums
Used a lot during endoscopy.
10
Q
Which artificial airway is preferred for patients w/ intact airway reflexes?
A
Nasopharyngeal
11
Q
What airway is preferable for patients with loose teeth, oral trauma, gingivitis, or limited mouth opening?
A
Nasopharyngeal airway
12
Q
When are Nasopharyngeal airways contraindicated?
A
- Basilar skull fracture
- Nasal deformity
- Hx of severe epistaxis
- Pregnancy
- Coagulopathy
13
Q
How are Nasopharyngeal airways sized?
A
By outer diameter in the french scale
14
Q
What are the possible complications of airways?
A
- Airway obstruction
- Ulceration (nose, tongue, etc.)
- Dental damage
- Laryngospasm
- Latex allergy
- Retention/swallowing
15
Q
Who developed Supraglottic airways?
A
Dr. Archie Brain
16
Q
What airway is intermediate in invasiveness between a face mask and endotracheal tube?
A
Supraglottic airway (LMA, Laryngeal mask airway)
17
Q
Are supraglottic airways used for spontaneous ventilation or positive pressure ventilation?
A
Either
18
Q
Where do LMA classic’s sit after insertion?
A
Hypopharynx surrounding the supraglottic structure.
19
Q
What LMA size is necessary for adults 50-70 kg?
A
LMA 4
20
Q
What LMA size is necessary for children 30-50kg?
A
LMA 3
21
Q
What size LMA is necessary for adults over 100kg?
A
LMA 6
22
Q
What LMA size is necessary for adults 70-100kg?
A
LMA 5
23
Q
What LMA size is necessary for neonates and infants up to 5kg?
A
LMA 1
24
Q
What LMA size is necessary for infants/children between 10-20kg?
A
LMA 2
25
What LMA size is necessary for infants between 5-10kg?
LMA 1.5
26
What LMA size is necessary for children between 20-30kg?
LMA 2.5
27
What occurs with an LMA that is too small?
Leaking occurs during positive pressure ventilation
28
What occurs with an LMA that is too large?
- Won't seat on glottis
- Sore throat
- Pressure on nerves
29
What nerves might be compressed with an overly large LMA?
- Lingual
- Hypoglossal
- Recurrent Laryngeal
30
Label the following steps of LMA insertion as true or false.
- Insert well lubricated w/ the cuff inflated
- Hold like a pencil
- Upward against the hard palate
- Follow the anterior pharyngeal wall
- Feel curve downward into airway then come to a stop.
- Insert well lubricated w/ the cuff inflated **(False, cuff should not be inflated)**
- Hold like a pencil **(T)**
- Upward against the hard palate **(T)**
- Follow the anterior pharyngeal wall **(False, follow the posterior pharyngeal wall)**
- Feel curve downward into airway then come to a stop. **(T)**
31
What anatomic technique would one use for a difficult LMA insertion?
- Jaw lift
- Pull tongue forward
- Slightly inflate balloon
32
How does an LMA Unique compare to an LMA classic?
- Stiffer (made of PVC)
- Less compliant cuff
33
What are the characteristics of an LMA Proseal?
- Shorter than Classic
- Reinforced w/ wire
- Access to Esophagus for gastric tube
34
Which LMA type has no cuff to seal around the supraglottic opening?
I-gel LMA's
35
Which LMA's provide access to the esophagus through a built in opening?
- LMA Proseal
- I-gel LMA's
36
What are the characteristics of I-gel LMA's?
- No cuff (non-inflatable anatomic seal)
- Gastric channel
- Can intubate through
37
What are the advantages of LMAs?
- Easy and speedy placement
- Improved hemodynamic stability
- Reduced anesthetic requirements
- No muscle relaxation needed
- Tracheal intubation risks avoided
38
Which LMA allows for intubation through the LMA itself?
I-gel LMA's (typically)
39
Would an LMA or an ETT be better for hemodynamic stability?
LMA
40
Would an LMA or ETT be better for protection from gastric regurgitation and aspiration?
ETT
41
Would an LMA or ETT be better for protection from Laryngospasm?
ETT
42
What size Mac blades are used for adult laryngoscopy?
3 and 4
43
What size Miller blades are used for adult laryngoscopy?
2 and 3
44
Which intubating blade style is generally better for smaller mouths and longer necks?
Miller
45
Which intubating blade shows more cervical spine movement with its use?
Mac
46
Which laryngoscopy blade is inserted into the vallecula?
Mac
47
What imaginary line is created when placing a patient in the sniffing position?
Horizontal line connecting external auditory meatus and sternal notch.
48
Is a laryngoscopy blade inserted into the right or left of the mouth?
Right
49
How much cervical flexion and head extension are present in the sniffing position?
- 35° lower cervical flexion
- 80-90° head extension
50
How is the larynx displaced to provide a better intubating view?
BURP technique
**B**ackward
**U**pward
**R**ightward
**P**ressure
51
What laryngoscopic positioning is useful for obese patients?
Ramped Position
52
What is a Shikani Optical Stylet?
53
What are the disadvantages to the optical stylet?
- Longer intubation time
- No nasal intubations
- No malleable stylet for precise directing.
54
What are the benefits of the optical stylet?
- Visualized trachea
- ↓ sore throat incidence
- ↓ c-spine movement
55
What are the strongest predictors of failure of video laryngoscopy?
Presence of:
- Surgical scar
- Radiation changes
- Mass
56
What are overall limitations of video laryngoscopes?
- Video system required
- Limited portability
- Can fail w/ anatomic abnormalities
57
What is the most frequent anesthesia-related claim?
Dental injury
58
Which teeth are most likely to be injured from laryngoscopy?
- Upper incisors
- Restored or weakened teeth
59
What can help prevent dental injury?
Tooth protectors placed on upper teeth
60
What objects can be swallowed during laryngoscopy?
- Light bulbs
- Teeth
61
What structures (other than teeth) can be injured during laryngoscopy?
- Abrasion/hematoma
- Lingual/hypoglossal nerve injury
- Arytenoid subluxation
- Anterior TMJ dislocation
62
How can cervical spinal cord injury occur during laryngoscopy?
- Aggressive head positioning
- Manual in-line stabilization
63
What nerves could be injured via laryngoscopy?
- Lingual nerve
- Hypoglossal nerve
64
What components of the tracheal tube will change resistance in the breathing system?
- Internal diameter
- Length
- Configuration
- Connectors
65
What manufacturing requirements are there for ETT's?
66
What aspect of ETT's decrease kinking?
Round, circular structure
67
What is the purpose of the Murphy eye?
Provides alternative pathway for gas flow
68
What is the purpose of the slanted bevel of an ETT?
Helps view Larynx
69
What is a Ring-Adair-Elwin (RAE) tube used for?
Facilitation of surgery around the head and neck
70
Are RAE tubes ever straight?
Only on insertion
71
What are disadvantages to RAE tubes?
- Difficult to pass suction/scope
- Increased airway resistance
72
What are alternative names for "armored" tubes?
- Reinforced
- Anode
- Spiral-embedded
73
What are the benefits of reinforced tubes?
- Prevention of kinking and compression
- Good for head, neck, and tracheal surgeries
74
What are the disadvantages of reinforced ETT's?
- Need for stylet or forceps
- Difficult use in nasal intubation
- Cannot be shortened
- Damaged when bit by the patient
75
What are laser resistant tube made from?
Metal, silicone, or metal mixture
76
What is the purpose of a laser resistant ETT?
- Reflection of CO₂ or KTP laser
77
What are the cuffs filled with in laser resistant ETT's?
- **Methylene Blue** saline solution
78
How are the double cuffs of a laser resistant tube filled?
Distal first, proximal last
79
The ETT _____ must not herniate over the murphy eye or bevel of the tube.
cuff
80
What is the cuff pressure of an ETT?
How much air is this typically?
- 18 - 25 mmHg
- 8 - 10 mL of air
81
ETT cuff pressure should be monitored frequently if using _______.
N₂O (easy expansion & contraction)
82
How does a high-volume, low pressure ETT cuff work?
- Thin, compliant wall
- Occludes trachea w/o stretching the trachea
- ↑ area of contact
83
What are advantages to a high-volume, low pressure ETT cuff?
- Easy to regulate pressure
- Pressure to trachea won't exceed mucosal perfusion pressure.
84
What are disadvantages of high-volume, low pressure ETT cuff?
- Difficult insertion
- Can tear easily
- **Sore throat** more likely
- Won't prevent fluid leakage
- NGT can slip past cuff
85
What is a low-volume high pressure ETT cuff?
- Small area of contact
- High pressure
- Deforms trachea to circular shape
86
What are advantages of a low-volume high pressure ETT cuff?
- Protects from aspiration
- Better visibility during intubation
- Lower incidence of sore throat
87
What are disadvantages of a low-volume high pressure ETT cuff?
- Pressure greater than mucosal perfusion pressure
- Needs replacement if post-operative intubation is required.
88
What factors can change cuff pressure?
- N₂O usage
- Hypothermic cardiopulmonary bypass
- Increases in altitude
- Coughing, straining, changes in muscle tone
89
What factors will increase the risk of airway trauma from ETT insertion?
- Excessive force
- Multiple attempts
- Stylet inside tube
- Skill
- Degree of muscle relaxation
90
When is inadvertent bronchial intubation most likely?
W/ pediatric female patients
*Right main bronchus*
91
What causes a decreased distance to the carina?
- Trendelenburg
- Laparascopy
92
Bronchial intubation will lead to _________.
atelectasis
93
What should the ETT be secured at for males and females?
Male: 23 at the teeth
Female: 21 at the teeth
94
In what patient population upper airway edema most likely to occur?
Why is this?
- Young children 1- 4 y/o
- cricoid cartilage completely surrounds subglottic area
95
When will upper airway edema be noticed usually?
1-2 hours to 48 hours post-op
96
What is a vocal cord granuloma?
Mass on vocal cord from excess stimulation
97
Who are vocal cord granuloma's most common in?
Adult females
(Trauma, large ETT, infection, excessive cuff pressure)
98
What are the s/s of vocal cord granuloma?
- Persistent hoarseness
- Fullness
- Chronic cough
- Intermittent loss of voice
99
How are vocal cord granuloma's treated?
- Laryngeal evaluation and vocal rest
100
What is the angle at the distal end of a bougie?
30 - 45°
101
How is a bougie inserted?
Tip anterior
102
What should be known about Magill forceps?
- Primarily used with nasal intubations
- Possible damage to tube cuff or murphy eye lodgement can occur
103
What are indications for lung isolation?
- Thoracic procedures
- Control of contamination or hemorrhage
- Unilateral pathology
104
What should be known about the right mainstem?
- Shorter, straighter, larger diameter
- 25° takeoff from trachea
- 2.5 cm length
105
What should be known about the left mainstem?
- 45° takeoff
- 5.5 cm length from carina to takeoff
106
What size double lumen tubes are available for adults?
35, 37, 39, 41 fr
107
What size double lumen tubes are available for children?
26, 28, 32 Fr
108
When would a right double lumen tube be utilized?
For left-sided lung surgeries
109
What occurs after the bronchial cuff passes the cords?
ETT is turned 90°
110
Where is the blue bronchial cuff located?
Just below the carina in the appropriately blocked bronchus
111
How is the correct location of the bronchial baloon verified?
Fiberoptic scope
112
How is a lung isolated with a double lumen tube in place?
Clamping of the tracheal or bronchial connector
113
What are complications of double lumen tube insertion?
- Tube malposition (w/ unsatisfactory lung collapse)
- Hypoxemia
114
When would a bronchial blocker be advised?
When a double lumen tube cannot be used
115
When would a double lumen tube not work? (and thus require the use of a bronchial blocker)
- Nasal intubation
- Difficult intubation
- Tracheostomy
- Subglottic stenosis (DLT are large)
- Need for post-operative ventilation
- Single lumen tube already in place
116
What would be used to block a specific segment of a lung? (not the entire mainstem and thus lung)
Bronchial blocker
117
What are some factors that cause difficulty with bronchial blockers?
- Right upper lobe bronchus takeoff too high
- Tracheal bronchus
- Fixation by staples during surgery
- Perforation by suture needle or instrument
118
What are the characteristics of I-gel LMA's?
- No cuff (non-inflatable anatomic seal)
- Gastric channel
- Can intubate through
