Airway highlights- In class need to know Flashcards
Nasal airways (describe how placed)
leave phalange on outside
could be awake or light
use water-soluble lubricant- don’t occlude the opening
aim straight to the floor
Nasal airways should be avoided in patients with
facial trauma, pregnant because increased blood volumes and nose is highly vascular, history of recurrent nosebleeds, anti-coagulants, hemophiliac, liver disease, integrity issue with hard palate
In this stage of anesthesia, we should avoid placing anything…
stage 2
Concerns when masking include
excessive pressure which could cause tissue and nerve damage (facial), temporal, buccal, cervical, mandibular
How to place a face mask
start at bridge of nose and roll down while pulling cuff out
could injure the eyes so use smallest size mask & avoid excessive pressure on nose
“C” and “E” with fingers- 2 fingers on bony prominence- do not put pressure on soft tissue, nose, or eyes
Steps to perform when you cannot mask-ventilate
reposition patient, insert oral airway, insert nasal airway, two handed masks
What occurs with ETT placement?
increased heart rate, increased blood pressure, increased ICP, increased IOP (all of these are avoided with LMA & mask general)
Reasons for using mask ventilation over ETT?
don’t have to paralyze, cheaper, less risk for trauma, not as deep of anesthesia
What is the size connector for the LMA?
15 mm
Where does the LMA sit?
supraglottic above the cords
The fast track LMA
has a preformed curvature and could be exchanged for ETT if you have the right equipment
Can the LMA be used for mechanical ventilation?
Yes, as long as you maintain peak pressure <20 cmH2O
What is a laryngospasm?
adduction of vocal cords
How do we treat a laryngospasm?
give positive pressure- turn APL valve all the way down need a good mask seal align axis Larson's maneuver- dig behind the jaw deepen anesthetic- give Propofol Succinylcholine
What muscle is involved with laryngospasm?
lateral cricoartynoid, thryoartenoids, cricothyroid
Difficult mask airway:
BONES & MOANS
beard, obese, no teeth, elderly >55, snores
provider experience, NG tube, retrognathia, tall/big nose, appropriately fitted mask
LEMON stands for
Look externally, evaluate the 3-3-2 rule, Mallampati >3, obstruction, limited neck mobility
Basic airway set up includes:
suction, 2 blades & 2 handles, 2 oral airways, 2 ET tubes, stylets, tape, syringe, ambu bag
Sizing of the oral airway
phalange-corner of the mouth to the tip of the mandible
The airway is composed of the
pharynx, larynx, and trachea
What is BURP?
back, upward right pressure because 60% of people have esophagus to the left
List the cranial nerves:
- olfactory
- optic
- oculomotor
- trochlear
- trigeminal
- abducens
- facial
- acoustic
- glossopharyngeal
- vagus
- spinal accessory
- hypoglossal
Which cranial nerves are important to the airway?
trigeminal, facial, glossopharyngeal, and vagus
What might a hypoglossal injury cause?
tongue could fall backward and obstruct the airway
could use an oral airway
