Airway Lectures (Hall) Flashcards
2 types of Endotracheal Intubation
Orotracheal Intubation
Nasotracheal Intubation
3 types of Laryngoscope Blades
Macintosh (Mac)
Miller
D-Blade (video laryngoscope)
Macintosh Blades
Curved with the tip placed in the vallecula
typically left handed
Miller Blades
Straight with the tip lifting the epiglottis
D-Blades
Great curvature, resulting in the lack of direct line of sight of the glottis. Requires the use of an intubating stylet.
Video Laryngoscopes
Equipped With: Handle Blade Light Source Viewing Screen Recording System
Conventional Endotracheal Tube (ETT)
Consists of: Machine end adapter Tube body Inflation System Tip with Bevel and Murphy Eye at distal end
Outside Diameter of ETT machine connector
15 mm
Purpose of Murphy Eye
Alternate gas pathway in the event that bevel is obstructed by tracheal wall
How to prepare the ETT
Seat connector
Check cuff integrity
Deflate cuff
Know how much air is in the syringe (6ml)
Magill Forceps
Used for retrieval of foreign bodies and assists with nasotracheal intubation
Introducer tubes
Designed to assist with tube placement
Intubating Stylets
Provides rigidity in hockey stick shape
Should not be used unless there is a real need
Risk associated with use:
puncture
abrasion
laceration
cricoarytenoid dislocation
failure to intubateSteps for DL and ET intubation
Obtain correct height of patient Operator assumes good position Create axial alignment Perform DL Intubate Confirm intubation Secure ETT
How to position patient for intubation
Patient head at your waist
Your upper arm loosely held at your side
Your lower arm horizontal
Proper intubating positioning allows for
Max endurance
Min energy consumption
Optimal depth of field
Visibility of teeth and vocal cords
Proper vector for Laryngoscope during intubation
Lift towards the wall/ceiling intersection
Most common error leading to failure to obtain a direct view of the glottis
Failure to correctly use towels in head positioning. The use of towels decreases airway patency.
Confirming Endotracheal Intubation
Capnography (repeating wave forms) Chest Rise Condensation Compliance Auscultation
What not to use to confirm ETT intubation
SpO2
Where to listen for Auscultation
Farthest from the bronchioles, bilaterally under the arm pits
Functions of the Human Airway
Protection (Aspiration, Microorganisms) Conduction (O2/CO2 exchange, Anesthetic Gases) Air Conditioning (heat/humidity)
Proper vector of jaw thrust maneuver
90° to the long axis of patient
Correct finger positioning of jaw thrust maneuver
Fingers behind the angle of the jaw, thumbs on either side of patients nose
Muscle that allows jaw thrust maneuver to be effective
Genioglossus
How does bag and mask ventilation work?
Positive pressure flow is directed toward patient by unidirectional valves
LMA means?
Laryngeal Mask Airway
How do LMAs work?
Placed into hypopharynx and is inflated to give a seal above the glottis (a blind technique)
Proper LMA insertion
Deflate cuff
Fill lip of cuff with KY lubricant
Depress tongue with tongue depressor
Pass LMA over tongue and seat it in the hypopharynx
Inflate the cuff and check for capnography waves
Why is airway management so important?
Provides anesthesia for surgical procedures
Supports resuscitation
Provides long term respiratory care
Purpose of preoperative airway examination
In order to:
Do no harm during subsequent airway management
Determine airway related risks
Obtain information necessary for bag/mask, DL, LMA
Obtain info needed for post-op management
4 key steps to physical examination
Palpation
Percussion
Inspection
Auscultation
How many plans of action should you have?
Always have 5 plans and be prepared to execute 3 of them
What are you checking for when conducting a ROM exam?
Rotation, Flexion, Extension
Rotation of head from left to right
Flexion of lower c-spine
Extension of atlanto-occipital joint
Proper extension of AO joint can be seen as what?
“Closure of the gap”
Upper and lower dentition angle should create a 35° angle when going from “horizontal upper to horizontal lower”
What is Paresthesias?
An abnormal sensation, typically tingling or prickling feeling, caused chiefly by pressure on or damage to peripheral nerves (pins and needles)
Things to look for in a Oropharyngeal Examination
Inter-incisor distance Dentition Tongue, gums, and floor of mouth Structures that could cause potential DL difficulty Asses TMJ
TMJ has two actions. What are they?
Rotation = 50%
Gliding (sliding) = 50%
The inter-incisor distance should be what?
Greater than or equal to 4cm
When identifying problems with the dentition, always use notation with what?
Tooth numbering system
What do you expect to see during an OPE?
Hard Palate Soft Palate Uvula Palatine Tonsils or Fossa Palatoglossal Arches Palatopharyngeal Arches
What is the risk of an incisor opening of less than 4cm ?
A conventional DL may not be possible
Thyromental Distance
Should be greater than or equal to 6.5cm
If less than 6.5cm, a conventional DL may not be possible
Mandibular Length from angle to center jaw
Should be greater than or equal to 9cm
If less than 9cm, there is limited space for soft tissue displacement and a conventional DL may not be an option.
Dysphagia
Difficulty Swallowing
Prevalence
Portion of population that has a condition
Incidence
Number of new cases occurring in a population in a given time period
Where is the Gastroesophageal (GE) junction located?
Where the semi-hemispheres of the diaphragm join
GE junction opening pressure
16 cmH2O = normal
4 cmH2O = Hiatal Hernia
1 cmH2O = GERD
Prevalence of Hiatal Hernias
20% to 50% of the population
Increases with Age
Majority are Asymptomatic
Two types of hiatal hernias
Axial (sliding) = 95%
Non-Axial (paraesophageal) = 5%
Hiatal Hernia complications
Increased risk of aspiration
Esophagitis
Inflammation of the Esophagus
GERD
Gastroesophageal Reflux Disease
GERD Prevalence and side effects
Increases with age
Daily symptoms 7% to 10%
Occasional Symptoms 25% to 40%
Esophagitis
Adenocarcinoma
