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Apex Review > Airway management > Flashcards

Airway management Flashcards

1
Q

What is a Mallampati exam?

A

assesses the oropharyngeal space to determine how much room there is to work
helps us quantify the size of the tongue relative to the volume in the mouth

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2
Q

A higher Mallampati score (3 or 4) is associated with

A

a more difficult intubation

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3
Q

By itself, ______ is a poor predictor of a difficult airway

A

Mallampati

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4
Q

What is the inter-incisor gap exam?

A

assesses how well the patient can open his mouth which directly affects your ability to align the oral, pharyngeal, and laryngeal axes

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5
Q

A small inter-incisor gap creates a

A

more acute angle between the oral and glottic openings, increasing the difficulty of intubation

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6
Q

What is normal inter-incisor gap?

A

2-3 finger breadths (4 cm)

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7
Q

_________ reduce the inter-incisor gap

A

long incisors

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8
Q

___________ teeth increase the risk of dental damage

A

Buck

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9
Q

What is the mnemonic for Mallampati classification?

A

PUSH

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10
Q

What is a class 1 Mallampati entail?

A

Pillars, Uvula, Soft palate, Hard palate

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11
Q

What is a class 2 Mallampati?

A

Uvula, soft palate, hard palate

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12
Q

What is a class 3 mallampati?

A

soft palate, hard palate (base of uvula may be seen)

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13
Q

What is a class 4 mallampati?

A

hard palate

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14
Q

To perform the Mallampati exam, ask the patient to:

A

sit upright
extend the neck
open the mouth wide
stick out the tongue
NOT phonate

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15
Q

Restriction of mouth opening can be caused by

A

arthritis, scar tissue, temporomandibular joint disease and prior surgery

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16
Q

The ability to place the patient into the sniffing position is highly dependent on the mobility of the

A

atlanto-occipital joint

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17
Q

Some conditions that impair the atlantooccipital mobility include

A

arthritic disease, trauma, and Down syndrome
ankylosing spondylitis, trauma, surgical fixation, Klippel-Feil, diabetes

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18
Q

The mandibular protrusion test assesses the

A

function of the temporomandibular joint

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19
Q

_______________ mandibular protrusion test correlates with an increased difficulty of intubation.

A

A class 3

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20
Q

How is the mandibular protrusion test performed?

A

The patient is asked to sublux the jaw and the position of the lower incisors is compared to the position of the upper incisors

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21
Q

To expose the glottic opening during laryngoscopy, you must displace the tongue into the

A

submandibular space

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22
Q

If the submandibular space is too small or poorly compliant, then you may not

A

be able to move the tongue enough to expose the glottis

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23
Q

The thyromental distance helps us estimate

A

the size of the submandibular space

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24
Q

A TMD less than ______ or greater than _______ correlates with an increased risk of difficult intubation

A

6 cm or greater than 9 cm

25
Q

The borders of the submandibular space include

A

superior border= mentum
inferior border= hyoid bone
lateral border= either side of the neck

26
Q

TMD less than 6 cm indicates

A

mandibular hypoplasia

27
Q

What is a class 1 mandibular protrusion test?

A

patient can move LI past UI and bite the vermilion of the lip (where the lip meets the facial skin)

28
Q

What is a class 2 mandibular protrusion test?

A

Patient can move LI in line with UI

29
Q

What is a class 3 mandibular protrusion test?

A

patient cannot move LI past UI (increased risk of difficult intubation)

30
Q

Normal AO flexion and extension is between

A

90-165 degrees

31
Q

Normal AO extension

A

35 degrees (laryngoscopy will be difficult if <23 degrees)

32
Q

What is the 3-3-2 rule?

A

combines several airway tests to give us a more accurate prediction of airway difficulty
inter-incisor gap > 3 finger breadths
TMD > 3 fingerbreadths
Thyrohyoid > 2 fingerbreadths

33
Q

Only the epiglottis can be visualized during direct vision laryngoscopy. What is this patient’s Cormack and Lehane score?

A

3

34
Q

The Cormack and Lehane grading system helps us measure

A

the laryngoscopic view we obtain during direct vision laryngoscopy

35
Q

What is a grade 1 Cormack Lehane score?

A

complete or nearly complete view of the glottic opening

36
Q

What is a grade 2A view?

A

posterior region of the glottic opening

37
Q

What is a grade 2B view?

A

corniculate cartilages and posterior vocal cords (no glottic opening)

38
Q

What is a grade 3 view?

A

epiglottis only

39
Q

What is a grade 4 view?

A

soft palate only

40
Q

How does the Cormack and Lehane score relate to the difficulty of laryngoscopy?

A

Grade 1 & 2A= easier intubation
Grade 2B & 3= harder intubation (consider a bougie)
grade 4= requires an alternative approach to intubation

41
Q

Identify the BEST predictors of difficult mask ventilation. (select 3)
a. mallampati class 3
b. old age
c. edentulousness
d. small mouth opening
e. high, arched palate
f. presence of a beard

A

b. old age
c. edentulousness
f. presence of a beard

42
Q

What is the mneomic for difficult mask ventilation?

A

BONES
beard, obese, No teeth, elderly (age > 55 years), snoring

43
Q

If the patient has a full stomach or risk factors for aspiration, then a

A

RSI is indicated

44
Q

Complications related to cricoid pressure include:

A

airway obstruction
difficulty with laryngoscopy
impaired glottic visualization
difficult intubation
reduced LES tone
esophageal rupture if patient is actively vomiting

45
Q

What are the five questions to ask before providing airway management?

A
  1. Can I mask ventilate
  2. Can I intubate?
  3. Can i place a supraglottic airway?
  4. Can I place an invasive airway?
  5. How fast must I secure the airway?
46
Q

Risk factors for difficult laryngoscopy and endotracheal intubation:

A

small mouth opening
long incisors
prominent overbite
high, arched palate
MP 3 or 4
retrognathic jaw
inability to sublux jaw
short, thick neck
short thyromental distance
reduced cervical mobility

47
Q

Risk factors for difficult supraglottic device placement include:

A

limited mouth opening
upper airway obstruction
altered pharyngeal anatomy (anything that prevents a seal)
poor lung compliance (requires excessive PIP)
increased airway resistance (requires excessive PIP)
lower airway obstruction

48
Q

Risk factors for difficult invasive airway placement include:

A

abnormal neck anatomy
obesity
short neck
laryngeal trauma
limited access to the cricothyroid membrane

49
Q

What could cause abnormal neck anatomy?

A

tumor, hematoma, abscess, history of radiation

50
Q

Why could obesity lead to difficult invasive airway placement?

A

difficult to identify cricothyroid membrane (same as for a short neck)

51
Q

Why might access be limited to the cricothyroid membrane?

A

halo
neck flexion deformity

52
Q

What are the current NPO recommendations?

A

2 hours= clear liquids
4 hours= breast milk
6 hours= light meal, infant formula, nonhuman milk
8 hours= fried or fatty foods

53
Q

The mnemonic for difficult surgical airway placement is

A

SHORT: surgery (neck surgery or previous scar), hematoma, obesity, radiation, tumor

54
Q

The mnemonic for difficult laryngoscopy and intubation is

A

LEMON: look externally (shape of face, morbid obesity, pathology of head and neck), evaluate 3-3-2 rule, mallampati score, obstruction (indications for upper and lower airway obstruction), neck mobility

55
Q

The mnemonic for difficult supraglottic airway placement is

A

RODS: restricted mouth opening, obstruction, distorted airway, stiff lungs or C-spine

56
Q

Where should pressure be held for an RSI?

A

cricoid ring against the C5 vertebra

57
Q

What is the pressure before LOC for an RSI?

A

2 kg or 20 Newtons

58
Q

What is the pressure after LOC for an RSI?

A

40 Newtons or 4 kg

Apex Review (224 decks)

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