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Apex Flashcards > airway management > Flashcards

airway management Flashcards

1
Q

normal inter incisor gap

A

2-3 finger breadths or 4 cm

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2
Q

TMD less than ____cm or greater than ___ cm can pose difficulty

A

6cm, 9cm

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3
Q

identify the number that corresponds with this mandibular protrusion test

A

class one: patient can bite upper lip
class two: patient can line up upper and lower incisors
class three: patient cannot move lower incisors past upper incisors

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4
Q

pediatric conditions that impair AO joint mobility

A

kippel feil
down syndrome

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5
Q

3 3 2 rule

A

inter incisor gap 3fb
thyromental distance 3fb
thyrohyoid distance 2fb

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6
Q

label these with appropriate cormack lehane scores

A

grade 3: epiglottis only. cannot see any part of glottic opening
grade 4: soft palate only. cannot see any part of larynx

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7
Q

what’s the difference between grade 2a and grade 2b

A

2a: you can see the posterior region of the glottic opening
2b: you can only see the corniculate cartilages and posterior vocal cords. you cannot see any part of the glottic opening

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8
Q

which cormack lehane score can you visualize the anterior commissure?

A

grade 1

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9
Q

risk factors for difficult mask ventilation: BONES

A

Beard
Obese (BMI >26)
No teeth
Elderly (>55)
Snoring

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10
Q

most current fasting guidelines include

A

2 hours: clear liquids
4 hours: breast milk
6 hours: regular solids, non human milk, infant formula
8 hours: fried or fatty foods

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11
Q

difficult laryngoscopy and intubation: LEMON

A

Look externally (shape of face, morbid obesity, pathology of head and neck, pierre robin)
Evaluate 3-3-2 rule
Mallampati score
Obstruction
Neck mobility

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12
Q

difficult SGA placement: RODS

A

Restricted mouth opening
Obstruction
Distorted AW
S: stiff lungs or C spine

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13
Q

Difficult surgical aw placement: SHORT

A

Surgery (neck surgery or previous scar)
Hematoma
Obesity
Radiation or other deformation
Tumor

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14
Q

pressure for RSI

A

before LOC: 20 newtons or 2kg
after LOC: 40 newtons or 4kg

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15
Q

congenital conditions associated with c spine abnormalities

A

Kids Try Gold
goldenhar
klippel feil
trisomy 21

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16
Q

3 reasons for angioedema

A
  1. anaphylaxis
  2. ACEI’s
  3. C1 esterase deficiency
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17
Q

tx for ACEI related angioedema (inhibition of bradykinin breakdown) OR C1 esterase deficiency related angioedema (4 options)

A

icatibant (bradykinin receptor antagonist)
encalantide (plasma kallidrein inhibitor- stops conversion of kinogen to bradykinin)
FFP (contains enzymes that metabolize bradykinin)
C1 esterase concentrate

(those with C1 esterase deficiency should receive prophylaxis before AW stimulation- either C1 esterase concentrate or danazol)

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18
Q

ludwigs angina and aw securement tactics

A

bacterial infection- rapidly progressing cellulitis on floor of mouth. inflammation and edema compresses submandibular, submaxillary, and sublingual spaces. most significant concern is posterior displacement of tongue that causes obstruction

to secure aw:
awake nasal intubation
awake trach

retrograde intubation is contraindicated for patients with obstructions above trachea

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19
Q

congenital conditions that impact aw management: big tongue

A

big tongue
Beckwidth syndrome
Trisomy 21

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20
Q

congenital conditions that impact aw management: small/under developed mandible

A

please get that chin
pierre robin
goldenhar
treacher collins
cri du chat

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21
Q

congenital conditions that impact aw management: cervical spine anomaly

A

kids try gold
klippel feil
trisomy 21
goldenhar

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22
Q

characteristics of pierre robin syndrome

A

small/under developed mandible
tongue that falls down and backwards (glossoptosis)
cleft palate
neonates usually require intubation

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23
Q

characteristics of treacher collins

A

small mouth
small under developed mandible
nasal aw blocked by tissue (choanal atresia)
ocular and auricular anomalies

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24
Q

characteristics of trisomy 21

A

small mouth
large tongue
atlantoaxial instability
small subglottic diameter (subglottic stenosis)

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25
Q

characteristics of goldenhar

A

small under developed mandible
cervical spine abnormality

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26
Q

characteristics of cri du chat

A

small/under developed mandible
laryngomalacia
stridor

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27
Q

modifications for intubation with obesity: what’s another name for ramping

A

help position (head elevated laryngeal position)

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28
Q

2 ways to damage facial nerve during aw management and presentation

A

aggressive jaw thrust can stretch facial nerve. presentation: affected side of face may sag, patient may drool, chewing may be affected

too tight mask strap can damage buccal branch of facial nerve. presentation: patient will have difficulty opening and closing lips. orbicularis oris function impaired.

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29
Q

how can supraorbital nerve be affected by aw management?

A

ETT laying in patients face. presentation: pain, forehead numbness, photophobia

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30
Q

which le fort fractures contraindicate use of NPA’s

A

le fort 2 and 3

31
Q

name these OPA’s

A
32
Q

which two OPA’s are tailored for the use of FOB and ETT’s

A

williams and ovassapian

33
Q

name these le fort fractures and when to avoid NPA’s (5)

A

cribriform plate injury (risk of brain injury) (le fort 2 or 3)
cogulopathy
previous transphenoidal hypophysectomy
previous caldwell luc procedure
nasal fracture
basilar fracture

34
Q

s/sx of cribriform plate injury (cribriform plate separates nasal cavity from anterior cranial fossa) (5)

A

le fort 2 or 3 fracture
basilar skull fracture
CSF rinorrhea
raccoon eyes
periorbital edema

35
Q

ETT cuff pressure should stay less than

A

25cmH2O

36
Q

is a low volume high pressure cuff or a high volume low pressure cuff better at protecting against aspiration

A

the low volume high pressure cuff is better (but does carry a higher risk of tracheal ischemia)
(high volume low pressure though is most common one in everyday practice)

37
Q

peds ETT size formula with and without cuff (and tube depth)

A

(age/4) + 4 (without cuff)
(age/4) + 3.5 (with cuff)
depth: tube ID x 3

38
Q

predictors of difficult video assisted laryngoscopy (5)

A

neck pathology (radiation, tumor, surgical scar)
short TMD
limited cervical motion
thick neck
mandibular protrusion score of 3

39
Q

VAL’s that have a NON channeled design (3)

A

C-Mac, Mcgrath, glidescope

40
Q

max classic LMA cuff pressure

A

60cmH2O (40-60 is goal)

41
Q

nerves at risk of injury when LMA is used (3)

A

lingual, hypoglossal, and RLN

42
Q

LMA size, patient size, max cuff inflation pressure, largest ett that fills ID, largest flexible endoscope

A
43
Q

ID this LMA and its unique features

A

LMA supreme (image) and pro seal. supreme is just a disposable pro seal
gastric drain tube for OG
better seal than LMA classic and max pressure for PPV <30cmH2O

44
Q

ID this LMA and its unique features

A

LMA fastrach
metal handle (cant use in MRI)
specific ETT
tube pusher
epiglottic elevating bar

45
Q

ID this LMA and its unique features

A

LMA flexible
flexible, wire reinforced, longer than LMA classic, but also narrower.
useful for head and neck surgery

46
Q

ID this LMA and its unique features
(can it help with FOB/intubation?)

A

iGEL
no inflatable cuff but there is a gastric port
safe for MRI
can provide conduit for FOB/intubation
has complications that include trauma to any surrounding tissue, nerve injury, aspiration, tracheal compression

47
Q

if patient aspirates with LMA in place, what are the next steps?

A

leave LMA in place
place patient in trendelenburg
deepen anesthetic
100% O2
use low FGF and low Vt
use flexible suction catheter to suction through LMA
use FOB to assess severity and next steps

48
Q

tendency of AW device placement to activate SNS in order from most to least stimulating

A

combitube > DVL > FOI > LMA

49
Q

ID this tube, benefits, insertion

A

combitube
blindly inserted into hypopharynx
inflating the distal balloon occludes the esophagus
inflating the proximal balloon occludes the hypo pharynx
since the tip usually enters the esophagus, attempt ventilation via blue lumen
does not require neck extension and can allow for high ventilatory pressures up to 50cmH2O

50
Q

contraindications of this device (4) and sizing

A

intact gag reflex
prolonged use (>2-3h) d/t risk of ischemia from oropharyngeal balloon
ingestion of caustic substances
zenkers diverticulum
37fr: 4-6ft
41fr: >6ft

51
Q

ID this airway type

A

king LTS-D.
distal cuff obstructs upper esophagus while proximal cuff seals oral and nasal pharynxes (like combitube)

52
Q

difference between combitube and king LTS-D

A

King LTD only has:
one lumen for ventilation
only one inflation port that simultaneously inflates proximal and distal cuffs
patient can only be ventilated through fenestrated apertures between the two cuffs
child sizes are available (>10kg)

53
Q

for FOI, which hand holds scope

A

non dominant hand moves lever
dominant hand moves cord

54
Q

ID this laryngoscope and its indications (5)

A

bullard laryngoscope
indicated for:
small mouth opening (minimum =7mm)
impaired cspine mobility
short, thick neck
treacher collins syndrome
pierre robin syndrome
adult and pediatric sizes available

55
Q

other names for bougie

A

eischmann introducer

56
Q

benefits of lighted stylet
(can it be used during nasal intubation?)

A

useful in anterior airway and small mouth opening
requires very little manipulation of neck
less stimulating than DVL
can be used for oral or nasal intubation
useful for cspine abnormality, pierre robin, burn contractures

57
Q

disadvantages of lighted stylet

A

difficult to use in patients with short thick neck
should not be used in emergencies
blind technique so no tumors, foreign body airways, or epiglottitis
do not use in patient with traumatic laryngeal injury

58
Q

indications for retrograde intubation (and when its best used as a tactic)

A

unstable cervical spine
upper aw bleeding
best used when intubation is failed but ventilation is still possible
can also be performed in awake patient

59
Q

contraindications to retrograde intubation (7)

A

neck flexion deformity (cannot access CTM)
unable to ID land marks (obesity)
prertracheal mass (thyroid goiter)
tracheal stenosis under puncture site
tumor
coagulopathy
infection

60
Q

complications related to retrograde intubation (6)

A

bleeding
pneumomediastinum
pneumothorax
trigeminal nerve neuralgia
breath holding
wire travels in wrong direction

61
Q

what PSI is necessary to ventilate patient when performing a percutaneous cricothyroidotomy

A

50PSI (because catheter of needle is so small)

62
Q

contraindications r/t transtracheal jet ventilation (2)

A

upper aw obstruction
laryngeal injury

63
Q

complications r/t percutaneous cricothyroidotomy

A

hemorrhage
aspiration
tracheal injury
esophageal injury
barotrauma/PTX

64
Q

contraindications to cricothyroidotomy (2)

A

children less than 6
laryngeal fx or neoplasm

65
Q

a reasonable approach during the difficult aw algorithm is limit attempts to how many

A

3 attempts from you and 1 attempt from skilled provider

66
Q

if you cannot ventilate or intubate what is the immediate next step per the algorithm

A

call for help

67
Q

Plan A through D of difficult aw algorithm starting with attempted intubation

A

failed intubation–> place SGA
failed SGA placement–>final attempt at face mask ventilation (succeed: wake patient up do not go forward)
failed face mask ventilation –> cricothyroidotomy

68
Q

4 techniques for extubating difficult aw

A
  1. extubate fully awake
  2. extubate over flexible FOB
  3. extubate over an aw exchange catheter
  4. extubate then place LMA
69
Q

how long does airway exchange catheter (AEC) stay in place for patient who was a plausible failed extubation

A

72h (insert ~25-26cm at the lip)

70
Q

what can you do with AEC in place? (3)

A

EtCO2 monitoring
jet ventilation
O2 insufflation

71
Q

the glide scope has what degree of anterior bend?

A

60 degrees

72
Q

click on the part of the LMA that rests on the cricopharynxgeus muscle of the upper esophageal sphincter

A
73
Q

in the obese patient, intubation is best when what two things are aligned

A

sternum and external auditory meatus

74
Q

can you do retrograde intubations with tracheal stenosis

A

NO HOE STOP TRYING TO SAY YES

Apex Flashcards (71 decks)

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