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Apex > Airway Management > Flashcards

Airway Management Flashcards

1
Q

What are some conditions that impair AO mobility?

A

DJD
RA
Ankylosing spondylitis
Trauma
Surgical fixation
Klippel-Feil
Down syndrome
DM

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2
Q

What is the 3-3-2 rule?

A

Inter-incisor gap > 3 finger Breaths
Thyromental distance > 3 finger breaths
Thyrohyoid > 2 finger breaths

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3
Q

What is a grade 1 Cormack and Lehane view?

A

Complete view of glottic opening

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4
Q

What is a grade 2 Cormack and Lehane view?

A

Posterior region of the glottis opening (loss of anterior commissure)

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5
Q

What is a grade 3 Cormack and Lehane view?

A

Epiglottis only (loss of any part of the glottic opening)

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6
Q

What is a grade 4 Cormack and Lehane view?

A

Soft palate only (loss of any part of the larynx)

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7
Q

What is a grade 2b Cormack and Lehane view?

A

You can only see the corniculate cartilages and posterior vocal cords (no glottic opening)

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8
Q

What are the risk factors to a difficult mask?

A

BONES

B: beard
O: obese
N: no teeth
E: elderly (> 55years)
S: snoring

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9
Q

What are some risk factors to difficult intubation?

A

Small mouth opening
Long incisors
Overbite
High arched palate
Mallampati class 3/4
Retrognathic jaw
Short thick neck
Short TMD
Reduced cervical mobility

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10
Q

What are some risk factors for LMA placement?

A

RODS

R: restricted airway
O: obstruction
D: distorted airway
S: stiff neck or C-spine

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11
Q

What are some risk factors for surgical airway placement?

A

SHORT

S: surgery (previous scar)
H: hematoma
O: obesity
R: radiation
T: tumor

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12
Q

What pressure should be given before loss of consciousness during RSI? What about after?

A

Before: 2 kg (20 newtons)
After: 4 kg (40 Newtons)

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13
Q

Angioedema r/t anaphylaxis?

A

Cause: triggering agent
Tx: epi, antihistamine, steroids

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14
Q

Angioedema r/t ACE Inhibitors

A

Cause: prevent bradykinin breakdown
Tx: discontinue ACE, Icatibant/Ecallantide, FFP, C1 esterase concentrate

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15
Q

Angioedema r/t genetics

A

Cause: genetics/hereditary
Tx: C1 inhibitor concentrate, FFP, ecallantide/icatibant

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16
Q

What is Ludwig’s angina?

A

Bacterial infection that causes cellulitis of the floor of the mouth ~ edema and inflammation compress airway structure ~ airway obstruction

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17
Q

What is the best way to secure an airway for someone with Ludwig’s Angina?

A

Nasal intubation
Awake trach

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18
Q

What are syndromes with large tongues?

A

Big Tongue

B: beckwith syndrome
T: trisomy 21

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19
Q

What are syndromes with underdeveloped mandibles?

A

“Please Get That Chin”

P: pierre Robin
G: goldenhar
T: treacher collins
C: cri du Chat

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20
Q

Which two oral airways are designed to accommodate a fiberoptic bronchoscope or ETT?

A

Williams and Ovassapian

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21
Q

What are contraindications to a nasal airway?

A

Lefort 2or 3 fx
Basilar scull fx
CSF rhinorrhea
Raccoon eyes
Periorbital edema
Coagulopathy
Previous transsphenoidal hypophysectomy
Nasal fx

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22
Q

How do you size a pediatric tube without a cuff?

A

(Age/4) +4

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23
Q

How do you size a pediatric tube with a cuff?

A

(Age/4) + 3.5

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24
Q

How do you determine depth placement?

A

ID x 3

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25
Q

What is a non-channeled design? In terms of video laryngoscopes.

A

It’s a device used to expose glottic structures BUT the ETT is passed separate from the laryngoscope

McGrath, glide, C-MAC

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26
Q

What is a channeled design? In terms of video laryngoscopes.

A

Interstates a channel for the endo trachea tube into the device

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27
Q

What are some predictors of a difficult video laryngoscopy?

A

Radiation
Tumor
Scar
Short TMD
Limited cervical motion
Thick neck
class 3 upper lip bite test

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28
Q

Where does the proximal end of the PMA sit?

A

Near the base of the tongue

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29
Q

Where do the sides of the LMA sit?

A

Piriform sinuses

30
Q

Where does the distal end of the LMA sit?

A

Along the upper esophageal sphincter

31
Q

What is the max PPV pressure on an LMA?

A

20 cm H2O

32
Q

What is the max cuff pressure of an LMA?

A

20 cm H2O

33
Q

What size LMA is appropriate for a pt < 5 kg?
What is the mL for inflation?
What is the largest size ETT it can fit?

A

LMA 1
4 mL
3.5 ETT

34
Q

What size LMA is appropriate for a pt 5-10kg?

what volume should be used for the cuff?

What is the largest ETT used to fit?

A

LMA 1.5
7 mL
4.0 ETT

35
Q

What size LMA should you use for a pt 10 kg- 20kg?

How much mL can you inflate the cuff?

What is the largest ETT that can fit inside?

A

LMA 2
10 mL
4.5 ETT

36
Q

What is the appropriate size LMA for a patient 20kg-30kg?

How much cuff volume is accurate?

What is the largest size ETT it can accommodate?

A

LMA 2.5
14 mL
5.0 ETT

37
Q

What is the appropriate size LMA for a patient of 30-50kg?

How much mL is used to insert the cuff?

What is the largest ETT it will accommodate?

A

LMA 3
20 mL
ETT 6.0

38
Q

What is the appropriate LMA size for a patient of 50-70kg?

How much volume in the cuff?

What size ETT can it accommodate?

A

LMA size 4
30 mL
6.0 ETT

39
Q

What size LMA for a patient of 70-100kg?

How much volume in the cuff?

What is the largest ETT it can accommodate?

A

LMA 5
40 mL
7.0 ETT

40
Q

What is the LMA ProSeal?

A

Adaption of LMA classic. Double lumen

Gastric drain tube (for easy gastric decompression) ~ must place an OG first
Larger mask
Biteblock

Better deal
Increased max pressure (< 30 cm H2O)

41
Q

What is the LMA Fastrach and how does it differ?

A

Intubating LMA

Metal handle
Specifically designed ETT (high pressure cuff)
Tube pusher
Epiglottic elevating bar

42
Q

What is the LMA C-Trach?

A

C-Trach is similar to the Fastrach, but includes a camera.

43
Q

What is the LMA flexible?

A

Flexible
Wire-reinforced (not suitable for MRI)
Longer use than the LMA classic
Narrower than the LMA classic (must use a smaller ETT or bronchoscope)

Useful for head and neck surgery

44
Q

What is the iGel?

A

It’s an alternative to the LMA

No inflatable cuff
There is a gastric port
It can serve as a conduit for ETT intubation
Save for use in MRI

Complications:
Tongue trauma
Mucosal erosion of the cricoid ring
Compression of the trachea
Nerve injury
Airway obstruction
Regurgitation and aspiration

45
Q

When should an LMA not be used?

A

Risk of regurgitation and aspiration (full stomach, hiatal hernia, small bowel obstruction, symptomatic GERD, delayed gastric emptying)

Airway obstruction
Tracheomalacia or external trachea compression
Poor compliance
High airway resistance

46
Q

What do you do if you observe gastric contents in the LMA?

A

Leave LMA in place
Tberg
100% FiO2
Use low FGF and low Vt
Use a flexible suction catheter
FOB evaluation gastric contents in trachea…if present, consider intubation.

47
Q

What airway devices are the most to least stimulating?

A

Combitube > DVL > Fiberoptic > LMA

48
Q

What is the combitube?

A

Supra glottic, double lumen device that is blindly inserted into the hypopharynx

(Usually pre-hospital settings)

49
Q

What is the size of combitube for a 4-6 ft person?

A

Size 37

50
Q

What is the size combitube for a patient > 6 ft

A

Size 41

51
Q

Where does the proximal and distal cuff sit with a combitube?

A

Proximal cuff (40-100 mL)sits: hypopharynx
Distal cuff (5-12 mL) sits: esophagus (usually)

52
Q

What are the benefits to the combitube?

A

Secure airway
Decompress the stomach
Use in obese
Blind insertion technique (min training)
No neck extension
High vent pressures (< 50)
Doesn’t need to be taped

53
Q

What are some contraindications to the combitube?

A

Gag reflex
Prolonged use
Zenker’s diverticulum
Ingestion of caustic substances.

54
Q

What is the King Laryngeal tube?

A

Similar to combitube

Like: can insert blindly, distal cuff obstructs esophagus and proximal obstructs hypopharynx

Diff: one lumen, only one inflation port, child sizes available.

55
Q

What is hand placement for fiberoptic?

A

Non-dominant: moves the lever
Dominant: holds the cord

56
Q

How do you move the camera in a fiberoptic?

A

Lever down = tip up
Lever up = tip down

57
Q

What is the gold standard for managing difficult airways?

A

Fiberoptic bronchoscopy in the awake pt.

58
Q

What are absolute contraindications to fiberoptic use?

A

Uncooperative patient
Lack of provider skills
Near total upper airway obstruction
Massive trauma

59
Q

What is a Bullard Laryngoscope?

A

It is a rigid, fiberoptic device used for indirect laryngoscopy

60
Q

What are some indications for a Bullard scope?

A

Small mouth opening
Impaired cervical mobility
Short, thick neck
Treacher Collins
Pierre Robin

61
Q

What are the contraindications to the Bullard scope?

A

There are none, but learning curve is high

62
Q

What is another name for the Eschmann introducer?

A

Bougie or intubating stylet

63
Q

When is the best time to use a bougie?

A

Class IIb or class 3

Worst time to use is during a class 4!!!

64
Q

When is the best time to use a lighted stylet?

A

Anterior airways
Small mouth opening
Cervical spine abnormality
Pierre-Robin syndrome
Burn contractures

65
Q

When should you not use a lighted stylet?

A

Short, thick neck
Can’t ventilate, can’t intubate
Should be used if there is a tumor, foreign body, airway injury or epiglottitis
Do NOT use the lighted stylet in a patient with traumatic laryngeal injury

66
Q

What are the indications for a retrograde intubation?

A

Unstable cervical spine
Upper airway bleeding
Failed awake intubation.

67
Q

What are the contraindications to a retrograde intubation?

A

Inability to identify or access the Cricothyroid membrane

Pretrachial mass

Laryngotracheal disease

Tumor

Coagulopathy

Infection at puncture site

68
Q

What are the 3 ways to create a surgical airway?

A

Percutaneous cricothyroidotomy
Surgical cricothyroidotomy
Tracheostomy

69
Q

What psi pressure do you need for a percutaneous cricothyroidotomy?

A

50 psi

70
Q

What are some contraindications to a percutaneous cricothyroidotomy?

A

Upper airway obstruction
Laryngeal injury

71
Q

What are the contraindications for a surgical cricothyroidotomy?

A

Not for children < 6yrs
Laryngeal fx/neoplasm

Apex (47 decks)

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