Airway Management Flashcards
Airway must remain patent to ensure adequate _________ and _____________
ventilation and oxygenation
Advanced airway placement ensures uninterrupted ___________ during ventilation in cardiac arrest
chest compression
Airway consists of ??
Nasal and oral cavities
Pharynx
Larynx
Trachea
Bronchi
METHODS OF AIRWAY MAINTENANCE
________________ airway devices
_________________ airway devices
____________ airways
Supraglottic (upper )
Infraglottic (lower)
Surgical
METHODS OF AIRWAY MAINTENANCE
Supraglottic (upper )airway devices – mention 3
Infraglottic (lower) airway devices – mention 3
Surgical airways – mention 2
oro/ naso-pharyngeal airway, laryngeal mask airway, i-gel
endotracheal tube, combitube, laryngeal tube
cricothyroidotomy ,tracheostomy
ORO-PHARYNGEAL AIRWAYS (OPA)
e.g Guedel’s airway
•____-shaped device
•Inserted through ______ into _____________
•_________ prevent airway from falling back into mouth
•_______ portion lies between teeth and prevent occlusion by biting
J; mouth; oropharynx
Flanges; Bite
Oro-pharyngeal airways
•Size from neonate to large adult
•Paediatrics-size _____ to _____
•Adult-size ____ to _____
•May cause ________ on insertion
•May stimulate ________ or _________ if patient is semi-conscious
000 to 2
3 to 5
trauma
gag reflex or vomiting
SIZING THE ORO -PHARYNGEAL AIRWAY
Angle of ———— to _______
Or
____________ to ______________
mouth to earlobe
Centre of incisor to angle of jaw
CAUTION WHEN USING OPA
Oro-pharyngeal airways that are too large may _______________ or ____________ to the airway
Oro-pharyngeal airways that are too small or inserted wrongly may ______________________________ and obstruct the airway
obstruct the larynx or cause trauma
push the base of the tongue posteriorly
Insertion of oro-pharyngeal airway
Open the mouth
Insert airway into oral cavity
Advance airway until _____________________
In _________- do not rotate in oral cavity!
it lies in the pharynx
children
INSERTION OF ORO-PHARYNGEAL AIRWAY
Open the mouth
Insert airway into oral cavity in the ____________ position as far as the __________________
Rotate it through ______ –minimises chance of ___________________________
Advance airway until it lies in the _______
Fits over tongue and pushes it away from ______________________
Correct placement- improvement in airway reflexes and sitting of bite portion b/w teeth
upside-down; junction between the hard and soft palate
1800; pushing tongue backwards and downwards
pharynx; post. pharyngeal wall
NASO-PHARYNGEAL AIRWAY
Inserted through the ______ into the ________
Bypasses the _________ and ___________
______________ inserted through flange to prevent migration into the nose
nose; nasopharynx
mouth and oropharynx
Safety-pin
Naso-Pharyngeal Airway
Contra-indicated in cases of ____________________
Life saving in __________,__________, or _____________ injuries
Caution in children with _________
fracture base of skull
clenched jaw, trismus or maxillofacial
adenoids
(Oro or Naso?) Pharyngeal Airway is Better tolerated by semi-conscious patients
Naso
SIZING OF NASO-PHARYNGEAL AIRWAY
_________________ to ___________________
Diameter should be equal or (smaller or larger?) than patients ____________
Compare the outer circumference of the naso- pharyngeal airway with the __________________________
Tip of the nose to the tip of the earlobe
Smaller; little finger
inner aperture of the nares
INSERTION OF NASO-PHARYNGEAL AIRWAY
Select appropriate size
___________ the nasopharyngeal airway
Insert the _________ end (vertically or horizontally?) along the _______ of the nose with a slight ________ action
The flange should rest against the nasal opening. Maintain head tilt using chin lift or jaw thrust.
Once in place use ______,_________, and ___________ technique to assess patency and adequacy of ventilation
Lubricate; bevel; vertically
floor; twisting
look, listen and feel
LARYNGEAL MASK AIRWAYS
Alternative to facemasks or tube Inserted through mouth so cuff lies __________________
From neonatal to large adult sizes
above larynx
Laryngeal mask airway Does not protect against aspiration
T/F
T
Devices that are used to maintain the airway patency and provide ventilation by placing just above the glottis opening
They sit outside the __________ and provide a __________ means of gas tight airway
trachea; hands free
The first commercially available supraglottic airway device was ______- Classic (1988)
LMA
INDICATION for LMA
Alternative airway during ———- specially in ___________ procedures and ___________ or __________ procedures like radiation therapy, diagnostic and interventional radiology, endoscopy, ECT etc
Also used in _______________________ to secure the airway
GA; short surgical
Minor therapeutic or diagnostic
Cardiopulmonary resuscitation
Indications for LMA
Essential part of difficult airway trolley
Primary airway device when urgent airway patency is required in __________ position as lesser time required to place LMA in the lateral position as against _________________ in this position
lateral
endotracheal intubation
CONTRAINDICATION of LMA
Limited _____________ ( _______________ )
_________________ in pharynx, larynx and upper airway
Trismus, facial or upper airway trauma
Increase risk of ___________ – morbid obese, > 14 weeks pregnant, prior opiods medication, delayed gastric empting, acute abdominal or thoracic injury, history of GERD and hiatus hernia
Reduced lung compliance/increase work of breathing
mouth opening; <2 fingers
Local pathology; aspiration
Advantages of LMA
Increased ___________________________
Less requirement of _________
Improved hemodynamic stability at induction and during emergence of anaesthesia
Minimal ______ and ______ changes during insertion
Increase airway _______
Lower frequency of _______ during emergence
Improved _______________ during emergence
speed and ease of placement
expertise; aspiration
IOP and ICP
tolerance; coughing
oxygen saturation
Disadvantages of LMA
Inadequate ___________ ventilation
More chances of ________ of gastric content
____________
___________ compression and ________ damage
positive pressure
Aspiration; Sore throat
Vascular; nerve
LARYNGEAL MASK AIRWAY INSERTION
Select LMA of appropriate size
(Flex or Extend?) neck and (flex or extend?) head
Hold LMA like a _______, insert into mouth.
Advance tip behind __________ until it reaches the posterior pharyngeal wall
Press mask backwards and downwards until resistance is felt at back of pharynx
Connect inflating syringe, inflate cuff - 40ml (size 5); 30ml (size 4)
Flex; extend ; pen
upper incisor
I-GEL
___________airway device
airway device Made from ____, _____-like material
Easy to insert, cause reduced trauma
Bite-block on ______
Has a Narrow __________________ tube
Supraglottic
soft, gel
stem
oesophageal drain
ProSEAL LMA
___________ , silicon made
Modifications; _____________ tube
_____________________ cuff
Reinforced airway tube
___________ bite block
Introducer
_______ seal pressure (35cm H20)
Reusable
oesophagea drain
Posterior inflatable
Integral; High
LMA-Surpreme
________ Generation LMA
__________________ cuff, no ————- cuff
Oesophargeal drain tube, without ———
Preformed semi –rigid tube
_____________ to prevent obstruction
Pharyngeal seal of 26-30 cmH20
2ND
Large inflatable plastic; posterior
seal
Epiglottic fins
COMBITUBE
(Single or Double?) lumen tube
Tube enters either _______ or _________
Tracheal channel has open ————
Oesophageal tube has _____ opening.
Double
trachea or oesophagus
distal end; no
COMBITUBE
Oesophageal tube has small _____ cuff and large _______ cuff to be inflated within the ________.
Between the two cuffs are several _________ through which larynx is ventilated
distal; proximal
pharynx; small side holes
ENDOTRACHEAL INTUBATION
Passage of a tube through the ____________ into the _________.
Conduit for ventilation
Definitive airway
nose or mouth; trachea
Endotracheal intubation
Numerous indications – Respiratory insufficiency, severe head injury, cardiac arrest
Undertaken by ______ personnel only
Intubation attempts must not exceed __________
Intubation is not undertaken on the ______________!!
skilled
30 seconds
corridors of A&E
Endotracheal intubation Protects against aspiration
T/F
T
PREPARATION FOR INTUBATION
Tiltable trolley
_______ supply
_____________ bag, ________
_______ apparatus
___________, _________________ tubes – various sizes
Stethoscope
Assistant to apply _____________
Others – gloves, plaster, 20ml syringe
Oxygen; Self-inflating; face mask
Suction; Laryngoscope ; Endotracheal
cricoid pressure
ENDOTRACHEAL INTUBATION
A - endotracheal tube (blue)
B - _________ tube with _________
C – trachea
D - oesophagus
SECURE THE ETT TO PREVENT DISLODGEMENT
cuff inflation; pilot balloon
NASOTRACHEAL INTUBATION TECHNIQUE
Apply __________________________________ drops
____________ tube wall
Guide the tube slowly but firmly into the nasal passage, going (up or down?) from the nostril( to avoid the ______________________ ) and then backward and down into the _____________
Proceed with the procedure as an _________ intubation, guiding the tube through the ___________ with a magils forceps
vasoconstrictor nasal; Lubricate
Up; large inferior turbinate
nasopharynx; orotracheal
vocal cords
Most serious complication of endo-tracheal intubation is ???
unrecognised oesophageal intubation
NEEDLE CRICOTHYROTOMY PROCEDURE
Place supine, head extended Identify the __________
Puncture the membrane ________ in ________ with large bore intravenous cannula or ________________ attached to a syringe
_________________ confirms tracheal location
Angle cannula at ______and advance caudally into trachea. Remove needle. Confirm air aspiration
Attach cannnula to high pressure oxygen supply
cricothyroid membrane
vertically; midline
cricothyrotomy needle; Aspiration of air
45
NEEDLE CRICOTHYROIDOTOMY
Indication????
Complications
______________ of cannula
______ventilation
____________
Failure to provide an airway by any other means
Malposition; Hypo; barotrauma
SELF-INFLATING BAG (AMBU BAG)
___________ Bag, ___________ Valve, ___________ (BVM)
Indicated in patients not breathing or breathing inadequately – pt has to be ventilated
Bag size – infants, children, adults
Can be used with ————- and __________
Self inflating Bag, unidirectional Valve, Mask (BVM)
facemask & advanced airways
Ambu bag
Delivers room air ____% oxygen if not connected to any oxygen source
Disadvantage-______________ with supraglotic devices.
21
gastric inflation
AMBU BAG
1 - flexible mask to seal over the patients face
2 –_____-way valve & _____ (prevents __________ and ____________ )
3 - bag which is squeezed to expel air to the patient
4-oxygen port for administering supply O2
Self inflates with __________ or from ______ source when released
one; filter
rebreathing and bag contamination
room air; oxygen
Self-inflating bag with reservoir Delivers up to _______% oxygen
100
