Airway Management Flashcards
Predictors for Poor Visualization of the Vocal Cords During Direct Laryngoscopy
*Prominent incisors or abnormal dentition
*Mandibular protrusion
*Mouth opening (> 3 fingerbreadths, or 5– 6 cm is normal) *Mallampati classification
*Thyromental distance (> 3 fingerbreadths, or 5– 6 cm is normal)
*Cervical range of motion
*Anatomic abnormalities (masses, swelling)
*Thickness of neck *Length of neck (shorter neck associated with difficult intubation)
Fio2 for NC,FM,Venturi,Non rebreather,HFNC
-HFNC (i.e., 60 L/ min at 100% FiO2)
-Non-rebreathing mask > FiO2 > 90%
-Venturi mask (FiO2 24%– 60%)
-Face mask (FiO2 35%– 55%)
-Nasal cannula (FiO2 24%– 44%)
What is a Definitive Airway ?
placement of a cuffed tube in the trachea, attached to a source of oxygen and properly secured
The “6 P’s” of Rapid-Sequence Induction and Intubation
1-Preoxygenation (At least 3 Min)
2-Premedication (Induction agent +/– fentanyl, lidocaine, atropine, defasciculating agents (vecuronium, rocuronium; usually 1/ 10 the induction dose)
3-Paralysis ( Midazolam, ketamine, etomidate, propofol, or other induction agents FOLLOWED BY succinylcholine or rocuronium )
4-Placement
5-Performance
6-Post intubation management
if an intravenous line is not established,which agent for paralysis to chose
Succinylcholine can be administered intramuscularly
Succinylcholine is contraindicated in patients with
burns
open globe injuries
neuromuscular disorders
hyperkalemia
pseudocholinesterase deficiency
severe crush injuries
chronic paralysis
example of when to use awake fiber-optic fiber-optic intubation
When patients are suspected of having cervical spinal cord injuries but do not require emergent intubation
lidocaine ointment is applied to the posterior tongue via a tongue depressor to anesthetize
the glossopharyngeal nerve
Lidocaine cotton balls are gently introduced deep into the pyriforms and held in place for 60 to 90 seconds
anesthesia for branches of the superior laryngeal nerve.
1 to 2 mL of 1% or 2% lidocaine is sprayed through the injection port on the fiber-optic scope directly on the vocal cords
This anesthetizes the recurrent laryngeal nerve
After Third Attempt for Intubation ?
After a third failed attempt at intubation by an attending anesthesiologist
an LMA can be inserted to facilitate the transition to a definitive airway via fiber-optic intubation or intubation through the LMA
patient needs intubation but difficult airway
Awake Fiberoptic
or
Tracheostomy
If Uncooperative or Unstable > RSII
When to use Surgical Airway ?
patient committed to RSII (i.e., paralyzed), who subsequently cannot be ventilated or intubated, requires a surgical airway.
Options include a surgical cricothyroidotomy or tracheostomy
cricothyroidotomy is preferred as the surgical technique of choice
