airway management Flashcards
what simple manouevres can open airway?
head tilt / chin lift
jaw thrust: preferred if concern about cervical spine injury
when is oropharyngeal airway used?
Easy to insert and use
No paralysis required
Ideal for very short procedures
Most often used as a bridge to more definitive airway
when is laryngeal mask used?
Widely used
Very easy to insert
Device sits in pharynx and aligns to cover the airway
Poor control against reflux of gastric contents
Paralysis is not usually required
Commonly used for wide range of anaesthetic uses, especially in day surgery
Not suitable for high-pressure ventilation (small amount of PEEP often possible)
when is tracheostomy used?
Reduces the work of breathing (and dead space)
May be useful in slow weaning
Percutaneous tracheostomy widely used in ITU
Dries secretions, humidified air usually required
when Is endotracheal tube used?
Provides optimal control of the airway once the cuff inflated
May be used for long or short-term ventilation
Errors in insertion may result in oesophageal intubation therefore monitor end-tidal CO2 (capnography)
Paralysis often required
Higher ventilation pressures can be used
What are the ASA guidelines?
grading allows anaesthetists to stratify the overall risk of a patient prior to surgery, and predicts short- and long-term outcomes.
what is ASA grade 1?
normal healthy patients, who are non-smokers and with no/minimal alcohol intake.
what is ASA grade 2?
patients with mild systemic disease e.g. well controlled diabetes or hypertension, current smoker, obesity (BMI 30-40), and mild lung disease.
what is ASA grade 3?
patients with severe systemic disease e.g. poorly controlled diabetes or hypertension, COPD, morbid obesity (BMI >40), history of ACS/stroke/TIA >3 months ago.
what is ASA grade 4?
patients with severe systemic disease that is a constant threat to life e.g. MI/stroke/TIA within 3 months, severe valve dysfunction, severe reduction in ejection fraction, sepsis.
what is ASA grade 5?
moribund patients not expected to survive the operation e.g. ruptured abdominal aortic aneurysm, massive bleed, intracranial haemorrhage with mass effect.
what is ASA grade 6?
patient declared brain-dead whose organs are being removed for donation.
what are causes of airway compromise?
angioedema
anaphylaxis
thermal injury
neck haematoma
wheeze
surgical emphysema
reduced consciousness
what are simple airway manoeuvres?
suction
turn patient onto side if actively vomiting (not in C-spine injury)
head tilt/chin lift
jaw thrust
when is suction used?
if visible vomit, blood, secretions or foreign body
