airway management Flashcards
exam 3
When was the anesthesia face mask invented and with what material?
1917
silicone or rubber
what are 3 things to be careful with when masking a patient?
do not compress the facial nerve or artery
do not put pressure on patients lips
do no put pressure on patient’s eyes
if a patient has no teeth, you may need to include ____ in the mask
chin
why do we use clear masks now?
allows for visualization of the patient’s mouth to look for vomitus, blood, secretions, condensation, and lip color
describe early face masks
they were made of black rubber and reusable
ew
what are the key elements to mask technique
maintain a seal between mask and patient’s face
upper airway is unobstructed
one-handed ventilation
name the signs of effective ventilation
chest rise and fall
capnography
exhaled tidal volume
condensation in the mask
pulse ox
why do we tape the eyes?
to avoid corneal abrasions
during mask ventilation, peak inspiratory pressured need to be ________
no greater than 20 cm H20
why do we want peak inspiratory pressures 20 or less during mask ventilation?
to help prevent gastric insufflation during positive pressure ventilation
how to correct airway obstruction during mask ventilation?
atlantoocciptal extension
jaw thrust
as induction agents start to work, airway muscle tone will relax. tissue relaxes and can fall back and ____ the airway
obstruct
this position allows for alignment of the oral and pharyngeal axes
sniffing position
i
if there is neck injury or disease, the head must remain in the _____ position
neutral
____ is the volume of a breath that does not participate in gas exchange
dead space
what is ventilation without perfusion called?
dead space
physiologic or total dead space is the sum of ____ and ____
anatomic dead space and alveolar dead space
the volume of gas within the conducting zone and includes the trachea, bronchus, bronchioles, and terminal bronchioles
anatomic dead space
anatomic dead space is approximately ____ ml/kg in the upright position
2 mL/kg
the volume of gas within unperfused alveoli
alveolar dead space
what is the ratio of physiologic dead space to tidal volume?
1:3
why would you use a mask head strap?
if the clinician has small hands
patient has a beard
patient aint got no teef
what is a nasal mask typically used for?
anesthesia by dentists
it has an APL
name all the ways a procedural oxygen mask (POM) can be utilized as a universal multi-function device:
theres like 6
Upper endoscopies
conscious sedation
nasal bronchs
TEE
PEG
fiberoptic intubations
what does the catheter mount connect the breathing circuit to?
tracheostomy
supraglottic airway
ETT
face masks
does a catheter mount have corrugated tubing?
yes sir
name the type of mask:
has a resevoir
provides a higher FiO2
one way valve betweent the bag and mask to prevent rebreathing
partial rebreathing mask
oxygen via a nasal cannula and face masks are considered ___ oxygen
open
you want to decrease the FiO2 to ____ during times of bovie use to decrease fire risk when there is open oxygen
30%
what FiO2 and liters can a nasal cannula provide
28-36%
says don’t go above 2-4L /min
fixed high performance device
high air flow oxygen enrichment
delivers a fixed and predetermined concentration of oxygen
venturi mask
give me the formula for Bernoli’s Principle
P + 1/2 pv squared = K
k= density, v= velocity, p=pressure
name me some predictors of a difficult mask ventilation
OSA/snoring
55+
male
BMI 30+
Mallampati 3 or 4
beard
edentulous
oral and nasal airways work to keep open the space between the ____ and the ____
tongue and the posterior pharyngeal wall
how do you size an oral ariway
measure from corner of the mouth to earlobe
T/F awake patients can get oral airways?
FALSE
improper sized oral airways can cause what two damages?
lingual nerve palsy or tooth damage
where do nasal airways sit?
from the nose to just above epiglottis
how do you measure a nasal airway?
measured from the meatus of ear to the nares
T/F: oral airways are longer than nasal airways?
FALSE, nasal airways are 2-4 cm longer than oral airways
what patients do you wannna be cautious with nasal airways with?
thrombocytopenia
or those on anticoags
name this enhanced airway
McMurray
used for EGD or MAC cases
what kind of cases is the Oberto Mouth Prop used for?
not a penis
it is a hard bite block used for electroconvulsive therapy (ECT)
what is a tooth guard used for?
used during intubation to protect the patients teeth
maybe kids but theyre wayy too small for adults
name this airway and what its used for
Berman Intubating Airway
used during fiberoptic intubation
it is split so that it can be removed once ETT is in place
what is the standard oral airway called
guedel airway
directs airflow to the glottis, the treachea, and the lungs
A supraglottic airway device
what is a SGA used for?
ventilated patients
spontaneous breathing patients
is a supraglottic airway a rescue device?
yes it can be used when unable to intubate or unable to ventilate
is an LMA a secure airway?
no way jose
Since the ETT, what is thought to be the greatest advancement in airway management?
the LMA
how are LMAs sized?
by kilogram weight
name the steps to ensure successful LMA insertion:
like 6 of them
pick the right size
position patient in sniffing position
LUBE IT
they must be adequately anesthesetized
use index finger to guide it
do not deflate cuff or remove until patient is awake and opens their mouth
T/F, you hold onto the LMA when youre inflating the cuff?
no let that shit go
it wont create a good seal if you hold it
name some complications that can occur from an LMA
pharyngeal necrosis
uvula trauma
nerve damage
vocal cord paralysis
what nerves can be damaged from an LMA insertion?
lingual nerve
recurrent laryngeal nerve
hypoglossal nerve
name some contraindications of an LMA insertion
full stomach, pregnant, hiatal hernia, trauma
pulmonary disease (restrictive disease)
what % of people get a sore throat after an LMA
10-20%
what are 3 major concerns when using LMA
risk of aspiration
risk of regurgitation
risk of gastric inflation
who invented the LMA Classic
Dr Archie Brain
what was the original LMA, reusable up to 40 times, and used for neonates to adult
LMA Classic
used in neonates to adults
has 7 sizes
has aperature bars
part of the ASA Diff airway algorithm
LMA Unique
disposable
used when the airway needs to be shared
airway tube can be moved side to side
ability to move patients head from side to side
LMA Flexible
children getting tonsils out and adenoids
what LMA protects the airway from blood accumulation above the airway?
LMA Flexible
used for difficult ariways or during CPR
size 3,4,5
intubating LMA
used in ER, prehospital, crash carts
LMA Fastrach
name this
Fastrach LMA
a resuable LMA
port fro gastric access
gastric contents bypass the pharynx
decreases aspiration risk
LMA Proseal
what are soem characteristic differences of the LMA Proseal?
larger bowl
gastric drainage tube
spot for index finger for insertion
silicon bite block
what LMA can provide positive pressure ventilation up to 30 mmH20?
LMA Proseal
name this LMA
Proseal LMA
what LMA is the same as the proseal bu thas a reinforced bite block?
the LMA Supreme
name the advantages of an LMA
like 6
better seal in patients with facial hair
hands are free to do other tasks
better able to maintain a patent airway
decreased injury to eyes or facial nerves
decreased OR Pollution
decreased airway secretions
name some disadvantages to LMA
like 5
risk of airway trauma
more invasive airway
deeper level of anesthesia is required
diffusion of N20 thru the cuff
contraindicated in some cases
name the cases that are contraindicated for LMA use
laparoscopic cases
obese peeps
pregnant mamas
prone gases
y
what has more risk for laryngospams? LMA or ETT
ETT
this LMA is single use, no need for cuff inflation, lessens risk of injury from compression or displacement trauma
i-Gel
name the structures in the mouth
name these zones of the pharynx
name these structures
name them
name the nerves
name the components of the mask
name the axes
