Airway management 2 Flashcards
Which congenital conditions are associated with cervical spine anomalies? Select 2
a. Treacher collins
b. Klippel-Feil
c. Goldenhar
d. Pierre Robin
B. Klippel-Feil
C. Goldenhar
____________ is the chief concern in the patient with angioedema
Upper airway obstruction
Three key causes of angioedema include
anaphylaxis, ACE inhibitors, and C1 esterase deficiency
Angioedema caused by anaphylaxis is best treated with
epinephrine, antihistamines, & steroids
Angioedema caused by ACE inhibitors or C1 esterase deficiency is best treated with
icatibant
ecallantide
FFP
C1 esterase concentrate
______________ is a bacterial infection characterized by a rapidly progressing cellulitis in the floor of the mouth
Ludwig’s angina
The most significant concern with Ludwig’s angina is
posterior displacement of the tongue resulting in complete, supraglottic airway obstruction
In the patient with Ludwig’s angina, the best methods of securing the airway include
awake nasal intubation or awake tracheostomy
Congenital conditions that impact airway management include:
Pierre Robin
Treacher Collins
Trisomy 21
Klippel-Feil
Goldenhar
Beckwidth
Cri du Chat
What is the cause of ACE-I angioedema?
ACE inhibitors prevent bradykinin breakdown
What is the treatment for hereditary angioedema?
C1 esterase concentrate
FFP
ecallantide
icatibant
patients should receive prophylaxis for porceudres that stimulate the upper airway
_________ is contraindicated in patients with an infection above the level of the trachea
Retrograde intubation
Which conditions are characterized by a large tongue?
“Big Tongue”
Beckwith syndrome
Trisomy 21
Which conditions are characterized by a small/underdeveloped mandible?
“Please get that chin”
Pierre Robin
Goldenhar
Treacher collins
Cri du Chat
Which conditions are characterized by a cervical spine anomaly?
Kids Try Gold
Klippel-Feil
Trisomy 21
Goldenhar
Pierre robin is characterized by
small/underdeveloped mandible (micrognathia or mandibular hypoplasia)
a tongue that falls back and downwards (glossoptosis)
cleft palate
neonate often requires intubation
Treacher Collins is characterized by
small mouth
small/underdeveloped mandible
nasal airway blocked by tissue (choanal atresia)
ocular and auricular anomalies
Trisomy 21 is characterized by
small mouth
large tongue
atlantoaxial instability
small subglottic diameter (subglottic stenosis)
Klippel-Feil is characterized by
congenital fusion of cervical vertebrae–> neck rigidity
Goldenhar is characterized by
small/underdeveloped mandible
cervical spine abnormality
Beckwith syndrome is characterized by
large tongue
Cri du chat is characterized by
small/underdeveloped mandible
laryngomalacia
stridor
What is the optimal position for tracheal intubation?
a. cervical flexion only
b. atlanto-occipital joint extension only
c. cervical flexion and atlanto-occipital joint extension
d. cervical extension and atlanto-occipital joint flexion
c. cervical flexion & atlanto-occipital joint extension
The “sniffing position” consists of
cervical flexion and atlanto-occipital extension
The sniffing positions aligns the
oral, pharyngeal, and laryngeal axes
What positioned should be used for morbidly obese patients?
HELP position (head elevated laryngoscopy position)
when patient lies supine, excess adipose on the neck, shoulders, and back place the chest higher than the head
For the morbidly obese patient, putting the bed in __________ unloads the diaphragm and may prolong the time between apnea and desaturation
reverse Trendelenburg
How does lateral rotation of the head affect the ETT?
ETT tip moves away from carina (risk of extubation)
How does the nose away from chest position affect the ETT?
ETT tip moves away from the carina (risk of extubation)
How does the nose to chest position affect the ETT?
ETT tip moves towards the carina (risk of endobronchial intubation)
Optimal position for laryngoscopy of the obese patient is achieved when the
sternum and the external auditory meatus are in the same horizontal plane
What are nerve injuries related to airway management?
aggressive jaw thrust
face mask strap is too tight
endotracheal tube connector resting on the patient’s face
An aggressive jaw thrust can cause injury to the
facial nerve
Presentation of injury to the facial nerve as a result of an aggressive jaw thrust includes
the affected side of the face may sag, the patient may drool, and chewing will be affected
A face mask strap that is too tight can compress the
buccal branch of the facial nerve (CN7)
Nerve injury as a result of a too tight face mask can present as
the patient will have difficulty opening and closing lips (orbiculares oris muscle function is impaired)
An endotracheal tube connector resting on the patient’s face may cause
damage to the supraorbital nerve
Presentation of damage to the supraorbital nerve appears as
eye pain, forehead numbness, photophobia
What axes are aligned when the head is lying flat on the bed and extended?
laryngeal & pharyngeal
Contraindications to the use of a nasopharyngeal airway include: (select 2)
a. dental trauma
b. coagulopathy
c. Pierre robin syndrome
d. Le Fort 2 fracture
b. coagulopathy
d. Le Fort 2 fracture
An oro or nasopharyngeal airway is used to
relieve upper airway obstruction
opens the airway by displacing the tongue and epiglottis from the posterior wall of the pharynx
How should you size an OPA?
measure from the corner of the mouth to the earlobe or the angle of the mandible
How should you size a NPA?
measure from the nare to the earlobe or the angle of the mandible
Placing an oral airway into a lightly anesthetized patient can precipitate
vomiting or laryngospasm
A __________ is usually better tolerated in a lightly anesthetized patient
nasal airway
Contraindications for a NPA include
cribriform plate injury (LeFort 2 & 3 fracture), coagulopathy, nasal fracture, previous Caldwell-Luc procedure, previous transphenoidal hypophysectomy
A cribiform plate injury presents as
LeFort 2 or 3 fracture, basilar skull fracture, CSF rhinorrhea, racoon eyes, periorbital edema
What complications may arise from use of an OPA?
dental injury
vomiting
oropharyngeal trauma
ischemia (compresses blood flow to affected areas)
An OPA that is ___________ can obstruct the airway by causing the tongue to kink against the roof of the mouth
too short
An OPA that is _________ can obstruct the patient’s airway by displacing the epiglottis towards the glottis, It can also cause trauma
too long
a too long NPA can also do the same
What are the types of oropharyngeal airways?
Guedel
Berman
WIlliams
Ovassapian
Specific uses for the Ovassapian OPA is
fiberoptic intubation
Specific uses for the Williams OPA include
blind orotracheal intubation
fiberoptic intubation
What is the cribiform plate?
a boney structure that separates the nasal cavity from the anterior cranial fossa; injury to this structure can allow an NPA or nasal ETT to enter the brain
