Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Apex Review > Airway management 4 > Flashcards

Airway management 4 Flashcards

1
Q

When compared to the LMA classic, benefits of the ProSeal include

A

a better seal
max pressure for PPV <30 cmH2O (LMA classic is <20 cmH2O)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The iGel is a

A

supraglottic airway that’s an alternative to the LMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

With the iGel there is no

A

inflatable cuff which can contribute to a poor seal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Can the iGel be used in MRI?

A

Yes, it doesn’t contain metal parts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The iGel has a

A

gastric port

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The iGel can serve as a conduit for

A

endotracheal intubation (the lumen has a larger diameter and there are no aperture bars)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications of the iGel include

A

tongue trauma
mucosal erosion of the cricoid cartilage
compression of the trachea
nerve injury
airway obstruction
regurgitation and aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

All of the following are contraindications to a laryngeal mask airway EXCEPT:
a. gastroparesis
b. asthma
c. tracheal tumor
d. hiatal hernia

A

b. asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the device in a can’t intubate, can’t ventilate scenario?

A

LMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The LMA should not be used in the following situations:

A

risk of gastric regurgitation and aspiration (full stomach, hiatal hernia, small bowel obstruction)
airway obstruction at the level of the glottis or below the glottis
poor lung compliance
high airway resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In patients with _____________, the LMA is preferred over a standard ETT assuming there are no contraindications to the LMA

A

reactive airway disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Compared to tracheal intubation, the LMA is less likely to

A

activate the SNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The risk of aspiration can be minimized with an LMA by

A

selecting the appropriate use based on the surgical procedure and position as well as the patient’s history (e.g. no history of GERD)
maintaining a deep enough plane of anesthesia to prevent swallowing as this can produce gastric insufflation
removing the LMA at the first sign of rejection during emergence
avoid using too much or too little air in the cuff
using the correct size device (not under-sizing)
minimizing inflation pressure (no higher than 20 cm H2O with a classic LMA)
epigastric auscultation can be used to assess for gastric insufflation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If you observe gastric contents inside the airway tube of the LMA, then you should perform the following interventions:

A

Leave LMA in place
Place in Trendelenburg (30 degrees) & deepen anesthesia
Give 100% oxygen via a self-inflating resuscitation bag (if gastric contents are in the breathing circuit)
use a low FGF and low Vt
use a flexible suction catheter to suction around the LMA
use a FOB to evaluate the presence of gastric contents in the trachea- consider intubation and aspiration protocols

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The tendency of airway device placement to activate the SNS (from most to least stimulating):

A

combitube
DVL
fiberoptic intubation
LMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If you’re going to use an LMA for a laparoscopic procedure, then the following guidelines should be observed:

A

select an LMA that allows for gastric drainage
use in patients with normal BMI
observe traditional NPO fasting guidelines
avoid light anesthesia
be an experienced LMA user
Follow the “15” rule: use <15 degree tilt, <15 cmH2O intraabdominal pressure, and <15 minutes of insufflation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Identify the contraindications to the combitube: (select 3)
a. full stomach
b. Zenker’s diverticulum
c. obesity
d. intact gag reflex
e. Klippel-Feil
f. prolonged use

A

b. Zenker’s diverticulum
d. intact gag reflex
f. prolonged use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The combitube is a

A

supraglottic, double lumen device that is blindly placed in the hypopharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The patient’s __________ determines which size Combitube is used:

A

height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A size 37 combitube is suitable for

A

4-6 ft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A size 41 combitube is suitable for

A

> 6 ft.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A size __________ combitube is suitable for <4 ft

A

no size available

23
Q

Benefits of a Combitube include

A

provides a secure airway (aspiration protection)
ability to decompress the stomach
useful for the obese population
minimal training required

24
Q

Contraindications for a Combitube include

A

intact gag reflex
esophageal disease (zenker’s diverticulum)
ingestion of caustic substances
prolonged use (>2-3 hours) due to the risk of ischemia from the oropharyngeal balloon

25
Q

What is the difference between the King laryngeal tube and the combitube?

A

King laryngeal tube: single lumen for ventilation and a single inflation port
child sizes are available

26
Q

The ________ is a disposable device that includes a second lumen that allows you to pass a gastric tube to suction the stomach

A

King LTS-D

27
Q

How much volume should be instilled in the oropharyngeal balloon of the combitube size 37?

A

40-85 mL

28
Q

How much volume should be instilled in the oropharyngeal balloon of the Combitube size 41?

A

40-100 mL + option for additional 50 mL

29
Q

The volume that should be instilled in the distal cuff of the combitube is

A

5-12 mL air (this is the second cuff that is inflated)

30
Q

Cuff pressures of the combitube should not exceed

A

60 cmH2O

31
Q

Overinflation of the cuffs of the combitube can

A

rupture the esophagus

32
Q

Regarding the operation of the flexible fiberoptic bronchoscope: (select 2)
a. the oral, pharyngeal, and laryngeal axes must align
b. pushing the lever down points the tip up
c. the non-dominant hand controls the lever
d. mask ventilation is impossible while the scope is in place

A

b. pushing the lever down points the tip up
c. the non-dominant hand controls the lever

33
Q

The gold standard for managing the difficult airway for the awake, spontaneously ventilating patient is

A

the flexible fiberoptic bronchoscopy

34
Q

The flexible fiberoptic bronchoscope is used for _________________ in awake or asleep patients

A

indirect laryngoscopy

35
Q

The absolute contraindications to fiberoptic bronchoscopy include

A

wild, uncooperative patient
lack of provider skills
near total upper airway obstruction (unless using FOB for diagnostic purposes)
massive trauma (unless used in conjunction with retrograde intubation)

36
Q

The relative contraindications to fiberoptic bronchoscopy include

A

hypoxia, bleeding, and lack of patient cooperation

37
Q

Before insertion of the flexible fiberoptic bronchoscope, remember to use a

A

defogger, antisialagogue and a vasoconstrictor

38
Q

Which hand should hold the lever of the fiberoptic scope?

A

non-dominant hand

39
Q

To move the scope horizontally,

A

the FOB is rotated in either direction

40
Q

Other indications for using the flexible fiberoptic bronchoscope is

A

C-spine limitation: severe cervical stenosis, cervical fracture, Chiari malformation, vertebral artery insufficiency
Limited mouth opening: TMJ disease, facial burns, mandibular-maxillary fixation

41
Q

Drugs that can be used in conjunction with awake fiberoptic intubation include

A

dexmedetomidine, remifentanil, ketamine, and midazolam

42
Q

The ____________ helps the FOB stay midline, although they may stimulate the gag reflex in the awake patient

A

Williams or Ovassapian airway

43
Q

Identify the statements that BEST describe the Bullard scope: (select 2)
a. the oral, pharyngeal, and laryngeal axes must align
b. it lacks disposable components
c. it requires a minimum mouth opening 7 millimeters
d. it is useful in the patient with Pierre Robin syndrome

A

c. it requires a minimum mouth opening of 7 mm
d. it is useful in the patient with Pierre Robin syndrome

44
Q

The Bullard laryngoscope is a

A

rigid, fiberoptic device used for indirect laryngoscopy

45
Q

With the Bullard laryngoscope, there’s a disposable tip extender which is useful for

A

tall patients; recover it after you’re done

46
Q

Compared with DVL, the Bullard causes

A

less cervical spine displacement

47
Q

Other types of rigid, fiberoptic devices include

A

the WuScope and UpsherScope

48
Q

The Bullard is recommended for patients with

A

small mouth openings
impaired cervical spine mobility
short thick necks
congenital airway syndromes (e.g. Treacher Collins or Pierre Robin)

49
Q

Contraindications for using the Bullard Laryngoscope include

A

no absolute contraindications but learning curve is high

50
Q

Compared to FOB, intubation with the Bullard is

A

usually faster

51
Q

Compared with DVL, the Bullard causes less

A

cervical spine displacement

52
Q

Sometimes the endotracheal tube hangs up on the right arytenoid cartilage with the Bullard scope, but you can fix this with

A

cricoid pressure and/or lifting the blade anteriorly

53
Q

With the bullard scope the head and neck must

A

stay in a neutral or slightly flexed position- any extension will make glottic visualization more difficult

54
Q

What is an absolute contraindication for the use of the Bullard?

A

there are no absolute contraindications

Apex Review (224 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions