Airway management Flashcards
Larynx
Consists of 9 cartilages, protects entrance to respiratory tract and allows phonation
Thyroid cartilage
largest and most prominent for lateral and anterior walls
Crick thyroid membrane
Connects thyroid and cricoid cartilage
Cricoid cartilage
Shaped like signet ring, inferior to thyroid cartilage only complete ring along trachea
Arytenoids
Originate in posterior aspect of larynx and posterior attachments of vocal cords, may be only visible structure if patient has anterior airway
Laryngeal muscles
Lateral cricoarytenoid (adduction) Posterior cricoarytenoid (abduction) Transverse arytenoids (open/close glottis)
Glossopharyngeal nerve (IX)
Posterior 1/3 tongue (gag), oropharynx to junction of pharynx and epiglottis (vallecula)
No motor function
Superior laryngeal nerve (internal)
Mucosa from epiglottis to vocal cords
No motor function
Superior laryngeal nerve (external)
Anterior subglottic mucosa - sensory Cricothyroid muscles (vocal cords) - motor
Recurrent laryngeal nerve
Subglottic mucosa and muscle spindles - sensory
All intrinsic muscles of larynx - motor
Hoarseness
Injury to SLN, RLN (ipsilateral vocal cord paralysis)
Airway History
Adverse events in past. Past surgical history? Edema? OSA? C-spine disease?
PE of airway
Mallampati score Symmetry? Teeth? Macroglossia? Palate arch? Mandible size Neck exam
Signs of difficult airway
Abnormal face shape Narrow mouth Obesity Buck teeth or edentulous Mallampati 3-4 Neck pathology Sunken cheeks
Airway Devices
Oral and nasal airways -> during induction
Mask -> 1-hand or 2-hand technique (jaw thrust)
LMA - insert blindly along roof of mouth, inflate and confirm
ETT
Used to deliver anesthesia and ventilate (Mac or Miller blades)
Infants - 3.5 diameter, 12 length
Child - 4+age/4 diameter, 14+age/2 length
Female - 7.0-7.5 diameter, 20 length
Male - 7.5-8.5 diameter, 22 length
Epiglottis
Divides into nasopharynx, oropharynx, laryngopharynx
Intubation Equipment
O2 w/ vent Mask and oral/nasal airway ETT w/ styles Syringe Suction Scope w/ handle Stethoscope Capnographer
RSI
For people at risk of aspiration
Use Suc (1-1.5 mg/jog) or Roc (.6-1.2 mg/kg)
Apply cricoid pressure (BURP)
Don’t ventilate during paralysis –> aspiration risk
Contraindications to nasal airway
Nasal fractures, basilar skull fracture, coagulopathies
Nerve blocking airway for awake intubation
Topical gel or spray
Block hyoid with local
Penetrate cricothyroid and squirt
Transtracheal procedures
Per cutaneous transtracheal ventilation
- place catheter thru cricothyroid membrane and attach O2
- don’t do cric in
Extension
Stage 3 or 1 --> stage 2 has risk of laryngospasm Criteria 1. Regular RR 2. Stable SpO2 3. Paralysis reversed (hold head >4 sec) 4. TV >4 mL/kg 5. Follow commands 6. Stable end-tidal CO2
Continue intubation?
Epiglottitis Airway edema Injury to RLN Bleeding Unstable hemodynamics Neuro compromise
