Airway management 5 Flashcards
The Eschmann introduces provides the most significant benefit when you obtain a
grade 3 view during laryngoscopy
The intubating stylet has several names including
Eschmann introducer and gum elastic bougie
The angle tip (coude) is used to facilitate intubation of a
very “anterior” glottis
The coude is useful when the patient has a
Cormack & Lehane score of 2B or 3
Feeling ________ confirms placement of the intubating stylet.
the click of the tracheal rings
If the endotracheal tube catches on the soft tissue of the larynx, then you should
rotate the ETT 90 degrees counter-clockwise
The EI is also useful for
nasotracheal intubation and orotracheal intubation through a supraglottic airway
How far should the Eschmann introducer be advanced into the trachea?
23-25 cm
What is the “Hold-up” sign?
it occurs when the introducer encounters resistance at the carina
Indications for the lighted stylet include: (select 3)
a. super morbid obesity
b. severe oropharyngeal bleeding
c. mandibular hypoplasia
d. epiglottitis
e. a can’t ventilate and can’t intubate scenario
f. microstomia
b. severe oropharyngeal bleeding
c. mandibular hypoplasia
f. microstomia
The lighted stylet uses a
blind intubation technique that transilluminates the anterior neck to facilitate endotracheal intubation
When the lighted stylet is in the esophagus, you’ll observe a
more diffuse transillumination of the neck without the circumscribed glow
When the lighted stylet is in the trachea, you’ll observe a
well-defined circumscribed glow below the thyroid prominence
Benefits of the lighted style include
requires very little neck manipulation
less stimulating and less sore throat vs. direct vision laryngoscopy
Disadvantages of the lighted stylet include
it’s difficult to use in the patient with a short, thick neck
it should not be used in an emergency or a “can’t ventilate, can’t intubate scenario”
The lighted stylet technique is a blind technique and shouldn’t be used in the presence of a
tumor, foreign body, airway injury, or epiglottitis
The lighted stylet is useful for
anterior airway
small mouth opening
The lighted stylet requires very little
manipulation of the neck
The lighted stylet can be used for
oral or nasal endotracheal intubation
The lighted stylet is useful for
cervical spine abnormality, Pierre-Robin syndrome, severe burn contractures
When using the Trachlight in the adult, the tip should be bent to
a 90 degree angle
When using this device in children, the angle should be
60-80 degrees
Choose the MOST appropriate indications for retrograde intubation. (select 2)
a. tracheal stenosis
b. unstable cervical spine
c. upper airway bleeding
d. can’t ventilate and can’t intubate scenario
b. unstable cervical spine
c. upper airway bleeding
Retrograde intubation is a _________ procedure
blind
Contraindications to retrograde intubation include
poor anatomy (neck deformity, neck mass)
laryngotracheal disease (stenosis)
coagulopathy
infection
Complications of retrograde intubation include
bleeding
pneumothorax
trigeminal nerve trauma
breath holding
pneumomediastinum
wire that travels in the wrong direction
What are the basic steps of retrograde wire intubation?
- puncture the cricothyroid membrane with a 14-18 g needle
- aspirate for air to confirm proper placement inside the tracheal lumen
- Pass a wire through the needle and advance it in a cephalad direction
- load the endotracheal tube over the wire and advance into the trachea
- Once the ETT is in the trachea and cannot be advance any further, withdraw the wire and then advance the ETT into its final position
How long does a retrograde intubation typically take?
5-7 minutes for experienced practitioners
What are the absolute contraindications to tracheostomy?
there are no absolute contraindications
What are the three ways to create a surgical airway:
percutaneous cricothyroidotomy
surgical cricothyroidotomy
tracheostomy
Percutaneous cricothyroidotomy with transtracheal jet ventilation is performed by
inserting a large-bore needle through the cricothyroid membrane and ventilating with a high-pressure oxygen source, such as a jet ventilator
Transtracheal jet ventilation requires a
high-pressure oxygen source (50 psi) during inspiration
With transtracheal jet ventilation, exhalation is
passive
__________ can prevent exhalation in the patient receiving transtracheal jet ventilation
Upper airway obstruction
Cricothyroidotomy is performed by
creating a small, horizontal incision through the cricothyroid membrane and then inserting a cuffed endotracheal tube through the hole
Cricothyroidotomy is contraindicated in
children less than 6 years of age
Tracheostomy tends to require _____________ than cricothyroidotomy
more time; makes it less attractive in emergencies
Upper airway obstruction with jet ventilation through a percutaneous cricothyroidotomy can lead to
barotrauma
pneumothorax
subcutaneous emphysema
mediastinal emphysema
Complications of percutaneous cricothyroidotomy include
hemorrhage
aspiration
tracheal injury
esophageal injury
Contraindications to surgical cricothyroidotomy include
laryngeal fracture
laryngeal neoplasm
children under 6
Complications of surgical cricothyroidotomy include
tracheal stenosis
tracheal or esophageal injury
hemorrhage
disordered swallowing
subcutaneous or mediastinal emphysema
Where is a tracheostomy incision performed
between the 2nd and 3rd tracheal rings
Acute complications of tracheostomy include
airway obstruction
hypoventilation
pneumothorax
bleeding
Long term complications of tracheostomy include
tracheal stenosis
tracheomalacia
tracheoesophageal fistula
tracheal necrosis
