Airway Management Flashcards
Who will be difficult to mask ventilate?
B- beard O- obesity N- no teeth E- elderly S- snoring
Who would be difficult to intubate?
D- disproportion: macroglossia, micrognathia, high arched palate, bony abnormalities, short thick neck
D- distortion: airway trauma, epiglottitis, abnormal larynx
D- dysmobility: limited mouth opening, fixed cervical spine, cervical spine injury
D- dentition: passion gap, buck teeth
Which bedside tests are done to predict possibility of difficult intubation?
- Mallamparti classification/ score
- Thyromental distance
- Extension at the Atlanto- occipital joint
What are the classes of the mallamparti classification?
Class I - soft palate, fauces, the whole uvula, anterior and posterior pillars
Class 2- visualization of soft palate, fauces and most of the uvula
Class 3- visualisation of soft palate and base of the uvula
Class 4- only hard palate visible
What thyromental distance may indicate a difficult intubation?
Less than 3 finger breadths or less than 6 cm in adults
When performing facemask ventilation, what maneuvers are necessary to provide a patent airway?
- head tilt, chin lift
- jaw thrust
If this remains ineffective, an oropharyngeal or nasopharyngeal airway maybe used
What are signs of upper airway obstruction?
- stridor
- tracheal tug
- accessory muscle use
- complete airway obstruction with ongoing respiratory effort leads to a see saw movement of the abdomen and chest
What are the advantages and indications for tracheal intubation?
Advantages:
Guaranteed airway
Protection from aspiration of gastric contents
Ability to provide effective positive pressure ventilation
Ability to clear secretions from the respiratory tract by suctioning
Indications: Controlled ventilation Protection of the airway Maintenance of a patent airway Postoperative ventilation in intensive care
What are two possible shapes of the laryngoscopes and names of them?
Straight- Macintosh
Curved- Magill or Miller
When do you use an endotracheal tube without a cuff?
Pediatrics
What size endotracheal tube is used for males and females and for children?
Orotracheal intubation: 7.5- 8 mm of males and 7- 7.5 mm in adult females
Nasotracheal intubation: size reduced by 1 or 0.5 mm
Children: (age in years/4) + 4
Always have a size above and below (0.5 mm) to hand
What should the depth of the endotracheal tube be?
20 +/- 2 cm - females
20 +/- 2 cm - males
Children: (age in years/2) + 12
What equipment is needed for intubation?
I - introducer M- mask, magills forceps A- airways, ambubag, alternate airway L- laryngoscopes E- endotracheal tube S- suction
How do you know if the endotracheal tube has entered the trachea?
- see tube going through vocal cords
- capnography
- oesophageal detector devices
- misting of the endotracheal tube
- chest movement of both sides of the chest
- auscultation: the each axilla, base of the lung, epigastrium
When is nasotracheal intubation used?
ENT, dentistry and maxillo- facial surgery
