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PMI > Airway Management > Flashcards

Airway Management Flashcards

1
Q

What are the three axis’ of the airway?

A
  1. ) oral axis
  2. ) laryngeal axis
  3. ) pharyngeal axis
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2
Q

true/false. When the patient is supine and lying flat without a pillow, the axis of the airway is aligned.

A

FALSE. not aligned

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3
Q

true/false. When the patient is in a “sniff” position (supine with a pillow) the axis’ of the airway are aligned.

A

TRUE

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4
Q

How would you be able to achieve a maximally aligned airway axis?

A

by asking the patient to lift their chin up and neck extended

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5
Q

order the following in order of least aligned to maximal aligned : sniff position, sniff position and neck extension, lying flat

A

lying flat, sniff position, sniff position and neck extension

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6
Q

What are the two problems with lying flat on your back and having the airway axis’ unaligned?

A

The first problem is there is not as clear of a path for ventilation, which means it’s hard for some patients to breathe.
The second problem is that when we fall asleep the tongue also falls asleep and falls against the back of our throats which can an “airway obstruction” . If obstruction is minor, then snoring occurs. If obstruction is severe, it can cause total apnea

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7
Q

Why can thin patients still breathe when lying flat (when their airway axis’ are not aligned) ?

A

because they don’t have other factors that contribute to airway obstruction (i.e. they have less soft tissue mass in the pharynx)

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8
Q

Why cant morbidly obese patients breathe at all when lying flat on their backs?

A

because the combination of having unaligned axis’ and more soft tissue mass in the airway can cause total airway obstruction

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9
Q

what are the advantages of aligning the airway axis’?

A

1.) a patient’s airway is “more open”
(better passage of air and less likely airway obstruction)
2.) it’s easier for an anesthetist to ventilate a patient
3.) an anesthetist has a better view of the vocal cords during laryngoscopy and intubation

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10
Q

what are the four types of airway obstruction?

A
  1. ) soft tissue obstruction
  2. ) airway swelling
  3. ) laryngospasm
  4. ) bronchospasm
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11
Q

how does soft tissue obstruction occur?

A

when patients are sedated or unconscious. when anesthetized, the soft tissues of the pharynx “fall asleep” or lose tone which causes the tongue to fall against the posterior pharynx which blocks the airway

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12
Q

When do we encounter soft tissue obstruction?

A

MAC anesthesia, right after induction of general anesthesia, after extubation

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13
Q

Why doesn’t soft tissue obstruction occur during general anesthesia?

A

LMA and endotracheal tube bypass the tongue

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14
Q

What are the treatments for soft tissue obstruction?

A
  1. ) chin lift
  2. ) jaw thrust
  3. ) nasal airway
  4. ) oral airway
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15
Q

a chin lift is indicated for _____.

A

a minor airway obstruction; it works by aligning the three axis’ of the airway

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16
Q

why is a jaw thrust beneficial to do?

A

it opens the airway (lifts the tissues off of the posterior pharynx), but it also stimulates respirations.

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17
Q

what is the best opportunity to get a good mask seal and mask ventilate a patient?

A

double handed jaw thrust with a mask

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18
Q

when should oral airways be used?

A

use on unconscious patients

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19
Q

What are the contraindications for using a nasal airway?

A

1.) contraindicated for patients using blood thinners
2.) contraindicated for patients with facial fractures
(nasal airway might penetrate the cribriform plate and damage the brain

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20
Q

how do you size an oral airway?

A

one end is at the lips

the other end is at the angle of the mandible

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21
Q

how do you size a nasal airway?

A
  1. ) the distance from the nares to the meatus of the ear

2. ) the diameter of the patient’s smallest finger

22
Q

what happens if the nasal airway is too big?

A

the distal tip may enter the esophagus which could lead to gastric inflation

23
Q

how can anesthetist fix an obstructed airway from an improper oral airway placement?

A

“lifting” the tongue up with a tongue depressor prior to oral airway insertion. this ensures the oral airway gets under the tongue

24
Q

what is the FIRST step to place an oral airway?

A

1.) pull the jaw down and lift the tongue UP with tongue blade

25
Q

what should be attempted BEFORE placing the tongue blade and oral airway?

A

open the mouth by pulling the jaw down. pulls the tongue up and out of the mouth to make it easier for the oral airway to slide underneath

26
Q

what are the possible etiologies of airway swelling?

A
  1. ) traumatic intubation/ multiple laryngoscopies
  2. ) anaphylaxis
  3. ) burned patient
  4. ) fluid overload
  5. ) pregnancy
27
Q

what are the possible treatments for airway swelling?

A
  1. ) steroids (decadron)
  2. ) Diuretics
  3. ) consider leaving the patient intubated
  4. ) epinephrine (if anaphylaxis is the cause)
28
Q

what are the common causes of stimulation of vocal cords during a laryngospasm?

A
  1. ) an endotracheal tube (ETT) during extubation

2. ) airway secretions (mucus, saliva, blood, etc.)

29
Q

during what stage of anesthesia do the vocal cords need to be stimulated for a laryngospasm to occur?

A

stage II, lightly anesthetized

30
Q

what is responsible for triggering laryngospasm?

A

stimulation of the superior laryngeal nerve

31
Q

True/False: never extubate a patient during stage II anesthesia.

A

True

32
Q

Name all the laryngospasm treatments.

A
  1. ) high jaw lift at laryngospasm notch
  2. ) positive airway pressure with a bag and mask
  3. ) propofol
    - relaxes the vocal cords by taking the patient from stage II to stage III anesthesia
  4. ) succinylcholine
33
Q

which patients are much more prone to airway irritation and bronchospasm?

A

smokers and asthmatics

34
Q

what are the possible intraoperative causes of bronchospasm?

A
  1. ) light anesthesia during surgery
  2. ) emergence during anesthesia
  3. ) desflurane
  4. ) anaphylaxis
  5. ) aspiration
35
Q

what is the treatment for bronchospasm caused by light anesthesia?

A

treat it by giving propofol and/or give more higher concentrations of volatile agent

36
Q

Endotracheal tubes are a big cause of bronchospasm. intubated patients need to be either _____ or ______ to prevent coughing

A

paralyzed; deeply anesthetized

37
Q

what is the treatment for bronchospasm during emergence from anesthesia?

A

during emergence, you give albuterol (beta 2/ bronchodilator) inhaler via the ETT

38
Q

what is the treatment of bronchospasm caused by anaphylaxis?

A

bronchodilators (epinephrine, beta 2 agonists–> 1a. albuterol inhaler 1b. subcutaneous terbutaline (0.25 mg ) injection, volatile agent (isoflurane and sevoflurane)

39
Q

What type of syringe do you place albuterol in?

A

60 ml syringe

40
Q

how do you set up albuterol?

A

1) remove albuterol from the inhaler
2. ) pull plunger out of 60 mL syringe and place albuterol in the syringe.
3. ) place the plunger back into the 60 mL syringe
4. ) remove the capnography tubing from the anesthesia circuit
5. ) connect the 60 ml syringe to the anesthesia circuit and “squirt” the albuterol in during inhalation (during squeezing of breathing bag.)

41
Q

how do you PREVENT coughing in an endotracheal tube?

A
  1. ) anesthetize the trachea with lidocaine jelly and/or an LTA kit
  2. ) keep the patient either paralyzed or deeply anesthetized
42
Q

how do you TREAT coughing in an endotracheal tube

A
  1. ) turn off the ventilator

2. ) either dose muscle relaxant or deepen the anesthetic

43
Q

what is another name for regurge?

A

passive reflux

44
Q

what is the cause of regurge?

A

reduction in tone of LOWER esophageal sphincter

45
Q

how can regurge be prevented?

A

by applying cricoid pressure also known as Sellick’s maneuver

46
Q

true/false: vomiting is a passive reflux.

A

FALSE; it is active reflux

47
Q

when gastric contents enter the trachea/lungs

A

aspiration

48
Q

what can occur if the airway obstruction is severe?

A

total apnea

49
Q

Nasal airways can cause ____

A

nosebleeds (epistaxis) and subsequent blood in the airway

50
Q

which anesthetic drug is more likely to cause a laryngospasm?

A

desflurane

51
Q

what are the benefits of cricoid pressure?

A

1.) occludes the esophagus and 2.) improves intubation view

PMI (21 decks)

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