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Orientation to Simulation and Clinical Expereince > Airway Management > Flashcards

Airway Management Flashcards

1
Q

3 Axis of airway

A

Oral/Pharyngeal/Laryngeal

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2
Q

Airways aligned

A

Sniff and Neck Extension

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3
Q

Problems with bad alignment

A
  1. Don’t have clear path for ventilation

2. Soft tissue can fall back and cause apnea in severe cases (obese patients)

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4
Q

Good airway looks like…

A

Nose above abdomen

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5
Q

Advantages of aligning the airway (3)

A
  1. Airway “more open” and easier to breathe
  2. Easier to ventilate the patient
  3. Better view of the vocal cords
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6
Q

4 Types of Airway Obstruction

A
  1. Soft Tissue (tongue/obese patients)
  2. Airway swelling (Edema/trauma/burn patients/pregnancy)
  3. Laryngospasm (risk every time in extubated)
  4. Bronchospasm (risk is patients are intubated “lightly”)
    • Patient still has reflex to protect the airway
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7
Q

Soft Tissue Obstruction

A

tissue falls against the pharynx (sedated/unconscious)

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8
Q

Soft Tissue Ob cases (3)

A
  1. MAC anesthesia (sedated patients)
  2. Right after induction of GA (before LMA/ETT inserted)
  3. After extubation (still not awake)
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9
Q

Is soft tissue obstruction a problem during GA?

A

No, LMA or ETT will be placed and tube will bypass the tongue.

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10
Q

Soft Tissue Treatment (4)

A
  1. Chin lift
  2. Jaw thrust
  3. Nasal Airway
  4. Oral Airway
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11
Q

Chin Lift

A
  • indicated for minor airway obs.

- aligns the 3 axis’

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12
Q

Jaw Thrust

A
  • opens airway by lifting soft tissue off the pharynx
  • stimulates respirations with pain
  • behind mandible
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13
Q

Double handed jaw thrust

A

best opportunity to get a good mask seal and the best opportunity to mask ventilate the patient (requires a 2nd provider to squeeze bag)

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14
Q

Oral/Nasal Airways

A

lift tongue off posterior pharynx

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15
Q

Oral airway

A

unconscious patients only, can cause gagging

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16
Q

Nasal airway

A
  • tolerated better in awake patients

- contraindicated with patients on blood thinners/facial fractures

17
Q

Proper sizing of oral airway

A

One end at the lips/ the other end at the angle of mandible

18
Q

Proper sizing of Nasal Airway

A
  • distance from the nares to the meatus of ear

- diameter of the patient’s smallest finger

19
Q

Anaphylaxis

A

allergic reaction that can cause severe swelling within the airway

20
Q

Swelling causes (5)

A
  1. Traumatic intubation/multiple laryngoscopies
  2. Anaphylaxis
  3. Burned patient
  4. Fluid overload
  5. Pregnancy
21
Q

Swelling Treatment (4)

A
  1. Steroids (Decadron)
  2. Diuretics
  3. Leave the patient intubated
  4. Epinephrine (if anaphylaxis is the cause)
22
Q

Laryngospasm

A

vocal cords snap shut

23
Q

Causes of laryngospasm

A
  1. ETT during extubation
  2. Airway secretions (mucus, saliva, blood)
    - Vocal cords must be stimulated during “light anesthesia” (stage II)
    - CANNOT occur when patient is deep asleep.
    - Stimulation of superior laryngeal nerve (branch of vagus nerve)
24
Q

When will a patient most likely experience a laryngospasm?

A

Stage II (half asleep)

25
Q

Is extubating a patient during stage II anesthesia a good idea?

A

No, pulling tube out during this time will stimulate the vocal cords.

26
Q

Laryngospasm Treatments (4)

A
  1. High jaw lift at laryngospasm notch (breaks larnygospasm when combined with positive pressure)
  2. Positive airway pressure with bag and mask (Double handed jaw thrust w/ bag squeezing/only to 20 cmH20, protects air from going into esophagus)
  3. Propofol (relaxes vocal cords by taking patient from stage II to stage III.
  4. Succinylcholine
27
Q

Bronchospasm

A

narrowing of the bronchioles caused by inflammation or constriction if lungs become irritated. (smokers and asthmatics more susceptible)

28
Q

Causes of bronchospasm (5)

A
  1. ETT irritating the lunch if patient not anesthetized deeply enough
  2. Emergence from anesthesia
  3. Desflurane (most pungent volatile agent)
  4. Anaphylaxis
  5. Aspiration
29
Q

Treatment for bronchospasm caused by light anesthesia

A
  • give more propofol and/or give more volatile agent–> put them more to sleep
  • ETT need to be paralyzed or deeply anesthetized
30
Q

If patient is in emergence from anesthesia, how would you treat a bronchospasm?

A

Give albuterol (best 2 agonist/bronchodilator) inhaler via the ETT (60 mL syringe)

31
Q

How would you treat a patient with a bronchospasm caused by Anaphylaxis?

A

Give bronchodilators (3)

  1. Epinephrine (~300 mcg IM)
  2. Best 2 agonists
    • albuterol inhaler
    • subcutaneious terbutaline (0.25mg)
  3. Volatile agent (isoflurane or sevoflurane)
32
Q

Coughing Prevention on ETT

A
  1. Lidocaine jelly or LTA kit (more effective/releases in 360 degrees)
  2. patient paralyzed or deeply anesthetized
33
Q

Coughing treatment on an ETT

A
  1. Turn off ventilator (can resume once cause of coughing is treated)
  2. Dose muscle relaxant (Zemuron) or deepen anesthetic (narcotics or higher conc of volatile anesthetic)
34
Q

Regurge (Passive Reflux

A

reduction in tone of the lower esophageal sphincter (LES).

35
Q

How can regurge (passive reflux) be prevented?

A

Sellick’s maneuver: applying cricoid pressure to prevent reflux through the esophagus. This also improves intubation view.

36
Q

Is vomiting an active or passive reflux?

A

Active: patient is treated with aggressive suctioning and them in Trendelenburg with their head tilted to the side. (Cricoid pressure controversial due to esophageal ruptures.)

37
Q

Aspiration

A

Gastric contents enter the trachea/lungs.

38
Q

What should you do if a patient aspirates?

A

Patient should be intubated and sent to the ICU. Could be placed on prophylactic antibiotics and possibly steroids.

Orientation to Simulation and Clinical Expereince (6 decks)

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