Airway Management Flashcards
components that protect the lower airway from aspiration of foreign bodies and secretions
- pharynx
- epiglottis
- vocal cords
laryngospasm
prolonged, intense glottic closure and an exaggeration of the glottic closure reflex
laryngospasm causes
- direct glottic or supraglottic stimulation
- secretions, foreign bodies, inhalational agents
- other noxious stimuli
treatment of laryngospasm
- remove stimulus
- CPAP for mild, incomplete glottic closure
- deepen anesthetic
- muscle relaxants and intubation necessary for more severe cases
coughing
important protective mechanism as it expels secretions and foreign bodies from the lower respiratory tract
partial upper airway obstruction
- diminished tidal exchange
- retraction of upper chest
- snoring sound heard with pharyngeal obstruction
- inspiratory stridor heard with laryngeal obstruction
complete upper airway obstruction
- characterized by lack of any air movement or breath sounds
- may observe diaphragmatic tugging or paradoxical movements of the abdomen and rib cage
upper airway obstruction treatment
- depends on cause of obstruction (i.e., soft tissue, foreign body, tumor, laryngospasm)
- soft tissue = treat with head-tilt, chin-lift maneuver or by jaw thrust; moves hyoid bone anteriorly and lifts epiglottis to clear the obstruction
- OP or NP airway to provide artificial passage behind tongue
Difficult mask ventilation predictors
- MOANS
- Mask seal (beard presence)
- Obesity (BMI > 26 kg/m2)
- Aged (older than 55)
- No teeth (edentulous)
- Snores
predict difficult intubation LEMON
- Look externally
- Evaluate mandibular space
- Mallampati classification
- Obstructions
- Neck mobility
cannot ventilate
fully trained anesthetist cannot cause a life-sustaining amount of gas exchange to occur with a jaw thrust and/or OPAW/NPAW
cannot intubate
fully trained anesthetist cannot place endotracheal tube through the vocal cords within a life-sustaining period of time
causes of inability to ventilate
- laryngospasm
- supraglottic soft-tissue relaxation
- chest wall rigidity
- pathologic, glottic, and subglottic
- equipment failure
intubating LMA
- fastrach LMA
- found in difficult airway cart
- sizes 3, 4, 5
- can accommodate up to 8.0 ETT
glidescope
- video laryngoscope with integrated high resolution camera
- clinical uses - known difficult airway, rescue, anterior larynx, poor neck mobility
fiberoptic intubation
- placement of ETT for difficult airway or patient with C-spine precautions
- assessment of double-lumen ETT placement
- airway evaluation
- gold standard for airway management
fiberoptic intubation reason for failed success
- inadequate anesthesia
- intraoperative laryngospasm or bronchospasm due to inadequate anesthesia
- visualization obscured by blood, secretions, fogging or edema
- inexperienced provider (most common)
fiberoptic intubation disadvantages
- fragile and expensive
- difficult to use
- requires more time and experience
- blood or secretions impeded view
bullard scope
- rigid laryngoscope anatomically shaped scope with fiberoptic bundle and eyepiece extending at 45 degree angle from handle
- useful in difficult airways
- expensive and not used much
Wu scope
- rigid anatomically shaped blade with separate flexible fiberoptic scope
- allows for O2 and suction during intubation
- slow learning curve and many parts
upsher scope
- rigid blade shaped in form of oropharynx with attached eyepiece
- considerations similar to Wu and Bullard
Eschmann introducer
- Bougie
- 15Fr 60 cm long, angled 40 degrees at tip
- useful when laryngoscopic view is poor (grade III or IV)
lighted intubation wand
- transillumination of neck to guide ETT
- larynx not directly visualized
combitube
- supraglottic
- used in emergency
- two lumens so can function whether in the esophagus or trachea
transtracheal jet ventilation (TTJV)
- need high pressure O2 source (~50psi, like O2 flush)
- tidal volume depends on i time, chest wall and lung compliance, catheter size
- 14g catheter - 1600 mL/s
- 16g catheter - 500 mL/s
complications of TTJV
- tracheal mucosal damage and thickened secretions blocking airway, resulting form inadequate humidification of inspired gases
- pneumothorax, pneumomediastinum, subcutaneous emphysema, barotrauma
- tracheal and esophageal rupture
- hematoma
- failure to ventilate
- inadequate delivery of anesthetic gases
retrograde intubation
- puncture cricothyroid membrane with 18g needle directed cephalad at 45degree angle
- thread J wire (flexible tip) through needle and out through mouth
- follow ETT over wire guide into trachea
cricothyrotomy
- 12-14g needle
- 3 mL syringe, no plunger
- 15mm ETT adaptor from 7.0 ETT
- breathing circuit
- TTJV
- call ENT
- ensures O2 supply for just 10 min (not long term)
cricothyrotomy complications
- pneumothorax
- subq emphysema
- bleeding
- esophageal puncture
- aspiration
- respiratory acidosis
