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N928 - Basics of Anesthesia > Airway Management > Flashcards

Airway Management Flashcards

1
Q

components that protect the lower airway from aspiration of foreign bodies and secretions

A
  • pharynx
  • epiglottis
  • vocal cords
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2
Q

laryngospasm

A

prolonged, intense glottic closure and an exaggeration of the glottic closure reflex

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3
Q

laryngospasm causes

A
  • direct glottic or supraglottic stimulation
  • secretions, foreign bodies, inhalational agents
  • other noxious stimuli
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4
Q

treatment of laryngospasm

A
  • remove stimulus
  • CPAP for mild, incomplete glottic closure
  • deepen anesthetic
  • muscle relaxants and intubation necessary for more severe cases
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5
Q

coughing

A

important protective mechanism as it expels secretions and foreign bodies from the lower respiratory tract

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6
Q

partial upper airway obstruction

A
  • diminished tidal exchange
  • retraction of upper chest
  • snoring sound heard with pharyngeal obstruction
  • inspiratory stridor heard with laryngeal obstruction
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7
Q

complete upper airway obstruction

A
  • characterized by lack of any air movement or breath sounds
  • may observe diaphragmatic tugging or paradoxical movements of the abdomen and rib cage
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8
Q

upper airway obstruction treatment

A
  • 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
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9
Q

Difficult mask ventilation predictors

A
  • MOANS
  • Mask seal (beard presence)
  • Obesity (BMI > 26 kg/m2)
  • Aged (older than 55)
  • No teeth (edentulous)
  • Snores
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10
Q

predict difficult intubation LEMON

A
  • Look externally
  • Evaluate mandibular space
  • Mallampati classification
  • Obstructions
  • Neck mobility
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11
Q

cannot ventilate

A

fully trained anesthetist cannot cause a life-sustaining amount of gas exchange to occur with a jaw thrust and/or OPAW/NPAW

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12
Q

cannot intubate

A

fully trained anesthetist cannot place endotracheal tube through the vocal cords within a life-sustaining period of time

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13
Q

causes of inability to ventilate

A
  • laryngospasm
  • supraglottic soft-tissue relaxation
  • chest wall rigidity
  • pathologic, glottic, and subglottic
  • equipment failure
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14
Q

intubating LMA

A
  • fastrach LMA
  • found in difficult airway cart
  • sizes 3, 4, 5
  • can accommodate up to 8.0 ETT
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15
Q

glidescope

A
  • video laryngoscope with integrated high resolution camera

- clinical uses - known difficult airway, rescue, anterior larynx, poor neck mobility

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16
Q

fiberoptic intubation

A
  • 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
17
Q

fiberoptic intubation reason for failed success

A
  • inadequate anesthesia
  • intraoperative laryngospasm or bronchospasm due to inadequate anesthesia
  • visualization obscured by blood, secretions, fogging or edema
  • inexperienced provider (most common)
18
Q

fiberoptic intubation disadvantages

A
  • fragile and expensive
  • difficult to use
  • requires more time and experience
  • blood or secretions impeded view
19
Q

bullard scope

A
  • 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
20
Q

Wu scope

A
  • rigid anatomically shaped blade with separate flexible fiberoptic scope
  • allows for O2 and suction during intubation
  • slow learning curve and many parts
21
Q

upsher scope

A
  • rigid blade shaped in form of oropharynx with attached eyepiece
  • considerations similar to Wu and Bullard
22
Q

Eschmann introducer

A
  • Bougie
  • 15Fr 60 cm long, angled 40 degrees at tip
  • useful when laryngoscopic view is poor (grade III or IV)
23
Q

lighted intubation wand

A
  • transillumination of neck to guide ETT

- larynx not directly visualized

24
Q

combitube

A
  • supraglottic
  • used in emergency
  • two lumens so can function whether in the esophagus or trachea
25
Q

transtracheal jet ventilation (TTJV)

A
  • 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
26
Q

complications of TTJV

A
  • 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
27
Q

retrograde intubation

A
  • 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
28
Q

cricothyrotomy

A
  • 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)
29
Q

cricothyrotomy complications

A
  • pneumothorax
  • subq emphysema
  • bleeding
  • esophageal puncture
  • aspiration
  • respiratory acidosis

N928 - Basics of Anesthesia (17 decks)

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