Airway Management Ch15 (Krek)

Question 0

Does transillumination intubation involve a laryngoscope?

Answer 0

No

p. 796

Question 1

What is transillumination intubation?

Answer 1

A bright light placed inside the trachea in an endotracheal tube that is visible on the outside of the trachea.
p.794

Question 2

What would the light in a transillumination intubation look like if the ET tube was correctly placed in the trachea?

Answer 2

A tightly circumscribed light slightly below the thyroid cartilage indicates the tip has entered the trachea.
p. 798

Question 3

Describe the basics of how a retrograde intubation is performed.

Answer 3

A needle is placed in the cricothyroid membrane and a wire is fed toward the head through the trachea and into the mouth. The wire is then used as a guide for the induction of the ET tube.
p. 798

Question 4

What is the technique called for a face-to-face intubation?

Answer 4

The Tomahawk method

p. 801

Question 5

Why is the tongue swept to the right in the Tomahawk method of face-to-face intubation?

Answer 5

The medic holds a Mac blade in the right-hand and sweeps the tongue to the right because he is facing the patient.
p. 802

Question 6

What percentage of intubations are considered failed attempts?

Define what is meant by a failed attempt?

Answer 6

5%
The failure to maintain oxygen saturation during or after one or more failed attempts or a total of three failed attempts even if oxygen saturation can be maintained.
p. 802

Question 7

What is tracheobronchial suctioning?

Answer 7

Passing a suction catheter into the ET tube to remove secretions.
p. 803

Question 8

What is the first rule in tracheobronchial suctioning?

Answer 8

Don’t do it if you don’t have to because it can cause cardiac dysrhythmias. Suctioning should last no more than 10 seconds.
p. 803

Question 9

What is the only reason to consider an extubation?

What should you expect if an extubation is performed?

Answer 9

If a patient is unreasonably intolerant of an ET tube and is unable to be sedated

Expect the patient to vomit and sit them up.
p. 803

Question 10

Name five differences in a pediatric airway.

Answer 10

1. A large head causes a flexed neck position
2. The tongue is larger and the mandible is smaller
3. Epiglottis is very floppy and must be lifted
4. Trachea is more anterior and superior
5. A cuff on an ET tube could damage the airway and is not needed
   p. 805

Question 11

How do you determine the size of an ET tube for pediatric patient?

Answer 11

Braslow tape, width of the nail on the little finger, inside diameter of one of the nares.
p. 805

Question 12

At what age do you begin to use a cuffed ET tube in a pediatric patient?

Answer 12

8-10

p. 806

Question 13

What is the appropriate depth of an ET tube in a pediatric patient?

Answer 13

2 to 3 cm beyond the cords

p. 806

Question 14

Why would you give atropine sulfate to a pediatric patient prior to intubation? What is the dose?

Answer 14

Stimulation of the parasympathetic nervous system can result in bradycardia.
.02 mg/kg
p. 806

Question 15

Where is the depth of an ET tube in a pediatric patient recorded?

Answer 15

At the right side corner of the mouth

p. 806

Question 16

A colorimetric ETCO2 detector cannot be used in children weighing less than ________, or an esophageal bulb if they weigh less than ________.

Answer 16

15kg
20kg
p. 807

Question 17

What is the mnemonic to troubleshoot an acute deterioration of a pediatric pt?

Answer 17

DOPE

Displacement, Obstruction, Pneumothorax, Equipment failure

Question 18

What are the two major classes of sedatives used in airway management?

Answer 18

Analgesics and sedative hypnotics

p. 810

Question 19

Why is sedation used in airway management?

Answer 19

To reduce anxiety, induced amnesia, and decrease the gag reflex
p. 810

Question 20

Give an example of butyrophenones used in sedation and why

Answer 20

Haldol and Inapsine
Used for anxiolysis
p. 810

Question 21

Provide an example of a benzodiazepine used for sedation
What is an additional benefit of these medications?
Name a benzodiazepine antagonist.

Answer 21

Diazepam (Valium) and midazolam (versed)
Anxiolytic, anti-seizure, retrograde amnesia
Flumazenil (romazicon)
p. 810

Question 22

Name to common side effects of benzodiazepines?

Answer 22

Respiratory depression and slight hypotension

Question 23

How are opioids used in intubation?

What are the common side effects

Answer 23

As premedication during induction and in maintenance of sedation or amnesia

Profound respiratory and central nervous system depression and severe hypotension
p. 811

Question 24

What is a non-narcotic, non-barbiturate hypnotic-sedative drug used in the induction of general anesthesia?

Answer 24

Etomidate

p. 811

Question 25

What muscle tissue do paralytics affect?

Answer 25

Skeletal muscle tissue

p. 811

Question 26

Why are paralytic medications referred to as neuromuscular blocking agents?

Answer 26

They function at the neuromuscular junction and relax the muscle by impeding the action of acetylcholine. They are classified into either depolarizing or non-depolarizing agents
p. 811

Question 27

What is the medication classification of succinylcholine?

Describe how it works.

Answer 27

Depolarizing neuromuscular blocker

Competitively binds with acetylcholine receptor sites but is not affected by acetylcholinesterase.
p. 812

Question 28

What are fasciculations why do they occur?

Answer 28

Brief twitching of small muscle groups in the face, neck, trunk, and extremities. They occur because depolarization is occurring at the neuromuscular junction.
p. 812

Question 29

In what types of patients should succinylcholine be used with caution?
Why should atropine be given to pediatric patients prior to administering succinylcholine?

Answer 29

Patients with burns, crush injuries, and blunt trauma due to the possibility of hyperkalemia.

The possibility of succinylcholine induced bradycardia.
p. 812

Question 30

Give an example of the nondepolarizing neuromuscular blocker and describe how it works

Answer 30

Vecuronium
Rapid onset of 2 min duration of 45 min.
Prevents fasciculations because the amount of the medication in the receptor exceeds the amount of acetylcholine and prevents the threshold of depolarization from occurring.

Question 31

6 steps for RSI

Answer 31

1. Pre-oxygenate
2. Defasciculating dose (10%) of non-depolarizing paralytic, lidocaine, or atropine
3. Sedate
4. Paralyze
5. Intubate
6. Maintain adequate sedation
   p. 813

Question 32

Contra indications of Combitube usage

Answer 32

Esophageal trauma varices or cancer, caustics ingestion, alcoholic, children> 16.

Question 33

What tube is first ventilated through on a Combitube?

Answer 33

The longest blue tube. Chest rise indicates tracheal placement. No chest rise indicates esophogeal placement, switch ports and ventilate.
p. 815

Question 34

What device surrounds the opening of the larynx with an inflatable silicone cuff positioned in the hypopharynx with the tip inserted into the proximal esophagus, that provides a conduit from the glottic opening to the ventilation device?

Answer 34

LMA

Disadvantage does not provide aspiration protection

Question 35

The LMA can be used as an ET tube guide, allowing for intubation with what size tube?

Answer 35

6.0

Question 36

What airway when properly placed in the esophagus, can an ET tube inducer be used, in order to intubate the patient?

Answer 36

King LT-D

Question 37

Name the two methods of securing a patent airway that can be used when conventional techniques and methods fail.

Answer 37

The open Cricothyrotomy and the translaryngeal catheter ventilation (nonsurgical or needle Cricothyrotomy)
p. 824

Question 38

What vessels are located near the Cricothyroid membrane?

Answer 38

The superior Cricothyroid vessels are located at a transverse angle across the upper third of the cricothyroid membrane. The external jugular veins run vertically and are located lateral to the cricothyroid membrane
p. 824

Question 39

When is an open cricothyrotomy indicated and when is it not?

Answer 39

Indicated when a patent airway cannot be secured by a more conventional means, as in extreme facial trauma or upper airway obstructions and swelling It is not indicated if the patient can be effectively ventilated with a bag mask ventilation technique or > 8 yo.
p. 824

Question 40

Displacement of the ET tube during a cricothyrotomy should be suspected when…

Answer 40

Subcutaneous emphysema is encountered by air infiltrating the subcutaneous fat and characterized by a crackling sensation.
p. 826

Question 41

Name that landmarks associated with a Cricothyrotomy.

Answer 41

Palpate for the V notch of the thyroid Cartlidge. Slide down into the depression between the thyroid and cricothyroid Cartlidge, this is where you make a 1 to 2 cm vertical incision.
p. 826

Question 42

What size ET tube is used in the cricothyrotomy?

Answer 42

6. 0 and the bottom 1/3rd is cut off.

p. 826

Question 43

Describe the process for a needle cricothyrotomy.

Answer 43

A 14-16 gauge needle is inserted at a 45° angle caudally, into the cricothyroid membrane. The catheter is left in place and hooked to a high-pressure jet ventilator. This method allows for future intubation.
p. 829