Airway Management in Anes. Practice Flashcards
what are the functions of airway?
physical protection from aspiration
lymphatic protection from microorganisms
conduction of O2, CO2, Anes. agents
air conditioning (heat, humidification)
What is the anesthetists role re: the airway
Support the functions of the airway i.e…
continue physical protection, protect agains infection
support conduction
minimize heat loss and water vapor loss
what is the importance of airway management
Provide anesthesia for surgery, protection, conduction, air conditioning.
Support resuscitation (protection, oxygenation, ventilation
Provide long-term respiratory care
what can be used to support a patent airway?
physical maneuver - jaw thrust
Adjuncts - oral airway (OAW), nasal airway (NAW)
Trace airflow through oral route? Nasal route?
a) Oral cavity > oropharynx > hypopharynx > glottis > vocol cords > larynx > trachea
b) Nasal cavity > nasopharynx > oropharynx > hypopharynx > glottis > vocol cords > larynx > trachea
Tracheostomy vs laryngectomy
tracheostomy is opening made through neck into trachea through which patient can breathe … laryngectomy is removal of the larynx (or voice box)
there is a separation of the airway from the mouth, nose
what happens to airway when tone and position is lost?
obstruction
base of tongue falls on posterior pharyngeal wall causing the obstruction
what anatomic points are involved in the jaw thurst/face mask maneuver?
little finger — anterior pressure applied just behind angle of mandible, uses sliding component of Temporomandibular joint (TMJ) to move the mandible, hyoid bone, and attached structures
Middle and ring finger — grasp bony mandible to facilitate extension of atlantoocipital joint
What mask points are involved with jaw thrust/face mask technique?
thumb and index finger on body of face mask (one hand technique)
thumbs only on body of mask when 2 handed technique is used
How do you maintain a gas-tight seal?
press the mask down onto the face by using your thumb and index finger while pulling the mandible up with the middle and ring finger
what are two types of oral airway?
guedel
berman
What are the structural differences?
Guedel - central lumen
Berman - cental I beam, side air channels
How do you size an Oral Airway (OAW)?
measure from the angle of the mandible to the corner of the mouth.
How do you insert an OAW with minimum trauma?
using a tongue depressor, depress the tongue and insert the OAW with body curvature toward palate. the distal end of the OAW should be turned or inserted in a manner that does NOT scrape the palate
contraindications for OAW
patient is conscious, has a gag reflex, or there is some foreign body blocking the airway
how do you size a nasal airway (NAW)
flange of NAW at nare and extend body to the tragus (or external meatus)
how do you insert a NAW with minimal trauma?
- Lubricate thewith water soluble jelly/lubricant.
- Place in the larger nostril with the bevel towards the nasal septum.
- Be sure the NPA follows the curve of the floor of the nose.
- When the right nostril is being used make sure the bevel faces the septum and insert until the flange rests against the nose. When using the left nostril you may need to have the bevel pointing upwards and turn 180 degrees when inserting. Again, the flange should rest on the nostril when fully inserted.
what are contraindications for NAW?
pt is on anticoag. therapy
nasal trauma
what are some anatomic considerations for insertion of a NAW?
penetration of base of skull into the brain
nasal concha
What is the correct path for NAW insertion?
perpendicular to the long axis of the patient
what are risks associated with NAWs and other instrumentation of the nasal passage?
mucosal trauma
turbinate fracture
epistaxis
acute sinusitis
failure to instrument
penetration of the base of skull
What is the official name of the AMBU bag?
hand operated, self-inflating resuscitation bag
Schematic of AMBU bag
How are inspiratory and expiratory gas flows directed in hand-operated, self inflating bag?
inspiratory - gas flows from ventilatioin bag (bag deflates) through one way patient valve to patient
expiratory - gas from patient and is vented to atmosphere. The bag inflates, the negative pressure pulls ambient air in through the one way inlet/intake valve.
what is the ID of a Face mask connection?
22 mm
How do you size a face mask?
It should sit over the bridge of the patient’s nose with the upper
border aligned with the pupils. The sides should seal just lateral to
the nasolabial folds with the bottom of the face mask sitting between
the lower lip and chin.
what part of the mask do you apply first to the patient’s face?
point of the mask to the bridge of the nose
Which finger is applied first to the patient for face mask technique? Where?
little finger (pinky) just behind the angle of the mandible
Name the airway
Guedel
Name the airway
berman
name the anesthesia face mask
rendell-baker-soucek face mask
