Airway Management & Intubation Equipment Flashcards

1
Q

Anesthesia Defined

A

total lack of awareness or a lack of awareness of a part of the body

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2
Q

GA Induction Sequence

A

Monitor application, pre-oxygenation, induction agents given, airway support through masking, LMA or ETT placement

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3
Q

Pre-Oxygenation

A

Increasing apnea threshold by filling FRC with oxygen

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4
Q

Functional Residual Capacity

A

Lung volume at end of normal exhalation- about 2.5 liters

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5
Q

Residual Volume

A

1.25-2 Liters

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6
Q

Tidal Volume

A

0.5-0.6 Liters

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7
Q

Expiratory Reserve Volume

A

1.25 liters

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8
Q

Vital Capacity

A

3.5-5.5 Liters

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9
Q

Total Lung Capacity

A

6 liters

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10
Q

Typical Mask Induction Sequence

A

Place monitors (sometimes just pulse ox), N2O then add Sevo, gentle mask ventilation until IV placed (patients susceptible to obstruction, laryngospasm & bradycardia during this time), airway placement after IV placed (if no IV MUST have backup plan)

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11
Q

What causes a Laryngospasm**

A

Mediated by the superior laryngeal nerve in response to irritating glottic or supraglottic stimuli such as presence of food, blood, vomit or airway secretions. Occurs most frequently with light anesthesia upon induction or emergence.

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12
Q

What happens during a laryngospasm**

A

False cords and epiglottic body come together firmly and allow no air flow and no vocal sound

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13
Q

Laryngospasm treatment***

A

Forward displacement of jaw, apply positive pressure with 100% oxygen, potentially give succinylcholine (0.1-1mg/kg) and re-intubate, let hypercarbia and hypoxia develop and it may break

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14
Q

Rapid Sequence Induction indications

A

Full stomach, severe GERD, anticipated difficult mask/intubation

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15
Q

Rapid Sequence Induction steps

A

Pre oxygenate up to 5 minutes, IV anesthetic, rapid-onset NMBA (succ), cricoid pressure, intubate, release cricoid after confirmation of ETT placement

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16
Q

Modified Rapid Sequence Induction

A

may mask with gentle pressure while maintaining cricoid pressure, if you need extra oxygenation or feel the need to see if patient has good mask airway

17
Q

Basis of Cricoid Pressure

A

Pressure on the front of the cricoid cartilage is transmitted to posterior lamina, occludes esophagus by compression against vertebral bodies

18
Q

Cricoid Disadvantages

A

Reduces tone of lower esophageal sphincter- risk of regurgitation from stomach to esophagus increases, impair insertion of laryngoscope, degrade view of larynx, impede passage of tube, cause airway obstruction, fracture, rupture of esophagus

19
Q

Mallampati Classes

A

Class 1 - visualize pillars, uvula, hard palate, soft palate. Class 2- visualize some pillars, portion of uvula, hard palate, some soft palate.
Class 3- visualize little bit of pillar, hard palate, maybe part of soft palate/uvula
Class 4- only see hard palate

20
Q

Mallampati Grades

A

Grade 1- see epiglottis, vocal cords, everything
Grade 2- see posterior arytenoids, epiglottis, part of cords
Grade 3- see epiglottis
Grade 4- cant even see epiglottis

21
Q

How to optimize visualization

A

“OPT” have oral, pharyngeal & trachea in line in sniffing position

22
Q

Curved blade intubation

A

Curved blade goes into vallecula- upward force brings posterior pharynx & vocal cords into view- displaces tissue & tongues and visualizes cords

23
Q

Straight blade intubation

A

Deliberately direct blade to right paraglossal space, no tongue should be present to right of blade, direct blade medially, trap epiglottis under blade tip, rock blade slightly backward

24
Q

Adult sizing for ETT (circumference)

A

Usually about 7.0-9.0 mm

25
Q

Children sizing for ETT

A

Age divided by 4 + 4 (If you have a 5 year old – 5/4 + 4 = 5)

26
Q

Children depth of ETT

A

ETT size x 3

27
Q

Poiseuille’s Law

A

Resistance increases as radius decreases by radius^4

28
Q

Microlaryngoscopy Tube

A

Small diameter, longer ETT

29
Q

When would you not use PVC ETT?

A

Laser surgeries! It is flammable. Use Laser-Shield (aluminum wrapped, silicone based tube & cuff)

30
Q

RAE ETT

A

Ring, Adair & Edwin- used for nasal intubation or oral intubation

31
Q

Nasal intubation insertion

A

Place ETT in warm saline, mix afrin with 2% lidocaine jelly, dilate nasal passage with nasal trumpets lubricated with above solution, uce McGill forceps to guide tube (usually need external laryngeal manipulation)

32
Q

Complications of supraglottic airway

A

sore throat, trauma, nerve injury including hypoglassal (vocal cord paralysis, excessive high cuff pressures, N2O use), gastric distention/aspiration

33
Q

Complications of ETT

A

Sore throat, vocal cord damage, cuff pressure erosion of mucosa (N2O use), damage to teeth/mouth with DL, bronchial irritation/spasm, pneumothorax/barotrauma, aspiration, esophageal intubation

34
Q

Contraindications to supraglottic airway

A

Prone position, obesity, severe lung disease, pregnancy, laparoscopic surgery, GERD, full stomach, long case, need for postoperative ventilation, maliampati score of III or above, trismus, limited mouth opening, airway pressure above 40 cmH2O

35
Q

ASA Difficult Airway Algorithm

A

1) Assess likelihood & clinical impact of difficult ventilation/intubation/patient cooperation/tracheostomy
2) Actively pursue opportunities to deliver supplemental oxygen throughout process
3) Consider relative merits and feasibility of basic management choices (awake, attempts, etc)
4) Develop primary & alternative strategies– awake intubation versus intubation attempts after induction of general anesthesia.
5) If after induction of GA & attempts unsuccessful– consider calling for help, returning to spontaneous ventilation & AWAKENING THE PATIENT**, face mask ventilate, consider LMA

36
Q

Rigid Fiberoptic Laryngoscopes - names & use

A

Bullard or Upsher, use to elevate jaw without extension of neck and useful with small mouth opening

37
Q

Bougie use

A

If you can only see posterior arytenoids

38
Q

Video laryngoscope name & use

A

Airtraq, CMAC provides wide-angle view