Airway Management/Mask/Intubation

Question 1

Release jaw during expiration to prevent

Answer 1

ballvalve

Question 2

describe One-handed bag-mask Ventilation

[EC clamp]

Answer 2

Mask is held with left hand, bag in right hand
Downward pressure using thumb and index finger
Middle & ring fingers on mandible not soft tissue extending jaw

Question 3

describe Two-handed mask ventilation

[TE clamp]

Answer 3

Both hands on mask, bag handled by 2nd person
Thumbs pressing mask downward against face
Index fingers on mandible moving it anteriorly
Jaw thrust
Atlanto-occipital joint extention

Question 4

What is a very IMPORTANT value to monitor during ventilation?

Answer 4

CO2

Question 5

4 disadvantages of MAC without Artificial Airway

Answer 5

-Airway tone reduced
-Tongue obstructs
-Difficult to detect apnea
-Difficult to detect reduced airflow and volume
Rocking and reduced chest wall movement

Question 6

where is the tongue when airway is obstructed?

Answer 6

the tongue and epiglottis fall back to the anterior posterior wall

Question 7

What leads to obstruction in an anesthetized patient?

Answer 7

loss of airway muscle tone

Question 8

7 Indications for Tracheal Intubation

Answer 8

1. Airway protection
2. Initiate and maintain patent airway
3. Pulmonary toilet needed
4. Positive pressure ventilation
5. Long surgical procedures
6. Airway compromise, inaccessible/shared airway
7. Inability to maintain control with mask

Question 9

what type of patients are in need of tracheal intubation for Airway protection purposes?

Answer 9

Full stomach, pregnancy, aspiration risk

Question 10

do Paralyzed patients need tracheal intubation?

Answer 10

yes! Positive pressure ventilation

Question 11

why do you need two laryngoscope handles?w

Answer 11

in case the battery is out on one of them

Question 12

Laryngoscope straight blade?

Answer 12

miller

Question 13

laryngoscope curved blade?

Answer 13

macintosh

Question 14

Lifts the epiglottis directly

Epiglottis is lifted out of the line of vision; better for “anterior” larynx

Answer 14

miller blade

Question 15

compare miller to mac blade in regards to size

Answer 15

Smaller than the curved “Mac” and fits in mouths with smaller opening

Question 16

Tip placed in the vallecula to indirectly lift the epiglottis, thus minimizing trauma

Answer 16

macintosh blade

Question 17

what does a mac blade do to the tongue

Answer 17

Better displacement of the tongue leftward for better visualization
Less temptation to “lever” against the upper teeth

Question 18

Transparent, non-irritating polyvinyl chloride

Softens and molds to contour of airway

Answer 18

Endotracheal Tubes

Question 19

how are Endotracheal Tubes measured

Answer 19

mm and measures the internal diameter of the tube

Question 20

High volume cuff =

Answer 20

greater seal area, less pressure, less injury

Question 21

you want the cuff pressure to be inflated __ why?

Answer 21

<20 torr, trachea capillary perfusion pressure 30 torr

Question 22

low volume cuff =

Answer 22

Low seal area, high pressure seal, more effective, more ischemia

Question 23

what are the 4 American National Standard for Anesthetic Equipment Markings on the ETT

Answer 23

Internal diameter (I.D.) in mm
External diameter (O.D.) in mm
Certification of “Implantation Testing” (I.T.)
Radiopaque line to allow visualization on x-ray

Question 24

what has greatest effect on ETT to the resistance to flow

Answer 24

Radius of ETT

Question 25

why choose small ETT?

Answer 25

to minimize trauma, short term intubations

Question 26

other than cause tracheal seal, what does ET cuff do?

Answer 26

Allows positive-pressure ventilation | Minimizes aspiration risk

Question 27

Hi-Lo = High volume Low Pressure cuff characteristics

Answer 27

Larger mucosal contact Lower incidence of mucosal damage Higher incidence of sore throat, aspiration, spontaneous extubation, and difficult intubation (bigger, floppy cuff) “Minimal leak” – pressures of 15-25 torr

Question 28

Low volume, High Pressure cuff characteristics

Answer 28

Higher incidence of tracheal mucosal ischemic damage Only for use in short duration Can have pressures up to 250 torr on tissues

Question 29

4 Factors affecting Cuff pressure

Answer 29

Volume of air used to inflate cuff Diameter of the cuff in relation to the trachea Tracheal and cuff compliance Intrathoracic pressure – cuff pressures increase with coughing

Question 30

what can diffuse into the air-filled cuff to increase the pressure?

Answer 30

nitrous

Question 31

Factors to consider ETT size?

Answer 31

``` Size of patient’s glottis Reason for intubation Pathology of the airway Attempts allowed (only one attempt – smaller) Length of intubation Maturity of airway ```

Question 32

average ETT size female?

Answer 32

7-7.5 mm

Question 33

average male ETT size?

Answer 33

7.5-9 mm

Question 34

Reinforced with wire in the wall of the ETT to resist kinking Head and neck surgeries, prone cases

Answer 34

Anode or armored tube

Question 35

what happens if wall of anode or armored tube becomes bent?

Answer 35

you have to replace it

Question 36

Very floppy, requires stylet for insertion

Answer 36

Anode or armored tube

Question 37

Preformed with angles placed at the site of emergence from the nose or mouth to minimize kinking and obstruction to flow.

Answer 37

Nasal Rae and Oral Rae TT

Question 38

tube directed toward the forehead

Answer 38

nasal rae

Question 39

tube directed toward the chin

Answer 39

oral rae

Question 40

Made of silicone impregnated with metal particles, spiral wound stainless steel ETT, or wrapped with metal foil Prevent puncture or ignition by laser heat

Answer 40

Laser-shielded tubes

Question 41

how should you fill cuffs of laser shielded tubes?

Answer 41

The cuff remains unprotected and should be filled with methylene blue stained saline so that perforation may be quickly recognized.

Question 42

Double lumen used for selective one-lung ventilation The bronchial tip is placed in a main bronchus. Has both a tracheal cuff and a bronchial cuff.

Answer 42

endobronchial tube

Question 43

nasal ETT characteristics

Answer 43

- Softer plastic to minimize trauma to nasal mucosa - Ring on connector end; tension causes the cuffed end to angle upward to direct the tip anteriorly during nasal intubation.

Question 44

use for Uncuffed ETT?

Answer 44

Pediatric use Minimize postintubation croup

Question 45

why use a bougie?

Answer 45

Inability to visualize glottis or guide ETT into proper position – insert distal tip of bougie over arytenoids – slide ETT over guide as CVL are slid over a guidewire into a vessel

Question 46

Anesthetizes airway blunting stimulation of laryngoscopy, reflexes. Minimizes irritation of propofol

Answer 46

2% lidocaine, local anesthetic

Question 47

Blunt stimulation and reflexes and SNS outflow due to laryngoscopy

Answer 47

IV narcotics

Question 48

patient is unconscious with suppression of reflexes

Answer 48

IV anesthetic: (propofol, thiopental)

Question 49

Facilitates ventilation bag mask by relaxing muscles of neck, jaw and thoracic cage. Allows atraumatic tracheal intubation by opening cords

Answer 49

paralytic

Question 50

goal of positioning for tracheal intubation

Answer 50

align 3 airway axes; oral, pharyngeal and laryngeal (some refer to as tracheal axis) smallest intubation triangle possible

Question 51

where do you insert blade of laryngoscope?

Answer 51

right side

Question 52

grade 1

Answer 52

no difficulty seeing structures

Question 53

grade 2

Answer 53

only posterior extremity of glottis seen

Question 54

grade 3

Answer 54

only epiglottis seen

Question 55

grade 4

Answer 55

no recognizable structures

Question 56

what does BURP stand for and why would you do this

Answer 56

Backward – posteriorly against vertebrae Upward - cephalad Right Pressure improve view of cords

Question 57

average ETT positioning marking?

Answer 57

20 for female, 22 male

Question 58

most reliable way to verify ETT placement?

Answer 58

ventilation

Question 59

ways to verify ETT placement?

Answer 59

Chest rise ETT fogging Bilateral breath sounds, also listen over epigastrium ETCO2 – does not rule out endobronchial intubation

Question 60

Indications, advantages for nasal intubations

Answer 60

Oral intubation difficult – awake patient Oral placement would interfere with surgical site Anticipate prolonged intubation More stable ETT fixation More tolerable technique to conscious patient

Question 61

Disadvantages nasal intubations

Answer 61

Tissue trauma – nasal mucosa, epistaxis, incidental adenoid damage Transmission of infection (URI) to trachea and lungs If smaller tube, increased resistance and secretions more difficult to suction.

Question 62

patients that nasal intubation contraindicated

Answer 62

mid-facial trauma, fracture nose, nasal obstruction, or basilar skull fracture

Question 63

cetacaine (benzocaine) can cause methemeglobin with doses

Answer 63

>200-300 mg (1.5 ml)

Question 64

cetacaine (benzocaine) use

Answer 64

Effective only on mucus membranes | Controls pain, gag reflex

Question 65

how do you introduce tube during nasal intubation?

Answer 65

with bevel directed laterally to avoid damage to turbinates

Question 66

describe angles of tube during nasal intubation

Answer 66

Insert the ETT along the floor of the nose – the angle should be perpendicular to the face and the proximal end should be angled from the cephalad side.