Airway Management PPT Flashcards
3 Axis of airway
Oral/Pharyngeal/Laryngeal
Airways aligned
Sniff and Neck Extension
Problems with bad alignment
- Don’t have clear path for ventilation
2. Soft tissue can fall back and cause apnea in severe cases (obese patients)
Good airway looks like…
Nose above abdomen
Advantages of aligning the airway (3)
- Airway “more open” and easier to breathe
- Easier to ventilate the patient
- Better view of the vocal cords
4 Types of Airway Obstruction
- Soft Tissue (tongue/obese patients)
- Airway swelling (Edema/trauma/burn patients/pregnancy)
- Laryngospasm (risk every time in extubated)
- Bronchospasm (risk is patients are intubated “lightly”)
- Patient still has reflex to protect the airway
Soft Tissue Obstruction
tissue falls against the pharynx (sedated/unconscious)
Soft Tissue Ob cases (3)
- MAC anesthesia (sedated patients)
- Right after induction of GA (before LMA/ETT inserted)
- After extubation (still not awake)
Is soft tissue obstruction a problem during GA?
No, LMA or ETT will be placed and tube will bypass the tongue.
Soft Tissue Treatment (4)
- Chin lift
- Jaw thrust
- Nasal Airway
- Oral Airway
Chin Lift
- indicated for minor airway obs.
- aligns the 3 axis’
Jaw Thrust
- opens airway by lifting soft tissue off the pharynx
- stimulates respirations with pain
- behind mandible
Double handed jaw thrust
best opportunity to get a good mask seal and the best opportunity to mask ventilate the patient (requires a 2nd provider to squeeze bag)
Oral/Nasal Airways
lift tongue off posterior pharynx
Oral airway
unconscious patients only, can cause gagging
Nasal airway
- tolerated better in awake patients
- contraindicated with patients on blood thinners/facial fractures
Proper sizing of oral airway
One end at the lips/ the other end at the angle of mandible
Proper sizing of Nasal Airway
- distance from the nares to the meatus of ear
- diameter of the patient’s smallest finger
Anaphylaxis
allergic reaction that can cause severe swelling within the airway
Swelling causes (5)
- Traumatic intubation/multiple laryngoscopies
- Anaphylaxis
- Burned patient
- Fluid overload
- Pregnancy
Swelling Treatment (4)
- Steroids (Decadron)
- Diuretics
- Leave the patient intubated
- Epinephrine (if anaphylaxis is the cause)
Laryngospasm
vocal cords snap shut
Causes of laryngospasm
- ETT during extubation
- Airway secretions (mucus, saliva, blood)
- Vocal cords must be stimulated during “light anesthesia” (stage II)
- CANNOT occur when patient is deep asleep.
- Stimulation of superior laryngeal nerve (branch of vagus nerve)
When will a patient most likely experience a laryngospasm?
Stage II (half asleep)
Is extubating a patient during stage II anesthesia a good idea?
No, pulling tube out during this time will stimulate the vocal cords.
Laryngospasm Treatments (4)
- High jaw lift at laryngospasm notch (breaks larnygospasm when combined with positive pressure)
- Positive airway pressure with bag and mask (Double handed jaw thrust w/ bag squeezing/only to 20 cmH20, protects air from going into esophagus)
- Propofol (relaxes vocal cords by taking patient from stage II to stage III.
- Succinylcholine
Bronchospasm
narrowing of the bronchioles caused by inflammation or constriction if lungs become irritated. (smokers and asthmatics more susceptible)
Causes of bronchospasm (5)
- ETT irritating the lunch if patient not anesthetized deeply enough
- Emergence from anesthesia
- Desflurane (most pungent volatile agent)
- Anaphylaxis
- Aspiration
Treatment for bronchospasm caused by light anesthesia
- give more propofol and/or give more volatile agent–> put them more to sleep
- ETT need to be paralyzed or deeply anesthetized
If patient is in emergence from anesthesia, how would you treat a bronchospasm?
Give albuterol (best 2 agonist/bronchodilator) inhaler via the ETT (60 mL syringe)
How would you treat a patient with a bronchospasm caused by Anaphylaxis?
Give bronchodilators (3)
- Epinephrine (~300 mcg IM)
- Best 2 agonists
- albuterol inhaler
- subcutaneious terbutaline (0.25mg)
- Volatile agent (isoflurane or sevoflurane)
Coughing Prevention on ETT
- Lidocaine jelly or LTA kit (more effective/releases in 360 degrees)
- patient paralyzed or deeply anesthetized
Coughing treatment on an ETT
- Turn off ventilator (can resume once cause of coughing is treated)
- Dose muscle relaxant (Zemuron) or deepen anesthetic (narcotics or higher conc of volatile anesthetic)
Regurge (Passive Reflux
reduction in tone of the lower esophageal sphincter (LES).
How can regurge (passive reflux) be prevented?
Sellick’s maneuver: applying cricoid pressure to prevent reflux through the esophagus. This also improves intubation view.
Is vomiting an active or passive reflux?
Active: patient is treated with aggressive suctioning and them in Trendelenburg with their head tilted to the side. (Cricoid pressure controversial due to esophageal ruptures.)
Aspiration
Gastric contents enter the trachea/lungs.
What should you do if a patient aspirates?
Patient should be intubated and sent to the ICU. Could be placed on prophylactic antibiotics and possibly steroids.
