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Spring 2020 - APA Foundations 1 > Airway Management - Quiz 1 > Flashcards

Airway Management - Quiz 1 Flashcards

1
Q

Difficult to Ventilate

A

When signs of inadequate ventilation cant be reversed by mask ventilation or patient’s O2 sat cant stay > 90% with mask ventilation

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2
Q

What is considered Difficult to Intubate

A

More than 3 attempts or more than 10 minutes to complete tracheal intubation

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3
Q

Difficult Airway

A

When a trained anesthetist has difficulty with mask ventilation, laryngoscopy, intubation or all three

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4
Q

What should anesthetist do prior to any airway manipulation?

A

Complete a thorough airway exam using multiple airway assesments - this will guide airway management plan

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5
Q

Causes of Difficult Intubation

A
  • Inadequate pre-op assessment
  • Anesthetist
  • Malfunctioning equipment
  • Inexperienced assistance
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6
Q

Basic Airway Evaluation in all patients

A
  • LEMON law
  • BONES
  • 4 D’s
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7
Q

LEMON Law

A
  • Look externally
  • Evaluate the 3-3-2 rule
  • Mallampati
  • Obstruction/Obesity
  • Neck mobility
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8
Q

What to look for externally for airway assessment

A
  • Short muscular neck
  • Obesity
  • Receding jaw
  • Dentures
  • Buck teeth
  • Macoglossia
  • Stridor
  • Facial trauma
  • Burns
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9
Q

3-3-2 Rule

A
  • 3 - Minimum distance the mouth should open - Inter incisor distance
  • 3 - Distance from tip of mandible to laryngeal cartilage
  • 2 - Distance from floor of mouth to prominence of laryngeal cartilage

(Distances measured in fingers)

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10
Q

Thyro-Mental Distance

A
  • Upper edge of thyroid cartilage to chin with head fully extended
  • Short Thyro-Mental Distance = Anterior Larynx
  • > 7cm usually easy intubation
  • < 6cm difficult airway
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11
Q

Mallampati Classification

A
  • Class 1: Complete view of uvula, tonsilar pillars, soft palate
  • Class 2: Partial view of uvula base, partial view of tonsils, soft palate
  • Class 3: Only soft palate
  • Class 4: Only hard plalate
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12
Q

Obstruction?/Obesity

A
  • Blood
  • Vomit
  • Teeth
  • Epiglottis
  • Dentures
  • Tumors
  • Impacted objects
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13
Q

Neck Mobility

A

Measurement of Atlanto-Occipital (AO) Angle

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14
Q

Mandibular Protrusion Test

A

Upper lip bite test.

Assess incisor length and mobility of TMJ and subluxation

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15
Q

Assessing difficulty of mask ventilation

A

BONES

  • *B**eard
  • *O**besity
  • *N**o teeth
  • *E**lderly
  • *S**noring
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16
Q

4 D’s of Laryngeal Visualization

A
  1. Disproportion
  2. Distortion
  3. Dismobility
  4. Dentition
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17
Q

4 D’s - Disproportion

A
  • Achondroplasia
  • Acromegaly
  • Prognathism
  • Pierre robin sequence - small jaw
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18
Q

4 D’s - Distortion

A
  • Neurofibromatosis - generalized bumps
  • Burn contracture
  • Cystic hygroma - fluid sac from lymph blockage
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19
Q

4 D’s - Dismobility

A
  • TM joint Ankylosis - stiff jaw
  • Klippel Fiel - fusion of neck vertebra
  • Advanced ankylosing spondylitis - neck stiffness
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20
Q

Patient conditions that make bag mask ventilation difficult?

A
  • Seal: Beards, anatomy, NG tube
  • Obstruction
  • Obesity
  • Age >55
  • Mallampati III-IV
  • No Teeth
  • Stiff lungs
  • Sleep apnea/snoring
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21
Q

Difficulty with DL or VL

A
  • If it looks difficult, it probably is
  • 3-3-2
  • Mallampati
  • Obstruction/obesity
  • Scarring, radiation, masses
  • Mobility
  • Operator experience
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22
Q

What are things that cause Difficulty with SGA (LMA)

A
  • Restricted mouth opening
  • Obstruction
  • Distortion of airway
  • Stiff Lungs
23
Q

What should be assessed if a difficult airway is anticipated?

A

Cricothyroid membrane should be identified BEFORE intervention starts

24
Q

Difficulty with Cricothyroidotomy

A
  • Neck distortion
  • Obseity/short neck
  • Trauma around neck
  • Impediments limitng access to neck (halo, fixed flexion)
  • Surgery

SHORT:

  • *S**urgery
  • *H**ematoma
  • *O**besity
  • *R**adiation
  • *T**umors
25
Q

Manuevers for Difficult Airway

A
  • Positioning - Sniffing position
  • Neck positioning - caution with neck disorders
  • Ramping - elevate shoulders, neck, head
  • Apneic oxygenation
  • Cricoid pressure
26
Q

ASA Difficult Airway Algorithm

A
27
Q

Options after airway assessment

A
  1. Awake intubation
  2. Quick look
  3. Induction and paralysis
28
Q

Awake Intubation

A

Patient needs to be awake. Big risk of complications if sedatives/muscle relaxants given before airway control

29
Q

Quick Look

A

Patient can be sedated for attempt of direct laryngoscope WITHOUT muscle relaxant

Some risk of failed laryngoscopy, but low risk of failed mask ventilation

30
Q

Induction and Paralysis

A

Patient can be induced and paralyzed when there is low risk of difficult laryngoscope and/or mask ventilation

31
Q

How much is enough Pre-Oxygenation

A

Two Techniques

  1. Tidal Volume Breathing (TVB) of oxygen for 3-5 min
  2. Deep breaths (DB) 4 times in 30 secs

Both equally effective in increasing arterial oxygen tension (PaO2)

32
Q

Why does Failure of airway access happen?

A
  • No discussion with colleagues about plan
  • No request for experienced help
  • Exaggerated idea of personal ability
  • Bad plan A or plan B
  • Poor execution of Plan A or Plan B
  • Trying Plan A for too long
  • Starting rescue plan too late
  • Not involving and preparing surgical colleagues
33
Q

Development of Primary and Alternative Strategies

A
34
Q

Difficutly Areas to Indentify

A
  • Bag Mask Ventilation (BMV)
  • Direct Laryngoscopy (DL) and Video Laryngoscopy (VL)
  • Supraglottic Airway Ventilation
  • Cricothyrotomy Airway Placement
35
Q

What does the use of face mask, LMA anesthesia, local anesthesia infiltration, or regional block usually imply?

A

Mask ventilation will not be problematic

36
Q

What to consider when initial intubation attempts are UNSUCCESSFUL after Induction of General Anesthesia?

A
  1. Call for help
  2. Returning to spontaneous ventilation
  3. Awakening the patient
37
Q

Algorithm

A
38
Q

Airway Tools

A
  • LMA SGA
  • Larygoscope Blades
  • LMA as intubation conduit
  • Fiberoptic Intubation
  • Intubating Stylet
  • Tube Changer
  • Light Wand
  • Blind oral/nasal intubation
  • Invasive Airway Access
    • Jet ventilation, Percutatneous Intubation, Retrograde Intubation, Surgical airway
39
Q

4 Plans For Airway Access

A
40
Q

Types of Laryngoscope Blades

A

Mac

MIller

Wis

Heine

41
Q

SGA/LMA

A
  • Provide ventilation above glottic opening
  • Sizing - kg weight
  • Slide along top of mouth, often folded w/ resistance
  • Intubating LMA for difficult airway
  • Combitube, King LT - Retroglottic/Infraglottic
42
Q

LMA Sizing

A
43
Q

Types of Intubation Stylets

A
  • Trachlite
  • Eschmann Stylet (Bougie)
  • Cook airway exchange catheter
44
Q

Types of Video Assisted Larygoscopy

A

Glidescope
Karl Storz C-Mac
McGrath VL
Airtraq Optical Laryngoscope

45
Q

Indication for Fibertopic Intubation

A
  • Patient awake and sedated
  • Anticipated Difficult Airway
  • Cervical Spine Immobilzation
  • Anatomical Abnormalities of Upper Way
  • Failed intubation attempt, but mask vent possible
46
Q

Subglottic Interventions/ Emergency Airway Access

A

Needle Cricothyrotomy with Jet Ventilation

Surgical Cricothyrotomy

Retrograde Intubation

Tracheotomy

47
Q

What should be used for Unexpected Difficult Airway

A

Difficult Airway Cart

  • Larygoscope - multiple blade types and sizes
  • ETTs, Combitube
  • Tube Exchangers, guides, introducers, LMA
  • Bougie, Stylet
  • Cricoidthyrotomy tray
  • Fiberoptic equipment
  • Suction
  • Tube Securing Device
  • CO2 Detector
48
Q

Difficulties - Upper Airway Obstructions

A

Emergency

Hoarse, muffled voice, difficulty swallowing secretions, stridor, dyspnea

49
Q

Difficulties - Lower Airway Obstructions

A

High peak pressures, low tidal volumes, impaired ventilation

Manage by optimizing ventilation and oxygenation

50
Q

Difficulties - OSA

A

Bring CPAP to use in PACU

51
Q

Managment of Obesity Difficulties

A

Position, Preoxygenate, 2nd Plan, Alternate Adjuncts, Assistants

Will Desat much quicker, limit time delay

52
Q

Criteria for Tracheal Extubation

A
  • Acceptable hemodynamic status
  • Normothermia
  • Ability to maintain airway
  • Adequate muscle strength
  • Adequate respiratory mechanics
  • Ability to maintain adequate oxygenation
53
Q

Complications of Intubation

A
  • Dental - most common
  • Vocal cord paralysis, granuloma formation, arytenoid dislocation, subluxations
  • Esophageal laceration
  • Aspiration
  • Esophageal (Goose) Intubation
  • Endobronchial Intubation
  • Kinking, biting, mucus plug of tube, cuff damage
54
Q

7 P’s of Preparation

A

Pre-Oxygenation

Pre-Treatment

Paralysis

Protection

Positioning

Placement (with Proof)

Post-Intubation Management

Spring 2020 - APA Foundations 1 (10 decks)

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