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Patient Monitoring/Instrumentation & SIM > Airway Management-SIM > Flashcards

Airway Management-SIM Flashcards

1
Q

What is the “sniff position”

A

Supine with a pillow
Airway axes are aligned
Extend neck for maximum alignment

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2
Q

True/false: When a patient is supine and laying flat without a pillow, their airway axes are aligned

A

False

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3
Q

What are causes of airway obstruction?

A

Soft tissue obstruction, airway edema, laryngospasm, bronchospasm,

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4
Q

What are advantages of using the “sniff position”

A
  1. A patient’s airway is more open (easier to breathe)
  2. Easier to ventilate
  3. Better view of vocal cords
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5
Q

When do we encounter soft tissue obstruction?

A
  1. MAC anesthesia
  2. Right after induction for GA, before the ETT is inserted
  3. After extubation if a patient is not yet awake
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6
Q

What are treatments for soft tissue obstruction?

A
  1. Chin lift
  2. Jaw thrust
  3. Oral airway
  4. Nasal airway
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7
Q

What are the downsides to using oral airways?

A

They can cause gagging in awake patients, so must be placed when they’re unconscious
Can possibly injure teeth if the patient bites down

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8
Q

What are the downsides to using nasal airways?

A

Can cause nosebleeds (epistaxis)

Cannot be used with facial fractures

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9
Q

How does vasodilation lead to edema?

A

When the blood vessels vasodilate, they allow blood to leak out into the interstitial space. The increased fluid in the interstitial space causes edema.

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10
Q

What are two common causes of vasodilation induced edema?

A

Injury and anaphylaxis

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11
Q

What happens when a patient has an anaphylatic reaction?

A

Mast cells destabilize and release histamine

A massive histamine release causes vasodilation and bronchoconstriction

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12
Q

How does epinephrine treat anaphylaxis?

A

Causes vasoconstriction and bronchodilation

Also stabilizes mast cells and curbs the future release of histamine

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13
Q

List 5 ways you can treat anaphylaxis

A
  1. Epinephrine
  2. Beta 2 agonists (Bronchodilators)
  3. Volatile agent (isoflurane or sevoflurane)
  4. Antihistamines
  5. Steroids
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14
Q

What are etiologies to airway swelling?

A
  1. Burn victims
  2. Allergic reactions/anaphylaxis
  3. Traumatic intubation/multiple laryngoscopies
  4. Pregnancy
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15
Q

What is the etiology of a laryngospasm?**

A

Stimulation of the superior laryngeal nerve (branch of the vagus nerve/CN X)

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16
Q

What causes simulation of the superior laryngeal nerve?

A

ETT during extubation

Airway secretions

17
Q

Why must a patient be suctioned prior to extubation?

A

Airway secretions can cause a laryngospasm

18
Q

What stage of anesthesia does a laryngospasm occur in?

A

Stage II

19
Q

True/false: You should NEVER extubate a patient during stage II anesthesia

A

True-the patient is not fully awake and cannot follow commands, they are at risk for a laryngospasm

20
Q

What are treatments for a laryngospasm?

A
  1. High jaw lift at “laryngospasm notch” (jaw thrust)
  2. Positive airway pressure with bag and mask
  3. Propofol
  4. Succinylcholine (4-6 mg/kg if IM)
21
Q

Who is more prone to airway irritation and bronchospasm?

A

Smokers and asthmatics

22
Q

Narrowing of bronchioles caused by inflammation or constriction, can occur if the lungs get “irritated”

A

Bronchospasm

23
Q

How do you prevent bronchospasms in a patient that is intubated?

A

Prior to intubation, coat ETT in lidocaine or LTA

Give more propofol and/or more higher concentrations of the volatile agent

24
Q

How do you treat bronchospasms at the end of a surgery?

A

Give an albuterol (beta 2 agonist/bronchodilator) inhaler through the ETT

25
Q

How do you treat a bronchospasms caused by anaphylaxis?

A

Bronchodilators: epinephrine, albuterol, subcutaneous terbutaline (0.25 mg) injection, volatile agent (isoflurane, sevoflurane)

26
Q

How do you treat coughing with an ETT?

A
  1. Turn off the ventilator

2. Dose muscle relaxant or deepen anesthesia with narcotics and/or higher concentrations of volatile anesthetics

27
Q

Caused by a reduction in the tone of the lower esophageal sphincter

A

Regurge or passive reflux

28
Q

How do you prevent passive reflux?

A

Cricoid pressure

29
Q

What are the benefits of cricoid pressure?

A
  1. Occludes the esophagus

2. Improves intubation view

30
Q

How is vomiting (active reflux) treated?

A

Aggressive suctioning, Tredelenburg with head tilted to the side

31
Q

Gastric contents enter the trachea/lungs

A

Aspiration

Patient Monitoring/Instrumentation & SIM (12 decks)

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