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Anaesthesia > Airway Mx And Adjunct > Flashcards

Airway Mx And Adjunct Flashcards

1
Q

Causes of airway obstruction

A
  • tongue in unconscious pt (commonest)
  • foreign body: vomitus, blood, teeth
  • inflammation/infection: epiglottitis, croup, abscess
  • tumours: polyps, larynx ca
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2
Q

Signs of airway obstruction

A
  • stridor
  • hoarseness
  • dysphagia/drooling
  • paradoxical see saw breathing
  • use of accessory muscles
  • intercostal/subcostal recession
  • cyanosis
  • decreased/absent breath sounds on lung auscultation
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3
Q

Mx of airway obstruction

A

Basic manouver
- head tilt chin lift
- jaw thrust
- orophryngeal or nasopharyngeal airway
- foreign body airway obstruction

Advanced airway
- supraglottic airway device (SAD) insertion
- endotracheal intubation
-cricothyroidotomy
- tracheostomy

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4
Q

Mx of airway obstruction

A
  • antibiotics for infection (epiglotitis)
  • nebulised adrenaline for airway edema
  • nebulised budesonide for croup
  • endoscopy/bronchoscopy to remove foreign body/aspirate from upper or lower airways
  • surgical removal of polyps/tumours of airway
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5
Q

How to do head tilt chin lift

A

-hand is placed on pt forehead and firm backward pressure is applied
- this relieves minor obstruction

  • with the other hand, chin is gently lifted to displace tongue anteriorly
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6
Q

How and when to do jaw thrust

A
  • grab and lift angle of mandible upwards
  • if mouth closed, push open with thumbs
  • do in the presence or suspicion of cervical spine injury
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7
Q

How to confirm ETT placement (signs of successful seal and ventilation)

A
  • direct visualization of ETT tip passing tru vocal cords
    -foggy mask/water vapour in ETT
  • equal chest rise on manual ventilation
  • breath sounds on auscultation (5 points: 2 infraclavicle, 2 inframammary, 1 epigastric)
  • CXR
  • return of/ end tidal co2 on exhalation capnography
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8
Q

Indications of ET tube

A
  • inadequate oxygenation not corrected by oxygen mask
  • inadequate ventilation
  • to control & remove pulmonary secretions
  • to protect airway in patients with depressed gag reflex eg; obtunded unconscious patients
  • to secure airway eg burns, facial injuries
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9
Q

Essential equipment for ET

A

MMALESSSS)

M- mask with bag valve device (oxygen)
M- magills forceps
A- airways (oropharyngeal, nasopharyngeal)
L- laryngoscope
L- lubricant
E- endotracheal tubes
S- supraglotic airway device (SAD)
S- stylet/bougie
S- suction apparatus
S- stethoscope
S- syringe
S- securing tape/tie

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10
Q

Indication to use self inflating bag valve with face mask and example

A

Use in pt not breathing adequately or not breathing spontaneously

Examples: ambu bag, laerdal bag

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11
Q

Indication of oropharyngeal airway (OPA)

A
  • prevents tongue from falling back
  • for pt without gag reflex (unconscious): bcs if give in conscious pt, can induce retching and vomiting
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12
Q

Indication of nasopharyngeal airway

A
  • better tolerated in pt with intact gag reflex
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13
Q

How to choose the right size of oropharyngeal and nasopharyngeal airway

A

Oropharyngeal: place the airway near the pt face with flange at the corner of mouth (midpoint of incisors) and tip of airway should end at the angle of mandible

Nasophrayngeal: place the flange of airway at the tip of nose and distal end of tragus of the ear

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14
Q

Types of laryngoscope blade

A
  • miller (straight)
  • macintosh (curved)
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15
Q

Size of ET tube

A
  • women: 6.5-7.0
    -men: 7.5-9.0
  • children (1-10y): (age/4) + 4
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16
Q

Indication of SAD

A

-use in spontaneously breathing pt
- alternative to ET intubation

17
Q

Function of ETT stylet

A

Maintain ETT curvature/shape during intubation

18
Q

Airway assessment in ET tube

A

General
- obesity
- soft tissue swelling of neck
- large beard
- receding mandible
- small chin (micrognathia)
- limited range of movement of the cervical spine

Airway
- reduce mouth opening
- poor dentitian
- large tongue (macroglossia)
- deviation of trachea
- limited range of movement of the cervical spine

19
Q

Bedside test to assess airway in ET intubation

A
  • mallampati classification
  • thyromental distance
  • interincisor gap
  • sternomental distance
20
Q

Mallampati classification

A

Class 1: soft palate, whole uvula, tonsillar pillars
Class 2: soft palate, portion pf the uvula
Class 3: soft palate, base of uvula
Class 4: hard palate only

21
Q

Thyromental & sternomemtal distance

A
  • neck fully extended
  • difficult intubation predicted if
    Thyromental distance < 6cm
    Sternomental distance < 12.5cm
22
Q

Hyomental distance

A

Normal > 6cm (or > 3 finger breadth)
<4cm predicts difficult laryngoscopy

23
Q

Definition of interincisor gap

A
  • distance between with incisors with max mouth opening
  • normal > 5cm (or >3 finger breadth)

<3cm predicts difficult laryngoscopy
<2cm predicts difficult SAD insertion

24
Q

Placement of ET tube

A

Cormack Lehane (CL) score

  1. Full view of glottis and vocal cords
  2. Only part of vocal cords visible
  3. Only epiglottis visible
  4. No glottic structure visible (only tongue and/or soft palate seen)
25
Q

Complication during laryngoscopy

A
  • hypertension/tachycardia
  • bronchospasm/laryngospasm
  • trauma to teeth, gums
  • aspiration of gastric contents
  • raised intracranial and intraocular pressure
26
Q

Complications while ETT in place

A
  • ETT malposition (esophageal intubation)
  • ETT malfunction (obstruction, kinking, disconnection)
27
Q

Post intubation and late cx

A
  • sore throat, laryngitis
  • aspiration of gastric content
  • laryngeal or subglottic oedema
  • subglottic/tracheal stenosis
28
Q
  • Indication of cricothyroidotomy
  • site
  • method
A

Emergency procedure

Cant intubate cant oxygenate (CICO)
Inability to intubate in the presence of unrelieved airway obstruction

Performed at cricothyroid membrane, between thyroid and cricoid cartilage

Percutaneous needle cricothyrotomy
Surgical cricothyrotomy

29
Q

When to remove ETT

A
  • is fully conscious
  • has adequate airway reflexes
  • able to breathe spontaneously with good muscle power
  • has stable vital signs
30
Q

Site of tracheostomy

A
  • creation of stoma between 3rd and 4th tracheal ring
  • can be either temporary or definitive airway mx
31
Q

Types of oxygen therapy

A
  • variable performance device: nasal cannula, hudson face mask, partial rebreathing mask
  • fixed performance device: venturi mask, non rebreathing mask
  • positive pressure ventilation: bag mask ventilation, NIV (non invasive ventilation), invasive ventilation

Anaesthesia (5 decks)

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