Anesthesia Equipment Part II (Ericksen) Exam 2 Flashcards
What is the Shikani Optical Stylet made of?
A. Plastic
B. Aluminum
C. Stainless steel
D. Carbon fiber
C. Stainless steel
What feature does the Shikani Optical Stylet have at its distal end?
A. Rigid tip
B. Blunt distal tip
C. Unflexible distal tip
D. Malleable distal tip
D. Malleable distal tip
Design utilizes eye piece
For what purpose does the Shikani Optical Stylet have an oxygen port?
A. For inflating a balloon
B. For oxygen insufflation if the patient desaturates
C. For oxygen and suctioning secretions
D. For medication delivery
B. For oxygen insufflation if the patient desaturates
In what position should the Shikani Optical Stylet be inserted?
A. Head-down position, inserted midline
B. Neutral position, inserted midline
C. Extended position, inserted midline
D. Flexed neck position, inserted midline
B. Neutral position, inserted midline
Available in adult and peds sizes
The Shikani Optical Stylet is advanced into the ______ with light pressure and the tip kept ______ at all times to avoid injury.
A. trachea; anterior
B. esophagus; posterior
C. trachea; posterior
D. esophagus; anterior
A. trachea; anterior
The Shikani Optical Stylet can be used for which of the following purposes? (Select 3)
A. As a light wand
B. To check ETT placement
C. For suctioning secretions
D. For placement of double-lumen ETT
A. As a light wand
B. To check ETT placement
D. For placement of double-lumen ETT
Which of the following is an advantage of using an optical stylet?
A. It is difficult to use for routine intubations.
B. Trachea is visualized, decreasing the risk of esophageal intubation.
C. It results in increased c-spine movement compared to conventional laryngoscopy.
D. It can be used for nasal intubation.
B. Trachea is visualized, decreasing the risk of esophageal intubation.
Advantages
* Easy to use for routine and difficult intubations –* not hard to use*
* Trachea is visualized, esophageal intubation should not occur (reduced risk)
* Decreased incidence of sore throat –one shot and done and you’re in
* Results in less c-spine movement over conventional laryngoscopy
What is one of the disadvantages of using an optical stylet?
A. It has a decreased incidence of sore throat.
B. It can be adjusted into a precise direction like a traditional malleable stylet.
C. It cannot be used with nasal intubation.
D. It is always faster to use compared to conventional methods.
C. It cannot be used with nasal intubation.
Disadvantages
* Longer intubation time – depends on familiarity with it
* Cannot be used with nasal intubation -
* Cannot be adjusted into a precise direction compared to a traditional malleable stylet
* Only distal portion is malleable
Video laryngoscopes such as Glidescope, Co-Pilot, King, and McGrath are considered ______ because you can have your own.
A. expensive
B. unreliable
C. cheap
D. complex
C. cheap
You can buy your own
True or False
Some scopes have curved/straight blades to mimic laryngoscopes
True
mimic miller and mac blades and can even have an exaggerated curve
One advantage of video laryngoscopes is that they provide ______ anatomy.
A. unclear
B. minimized
C. magnified
D. obscured
C. magnified
Operater and assitant can see
Video laryngoscopes may result in decreased ______ movement because the head does not have to be adjusted as much.
A. arm
B. jaw
C. L-spine
D. c-spine
D. c-spine
A limitation of video laryngoscopes is that they require a ______ system, which needs to be charged or powered by batteries.
A. video
B. manual
C. hydraulic
D. pneumatic
A. video
Portability varies, but most you can pick up and go
The strongest predictors of failure for video laryngoscopes are altered neck anatomy due to the presence of a ______ scar, radiation changes, or mass.
A. surgical
B. accidental
C. cosmetic
D. birth
A. surgical
Why might video laryngoscopes be beneficial in legal cases?
A. They are cheaper than traditional methods
B. They require less training to use
C. They demonstrate correct technique
D. They do not cause OR fires
C. They demonstrate correct technique
Video laryngoscopes might result in a further distance from ______ patients.
A. non-infectious
B. infectious
C. healthy
D. pediatric
B. infectious
Dental injury is the most frequent ______-related claim.
A. surgical
B. dental
C. medical
D. anesthesia
D. anesthesia
The most likely teeth to be damaged during laryngoscopy are the ______.
A. molars
B. canines
C. upper incisors
D. wisdom teeth
C. upper incisors
Restored or weakened teeth
Ask if their teeth are their own/real. People will sue you…..no tooth gets left behind
Tooth protectors are a “reminder” to be aware of ______.
A. the gums
B. the throat
C. the teeth
D. the hard palate
C. teeth
*Placed on upper teeth during direct laryngoscopy. *
Tooth protectors protect from the blade causing ______ damage.
A. surface
B. internal
C. lateral
D. severe
A. surface
What do tooth protectors not guarantee safety from?
A. Superficial damage
B. Dental trauma
C. Infection
D. Laryngospasm
B. Dental trauma
Help you be more vigilant. Help avoid pinching teeth with the laryngoscope blade
Cervical spinal cord injury can occur due to ______ head positioning.
A. passive
B. aggressive
C. careful
D. neutral
B. aggressive
If the head doesn’t extend.. it doesn’t extend. Won’t magically open up after induction. Don’t force extension
CHECK ROM in pre-op
Manual in-line stabilization is considered better than having a ______ in place.
A. headrest
B. neck brace
C. C-collar
D. pillow
C. C-collar
Do not remove the collar. Let the neuro surgeon remove it and do the manual in-line stabilization
DOCUMENT what has happened
Damage to other structures in the oral cavity can include abrasions or hematomas, often when the ______ gets pinched.
A. tongue
B. lower lip
C. upper lip
D. cheek
C. upper lip
sometimes lips/mouth is dry and it can get pinched between the teeth and blade
Lingual and/or ______ nerve injury is a potential complication during laryngoscopy.
A. vagus
B. hypoglossal
C. facial
D. trigeminal
B. hypoglossal
Swallowing or aspirating a foreign body such as ______ can occur during laryngoscopy.
A. a suction catheter
B. a laryngoscope light bulb
C. a syringe
D. a scalpel
B. a laryngoscope light bulb
TEETH can be swallowed as well. MRI, CT
How can arytenoid subluxation be prevented during laryngoscopy?
A. Forcing the mouth open
B. Using excessive pressure
C. Easing in gently
D. Rotating and adjusting the head
C. Easing in gently and seeing all structures
What action can lead to anterior TMJ dislocation during laryngoscopy?
A. Easing in gently
B. Not forcing the mouth open
C. Using manual in-line stabilization
D. Forcing the mouth open
D. Forcing the mouth open
The most important factor in determining resistance to gas flow in the ETT is the ______ of the tube.
A. external diameter
B. connectors
C. tube length
D. internal diameter
D. internal diameter
As the internal diameter of the tube changes and the number of connections increases, the ______ also increases.
A. flow rate
B. resistance
C. pressure
D. volume
B. resistance
*any corrugation, turns and curves.
*
Shortening the tube length will ______ resistance.
A. decrease
B. increase
C. not affect
D. eliminate
A. decrease
Making the tube longer will ______ resistance.
A. increase
B. decrease
C. not affect
D. stabilize
A. increase
Changes in configuration and the addition of ______ can also affect resistance in the breathing system.
A. cables
B. connectors
C. humidifiers
D. monitors
B. connectors
Manufacturing requirements Trachael Tube
A smooth, non-porous surface is required to prevent secretion buildup and to allow the passage of a ______ catheter or bronchoscope.
A. feeding
B. intravenous
C. suction
D. urinary
C. suction
AND prevent trauma
The tracheal tube should conform to patient ______.
A. size
B. anatomy
C. condition
D. age
B. anatomy
Which of the following are manufacturing requirements for tracheal tubes? Select 2
A. Low cost
B. High flammability
C. Lack of tissue toxicity
D. Difficult sterilization
A. Low cost
C. Lack of tissue toxicity
..Easy to sterilize (unless disposible)
Tracheal tubes should have which of the following characteristics to ensure safety and functionality? Select 2
A. Non-flammability
B. Collapsible walls with sufficient strength
C. High reaction with anesthetic agents
D. Flimsy body
A. Non-flammability
B. Collapsible walls with sufficient strength
Sufficient body to maintain its shape and not flimsy
Tracheal tubes should have a ______ reaction with ______ agents and lubricants.
A. strong, anesthetic
B. smaller, chemical
C. lack of, anesthetic
D. moderate, environmental
C. lack of, anesthetic
The Murphy eye provides an alternate pathway for ______.
A. liquid flow
B. gas flow
C. blood flow
D. air flow
B. gas flow
If bevel is occluded from secretions, the Murphy eye can allow for gas flow
Which of the following are considered disadvantges of the Murphy eye in tracheal tubes? (Select 2)
A. It is not an alternative for gas flow
B. Prevents all types of occlusions
C. Can get locked with Magill forceps
D. Located at machine end of the tube
E. Fiber optic scopes can get caught
C. Can get locked with Magill forceps and hard to removed
E. Fiber optic scopes can get caught
Tracheal tubes should be designed with which of the following features? (Select 2)
A. Circular internal and external walls
B. Square internal and external walls
C. Flat bevel at the machine end
D. Slanted bevel at the patient end
A. Circular internal and external walls
D. Slanted bevel at the patient end
Slanted bevel helps view the larynx
Tracheal tubes can be ______ at the machine end.
A. shortened
B. bent
C. elongated
D. rotated
A. shortened
The Ring- Adair- Elvin (RAE) tube facilitates surgery around the head and neck because it can be:
A. nasal or oral
B. rigid or flexible
C. long or short
D. thick or thin
A. nasal or oral
Also known as right angle tubes
They hang down over the chin and it stays out of the way
Used for head and neck cases - tosils
During insertion, the RAE tube can be temporarily:
A. bent at a right angle
B. straightened
C. folded
D. shortened
B. straightened
Can use a stylet to intubate. When stylet removed it will retain it’s curvature/shape
The increased tube diameter of the RAE tube provides an increased distance from:
A. base to tip
B. top to bottom
C. tip to curve
D. front to back
C. tip to curve
Its a little longer than an ETT
One of the advantages of the RAE tube is that it is easy to:
A. secure
B. clean
C. insert
D. remove
A. secure
Flipping down over chin, add some tape and there ya go
A disadvantage of the RAE tube is that it is difficult to pass suction or scope due to the:
A. material
B. length
C. angle
D. diameter
C. angle
The RAE tube increases airway resistance because of the added: (pick 2)
A. length
B. diameter
C. weight
D. curve
A. length
D. curve
Armored tubes are also called:
Select 3
A. flexible tubes
B. reinforced tubes
C. disposable tubes
D. standard tubes
E. anode tubes
F. spiral embedded
B. reinforced tubes
E. anode tubes
F. spiral embedded
Armored tubes are useful when the tube is likely to be ______ or compressed.
A. straightened
B. bent
C. lengthened
D. expanded
B. bent
*
Armored tubes offer resistance to:
A. heat and cold
B. kinking and moisture
C. water and moisture
D. air and gas
E. kinking and compression
E. kinking and compression
To reinforce and keep shape, inside of armored tubes can be made of:
A. plastic
B. silicone
C. stainless steel
D. rubber
C. stainless steel
spiral metal tube to reinforce shape
Armored tubes are commonly used in ______ surgeries. Select 3
A. tracheal
B. head
C. cardiac
D. orthopedic
E. neck
F. abdominal
A. tracheal
B. head
E. neck
more durable for these procedures
Armored tubes need a ______ or forceps for insertion.
A. clamp
B. stylet
C. syringe
D. scope
B. stylet
A disadvantage of armored tubes is that they are difficult to use during ______ intubation.
A. oral
B. pediatric
C. emergency
D. nasal
D. nasal
absolutely difficult
Armored tubes can be damaged when:
A. exposed to heat
B. bent
C. biting
D. cleaned
C. biting
It will bend the tube
Armored tubes cannot be:
A. sterilized
B. cleaned
C. shortened
D. reused
C. shortened
Which of the following materials are used to make laser-resistant tubes? Select 3
A. Plastic only
B. Metallic
C. Silicone
D. Glass
E. Metal mixture
B. Metallic
C. Silicone
E. Metal mixture
Laser-resistant tubes are designed to:
A. absorb the laser beam
B. reflect the laser beam
C. transmit the laser beam
D. scatter the laser beam
B. reflect the laser beam
Laser-resistant tubes are effective against:
A. CO2 or UV laser
B. KTP laster or infrared laser
C. CO2 or KTP laser
D. KTP laster or visible light laser
C. CO2 or KTP laser
The cuffs of laser-resistant tubes contain:
A. saline solution only
B. methylene blue
C. distilled water
D. alcohol
B. methylene blue crystals
Cuffs filled with methylene blue saline solution help the surgeon to:
A. inflate the tube
B. deflate the tube
C. detects tube bursts
D. secure the tube
C. detects tube bursts
True or false
Cuffs on Laser-Resistant Tubes are not laser resistant and can burst
True
Double cuffs should be filled with: Select 2
A. purified water
B. methylene blue
C. air
D. distilled water
E. saline solution
B. methylene blue
E. saline solution
The ______ cuff should be filled first in double cuff systems.
A. proximal
B. distal
C. secondary
D. primary
B. distal
If the proximal cuff is filled first, it prevents:
A. deflation of the distal cuff
B. inflation of the tube
C. proper sealing of the tube
D. filling of the distal cuff
D. filling of the distal cuff
Tube markings can be found:
A. On the bevel side above the cuff
B. On the machine side above the cuff
C. On the distal end of the tube
D. On the patient side above the cuff
A. On the bevel side above the cuff
Tube markings should be read from:
A. The proximal end to the distal end
B. The machine side to the patient side
C. The distal end to the proximal end
D. The patient side to the machine side
D. The patient side to the machine side
Safety standards for tube markings include: (Select 4)
A. The word oral or nasal or oral/nasal
B. The tube size in internal diameter in mm
C. The tube size in external diameter in mm
D. The name of the manufacturer
E. The patient’s name
A. The word oral or nasal or oral/nasal
B. The tube size in internal diameter in mm
C. The tube size in external diameter in mm (Ericksen said)
D. The name of the manufacturer
Graduated markings on the tube are in:
A. Inches
B. Millimeters
C. Centimeters
D. Micrometers
C. Centimeters
Which of the following are included in the safety standards for tube markings? Select 2.
A. Radiopaque marker at machine end
B. Cautionary note for single use if disposable
C. Radiopaque marker at patient end
D. Instructions for cleaning and sterilization
E. The tube size in internal diameter in cm
B. Cautionary note for single use if disposable
C. Radiopaque marker at patient end
Cuffs should be strong, tear-resistant, thin, soft, and:
A. Rigid
B. Thick
C. Pliable
D. Hard
C. Pliable
Cuffs must not herniate over: Select 2
A. The proximal end
B. The machine end
C. The Murphy eye
D. The distal end
E. Bevel of the tube
C. The Murphy eye
E. Bevel of the tube
If it does herniate over, it will occlude the tube
The cuff of a tracheal tube should typically be inflated with:
A. 2-4 mL of air
B. 5-7 mL of air
C. 8-10 mL of air
D. 11-15 mL of air
C. 8-10 mL of air
*Recheck cuff pressure frequently if using nitrous as this causes cuff inflation/expansion. *
The recommended cuff pressure range is:
A. 10 - 15 mm Hg
B. 18 - 25 mm Hg
C. 20 - 30 mm Hg
D. 25 - 35 mm Hg
B. 18 - 25 mm Hg
To prevent mucosal necrosis, cuff pressure should be kept below:
A. 15 mm Hg
B. 18 mm Hg
C. 25 mm Hg
D. 30 mm Hg
C. 25 mm Hg
The wall of the high-volume, low-pressure cuff is:
A. Thick and rigid
B. Thin and compliant
C. Thick and compliant
D. Thin and rigid
B. Thin and compliant
Most of the cuffs we use are this type
The high-volume, low-pressure cuff occludes the trachea without:
A. Compressing the tracheal wall
B. Contracting the tracheal wall
C. Inflating too much
D. Stretching the tracheal wall
D. Stretching the tracheal wall
One advantage of the high-volume, low-pressure cuff is that it:
A. Applies more pressure than mucosal perfusion pressure
B. Is easy to regulate pressure
C. Is more difficult to insert
D. Increases the risk of mucosal necrosis
B. Is easy to regulate pressure
The area of contact of the high-volume, low-pressure cuff is________, but the cuff adapts its shape to the ______ wall.
A. smaller, nasal
B. larger, esophageal
C. larger, tracheal
D. smaller, laryngeal
E. larger, pharyngeal
C. larger, tracheal
True or False
In High volume, low pressure cuffs, there is less pressure applied to the trachea than mucosal perfusion pressure
True
There is even pressure and won’t cause mucosal necrosis
Disadvantages of the high-volume, low-pressure cuff are: select 5
A. More difficult to insert and obscure view of tube tip and larynx
B. Cuff is more likely to be torn
C. More likely to cause a sore throat
D. May not prevent fluid leakage
E. Easy to pass NGT
F. Pressure exerted on trachea above mucosal perfusion pressure
A. More difficult to insert, may obscure view of the tube tip and larynx
B. Cuff is more likely to be torn during intubation
C. More likely to cause a sore throat
D. May not prevent fluid leakage despite having more contact with trachea
E. Easy to pass NGT
The low-volume, high-pressure cuff has a ______ area of contact with the trachea.
A. large
B. small
C. moderate
D. variable
B. small
Circular in shape
These are mostly off the market now
The low-volume, high-pressure cuff requires a ______ amount of pressure to achieve a seal.
A. small
B. moderate
C. large
D. variable
C. large
Distends and deforms the trachea
One advantage of the low-volume, high-pressure cuff is better protection against ______.
A. infection
B. aspiration
C. inflammation
D. edema
B. aspiration
One advantage of the low-volume, high-pressure cuff is:
A. Lower incidence of sore throat
B. Lower visibility during intubation
C. Higher incidence of mucosal necrosis
D. Increased difficulty in achieving a seal
A. Lower incidence of sore throat
One disadvantage of the low-volume, high-pressure cuff is that the pressure exerted on the trachea is probably __________ mucosal perfusion pressure.
A. below
B. equal to
C. near
D. above
D. above
**leads to ischemic damage
True or False
The Low-volume, High-pressure cuff has worse visibility during intubation than the High-volume, low-pressure cuff
False
The Low-volume, High-pressure cuff has better visibility during intubation
The low-volume, high-pressure cuff should be replaced with a low-pressure cuff if ______ intubation is required.
A. emergency
B. elective
C. postoperative
D. diagnostic
C. postoperative
The use of nitrous oxide tends to ______ cuff pressure.
A. decrease
B. increase
C. stabilize
D. not affect
B. increase
Hypothermic cardiopulmonary bypass ______ cuff pressure due to cold-induced vasoconstriction along the tracheal wall.
A. decreases
B. increases
C. stabilizes
D. does not affect
A. decreases
Hypothermic cardiopulmonary bypass decreaes cuff pressure* due to cold-induced vasoconstriction along the tracheal wall.*
Increases in altitude generally ______ cuff pressure.
A. decrease
B. increase
C. stabilize
D. do not affect
B. increase
Boyles law
Coughing, straining, and changes in muscle tone generally ______ cuff pressure.
A. decrease
B. stabilize
C. do not affect
D. increase
D. increase
After gaining confidence, you may not need to use a ______, and it is highly suggested to ______ the endotracheal tube in place to prevent displacement.
A. bite block, remove
B. stylet, secure
C. syringe, inflate
D. securing tape, shorten
B. stylet, secure
Bite blocks or airways should not be placed in ______ or ______ positions due to mucosal damage.
A. emergent, supine
B. supine, seated
C. lateral, prone
D. lateral, seated
C. lateral, prone
Can place during emergence, with patient in a supine position to prevent biting on ETT
When intubating the esophagus by mistake, it is important to:
A. Remove the tube immediately
B. Leave it in place and intubate around it
C. Ensure the patient is supine
D. Secure the tube with tape
B. Leave it in place and intubate around it
As long as your patient is pre-oxygenated enough
Excessive force and repeated attempts during intubation can cause:
A. Nerve damage
B. Aspiration
C. Infection
D. Rapid recovery
A. Nerve damage
Factors that can contribute to endotracheal tube trauma include:
A. Excessive force
B. Repeated attempts
C. Skill level of the operator
D. Difficulty of airway
E. Amount of muscle relaxation
F. All of the Above
All of the above
To reduce trauma during intubation, keep the stylet ______ the tube and _________ the Murphy eye.
A. outside, below
B. inside, above
C. inside, distal
D. outside, lateral
B. inside, above
Use vasoconstrictors for nasal intubation and pre-______ the nasal passage.
A. hydrate
B. pressurize
C. inflate
D. dilate
D. dilate
Inadvertent bronchial intubation is more likely to occur in: Select 3
A. Male patients
B. Pediatric
C. Elderly patients
D. Female patients
E. Athletic patients
F. Emergencies
B. Pediatrics
D. Females
E. Emergencies
Peds and females - distance from the trachea to right main bronchus is shorter
Straighter in pediatric patients
Inadvertent bronchial intubation typically affects which bronchus?
A. Left mainstem bronchus
B. Right mainstem bronchus
C. Upper bronchus
D. Lower bronchus
B. Right mainstem bronchus
Can lead to atelectasis
The recommended depth of endotracheal tube insertion at the teeth for males is:
A. 19 cm
B. 21 cm
C. 23 cm
D. 25 cm
C. 23 cm
To secure the endotracheal tube, the recommended depth at the teeth is approximately ______ cm for female patients
A. 21
B. 23
C. 25
D. 26
A. 21
The distance to the carina ______ with Trendelenburg and laparoscopy positions.
A. increases
B. decreases
C. remains the same
D. fluctuates
B. decreases
*During insufflation in laparoscopy, everything displaces cephalad. *
During surgery the ETT can become dislodged by instrumentation
True or False
Fluid accumulation occurs above the cuff of an endotracheal tube
True
Blood, teeth, increased secretions. Can be difficult to use yankaur to get down to suction
Upper airway edema can occur ______ along the path of the tube.
A. only at the tip
B. only at the entry point
C. anywhere
D. only in the trachea
C. anywhere
Upper airway edema is dangerous in young children because the ______ cartilage completely surrounds the subglottic area, and the peak incidence occurs between ______ years old.
A. thyroid, 1-2
B. cricoid, 1-4
C. arytenoid, 3-5
D. epiglottis, 4-6
B. cricoid, 1-4yrs old
The earliest signs of upper airway edema usually appear ______ hours to 48hrs postoperatively.
A. 0-1
B. 1-2
C. 2-4
D. 4-6
B. 1-2
*You can see s/s of increased wob, stridor, desaturation
To prevent upper airway edema, avoid irritating stimuli such as ______ and maintain adequate anesthetic depth.
A. dry air
B. smoke
C. dust
D. URI
D. URI
Upper Respiratory Infection, as long as it is resolving you can proceed with sx
If patient has inadequate anesthetic depth or too light, may cause laryngospasms
Causes of vocal cord granuloma include trauma, an ETT that is too large, infection, and excessive ______ pressure.
A. airway
B. cuff
C. blood
D. intubation
B. cuff
Those at most risk are adult females
Pay attention to cuff pressures
Symptoms of vocal cord granuloma include: Select 4
A. Persistent hoarseness
B. Fullness
C. Intermittent cough
D. Chronic cough
E. Intermittent loss of voice
F. Difficulty swallowing
G. Clicking sensation
A. Persistent hoarseness
B. Fullness
D. Chronic cough
E. Intermittent loss of voice
Treatments for vocal cord granuloma include:
Select 2
A. Laryngeal evaluation
B. Voice rest
C. Antibiotics
D. Surgery
E. Anti-inflammatory medications
A. Laryngeal evaluation - By ENT
B. Voice rest - No talking
Bougies have a polyester base with:
A. Metal coating
B. Plastic coating
C. Resin coating
D. Silicone coating
C. Resin coating
Typically blue
The distal end of a bougie is angled at:
A. 20-30 degrees
B. 30-45 degrees
C. 45-60 degrees
D. 60-75 degrees
B. 30-45 degrees
Bougies are introduced with:
A. Posterior positioning of the tip
B. Lateral positioning of the tip
C. Anterior positioning of the tip
D. Vertical positioning of the tip
C. Anterior positioning of the tip
Feeling for tracheal rings
If patient is more anterior, a glidescope can be more helpful for intubation. The curvature is deeper than the Mac blade
Indications for using bougies include:
Select 2
A. Blind intubation if glottic exposure is absent
B. ETT passage is difficult
C. Patient is fully awake
D. Clear visualization of the glottis
E. ETT passage is not difficult
A. Blind intubation if glottic exposure is absent
B. ETT passage is difficult
When advancing a bougie, one should ______ and ______.
A. advance gently, feel for a clicking sensation across tracheal rings
B. use excessive force, withdraw immediately upon resistance
C. feel for a clicking sensation across tracheal rings, rotate the bougie rapidly
D. advance gently, rotate the bougie rapidly
E. use excessive force, feel for a clicking sensation across tracheal rings
A. advance gently, feel for a clicking sensation across tracheal rings
Magill forceps are used primarily for:
A. Oral intubations
B. Nasal intubations
C. Tracheostomy
D. Suctioning
B. Nasal intubations
They help direct tube into the larynx
Should be immediately available
A potential complication of using Magill forceps is:
A. Damage to tube cuffs
B. Tube displacement
C. Increased patient comfort
D. Decreased visibility
A. Damage to tube cuffs
and lodged in Murphy eye
One indication for lung isolation during a thoracic procedure is to:
A. Increase lung capacity and decrease safety profile
B. Decrease safety and surgical exposure
C. Increase safety profile and surgical exposure
D. Reduce lung capacity and increase safety profile
C. Increase safety profile and surgical exposure
Remove diseased portion of the lung
Lung isolation can help control contamination or hemorrhage by: Select 2
A. Preventing material in one lung from contaminating the other
B. Allows material in one lung from contaminating the upper respiratory tract
C. Allowing both lungs to be ventilated while the other hemorrhages
D. Allowing one lung to be ventilated while the other hemorrhages
A. Preventing material in one lung from contaminating the other
D. Allowing one lung to be ventilated while the other hemorrhages
In the case of unilateral pathology, lung isolation excludes ______, ruptured cysts, or other issues with the diseased lung while allowing unilateral ______.
A. infections, ventilation
B. fistulas, ventilation
C. occlusions, perfusion
D. tumors, expansion
E. abscesses, inflation
B. Fistulas, ventilation
The right mainstem bronchus is:
A. Longer and narrower
B. Shorter and straighter
C. Longer and straighter
D. Shorter and narrower
B. Shorter and straighter
The right mainstem bronchus takes off from the trachea at a:
A. 25 degree angle
B. 45 degree angle
C. 30 degree angle
D. 60 degree angle
A. 25 degree angle
The average length from the carina to the take-off of the right upper lobe is:
A. 5.5 cm
B. 3.5 cm
C. 2.5 cm
D. 4.5 cm
C. 2.5 cm
The left mainstem bronchus takes off from the trachea at a:
A. 25 degree angle
B. 45 degree angle
C. 30 degree angle
D. 60 degree angle
B. 45 degree angle
The average length from the carina to the take-off of the left upper lobe is:
A. 5.5 cm
B. 2.5 cm
C. 3.5 cm
D. 4.5 cm
A. 5.5 cm
True or False
The left mainstem has a larger diameter than the right mainstem
False
The right mainstem has a larger diameter than the left main stem
The right upper lobe (RUL) tracheal takeoff is very ______ to origin, while the left upper lobe (LUL) tracheal takeoff is more ______.
A. close, distal
B. far, distal
C. proximal, near
D. close, proximal
A. close, distal
Common adult sizes for double-lumen tubes (DLTs) are:
A. 30, 32, 34, 36 Fr
B. 35, 37, 39, 41 Fr
C. 33, 35, 37, 39 Fr
D. 36, 38, 40, 42 Fr
B. 35, 37, 39, 41 Fr
Fr - french
Adult is odd
Pediatric sizes for double-lumen tubes (DLTs) include:
A. 22, 24, 26 Fr
B. 24, 26, 28 Fr
C. 26, 28, 32 Fr
D. 28, 30, 32 Fr
C. 26, 28, 32 Fr
EVEN numbers
Primarily, we use the ______ double-lumen tube (DLT), while the ______ DLT is used for left pneumonectomy, left lung transplantation, left mainstem bronchus stent, left tracheo-bronchus disruption.
A. left, right
B. right, left
C. pediatric, adult
D. adult, pediatric
A. left, right
Not used as often
*Ericksen - when we use a **right DLT **we are doing surgery on the left lung *
Double-lumen tubes are placed similarly to a standard ETT but are more difficult due to ______ and ______.
A. length, flexibility
B. stiffness, size
C. color, shape
D. diameter, weight
B. stiffness, size
When advancing a double-lumen tube through the larynx, the tip should be angled ______ into the trachea.
A. posteriorly
B. laterally
C. anteriorly
D. medially
C. anteriorly
After the bronchial cuff passes the cords, the tube should be turned ______ degrees.
A. 45
B. 60
C. 90
D. 180
C. 90
Bronchial portion points toward the appropriate bronchus
double lumen tube
Verification of the location of the bronchial port should be done with:
A. Direct visualization
B. X-ray
C. RSI Ultrasound
D. Fiberoptic scope
D. Fiberoptic scope
The blue bronchial cuff should be just below the ______ in the appropriate bronchus.
A. trachea
B. carina
C. epiglottis
D. larynx
E. pharynx
B. carina
True or False
The inflation of a bronchial ballon should be done under direct visualizaiton to verify proper placement
True
Fiberoptic scope
Ensure the bronchial cuff does not ______ over the carina.
A. inflate
B. collapse
C. herniate
D. deflate
C. herniate
To isolate a lung with a double lumen tube, you can:Select 2
A. Deflate the bronchial cuff
B. Clamp the tracheal connector
C. Deflate the tracheal cuff
D. Clamp the bronchial connector
E. Rotate the double-lumen tube
B. Clamp the tracheal connector
D. Clamp the bronchial connector
*Test this out before the surgeon gets into the room. *
What is a common cause of unsatisfactory lung collapse when using a Double-Lumen Tube (DLT)?
A. Tube too distal in airway
B. Bronchial lumen in wrong mainstem
C. Tube is too cephalad in airway
D. Inadequate suction
B. Bronchial lumen in wrong mainstem *due to malposition *
Tube is too proximal in airway
If the bronchial lumen is in the wrong mainstem, the recommended corrective measure is ______________.
A. Reinsertion
B. Using a fiberoptic bronchoscope
C. Switching to a single-lumen tube
D. Providing PEEP to the non-dependent lung
A. Reinsertion
A tube that is too proximal in the airway should be corrected using a ______________.
A. Reinsertion
B. Using a fiberoptic bronchoscope
C. Switching to a single-lumen tube
D. Providing PEEP to the non-dependent lung
B. Using a fiberoptic bronchoscope
When dealing with hypoxemia during DLT use, what factors need to be considered in patients with comorbidities? (Select 2)
A. PEEP to the dependent lung
B. Intermittent one-lung ventilation
C. Increasing FiO2
D. Intermittent two-lung ventilation
E. PEEP to the independent lung
A. PEEP to the dependent lung - due to lung dz
D. Intermittent two-lung ventilation - talk to the surgeon. Want to prevent V/Q mismatch
Hypoxemia can also be caused my malpositioned tube - must be reinserted
In which scenarios is a DLT is NOT advisable and a bronchial blocker should be used instead? (Select 5)
A. Nasal intubation
B. Supraglottic stenosis
C. Patients with tracheostomy
D. Easy intubation
E. Single-lumen tube already in place
F. Subglottic stenosis
G. Difficult intubation
H. Oral intubation
A. Nasal intubation
C. Patients with tracheostomy
E. Single-lumen tube already in place -
F. Subglottic stenosis -harder time to get DLT down
G. Difficult intubation - use a normal ETT and then place a bronchial blocker
True or False
It is ok to use a Double Lumen tube for continued postoperative intubation
False
If patient needs continued postoperative intubation, keep them asleep and switch out to normal ETT
Bronchial blockers can block a segment of lung without __________ the entire lung, a task that cannot be done with a DLT.
A. Collapsing
B. Ventilating
C. Obstructing
D. Isolating
E. Intubating
D. Isolating
CANNOT be done with a DLT only a bronchial blocker
Which anatomical feature makes the use of bronchial blockers difficult?
A. Low right upper lobe bronchus takeoff
B. High right upper lobe bronchus takeoff
C. Narrow trachea
D. Wide left mainstem bronchus
B. High right upper lobe bronchus takeoff
May still be able to use bronchial blocker…
What is a potential complication during surgery when using bronchial blockers?
A. Tube displacement
B. Fixation by staples
C. Vocal cord damage
D. Increased mucus production
B. Fixation by staples
Tell surgeon nicely to remove them
What difficulties are associated with the use of bronchial blockers? (Select 4)
A. Left upper lobe bronchus takeoff is high
B. Tracheal bronchus
C. Fixation by staples during surgery
D. Perforation by suture needle
E. Perforation by instrumentation
F. Increased secretion clearance
B. Tracheal bronchus - might need a second bronchial blocker or DLT
C. Fixation by staples during surgery
D. Perforation by suture needle
E. Perforation by instrumentation
Can happen with double lumen tube, but they are stiffer and more compliant
