APA test 1 Flashcards
what are the three unpaired laryngeal cartilages
- thyroid
- cricoid
- epiglottis
what are the three paired cartilages
- arytenoid
- corniculate
- cuniform
what is the only complete ring of cartilage
the cricoid ring
what is the 3-3-2 rule
3- the minimal distance the mouth should open.
3- distance from the tip of the mandible to the laryngeal cartilage.
2- distance from the floor of the mouth to the prominence of the laryngeal cartilage.
lemon law
L- look externally E- evaluate the 3-3-2 rule M- mallampati O- obstruction/ obesity N- neck mobility
thyro-mental distance
Measure from upper edge of thyroid cartilage to chin with the head fully extended.
A short thyromental distance = an anterior larynx
> 7 cm is usually = easy intubation
< 6 cm = difficult airway
mallampati classifications.
Class I: Soft palate, uvula, fauces, pillars visible.
Class II: Soft palate, major part of uvula, fauces visible. Class III: Soft palate, base of uvula visible.
Class IV: Only hard palate visible.
obstruction reasons are
Blood Vomitus Teeth Epiglottis Dentures Tumors Impacted Objects
neck mobility measurement
Measurement of Atlanto-Occipital Angle
is mask ventilation going to be difficult? BONES
BONES” Beard Obesity No teeth Elderly Snoring LMA if needed, also after age 55 you loose upper airway elasticity.
is the laryngeal visualization going to be difficult? 4 D’s
Disproportion
Distortion
Dismobility
Dentition
what was the first educational anesthesia program
lakeside hospital, school of anesthesia Cleveland, Ohio 1915, founded by Agatha Hodgins
who founded the first anesthesia school and what year
Agatha Hodgins in 1915
who is known as the mother of anesthesia?
Alice McGaw
who was the first known nurse to specilize in anesthesia
sister mary bernard , saint vincents hospital, er PA, 1877
who founded the AANA and was the first president
Agatha Hodgins.
compressed gas cylinder chart
slide 12
what are the three types of anesthesia gas machine valves
- Free-floating valve
- Ball and Spring valve
- Diaphragm valve
what do free-floating valves do? and where are they found
Moves in the direction or “push” of gas flow
Prevents gas from leaking out of the system
Found in DISS and dual hanger yoke systems
also called check valves.
ball and spring valves where are they found
found at the oxygen flush system. delivers oxygen at 35-75 L/min pressurized at 40-50 psi from the wall. can cause barotrauma.
what valve makes up the fail-safe system?
ball and spring valve. if oxygen failers it will shut off the other gases. It senses the 50 psi of pressure required.
how many diaphragm valves are found on the anesthesia machine? and where at
There are only 2 of
these valves in the
machine
First stage regulator
Second stage regulator
pts that are difficult to bag-mask?
Seal: Beards, anatomy, NG tube Obstruction Obesity Age > 55 Mallampati III-IV No Teeth Stiff lungs Sleep apnea or snoring
difficulty with intubation
If it looks difficult it probably is 3-3-2 Mallampati Obstruction Obesity Scarring, radiation, or masses Mobility Operator experience
difficult with LMA
Restricted mouth opening
Obstruction
Distortion of airway- older pts
Stiff lungs
what is an LMA
supraglottic airway.
ASA difficult airway algorithm (DAA)
slide 43
on the DAA after airway assessment what are the three possible options.
- Awake intubation
- Quick look- can get ketamine and versed to take a look or do awake intubated
- Induction and paralysis
Pre-oxygenation: How Much Is Enough?
Two techniques common in use:
Tidal volume breathing (TVB) of oxygen for 3–5 min
Deep breaths (DB) 4 times within 0.5 min
Both are equally effective in increasing arterial oxygen tension (Pao2).
LMA size 5 fits what weight adults and cuff inflation volume.
adults 70-100 kg
40 ml volume max
LMA size 4 fits what weight adults and cuff inflation volume.
50-70kg adult
30 ml max volume
LMA size 3 fits what weight adults and cuff inflation volume.
children 30-50 kg
20 ml max volume
LMA size 2 1/2 fits what weight adults and cuff inflation volume.
children 20-30kg
14 ml max volume
LMA size 2 fits what weight adults and cuff inflation volume.
infants/ children 10-20kg
max volume is 10 ml
LMA size 1 1/2 fits what weight adults and cuff inflation volume.
infants 5-10 kg
max volume is 7
LMA size 1 fits what weight adults and cuff inflation volume.
neonates/ infants up to 5 kg
max ml is 4
Class I
ASA
No organic, physiologic, biochemical or psychiatric disturbance
Healthy pt.
Class II
ASA
Mild to moderate systemic disturbance
Heart disease that slightly limits physical activity, essential HTN, diabetes, chronic bronchitis, anemia, morbid obesity, age extremes
Class III
ASA
Class III
Severe systemic disease that limits activity
Heart or chronic pulmonary disease that limits activity, poorly controlled essential hypertension, diabetes mellitus with vascular complications, angina pectoris, history of previous MI
Class IV
ASA
Severe systemic disease that is constantly life threatening
CHF; persistent angina pectoris, advanced pulmonary, renal, or hepatic dysfunction
Class V
ASA
Moribund patient, undergoing surgery as a resuscitative effort, despite a minimal chance for survival
Uncontrolled hemorrhage from a ruptured abdominal artery aneurysm, PE, head injury with increased ICP
EX. pt probably won’t make it.
Class VI
ASA
Declared brain dead patient whose organs are being removed for donor purposes
Emergency Operation (E)
Emergency surgery is required
Ex. Otherwise healthy 30 y/o female who needs D&C for moderate persistent hemorrhage is classified a ASA IE
