Basic Airway /Advanced Airway Flashcards
Problems that can occur in association with difficult airway
Dental damage pulmonary aspiration airway trauma unanticipated trach anoxic brain injury cardiopulmonary arrest
The upper and lower airway is divided where?
cricord cartilage
5 parts of upper airway
Nose mouth pharynx hypopharynx larynx
6 parts of lower airway
Trachea Bronchi Bronchioles terminal brinchioles respiratory bronchioles alveoli
Function of the nose
warm and humidify air
primary source of filtration
Anatomy of the mouth/oral cavity
Hard palate soft palate tongue Uvula tonsils
What structure of the mouth is at high risk for obstruction
tongue
Parts of the pharynx
Nasopharynx
oropharynx
hypopharynx
What are S/S of SLN injury, both unilateral and bilateral
Unilateral- minimal ( no real signs)
Bilateral- hoarseness
What are S/S of RLN injury, both unilateral and bilateral (acute and chronic)
Unilateral- Hoarseness
Bilateral-
—Acute-stridor, resp distress
– Chronic- Aphonia
3 paired cartilages that make up the larynx
- 2 arytenoids
- 2 corniculate
- 2 cuneiform
Vallecula
Space between the epiglottis and base of the tongue
2 types of muscles in the larynx
Intrinsic
extrinsic
What do the intrinsic muscles of the larynx do
control of vocal cords
opening and closing of the glottis
What do the extrinsic muscles of the larynx do
- connect larnyx with the hyoid bone and other structure
- adjust position of trachea for phonation, breathing, and swollowing
How long is the adult trachea
10-20 cm
What is the only cartilage with a complete ring in the trachea
Cricord ring
What is pertinent to airway assessment (questions to ask or look up; not physical)
- prior sx or hx of intubation/trach
- pror hx of diff intubation
- Hx of OSA
- Hx of oral, pharyngeal, esophageal disease
- trauma, burns, chemicals, radiation exposure to neck
S/S that indicate a pt has an increased risk for aspiration
- Loss of airway reflex
- LOC
- full stomach
- obese, pregnant, hiatial hernia
- GERD
- Decrease GI motility (DM, Trauma)
- volume > 25 ml (ph < 2.5)
Mendelson Syndrome
chemical pneuminitis due to the parenchymal inflammatory reaction caused by a large volume of gastric contents in lungs from aspiration ( independent of infection)
Ways to decrease risk of aspiration
- NPO
- Block histamine release (H2 blockers)
- increase gastric PH (antacids)
- Increase GI motility (reglan)
- use caution with sedationa and opiods
- ETT vs LMA
- RSI vs awake FOI
- Awake vs deep extubation
Liter flow rates and Fi02 delivered
Nasal cannula
Simple face mask
Non-rebreather
NC- 1-6 LPM / 24-44%
SFM- 5-12 LPM / 30-85%
NRB- 10-15 LPM / 60-85%
4 techniques to manipulate head, neck, and jaw for airway patency
- chin lift
- head tilt and chin lift
- Jaw thrust
- Hyperextension of Neck (head tilt)
3 axis to align for maximal exposure with intubation
- Oral axis
- pharyngeal axis
- laryngeal axis
3 main types of LMAs
Classic
Proseal
Fast track
What is unique about the proseal LMA
-drain tube
What is unique about the fast track LMA
Allows you to place an OETT
has an epiglottis flap
Tracheal intubation is recommended when?
- compromised airway
- long procedures
- procedures of head/neck/chest/abd
- Need for positive pressure ventilation
- inability to maintain mask ventilation
- disease of the airway
- risk of aspiration
What are indications for Awake FOI
- anticipated difficult airway
- unstable neck fx
- Halo
- small / limited oral opening
- critical care settings
What airway structures are most vulnerable to injury during intubation
arytenoids
posterior half of vocal cords
posterior tracheal wall
What can occur up to 3 hours post extubation
Croup
LMA size compared to weight and max inflation (only adult sizes)
LMA size Weight MAX inflate #3 30-50kg 20 ml #4 50-70kg 30 ml #5 70-100kg 40 ml #6 >100kg 50 ml * how to remember the max inflate for test- minus 1 and add 0 to the size. ex #3 -1=2 add 0 = 20 ml
What muscle acts as a barrier to regurgitation in conscious Pts.
cricopharyngeos muscle
Extubation criteria
- adequate TV and rate
- open eyes to commands no diplopia
- sustained protrusion and purposeful movements of the tongue
- effective swollow
- head lift >5 sec
- effective cough
- sustained titanic response to 50 hrz for 5 sec’s
- TOF > 90 ratio with NO fade
Whats the difference in airway resistance between the nasopharynx and oropharynx
the resistance to airflow through the nasopharynx is twice that of the oropharynx and accounts for about 2/3rds of the total airway resistance
Disadvantages of oropharyngeal airways
- cut lips, tongue, oral mucose
- Can cause a gag reflex
- obstruction of glottis (if to large)
- Push tongue posterior and cause obstruction (if too small)
Advantages of oropharyngeal airways
- air can pass around or through
- keeps teeth/lips open
Advantages of nasopharyngeal airways
- better tolerated in light planes
- prefered with pts with limited mouth openings or dental caries
Disadvantages of nasopharyngeal airway
nose bleeds
-contraindicated with coagupathies and basilar skull fx
LMA contraindications
- pharyngeal pathology
- pharyngeal obstruction
- full stomach
- decreased pulmonary compliance (RAD), that requires > 30 cmH20 pressure
What LMA is designed for anticipated difficult airways situations and CPR, b/c it can facilitate continuous ventilation during intubation
Fast track