Basics Module 1 Flashcards
What is the number 1 cause of morbidity & mortality?
Airway Events
In a patient that has been put to sleep is now a difficult airway, what medication can you give to wake the patient?
Epi
What group of patients have less pliable lungs?
Old & Obese
In the aging process, the airway becomes?
Less pliable, mobile, & flexible
It becomes an airway emergency when you are unable to
Ventilate
How much water is needed to get chest rise?
20-25cm of water
A BMIn greater than____will cause a leak
50
What happens to the vocal cords when the patient is given a paralytic?
Vocal cords relax
Characteristics of a child’s epiglottis?
Shorter, stiffer, & white
What connects the nasal & oral cavities?
The pharynx connects the nasal & oral cavities to the larynx & esophagus
Name order of pharynx from head to toe
Naso, Oro, & Hypo
What is the job of the larynx?
Prevent aspiration
The larynx is also called the…
Voicebox, located in the neck
Name the innervation of the airway from head to toe
Trigeminal, Glossopharyngeal, Vagus
The superior laryngeal nerve (internal) is…
Sensory
The superior laryngeal nerve (external) is…
Motor
The recurrent laryngeal nerve controls what?
Vocal Cords
BMI greater than____can cause airway difficulty
30
What is prognathic?
Extension/bulging of lower jaw
What is retrognathic?
Growth deficiency
The ULBT assesses what?
Mobility of mandible
A TMD_____is a cause of concern
Less than 6
The 3-3-2 rules assesses what?
Mouth opening, tip of mentum to hyoid bone, &TMD
What 2 things should you not use with an LMA?
Aspiration risk & no MAC
How long does it take Roc to work?
3-5 min
Pressure control should be ____ to mask ventilate
Less than 20
Standard size oral airway for male & female?
M=6
F=5
What is the end tidal oxygen goal with pre-oxygenation?
Above 90%
8 breaths, 60 sec each
3 min of breathing 100% oxygen
Positioning aligns what?
The oral, pharyngeal & laryngeal axes (ramped up)
With repositioning, the ear should be level with the…
Sternal Notch
The sniffing position involves…
Flexing the neck and extending the head
A supraglottic Airway (SGA), is also known as…
An LMA
With placement of a SGA, where does the tip of the cuff sit?
The upper esophageal sphincter
How are the SGA sized?
By weight
What are the adult sizes for SGAs?
3,4, & 5
What are the PED size SGAs?
0, 1,2, & 2.5
What amount of pressure will seal a SGA?
A pressure less than 20cm of H2O
What body weight should be used when sizing a SGA?
Ideal body weight
SGAs are good for…
Reactive Airway
Less Stimulating
Smoother wakeup
Less coughing
Less trauma
Does not require paralysis
SGAs do not protect against…
Aspiration
What are LMA complications?
Sore Throat
Bronchospasm
Edema
Nerve Injury
Tongue numbness
Aspiration risk
What is the most common method of intubation?
Direct Laryngoscopy (DL)
The table height should be where?
At your xiphoid
Using the Cormack & Lehane classification, a grade 1 view means…
Full view of the glottis
RAEs tubes are used when?
For eye & face cases (this type of tube is bent in half)
The Murphys eye is only seen in…
Adult population
Reinforced tubes…
Do not kink
When should you perform a rapid sequence induction?
Patient is vomiting, has uncontrolled GERD, or has a full stomach
Do you ventilated during RSI?
NOO
Is the glidescope good in PEDs population?
NOO
When is the VL useful?
Routinely
Difficult airway
Improves first attempt
In patients w/ limited ROM
Can be further away from patient
When using a glidescope for adults & children, should you sweep the tongue?
NOO
Which blade should you use in VL?
D blade
Do you need the 3 patient alignment when using a VL?
NOO
Can you jet ventilate through the Cook Exchange?
YES
How do you check placement of the Cook Exchange?
Perform a laryngoscopy during procedure
When should an awake fiberoptic be used?
If there is an unstable spine
Difficult airway
Fiberoptic allows for__________ and_______
Preservation of muscle tone & airway reflexes
What is easier? Nasal or Oral fiberoptic?
Nasal, but caution with bleeding risk of oral passage
What can be used to prep the nasal passage of a patient getting ready for a fiberoptic?
Give Oxymetazoline (Affrini)
Glyco for secretions
What is the maximum dose of lidocaine?
7mg/kg
What 2 blocks can be performed to initiate intubation?
Superior Laryngeal Block (bilaterally)
Transtracheal Block
What are 4 types of invasive Airways?
Trach
Crico
Retrograde
Transtracheal Jet Ventilation
When is it appropriate to extubate?
Spontaneous breathing
Stability
Norm acid/base balance
NMB is reversed
Extubating off 100% FIO2
When is deep extubation performed?
During Stage 3
What are the benefits of extubating during stage 3?
Less coughing
Fewer hemodynamic changes
Avoids bleeding, increased ICP/IOP
When should you not deep extubate?
Morbid obese
Difficult Mask
Risk of Aspiration
Airway edema
OSA
Restricted access to the airway
Laryngoscopy can be…
Stimulating
What is the most common cause of death iin securing the airway?
Aspirationo
If you suspect an esophageal intubation, you can check…
BBS & ETCO2
Airway complication are mostly related to…
Bronchospasm, Laryngospasm, and Pulmonary Edema
What causes subglottic stenosis?
High cuff pressure
How can you treat pulmonary edema?
Sit the patient up and give 100%
How can you tell a laryngospasm is happening?
Rigid ABD
Trying to take a breath
Who is more prone to laryngospasms?
Infants & children (they go in and out of stage II frequently)
How can you treat laryngospams?
Positive Pressure
Paralyze
Supportive Care
Mask/Oral airway
May give versed if partially awake
In PEDs, what is the narrowest part of the airway?
Cricoid Cartilage
What are the characteristics of a child’s airway anatomy?
More Anterior
Large Tongue
Epiglottis is large & omega shaped
Stiff or floppy
Larger head
Usually have more loose teeth
Do PEDs have a higher metabolic rate?
YES
What is the oral dosage of versed for a PED patient?
0.5-1mg/kg (20mg max)
In PEDs, what dose of Ketamine can you give IM?
3mg/kg & add glyco or versed
What medication can you give intranasally to Peds?
Precedex
What do Peds usually get for induction?
Mask induction with N2O & Sevo
How do you calculate ETT size?
(Age/4) + 4
OR
(Age+16)/4
Which ETT is preferred in Peds?
Microcuff (there is no Murphy’s eye)
Microcuffs have…
Low volume & low pressure cuff
When extubating in the Peds population, they are at a higher risk for…
Stridor
How is stridor treated?
Humidified Oxygen
Steroids
Racemic Epi
You can give Sux or Atropine IV to help treat a laryngospasm. What is the dose?
Sux 1.5-2mg/kg
Atropine 0.02mg/kg
IM
In Peds, if you have an IV, how can you treat a laryngospasm?
Deepen with Propofol
What difficult airway devices are available for Peds?
look up
Depth of
Ett??
Note Calculations
…
To prevent gag reflex, which nerve must be blocked?
Superior Laryngeal Nerve Internal branch
