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ACRM > Broncho/Laryngospasm-Pneumo-AirwayFire > Flashcards

Broncho/Laryngospasm-Pneumo-AirwayFire Flashcards

1
Q

Differential diagnoses for s/s associated with bronchospasm:

A
  • obstructed ETT
  • light anesthesia
  • pneumo
  • aspiration
  • R mainstem
  • anaphylaxis
  • medication
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2
Q

Pathphys of bronchospasm:

A

reflexive bronchiolar constriction (either centrally mediated OR local airway irritation)

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3
Q

Common causes of bronchospasm:

A
  • anaphylactoid drug rxn
  • blood trf rxn
  • histamine releasing drugs
  • smokers
  • chronic bronchitis/COPD
  • light anesthesia
  • noxious stimuli (secretions, intubation, ETT manipulation)
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4
Q

3 compounds mediating bronchoconstriction

A

1) IP3
2) phospholipase C
3) leukotrienes

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5
Q

Process of bronchoconstriction:

A

1) airway innervated by PNS (vagus nerve (X))
2) ACh hits M3 receptors
3) activates phospholipase C
4) activates IP3 (2nd msgr)
5) stimulates Ca2+ release
6) smooth muscle contraction/bronchoconstriction

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6
Q

Compounds mediating bronchodilation:

A
  • cAMP
  • cGMP
  • NO
  • vasoactive intestinal peptide
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7
Q

Process of bronchodilation

A

1) no SNS innervation
2) B2 activated by Epi/NE
3) Gprotein coupled receptor > adenylate cyclase > increase cAMP
4) cAMP (+ phospkinase A) decrease Ca2+ release
5) decreased smooth muscle contraction / bronchodilation

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8
Q

MOA of NO on bronchodilation

A
  • non-cholinergic PNS nerves release vasoactive intestinal peptide into airway smooth muscle > NO production > cGMP stimulation > airway relaxation
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9
Q

Symptoms of bronchspasm

A
  • reduced SaO2
  • shark fin capnography waveform
  • wheezing
  • increased airway resistance (PIP)
  • decreased exp flow rate
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10
Q

Hallmark symptom of both awake and anesthetized patients experiencing bronchospasm

A

wheezing
worse on expiration

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11
Q

Decreased expiratory flow rates leads to…

A
  • air trapping
  • increased intrathoracic pressure
  • decreased VR, CO, BP
  • Auto-PEEP
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12
Q

Treatment for bronchospasm:

A
  • 100% O2
  • confirm ETT position
  • deepen anesthetic
  • inhaled B2 agonist/anti-muscarinic
  • bronchodilators
  • steroids
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13
Q

Possible bronchodilators used to treat bronchospasm

A
  • volatile agents
  • Epi 1-10mcg/kg bolus
  • Ketamine 0.2-1mg/kg
  • Mg
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14
Q

Describe steroid use in bronchospasm

A
  • Hydrocortisone 100mg IV
  • not helpful in acute phase
  • won’t reverse acute bronchospasm
  • used for LT airway irritation
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15
Q

Methods for prevention of bronchospasm

A
  • avoid airway manipulation in at-risk pts (URI, smoker, asthma exacerb)
  • bronchodilators on induct/emerg
  • regional
  • deepen prior to intubation
  • deep extubation
  • monitor P-V loops (early detection)
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16
Q

Complications of bronchospasm

A
  • hypoxemia
  • hypercarbia
  • HoTN
  • arrhythmias
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17
Q

Tx for Auto-PEEP

A
  • disconnect ETT x5-10 sec
  • decrease RR, Vt, inspiratory time
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18
Q

How is Auto-PEEP recognized on ventilator

A

failure of expiratory waveform to return to zero baseline before next inspiration

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19
Q

Vagus nerve forms 2 important branches:

A
  • superior laryngeal nerve
  • recurrent laryngeal nerve
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20
Q

Superior laryngeal nerve EXTERNAL branch provides…

A

motor innervation to the cricothyroid muscle (tenses vocal cords)

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21
Q

Superior laryngeal nerve INTERNAL branch provides…

A

sensory innervation to the larynx between epiglottis and including vocal cords

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22
Q

Recurrent laryngeal nerve provides…

A

motor innervation to all muscles EXCEPT cricothyroid
AND
sensory innervation to the larynx below the vocal cords & trachea

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23
Q

SCAR pneumonic for motor innervation

A

Superior laryngeal nerve ext branch
Cricothyroid muscle
All other muscles
Recurrent laryngeal nerve

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24
Q

Muscle responsible for adduction of glottis

A

lateral cricoarytenoid

25
Muscle responsible for abduction of glottis
Posterior CricoArytenoid *pulls cords apart*
26
Muscle responsible for tensing vocal cords
cricothyroid
27
Muscle responsible for decreasing tension on vocal cords
thryroarytenoid
28
Major motor nerve of the larynx
recurrent laryngeal nerve
29
Major sensory nerve of the larynx
internal branch of the superior laryngeal nerve
30
Location of the adult larynx
C3-C6 (usually C4-C5)
31
Define laryngospasm
forceful involuntary spasm of the laryngeal musculature
32
Laryngospasm is caused by *sensory* stimulation of...
internal branch of superior laryngeal nerve
33
Laryngospasm is caused by *motor* stimulation of...
external branch of superior laryngeal nerve (cricothyroid muscle) OR recurrent laryngeal nerve (lateral cricoarytenoids
34
Laryngospasm is most commonly caused by what?
irritative stimulus to the airway during light plane of anesthesia (e.g. secretions, volatiles, DL, OPA, pain, aspiration)
35
Symptoms of laryngospasm
- sudden onset - absent EtCO2 - stridor - rocking obstruction pattern - can't ventilate --> desat - hypoxia, hypercarbia, acidosis - HTN & tachycardia - HoTN, bradycardia, arrhythmias - cardiac arrest
36
Early s/s of laryngospasm
hypoxia, hypercarbia, acidosis, HTN, tachycardia
37
Late s/s of laryngospasm
HoTN, bradycardia, ventricular arrhythmias, cardiac arrest
38
Situations when laryngospasm is most likely to occur
- excitement phase on induct/emerg - light anesthesia - URI in last 2 weeks, smoker, recent asthma attack - mask anesthesia, LMAs - airway procedures - mechanical irritants in airway
39
Methods to prevent laryngospasm
- maintain anesthetic depth - deep extubation - suction secretions - CPAP on induction/emergence - IV lidocaine - LTA kit
40
Treatment for laryngospasm
1) PPV 2) 100% O2 3) succinylcholine 4) atropine
41
Laryngospasm dose of succs for adults and peds
Adults: 0.2-0.5mg/kg IV Peds: 4-5mg/kg IM or 2-3mg/kg IV
42
Laryngospasm dose of atropine
0.02mg/kg IV or IM - minimum dose of 0.1mg
43
What is Larson's Maneuver? What is it used for?
- pressure applied behind the earlobes on the laryngospasm notch - apply bilaterally towards skull base for 3-5 seconds, pausing for 5-10 seconds used for laryngospasm
44
2 effects of the Larson's Maneuver
1) displaces mandible anteriorly to open airway 2) causes a lightly anesthetized patient to sigh, breaking laryngospasm
45
Complications of laryngospasm
- hypoxemia - hypercarbia - neg pressure pulm edema - bradycardia - cardiac arrest
46
Common situations when a pneumothorax can occur:
- CVP placement - regional nerve block - bronchoscopy, needle biopsy, laparoscopic procedures - chest trauma - barotrauma - spontaneous in pts with bullous lung dz
47
Manifestations of pneumothorax
*hypoxemia *high PIP *HoTN *tachycardia *increased CVP - asymmetric BS - tracheal deviation (late) - neck vein distension
48
Treatment for pneumothorax
- 100% O2 - turn off N2O - support BP (pressors, IVF) - lighten anesthetic - tell sx team - needle compression if significant HoTN
49
Needle decompression process & landmarks
- large bore IV catheter - 2nd ICS, MCL or 4th ICS, MAL - 90* angle, cephalad to 3rd rib *CT placement is definitive tx*
50
3 parts to the fire triangle
1) oxygen/oxidixer 2) heat/ignition source 3) fuel source (drapes, sponges, solutions)
51
Most common airway fire fuel source?
surgical drapes
52
Most common airway fire ignition source?
cautery
53
3 factors that increase the r/f airway fire
- surgical procedure of head/neck - MAC cases on upper half of body (tent of O2) - bacteria in lungs (staph and pseudomonas)
54
Manifestations of airway fire
- fire/smoke - visible burning of ETT - odor of burning tissue later signs: - decreased SpO2 - airway/pulm edema - decreased pulm compliance
55
Treatment of airway fire
- extubate the trachea - stop flow of O2 - douse airway with NS or H2) - mask ventilate with AIR
56
Post-extubation after airway fire:
- reintubate/ventilate with AIR - inspect airway - cricothyrotomy or tracheostomy if unable to reintubate - high dose steroids - fiberoptic bronchoscopy
57
Methods to prevent airway fire
- assess fire risk in every case - cuffed ETT in airway procedures - low FiO2 (<30%) - protect ETT during laser sx (laser proof, fill with NS or dye - be prepared - vent drapes in MAC cases
58
3 FRA questions:
1) is the surgical site at the xiphoid or above? 2) is there an open O2 source? 3) is an ignition source being utilized?
59
What % O2 helps to prevent an airway fire?
<30%

ACRM (9 decks)

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