CA airway management

Question 1

in a normal adult, at which level does the glottis sit?

Answer 1

level of the 5th cervical vertebrae

Question 2

what is the name of the pre-operative airway assessment classification we use?

Answer 2

mallampati classification

Question 3

describe what you will see with the following mallampati classifications:

1) class 1
2) class 2
3) class 3
4) class 4

Answer 3

1) can see everything (full uvula)
2) can only see tip of uvula
3) can only see base of uvula
4) can’t see uvula at all

Question 4

what is the number one cause of airway obstruction?

Answer 4

the tongue!

Question 5

what will often relieve an airway obstruction by the tongue?

Answer 5

chin lift/jaw thrust

Question 6

where must you be sure to keep your fingers away from when performing mask ventilation? where should you place them?

Answer 6

avoid placing fingers on soft tissue – could compress airway

thumb up by nose, fingers on the mandible

Question 7

who can you NOT use an oral airway in?

Answer 7

someone with active gag reflexes

Question 8

a _____ is less stimulating, and better tolerated than oral airways

Answer 8

nasal airway

Question 9

what is the number one complication of placing a nasal airway?

Answer 9

hemorrage

Question 10

what are relative complications of placing a nasal airway?

Answer 10

coagulopathies, head trauma, low platelets, anticoagulants

Question 11

ventilatory pressure when using a laryngeal mask airway should not exceed what mmHG?

Answer 11

20 mmHG

Question 12

how do you confirm placement of your laryngeal mask airway?

Answer 12

breath sounds, ETCO2 on wave capnography

Question 13

which populations can you NOT use a laryngeal mask airway in?

Answer 13

pregnancy, heavy opiate intoxication, gross obesity

Question 14

contraindications to endotracheal intubation?

Answer 14

NONE, but many precautions

Question 15

what must you always keep next to the bedside when performing an intubation?

Answer 15

suction catheter with yankauer tip!

Question 16

you should always hold the laryngoscope in your _____ hand

Answer 16

left

even if dominant

Question 17

allows for the epiglottis to be lifted indirectly and incompletely, but is easier and better displaces the tongue

Answer 17

curved blades (macintosh blades) on laryngoscope

tip of blade rests in valecula

Question 18

allows for the epiglottis to be directly lifted and more completely, allowing enhanced visualization

Answer 18

straight (miller or wisconsin) blade

tip of blade inserted beneath the epiglottis

Question 19

a female adult typically requires what sized endotracheal tube? what about males?

Answer 19

female = 7.0-7.5
male = 7.5-9.0

Question 20

cuff pressures when placing an endotracheal tube should not exceed what pressure?

Answer 20

25 torr (capillary pressure)

Question 21

what four pieces of equipment are essential in ensuring proper tube placement?

Answer 21

1) stethoscope
2) end-tital CO2 monitor
3) esophageal syringe
4) chest x-ray to verify position

Question 22

what is the name of the position you should place your patient into prior to intubation? whats it look like?

Answer 22

sniffing position

moderate head elevation (7-10 cm) - flexion of lower CS and extension of upper CS

Question 23

describe the scissor maneuver

Answer 23

use the index finger to pull the upper right incisors toward the operator (to open the mouth), extend the AO joint, and protect the teeth in lips

at the same time the thumb depresses the lower mandible, further opening the mouth

Question 24

when inserting a straight blade, there is no _____ involved

Answer 24

sweeping

Question 25

you should advance the blade until these 2 landmarks are recognized

Answer 25

tip of epiglottis and arytenoid cartilages

then continue to advance

Question 26

you should ____ and not ____ the laryngoscope in the direction of the handle to lift the tongue and posterior pharyngeal structures out of the line of sight, exposing the glottis

Answer 26

LIFT

don’t lever

Question 27

what are 3 common mistakes made while intubating?

Answer 27

1) inserting blade too far into upper esophagus and lifting entire larynx
2) pulling the lever (wrist NEVER moved, motion of handle is upward and away)
3) inserting ETT too far (bronchial intubation)