CA airway management Flashcards
in a normal adult, at which level does the glottis sit?
level of the 5th cervical vertebrae
what is the name of the pre-operative airway assessment classification we use?
mallampati classification
describe what you will see with the following mallampati classifications:
1) class 1
2) class 2
3) class 3
4) class 4
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
what is the number one cause of airway obstruction?
the tongue!
what will often relieve an airway obstruction by the tongue?
chin lift/jaw thrust
where must you be sure to keep your fingers away from when performing mask ventilation? where should you place them?
avoid placing fingers on soft tissue – could compress airway
thumb up by nose, fingers on the mandible
who can you NOT use an oral airway in?
someone with active gag reflexes
a _____ is less stimulating, and better tolerated than oral airways
nasal airway
what is the number one complication of placing a nasal airway?
hemorrage
what are relative complications of placing a nasal airway?
coagulopathies, head trauma, low platelets, anticoagulants
ventilatory pressure when using a laryngeal mask airway should not exceed what mmHG?
20 mmHG
how do you confirm placement of your laryngeal mask airway?
breath sounds, ETCO2 on wave capnography
which populations can you NOT use a laryngeal mask airway in?
pregnancy, heavy opiate intoxication, gross obesity
contraindications to endotracheal intubation?
NONE, but many precautions
what must you always keep next to the bedside when performing an intubation?
suction catheter with yankauer tip!
you should always hold the laryngoscope in your _____ hand
left
even if dominant
allows for the epiglottis to be lifted indirectly and incompletely, but is easier and better displaces the tongue
curved blades (macintosh blades) on laryngoscope
tip of blade rests in valecula
allows for the epiglottis to be directly lifted and more completely, allowing enhanced visualization
straight (miller or wisconsin) blade
tip of blade inserted beneath the epiglottis
a female adult typically requires what sized endotracheal tube? what about males?
female = 7.0-7.5 male = 7.5-9.0
cuff pressures when placing an endotracheal tube should not exceed what pressure?
25 torr (capillary pressure)
what four pieces of equipment are essential in ensuring proper tube placement?
1) stethoscope
2) end-tital CO2 monitor
3) esophageal syringe
4) chest x-ray to verify position
what is the name of the position you should place your patient into prior to intubation? whats it look like?
sniffing position
moderate head elevation (7-10 cm) - flexion of lower CS and extension of upper CS
describe the scissor maneuver
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
when inserting a straight blade, there is no _____ involved
sweeping
you should advance the blade until these 2 landmarks are recognized
tip of epiglottis and arytenoid cartilages
then continue to advance
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
LIFT
don’t lever
what are 3 common mistakes made while intubating?
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)
