Chapter 15 Airway Management Flashcards
3-3-2 rule
A method used to predict difficult intubation.
A mouth opening of less than three fingerbreadths, a mandible length of less than three fingerbreadths, and a distance from hyoid bone to thyroid notch of less than two fingerbreadths indicate a possibly difficult airway
Abdominal thrust maneuver
Abdominal thrusts performed to relieve a foreign body airway obstruction.
Accessory muscles
The muscles not normally used during normal breathing; include the sternocleidomastoid muscles of the neck, the pectoral is major muscles of the chest, and the abdominal muscles.
Acetylcholine (ACh)
A chemical neurotransmitter of the parasympathetic nervous system.
Adventitious
Abnormal
after load
The pressure gradient against which the heart must pump; an increase can decrease cardiac output.
Atonal gasps
Slow, shallow, irregular respirations or occasional gasping breaths that result from cerebral anoxia.
anoxia
An absence of oxygen .
Anterograde amnesia
An inability to remember events after the onset of amnesia.
Aphonia
The inability to speak
Apneic oxygenation
The continued alveolar uptake of oxygen, even when the patient is apneic; can be facilitated by administering oxygen via nasal cannula during intubation.
Apneustic respirations
Prolonged gasping inspirations followeed by extremely short, ineffective expirations; associated with brainstem insult.
Asymmetric chest wall movement
Unequal movement of the two sides of the chest; indicates decreased airflow into one lung.
Automatic transport ventilator (ATV)
A portable mechanical ventilator attached to a control box that allows the variables of ventilation (such as rate and tidal volume) to be set.
Bag-mask device
A manual ventilation device that consists of a bag, mask, reservoir, and oxygen inlet; capable of delivering up to 100% oxygen.
Barotrauma
Trauma resulting from excessive pressure.
Benzodiazepines
Sedative-hypnotic drugs that provide muscle relaxation and mild sedation; include drugs such as diazepam (Valium) and midazolam (versed)
Biannual laryngoscopy
An effective technique to improve laryngoscopy view of the vocal cords by external manipulation of the larynx.
Bilevel positive airway pressure (BPAP)
A form of noninvasive positive pressure ventilation that delivers two pressures (a higher inspirations positive airway pressure, and a lower exploratory positive airway pressure).
Biot (ataxic) respirations
Irregular pattern, rate, and depth of respirations with intermittent periods of apnea; result from increased intracranial pressure.
Bourdon-gauge flowmeter
An oxygen flowmeter that is commonly used because it is not affected by gravity and can be placed in any position.
Bronchovesicular sounds
A combination of the tracheal and vesicular breath sounds; heard where airways and alveoli are found, the upper part of the sternum and between the scapulas.
BURP maneuver
The backward, upward, and rightward pressure used during intubation to improve the laryngoscopic view of the glottis opening and vocal cords; also called external laryngeal manipulation.
capnographer
A device that attaches between the endotracheal tube and ventilation device; provides graphic information about the presence of exhaled carbon dioxide.
Capnometer
A device that performs the same function and attaches in the same way as a capnographer but provides a digital reading of the exhaled carbon dioxide.
Carbon monoxide oximeter
a device that measures absorption at several wavelengths to distinguish oxyhemoglobin from carboxyhemoglobin.
carboxyhemoglobin (COHb)
Hemoglobin loaded with carbon monoxide
Cheyne- Stokes respirations
A gradually increasing rate and depth of respirations followed by a gradual decrease with intermittent periods of apnea; associated with brainstem insult.
Cobra perilaryngeal airway (CobraPLA)
A supraglottic airway device with a shape that allows the device to slide easily along the hard palate and to hold the soft tissue away from the laryngeal inlet.
Colorimetric carbon dioxide detector
A device that attaches between the endotracheal tube and ventilation device; uses special paper that should turn from purple to yellow during exhalation, indicating the presence of exhaled carbon dioxide.
Combo tube
A multilumen airway device that consists of a single tube with two lumens, two balloons, and two ventilation ports; an alternative device if endotracheal intubation is not possible or has failed.
Continuous positive airway pressure (CPAP)
A method of ventilation that delivers a single pressure, used primarily in the treatment of critically ill patients with respiratory distress; can prevent the need for endotracheal intubation.
Cormack- Lehane classification
A system used to predict intubation difficulty based on the airway structures observed during laryngoscopy
Crackles
The breath sounds produced as fluid-filled alveoli pop open under increasing inspiratory pressure; can be fine or coarse; formerly called rales.
Curved laryngoscopes blade
A blade designed to fit into the vallecula, indirectly lifting the epiglottis and exposing the vocal cords; also called the Macintosh blade.
Cyanosis
Blue or purple skin; indicates inadequate oxygen in the blood.
delayed sequence intubation (DSI)
A procedure in which a patient is sedated for the purpose of preoxygenation prior to the administration of a paralytic and intubation.
denitrogenation
The process of replacing nitrogen in the lungs with oxygen to maintain a normal oxygen saturation level during intubation
Depolarize got neuromuscular blocker
A drug that competitively binds with the acetylcholine receptor sites but is not affected as quickly by acetylcholinesterase; an example is succinylcholine chloride.
Digital intubation
A method of intubation that involves directly palpating the glottis structures and elevating the epiglottis with the middle finger while guiding the endotracheal tube into the trachea by using the sense of touch.
Direct laryngoscopy
Visualization of the airway with a laryngoscope
Dissociative anesthetic
A medication that distorts perception of sight and sound and induces a feeling of detachment from environment and self.
dysphonia
Difficulty speaking
Dyspnea
Difficulty or labored breathing.
Endotracheal (ET) tube
A tube that is inserted into the trachea for definitive airway maintenance; equipped with a distal cuff, proximal inflation port, a 15/22-mm adapter, and centimeter markings on the side.
Endotracheal (ET) intubation
Inserting an endotracheal tube through the glottis opening and sealing the tube with a cuff inflated against the tracheal wall.
End-tidal carbon dioxide (ETCO2) monitors
Devices that detect the presence of carbon dioxide in exhaled air.
epiglottis
A leaf-shaped cartilaginous structure that closes over the trachea during swallowing.
Esophageal detector device
A bulb or syringe that is attached to the proximal end of the endotracheal tube; a device used to confirm proper endotracheal tube placement.
Extubation
The process of removing the endotracheal tube from an incubated patient.
Face-to-face intubation
Performing intubation at the same level as the patient’s face; used when the standard position is not possible. In this position, the laryngoscope is held in the provider’s right hand and the endotracheal tube in the left.
Fasciculations
Brief, uncoordinated twitching of small muscle groups in the face, neck, trunk, and extremities; may be seen after the administration of a depolarizing neuromuscular blocking agent (succinylcholine chloride).
gag reflex
An automatic reaction when something touches an area deep in the oral cavity that helps protect the lower airway from aspiration.
Gastric distention
The enlargement or expansion of the stomach, often with air; can be a complication of ventilating the esophagus instead of the trachea.
Gastric tube
A tube that is inserted into the stomach to remove its contents
Gum elastic bougie
a flexible device that is inserted between the glottis under direct laryngoscopy; the endotracheal tube is threaded over the device, facilitating its entry into the trachea. also called a tracheal tube introducer.
Head tilt chin lift maneuver
Manual airway maneuver that involves tilting the head back while lifting up on the chi; used to open the airway of an unresponsive nontrauma patient.
Hemoglobin
An iron-containing protein within red blood cells that has the ability to combine with oxygen.
Hypercapnia
Increased carbon dioxide content in arterial blood.
Hyperventilation
A condition in which an increased amount of air enters the alveoli; carbon dioxide elimination exceeds carbon dioxide production.
Hypocapnia
Decreased carbon dioxide content in arterial blood.
Hypoventilation
a condition in which a decreased amount of air enters the alveoli; carbon dioxide production exceeds the body’s ability to eliminate it by ventilation
Hypoxemia
A decrease in arterial oxygen level.
Hypoxia
A lack of oxygen to cells and tissues
I gel
A supraglottic airway device that uses a non inflatable, gel like mask tho isolate the larynx and facilitate ventilation.
Inspiratory / expirations ratio (I/E)
An expression for comparing the length of inspiration with that of expiration, normally 1:2, meaning that expiration is twice as long as inspiration (not measured in seconds)
Intrapulmonary shunting
Bypassing of oxygen-poor blood past nonfunctional alveoli.
Jaw thrust maneuver
A technique to open the airway by placing the fingers behind the angle of the jaw and bringing the jaw forward; used when a patient may have a cervical spine injury.
King LT airway
A single lumen airway that is blindly inserted into the esophagus; when properly placed in the esophagus, one cuff seals the esophagus, and the other seals the oropharynx.
Kussmaul respirations
A respiration pattern characteristic of diabetic ketoacidosis, with marked hyperpnea and tachypnea; represents the body’s attempt to compensate for the acidosis.
Laryngeal mask airway (LMA)
A device that surrounds the opening of the larynx with an inflatable silicone cuff positioned in the hypopharynx; an alternative to bag-mask ventilation.
Laryngectomy
A surgical procedure in which the larynx is removed.
Laryngoscope
A device that is used in conjunction with a laryngoscope blade to perform direct laryngoscopy.
Lung compliance
The ability of the alveoli to expand when air is drawn into the lungs during negative pressure ventilation or positive pressure ventilation.
Magill forceps
a special type of forceps that is curved, thus allowing paramedics to maneuver it in the airway.
Mallampati classification
a system for predicting the relative difficulty of intubation based on the amount of oropharyngeal structures visible in an upright, seated patient who is fully able to open his or her mouth.
Metabolism
The chemical processes that provide the cells with energy from nutrients.
Methemoglobin (metHb)
A compound formed by oxidizing the iron on hemoglobin
Multilumen airway
Airway device with a single long tube that can be used for esophageal obstruction or endotracheal tube ventilation, depending on where the device comes to rest following blind positioning.
Murphy eye
An opening on the side of an endotracheal tube at its distal tip that permits ventilation to occur even if the tip becomes occluded by blood, mucus, or the tracheal wall.
Nasal cannula
A device that delivers oxygen via two small prongs that fit into the patient’s nostrils; with an oxygen flow rate of 1-6 L/min, an oxygen concentration of 24% to 44% can be delivered.
Nasogastric (NG) tube
A gastric tube is inserted into the stomach through the nose.
Nasopharyngeal (nasal) airway
A soft rubber tube about 6 inches (15cm) long that is inserted through the nose into the posterior pharynx behind the tongue, thereby allowing passage of air from the nose to the lower airway.
Nasotracheal intubation
Insertion of an endotracheal tube into the trachea through the nose.
Needle cricothyrotomy
Insertion of a 14 to 16 gauge over-the-needle intravenous catheter (such as an angiocath) through the cricothyroid membrane and into the trachea.
Negative pressure ventilation
Drawing of air into the lungs; airflow from a region of higher pressure (outside the body) to a region of lower pressure (the lungs); occurs during normal (Unassisted) breathing.
Nondepolarizing neuromuscular blockers
Drugs that bind to acetylcholine receptor sites; they do not cause depolarization of the muscle fiber; examples are vecuronium (Norcuron) and pancuronium (Pavulon); also called paralytics.
Nonrebreathing mask
A combination mask and reservoir bag system in which oxygen fills a reservoir bag attached to the mask by a one-way valve permitting a patient to inhale from the reservoir bag but not to exhale into it; at a flow rate of 15 L/min, it can deliver 90% to 100% inspired oxygen.
Open cricothyrotomy
An emergency incision of the cricothyroid membrane with a scalpel and insertion of an endotracheal or tracheostomy tube directly into the subglottic. Area of the trachea; also called surgical cricothyrotomy.
Opioids
Potent analgesics with sedative properties; examples are fentanyl (sublimaze) and alienating (Alfenta); also called narcotics.
orogastric (OG) tube
A gastric tube inserted into the stomach through the mouth
Oropharyngeal (oral) airway
A hard plastic device that is curbed so that it fits over the back of the tongue with the tip in the posterior pharynx.
Orotracheal intubation
Insertion of an endotracheal tube into the trachea through the mouth
Orthopaedics
Positional dyspnea
Oxygen humidifier
A small bottle of water through which the oxygen leaving the cylinder is moisturized before it reaches the patient.
Oxyhemoglobin (Hbo2)
Hemoglobin that is occupied by oxygen.
Pancuronium
A nondepolarizing neuromuscular blocking agent; used to maintain paralysis following succinylcholine facilitated intubation.
Paradoxical motion
The inward movement of the chest during inhalation and Woodward movement during exhalation; the opposite of normal chest wall movement during breathing.
Paralytics
Drugs that paralyze skeletal muscles; used in emergency situations to facilitate intubation; also called neuromuscular blocking agents.
Partial laryngectomy
Surgical removal of part of the larynx
Partial rebreathing mask
a mask similar to the non rebreathing mask but without a one way valve between the mask and the reservoir; room air is not drawn in which inspiration; residual expired air is mixed in the mask and rebreathed
Patent
Open
Peak expiration flow
An approximation of the extent of bronchoconstriction; used to determine whether therapy (such as with inhaled bronchodilators) is effective.
Pleural friction rub
The result of an inflammation that causes the pleura to thicken, decreasing the pleural space and allowing the pleurae to rub together.
Positive end-expiratory pressure (PEEP)
Mechanical maintenance of pressure in the airway at the end of expiration to increase the volume of gas remaining in the lungs.
Positive pressure ventilation
Forcing of air into the lungs
Preload
The pressure of blood that is returned to the heart (venous return)
Pressure compensated flowmeter
An oxygen flowmeter that incorporates a float ball in a tapered calibrated tube; the float rises or falls according to the gas flow in the tube; is affected by gravity and must remain in an upright position for an accurate reading.
Pulse oximeter
A device that measures oxygen saturation level (SPO2)
Pulses paradoxus
A drop in the systolic blood pressure of 10 mm Hg or more; commonly seen in patients with pericardial tamponade or severe asthma.
Rapid sequence intubation (RSI)
A specific set of procedures, combined in rapid succession, to induce sedation and paralysis and incubate a patient quickly.
Recovery position
Left lateral recumbent position; used in all unresponsive nontrauma patients who are able to maintain their own airway spontaneously and are breathing adequately.
Reduced hemoglobin
The hemoglobin after the oxygen has been released to the cells.
Reemergence phenomenon
The occurrence of dreams, nightmares, or delirium that can take place during the end of the half-life of ketamine
Respiratory acidosis
A pathologic condition characterized by a blood pH of less than 7.35 and caused by the accumulation of acids in the body from a respiratory cause.
Respiratory alkalosis
A pathologic condition characterized by a blood pH of greater than 7.45 and resulting from the accumulation of bases in the body from a respiratory cause.
Retractions
The drawing in of the intercostal muscles and the muscles above the clavicles that can occur in respiratory distress.
Retrograde intubation
A technique in which a wire is placed through the trachea and into the mouth with a needle via the cricoid membrane; the endotracheal tube is then placed over the wire and guided into the trachea.
Rhonchi
A continuous, low pitched sound; indicated mucus or fluid in the larger lower airways.
Rocuronium
A nondepolarizing neuromuscular blocking agent; used to maintain paralysis following succinylcholine facilitated intubation
Safe residual pressure
The pressure at which an oxygen cylinder should be replaced with a full one; often is 200 psi
Sedation
The reduction of a patients anxiety, induction of amnesia, and suppression of the gag reflex, usually by pharmacological means.
Stenosis
A narrowing, such as of a blood vessel or stoma
Stoma
In the context of the airway, the resultant orifice of a tracheostomy that connects the trachea to the outside air; located in the midline of the anterior part of the neck.
Straight laryngoscope blade
A blade designed to lift the epiglottis and expose the vocal cords; also called the miller blade.
Stridor
A high pitched inspiratory sound representing air moving past an obstruction within or immediately above the glottis opening.
Stylet
In the context of intubation, a semirigid wire inserted into an endotracheal tube to mold and maintain the shape of the tube.
Succinylcholine chloride
A depolarizing neuromuscular blocker frequently used as the initial paralytic during rapid sequence intubation; causes muscle fasciculations.
Therapy regulator
A device that attaches to the stem of the oxygen cylinder and reduces the high pressure of gas to a safe range (about 50 psi)
Tongue jaw lift maneuver
A manual maneuver that involves grasping the tongue and jaw and lifting; commonly used to suction the airway and to place certain airway devices
Tonsil tip catheter
A hard or rigid suction catheter; also called a yankauer catheter.
Total laryngectomy
Surgical removal of the entire larynx.
Tracheal breath sounds
Breath sounds heard by placing the stethoscope diaphragm over the trachea or sternum; also called bronchial breath sounds.
Tracheobronchial suctioning
Inserting a suction catheter into the endotracheal tube to remove pulmonary secretions.
Tracheostomy
A surgical opening into the trachea.
Tracheostomy tube
A plastic tube placed within the tracheostomy site (stoma).
Transillumination intubation
A method of intubation that uses a lighted sylhet to guide the endotracheal tube into the trachea
Translaryngeal catheter ventilation
A method used in conjunction with needle cricothyrotomy to ventilate a patient.
Trismus
Clenched teeth caused by spasms of the jaw muscles
Vecuronium
A nondepolarizing neuromuscular blocking agent; used to maintain paralysis following succinylcholine-facilitated intubation.
Venturi mask
A mask with a number of interchangeable adapters that draws room air into the mask along with the oxygen flow; allows for the administration of highly specific oxygen concentrations.
Vesicular breath sounds
Soft, muffled breath sounds in which the expiratory phase is barely audible
Video laryngoscopy
Visualization of the epiglottis and vocal cords through a video monitor that is attached to a laryngoscope
V/Q mismatch
An imbalance between the anatomic portions of the lung being ventilated (V) and the anatomic portion being perfumed (Q)
Waveform capnography
A waveform display of exhaled carbon dioxide shown on a portable cardiac monitor/ defibrillator
Wheezing
A high pitched whistling sound that may be heard on inspiration, expiration, or both; indicates air movement through a constricted lower airway, such as with asthma.
Whistle tip catheters
Soft plastic, nonrigid catheters; also Called French catheters.
