Chapter 33: Techniques for Managing Difficult Airways Flashcards
How long is the adult larynx?
Males: 4.5 cm, Females: 3.5 cm
How long is the adult trachea?
Males: 12 cm, Females: 11 cm
Anatomical landmarks to locate the larynx?
Thyroid and cricoid cartilage = borders
Anatomical landmarks to locate the trachea?
Tracheal rings; cricoid cartilage marks the start of the trachea
Transverse diameter of larynx?
Male: 4.5 cm, Female: 4 cm
AP diameter of larynx?
Male: 3.5 cm, Female: 2.5 cm
Hyoid bone at what cervical level?
C3
Vocal cords at what cervical level?
C5
Cricoid cartilage at what cervical level?
C6
Transverse diameter of adult trachea?
Males: 2.5 cm, Females, 2.0 cm
Cost of a Bougie introducer?
$10
What is the purpose of the lumen of an ETT introducer?
We can provide HPOV through it.
Where should we create a bend in an ETT introducer? At what angle?
In the distal 2 cm
15-30* angle
Why is it important that an ETT introducer be relatively stiff?
It must lift the epiglottis to pass through the glottis and into the trachea
Which surface of the pharyngeal wall do you use to slide in an ETT introducer?
Dorsal surface
What provides tactile feedback when you successful place an ETT introducer into the trachea?
Tracheal cartilages: we will feel “bumps.”
In order to use an ETT introducer, you must be able to visualize:
at least the tip of the epiglottis
Which angle should you begin with when using an ETT introducer?
15* (lesser angle)
What are some risks of using an ETT introducer incorrectly?
Tracheal abrasion
Tracheal, laryngeal, pharyngeal puncture
Failure to obtain glottic entry
Failure to pass ETT
What is the most common length and ID of an ETT introducer?
ID: 6.0
Length: 66 cm
What risks do retrognathism pose to endotracheal intubation?
Small mouth opening
Small laryngopharyngeal space
Equipment for retrograde guidewire-assisted intubation?
J-tipped guidewire
2 Hemostats
Small-diameter ETT or ETT introducer
What is the minimum length of the J-tipped guidewire used in retrograde guidewire-assisted intubation?
60 cm
What is the life-threatening problem related to loss of upper airway patency?
HYPOXIA, not hypercapnia
What is the primary purpose of HPOV?
OXYGENATE, not ventilate
What does HPOV technique depend upon? Under what circumstances does this occur?
Depends upon egress of respiratory gases via the natural upper airway, which occurs when the upper airway obstructive problem is a ball-valve obstruction
For what kind of obstruction is HPOV useful?
Ball-valve obstruction
Under what circumstances should you NOT employ HPOV technique?
The obstruction is complete, not ball-valve.
Describe the anatomy and function of a Sanders Manual Jet ventilator.
Two ventilating attachments for a bronchoscope that allow continuous respiration without respiratory movements
What kind of O2 supply tubing is necessary for HPOV?
high-pressure, small diameter O2 supply tubing
The three way stopcock in HPOV is turned so that:
all ports are open
What are the two possible connectors sites for high pressure oxygen supply?
May connect to oxygen flow meter via nipple
May connect to anesthesia machine fresh-gas outlet with 6.0-mm ETT connector
An HPOV kit comes with what kind of supply of local anesthetic?
Vial lidocaine 2%
Catheter was placed cephalad is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?
Acute
Stylet not removed from catheter prior to HPOV is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?
Acute
Attempted HPOV using breathing circuit is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?
Intermediate
Failed to recognize inadequate HPOV is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?
Intermediate
Catheter placement not confirmed is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?
Acute
Barotrauma is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?
Long-term
Began HPOV with misplaced catheter is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?
Acute
Failed to maintain catheter position is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?
Intermediate
Inadequate oxygenation is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?
Intermediate
What is the most common acute practitioner-based error or complication in HPOV?
Catheter placement not confirmed (50%)
What is the most common intermediate practitioner-based error or complication in HPOV?
Inadequate oxygenation (92%)
How often does barotrauma occur in incorrectly administered HPOV?
75%
Three ways to provide HPOV:
FFO scope
Rigid bronchoscope
Ventilating laryngoscope
How many flexible fiberoptic airway procedures (using FFOB) are there per year?
500,000/year
How common are acute/intermediate complications in FFOB?
1-3%
What are some infection variables in FFOB?
Personal education/practice
Poor handling/disinfecting practice
Preceding patients’ contamination
Two most common bacterial strains residually left on FFOBs?
Strep/ staph
Normal skin flora include how many bacterial species? How many fungal species? How many viral species?
1000 bacterial species
30 fungal species
5 viral species
If an ETT is size 7.0 or greater, what are the dimensions of its Aintree catheter?
3.4 mm ID x 6 mm OD x 54 cm L
How does one connect an Aintree catheter to an LMA?
Boudaz connector
