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ANES 512b Midterm > Chapter 33: Techniques for Managing Difficult Airways > Flashcards

Chapter 33: Techniques for Managing Difficult Airways Flashcards

1
Q

How long is the adult larynx?

A

Males: 4.5 cm, Females: 3.5 cm

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2
Q

How long is the adult trachea?

A

Males: 12 cm, Females: 11 cm

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3
Q

Anatomical landmarks to locate the larynx?

A

Thyroid and cricoid cartilage = borders

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4
Q

Anatomical landmarks to locate the trachea?

A

Tracheal rings; cricoid cartilage marks the start of the trachea

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5
Q

Transverse diameter of larynx?

A

Male: 4.5 cm, Female: 4 cm

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6
Q

AP diameter of larynx?

A

Male: 3.5 cm, Female: 2.5 cm

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7
Q

Hyoid bone at what cervical level?

A

C3

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8
Q

Vocal cords at what cervical level?

A

C5

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9
Q

Cricoid cartilage at what cervical level?

A

C6

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10
Q

Transverse diameter of adult trachea?

A

Males: 2.5 cm, Females, 2.0 cm

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11
Q

Cost of a Bougie introducer?

A

$10

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12
Q

What is the purpose of the lumen of an ETT introducer?

A

We can provide HPOV through it.

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13
Q

Where should we create a bend in an ETT introducer? At what angle?

A

In the distal 2 cm

15-30* angle

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14
Q

Why is it important that an ETT introducer be relatively stiff?

A

It must lift the epiglottis to pass through the glottis and into the trachea

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15
Q

Which surface of the pharyngeal wall do you use to slide in an ETT introducer?

A

Dorsal surface

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16
Q

What provides tactile feedback when you successful place an ETT introducer into the trachea?

A

Tracheal cartilages: we will feel “bumps.”

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17
Q

In order to use an ETT introducer, you must be able to visualize:

A

at least the tip of the epiglottis

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18
Q

Which angle should you begin with when using an ETT introducer?

A

15* (lesser angle)

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19
Q

What are some risks of using an ETT introducer incorrectly?

A

Tracheal abrasion
Tracheal, laryngeal, pharyngeal puncture
Failure to obtain glottic entry
Failure to pass ETT

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20
Q

What is the most common length and ID of an ETT introducer?

A

ID: 6.0
Length: 66 cm

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21
Q

What risks do retrognathism pose to endotracheal intubation?

A

Small mouth opening

Small laryngopharyngeal space

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22
Q

Equipment for retrograde guidewire-assisted intubation?

A

J-tipped guidewire
2 Hemostats
Small-diameter ETT or ETT introducer

23
Q

What is the minimum length of the J-tipped guidewire used in retrograde guidewire-assisted intubation?

A

60 cm

24
Q

What is the life-threatening problem related to loss of upper airway patency?

A

HYPOXIA, not hypercapnia

25
Q

What is the primary purpose of HPOV?

A

OXYGENATE, not ventilate

26
Q

What does HPOV technique depend upon? Under what circumstances does this occur?

A

Depends upon egress of respiratory gases via the natural upper airway, which occurs when the upper airway obstructive problem is a ball-valve obstruction

27
Q

For what kind of obstruction is HPOV useful?

A

Ball-valve obstruction

28
Q

Under what circumstances should you NOT employ HPOV technique?

A

The obstruction is complete, not ball-valve.

29
Q

Describe the anatomy and function of a Sanders Manual Jet ventilator.

A

Two ventilating attachments for a bronchoscope that allow continuous respiration without respiratory movements

30
Q

What kind of O2 supply tubing is necessary for HPOV?

A

high-pressure, small diameter O2 supply tubing

31
Q

The three way stopcock in HPOV is turned so that:

A

all ports are open

32
Q

What are the two possible connectors sites for high pressure oxygen supply?

A

May connect to oxygen flow meter via nipple

May connect to anesthesia machine fresh-gas outlet with 6.0-mm ETT connector

33
Q

An HPOV kit comes with what kind of supply of local anesthetic?

A

Vial lidocaine 2%

34
Q

Catheter was placed cephalad is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?

A

Acute

35
Q

Stylet not removed from catheter prior to HPOV is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?

A

Acute

36
Q

Attempted HPOV using breathing circuit is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?

A

Intermediate

37
Q

Failed to recognize inadequate HPOV is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?

A

Intermediate

38
Q

Catheter placement not confirmed is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?

A

Acute

39
Q

Barotrauma is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?

A

Long-term

40
Q

Began HPOV with misplaced catheter is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?

A

Acute

41
Q

Failed to maintain catheter position is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?

A

Intermediate

42
Q

Inadequate oxygenation is what kind of practitioner-based error or complication in HPOV? Acute, intermediate, or long-term?

A

Intermediate

43
Q

What is the most common acute practitioner-based error or complication in HPOV?

A

Catheter placement not confirmed (50%)

44
Q

What is the most common intermediate practitioner-based error or complication in HPOV?

A

Inadequate oxygenation (92%)

45
Q

How often does barotrauma occur in incorrectly administered HPOV?

A

75%

46
Q

Three ways to provide HPOV:

A

FFO scope
Rigid bronchoscope
Ventilating laryngoscope

47
Q

How many flexible fiberoptic airway procedures (using FFOB) are there per year?

A

500,000/year

48
Q

How common are acute/intermediate complications in FFOB?

A

1-3%

49
Q

What are some infection variables in FFOB?

A

Personal education/practice
Poor handling/disinfecting practice
Preceding patients’ contamination

50
Q

Two most common bacterial strains residually left on FFOBs?

A

Strep/ staph

51
Q

Normal skin flora include how many bacterial species? How many fungal species? How many viral species?

A

1000 bacterial species
30 fungal species
5 viral species

52
Q

If an ETT is size 7.0 or greater, what are the dimensions of its Aintree catheter?

A

3.4 mm ID x 6 mm OD x 54 cm L

53
Q

How does one connect an Aintree catheter to an LMA?

A

Boudaz connector

ANES 512b Midterm (12 decks)

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