Difficult Airway

Question 1

ASA suggested signs of difficult to ventilate:

Answer 1

1. Inadequate ventilation cannot be reversed by mask ventilation
2. O2 Sat cannot be maintained above 90%
3. Difficult to intubate (> 3 attempts)
4. > 10 minutes to intubate

Question 2

Which patient is more prevalent in having difficult intubations?

Answer 2

Obstetrics

Question 3

Principle Elements of airway management:

Answer 3

1. Assessment
2. Anticipation
3. Preparedness
4. Resources
5. Skill

Question 4

Patient appearance for difficult intubation:

Answer 4

1. Large beard
2. Neck trauma, cervical collar
3. Ear and hand anomalies
4. Short thick neck and/or obese pt

Question 5

Lemon Law

Answer 5

Look externally
Evaluate the 3-3-2 rule
Mallampati
Obstruction?
Neck mobility

Question 6

Evaluate: 3-3-2 Rule

Answer 6

3 Fingers in mouth
3 fingers fit from mentum to hyoid cartilage (6.5 - 7 cm)
2 finger fit from the floor of mouth to top of thyroid cartilage

Question 7

Mallampati grade and thyromental distance can predict difficult intubation in ___ of patients.

Answer 7

95%

Question 8

Pre-Oxy:

Answer 8

1.TVB (Tidal Volume Breathing) of O2 for 3-5 min
2. Deep breaths (DB) 4 times within 0.5 min
(Both are good for ARTERIAL O2 saturation)

Question 9

Plan “A”: Alternate

Answer 9

1. Change length of blade
2. Change type of blade
3. Different position

Question 10

Plan “B”

Answer 10

1. Can you ventilate
2. LMA an option?
3. Combi-tube

Question 11

Plan “C”

Answer 11

Cric, needle or surgical

Question 12

Supraglottic airways:

Answer 12

1. Combitube

2. LMA

Question 13

LMA allowable positive pressure:

Answer 13

15-20 cm H2O

Question 14

LMA you can intubate through:

Answer 14

Fastrach

Question 15

LMA-Proseal

Answer 15

High seal pressure - up to 30 cm H2O

Question 16

Combitube

Answer 16

Two lumens allows function whether placed in esophagus or trachea
Contraindicated in people < 5 ft, intact gag, esophageal disease, or caustic ingestion.

Question 17

Awake intubation options:

Answer 17

1. Fiberoptic
2. Retrograde intubation (not recommended in cannot intubate/cannot ventilate)
3. Tracheostomy

Question 18

Difficult airway flowchart:

Answer 18

1. Manipulation of airway, different blade, bugie -> 2. LMA, ILMA, Combitube ->3. Transtracheal Jet Ventilation -> Cricothireotomy, Tracheostomy