Difficult Airway

Question 1

Difficult Mask Ventilation - definition

Answer 1

When you are unable to:

1. maintain O2 Sat >90% or
2. prevent or reverse signs of inadequate ventilation during positive-pressure mask ventilation

Question 2

Difficult tracheal intubation (DTI) - definition

Answer 2

when DVL takes:

1. multiple attempts >3 or
2. more than 10 minutes

Question 3

predictors of difficult mask

Answer 3

1. age > 55
2. beard
3. edentulous
4. snoring
5. BMI > 26
   
   1. especially if BMI > 40
   2. especially if the neck is short, with large circumference
6. facial anomaly/trauma

Question 4

scenarios when the oral, pharyngeal and laryngeal axis cannot be aligned or alternate scopes should be considered

Answer 4

1. anterior larynx
2. unstable cervicals pine fracture
3. upper body burns
4. trauma
5. TMJ immobility
6. micrognathia (small lower jaw)

Question 5

scopes to have when unable to align oral, pharyngeal and laryngeal axis

Answer 5

1. Upsher
2. Air Traq
3. Glidescope
4. Bullard

Question 6

Which scope requires the lear amount of mouth opening?

Answer 6

Bullard - 6 mm

• then the Upsher - 15 mm
• then the AirTraq
  
  • 16mm for small size and
  • 18 mm for regular size ETT

Question 7

awake intubation

when to consider it?

Answer 7

• cooperative & did not refuse awake intubation
• shock or poor cardiac reserve where they can’t tolerate induction meds
• hypoxic pt that will be difficult to ventilate if asleep - ex: because they have severe upper airway obstruction from an airway tumor
  
  • precipitating worsening hypoxia and a can’t intubate can’t ventilate scenario is high - awake intubation is best
• congenital facial anomaly like Pierre Robbin
• radical airway surgery and neck irradiation that would limit manipulation of larynx and neck angles
• obvious abnormality predisposing to difficult intubation or difficult ventilation
• pt can’t open their mouth widely enough to accept the laryngoscope
• thyromental distance extremely short
• there is a large tumor or swelling filling their mouth or submandibular space etc
• full stomach that looks difficult to intubate
• cervical spine compression (spinal stenosis) or unstable cervical spine fracture

Question 8

awake intubation

contraindications

Answer 8

• pt refusal
• pt uncooperative
• local anesthetic allergy