E2 - Airway Equipment I Flashcards
What is the airway equipment allows gas administration to the patient from the breathing system without any apparatus in the patient’s mouth?
A. Nasal cannula
B. Face mask
C. Nasopharyngeal airway
D. LMA Classic
B. Face Mask
What does a face mask allow us to do before induction of anesthesia?
A. measure their oral, pharyngeal and laryngeal axis
B. provide our volatile gas
C. preoxygenate/denitrogenate
D. do a pressure check with the patient
C. Preoxygenation/Denitrogenation
get out their damn nitrogen (filler gas) so we have more space for our o2 + gas to take up in the lungs
What are the three components of the Face Mask?
A. body
B. corrugated tubing
C. connector
D. straps
E. seal
F. fresh gas inlet valve
A. Body - Transparent, Provides shape
E. Seal - Inflatable cushion, 20 to 25 cm H2O with minimal leak
C. Connector - 22 mm internal diameter, circular ring with prongs for straps
What pressure should the inflatabale cushion be at to provide enough of a seal?
A. 10-15 cm H2O
B. 15-20 cm H2O
C. 20-25 cm H2O
D. 25-30 cm H2O
C. 20-25 cm H2O with minimal leak
What can we add to the face mask to provide comfort to a pediatric patient?
A. volatile gas
B. vaseline
C. scent
D. more air in the cushion
C. scent
lol gas
What is the criteria associated with difficult mask ventilation?
- Obese (BMI > 30 kg/m2)
- Beard (big bushy ones)
- Edentulousness
- Snore/OSA
- Elderly >55, Male
- Mallampati 3 or 4
OBESE-M
What are some ways to overcome Difficult Mask Ventilation?
A. nasal intubation
B. two handed technique
C. video laryngoscope
D. tell the patient to close their mouth
E. cut the beard
B. Two-handed technique
E. Cut the beard (let the pt know beforehand)
Other: Oral airway OR nasopharyngeal airway, Tegaderm
not in this order
What should you NOT give if you cannot mask ventilate your patient?
Do not give paralytics!!!
What should you do if you cannot mask ventilate the patient?
A. keep trying to fit the same mask
B. difficult airway algorithm
C. give 0.6 mg/kg rocuronium
D. nasal intubation
B. Emergency adjunct (difficult airway algorithm)
What might be used to hold the face mask in place and allows the CRNA’s hand to be free?
A. tell OR circulator to hold the mask
B. tape
C. tell patient to hold it until you paralyze them
D. mask straps
D. Mask Straps
How does an OPA open the airway?
A. by sliding the tongue and epiglottis into the posterior pharyngeal wall
B. by lifting the tongue and epiglottis away from the posterior pharyngeal wall
C. by lifting only the tongue away from the posterior pharyngeal wall
D. by sliding only the epiglottis towards the posterior pharyngeal wall
B. maintain or opens the airway by lifting the tongue and epiglottis away from the posterior pharyngeal wall
OPA decreases the work of breathing during spontaneous ventilation.
Why should you not put an OPA in an awake patient?
A. patient will spit too much
B. gag reflex isn’t intact anymore
C. high risk of laryngospasm
D. patient might cough during
C. High risk of laryngospasm
Also: Patient will fight you and Gag reflex still intact
Most OPAs are made of _______
A. rubber
B. plastic
C. paper fiber
B. mesh
B. Plastic
Why should the bite portion of an OPA be firm enough?
A. To stay open during a deep inspiration
B. Prevents closure during a deep cough
C. Prevents lumen from closing when the patient bites
D. For patient to have a soft area to bite
C. Prevents lumen from closing when the patient bites
NO OPAs FOR METH MOUTH! TEETH WILL FALL OUT
The OPAs are color-coded by size, which is measured in ______.
millimeters
How is appropriate sizing of OPA determined? select 2.
A. using measuring tape
B. measure from corner of mouth to the angle of maxilla or earlobe
C. ask patient to open mouth to eyeball distance to oropharynx
D. use the OPA
E. measure from corner of mouth to the angle of mandible or earlobe
F. using tongue depressor
D. OPA should be used
E. measure from the corner of the mouth to the angle of the mandible or the earlobe for appropriate sizing.
What should be depressed when placing an OPA?
A. the patient
B. gag reflex
C. pharyngeal and laryngeal reflexes
D. the SRNA
E. neural reflexes
C. Pharyngeal and Laryngeal Reflexes
What are the two methods to OPA insertion?
- Approach with OPA backward and use 180-degree turn method
- Use a tongue depressor to insert OPA method
Where should the CRNA place the bite block?
A. between the upper and lower teeth and gums
B. between the maxilla and lower teeth
C. between the maxilla and gums
D. between the upper and lower teeth and tongue
A. bite block should be placed between the upper and lower teeth and gums
used often in endoscopy!
NPAs are tolerated in patients with intact _________.
A. gag reflexes
B. neuro reflexes
C. airway reflexes
D. babinski reflexes
C. Airway Reflexes
When would a NPA be contraindicated? Select 3.
A. Nose piercings
B. Basilar skull fracture
C. Hx of epistaxis
D. Chronic heparin use
E. Pregnancy
F. Trauma patients
G. Mandible fracture
B. basilar skull fracture
C. Hx of epistaxis
E. Pregnancy
other CIs: Nasal deformity, Coagulopathy
NPAs are preferably used with these patients: Select 2.
A. Normal mouth opening
B. Oral trauma
C. Edentulous
D. Gingivitis
B. Oral Trauma
D. Gingivitis
also preferred in loose teeth and limited mouth opening
Describe the design of NPA: Select 2
A. flange is on distal end of tube
B. resembles shortened tracheal tube
C. more stimulating than OPA
D. sized by inner diameter
E. trumpet at outer end prevents complete passage
B. Resembles shortened tracheal tube
E. Flange (trumpet!) at outer end to prevent complete passage
and:
* Less stimulating than OPA
* Sized by outer diameter in French scale
How should the appropriate size of the NPA be determined?
A. bony mandible to base of skull
B. nostril to the external auditory meatus
C. bony mandible to superior part of ear
D. nostril to posterior mandible
B. nostril or bony mandible to the external auditory meatus
How can you mitigate epistaxis during NPA insertion?
Lubricate NPA thoroughly
What are some complications of airways discussed per lecture?
- Airway obstruction (from incorrect placement)
- Dental/oral damage
- Retention/swallowing
- Ulceration of the nose or tongue
- Laryngospasm
- Latex allergy (some older NPAs usually green in color)
ADRULL (“a drool”)
What is the type of airway that can be inserted into the pharynx to allow ventilation, oxygenation, and administration of anesthetic gases without the need for endotracheal intubation?
Hint: the intermediate bridge between a face mask and ETT
Supraglottic Airway
Can be used in both spontaneous ventilation and PPV
Who created the Supraglottic Airway?
What year was it created?
- Dr. Archie Brain
- 1982/1983
Proximally, LMA classic is shaped like a ________.
A. tracheal tube
B. NPA
C. OPA
D. face mask
- Tracheal Tube
distally: elliptical mask
proximally: TT
Distally, LMA classic is shaped like a ________.
A. tracheal tube
B. NPA
C. OPA
D. elliptical mask
D. Elliptical mask
Where does the LMA classic sit when inserted properly?
A. oropharynx
B. hypopharynx
C. nasopharynx
D. epiglottis
B. Sits in hypopharynx and surrounds the supraglottic structure
An inflatable cuff provides seal
LMA Sizing Chart to Memorize.
-_-
What happens if the LMA size is too small?
A. might slip into esophagus
B. patient will complain of sore throat
C. doesn’t seat over glottis
D. gas leaks during PPV
D. Gas leaks during positive pressure
What happens if the LMA size is too large?
A. won’t seat over epiglottis
B. gas will leak during positive pressure
C. possible pressure on lingual, hypoglossal, and recurrent laryngeal nerve
D. could cause a bronchospasm
C. Possible pressure on lingual, hypoglossal, and recurrent laryngeal nerves
Also, it Won’t seat over GLOTTIS, and Greater incidence of sore throat
What is the process for inserting a LMA?
- Needs to be well lubricated; cuff down
- hold it like a PENCIL
- Place LMA upward against the hard palate
- Follow the posterior pharyngeal wall in a smooth motion
- Should feel it curve downward in the airway, then come to a stop
- Inflate balloon
When the LMA balloon is inflated, what happens to the patient’s neck?
Neck bulges and LMA may “rise” slightly
What are 4 things you can do to troubleshoot a difficult LMA placement?
- Jaw lift
- Pull the tongue forward
- Slightly inflate the balloon
- Change to a different technique
What makes a “LMA Unique” different than a LMA Classic? Select 3.
A. flimsier
B. stiffer
C. cuff less compliant
D. cuff more compliant
E. harder to place
F. easier to place
B. Stiffer
C. cuff less compliant than LMA classic
F. Easier to place
also, its made of PVC! and Same insertion technique as LMA classic!
What describes a LMA Proseal?
A. wire reinforced
B. shorter than LMA classic
C. Gastric access
D. All of the above
D. All of the above
* Wired reinforced LMA
* Shorter than Classic LMA
* Gastric access - OGT can be passed through to deflate the stomach to decrease the risk of aspiration
What make an IGEL LMA different than the rest? Select 2.
A. it has high risk of esophageal intubation
B. it does not have a gastric channel
C. it only seals the laryngeal structures
D. it does not have a cuff
E. it has a conduit for intubation
D. IGEL LMAs do not have a cuff bc it conforms to create an anatomical seal of the pharyngeal, laryngeal, and peri-laryngeal structure
E. IGELs have a conduit for intubation
ALSO: IGEL has gastric access (like proseal)
Which LMA creates the most adequate seal of the supraglottic structure per lecture?
IGEL LMAs
that’s why it doesn’t have a cuff
What are some advantages of LMAs? Select 2.
A. risks similar to ETT
B. reduced anesthetic requirements
C. reduced hemodynamic stability
D. ease and speed of placement
B. Reduced anesthetic requirements
D. Ease and speed of placement (as fast as 5 secs)
And:
Improved hemodynamic stability
No muscle relaxation needed
Avoidance of some of the risks of tracheal intubation
What are disadvantages of using an LMA? Select 2.
A. smaller seal pressures than ETTs
B. none can protect from regurgitation or aspiration
C. ineffective ventilation
D. no protection from laryngospasm
E. patients will wake up with more of a sore throat unlike using an ETT
A. Smaller seal pressures than ETTs - causing ineffective ventilation WHEN HIGHER PRESSURES are needed.
B. No protection from laryngospasm
And: only first generations (Classic and Unique) provide little protection from gastric regurgitation and aspiration
while IGEL (2nd gen) = BEST PROTECTION FOR GASTRIC REGURG & ASPIRATION
Name First Generation LMAs
- LMA Classic
- LMA Unique
NO OGT access = Little protection from gastric regurgitation and aspiration with these
Name Second Generation LMAs
- LMA Proseal
- LMA IGEL
have OGT access = better protection from regurg + aspiration
What are the 3 components of the rigid direct laryngoscopes?
- Handle
- Blade
- Light source (usually fiberoptic)
Manufactured as a single piece or detachable blade/handle
Which hand (R or L) should handle the laryngoscope?
- Left Hand
Source of power for the laryngoscope light.
- Disposable batteries in the handle of the laryngoscope
- Typically C-Size Batteries
Most laryngoscope blades form a ________ angle to blade when ready for use.
- right
What does the tip of laryngoscope blade do to the epiglottis?
A. slide directly into it
B. directly or indirectly elevate it
C. manipulates soft tissue
D. compresses soft tissue
E. sweep it to the side
B. Tip of blade will directly or indirectly elevates epiglottis
and the Tongue of blade will Manipulate and compress soft tissue
What does the tongue of the laryngoscope blade do?
A. manipulates and compresses soft tissue
B. directly elevates epiglottis
C. lets blade slide into vallecula
D. indirectly elevates epiglottis
A. manipulates and compresses soft tissue
What are the two types of laryngoscope blades?
- Mac (Curved)
- Miller (Straight)
What is the typical Mac sizes for adults?
- Mac #3 (most common)
- Mac #4
What is typical Miller sizes for adults?
- Miller #2 (most common)
- Miller #3
Which laryngoscope blade has been shown to cause greater cervical spine movement?
Mac Blade
so riskier for c-spine patients or those w atlantoaxial instability…
Which laryngoscope blade is great for smaller mouths and longer necks?
Miller Blade
long neck = long (straight) blade
Which laryngoscope blade will be used to minimize the movement of the cervical spine?
Miller Blade
Which laryngoscope blade makes intubation easier because the blade requires adequate mouth opening?
- Macintosh Blade
Describe the person you would want to use a Miller #3 blade with.
- Tall person
- Long neck
What laryngoscope blade requires less force, less head extension, and less cervical spine movement?
- Miller Blade
When using a Mac Blade, after epiglottis is visualized, the tip advanced into the _________.
Vallecula
When using a Mac Blade, the pressure applied at the right angle of the blade and the handle moves the ______ and ________forward.
A. epiglottis and vallecula
B. base of tongue and epigottis
C. trachea and vocal cords
D. epiglottis and vocal cords
B. Base of the tongue and Epiglottis
The Miller Blade will directly lift the ______.
A. vallecula
B. glottis
C. vocal cords
D. epiglottis
D. Epiglottis
If the Miller Blade is inserted too far, what structures can it elevate?
A. tongue and vallecula
B. epiglottis and vallecula
C. larynx and esophagus
D. mandible and epiglottis
C. Larynx and Esophagus
What can happen if the Miller Blade is withdrawn too far?
A. can put too much pressure on tongue
B. can lift the larynx
C. epiglottis will flip down and cover glottis
D. can lift the esophagus
C. Epiglottis flips down and covers the glottis
How can the Miller Blade be used as a Macintosh?
- Miller Blade can also be inserted into the vallecula
What is the optimal position for the patient undergoing direct laryngoscopy?
- Sniffing position
The sniffing position will have a ______ degree neck flexion (lower cervical).
The sniffing position will have a ______ degree head extension at the atlanto-occiptal level.
- 35 degree
- 80-90 degree
picture C
In the sniffing position, what should the imaginary horizontal line connect?
A. external auditory meatus and mandible
B. external auditory meatus and sternal notch
C. external auditory meatus and cervical spine
D. external auditory meatus and clavicle
b. external auditory meatus (ear) and sternal notch
Steps to inserting laryngoscope blade.
ericksen said she won’t specifically ask this…
- Right hand opens mouth (“scissor”) to keep the lips free to accommodate blade insertion
- Insert blade on right side of the mouth
- Advance blade, keeping tongue to the left and elevated
- Epiglottis comes into view
What are some interventions for difficult airways?
- Maintain a neutral position and use an OPA
- Flexible fiberoptic scope or Video laryngoscope
- awake intubation!
What is the maneuver to displace the larynx to get the glottis in view?
A. Backwards Upward Leftward Pressure
B. Backwards Upward Rightward Pressure
C. Backwards Downward Rightward Pressure
D. Backwards Downward Leftward Pressure
B. BURP (Backwards Upward Rightward Pressure)
___________ patients will require elevation of the shoulder and upper back.
- Obese
Use ramping technique for these patients so they can have a horiztonal ear to sternal notch line.
What can be used to ramp a patient?
- Troop Elevation Pillow
- Folded Blankets
