E2 - Airway Equipment II Flashcards
Describe a Shikani Optical Stylet.
- Stainless steel lighted stylet with a malleable distal tip
- Design utilizes an eyepiece for DL
- Oxygen port for oxygen insufflation
What kind of position will the patient have for a Shikani Optical Stylet and how is it inserted?
A. supine and inserted from the left
B. left lateral and inserted midline
C. right lateral and inserted midline
D. neutral and inserted midline
D. Neutral Position and stylet inserted midline
Shikani Optical Stylet will advance into the trachea with light pressure, and the tip should remain _________ at all times to avoid injury.
A. anterior
B. posterior
C. midline
D. lateral
A. Anterior (pointed up)
Shikani Optical Stylet uses: Select 3.
A. double-lumen ETT
B. mac Blade
C. bronchoscope
D. light wand
E. check ETT placement
F. easier extubation
A. double lumen ETT
D. Light wand
E. check ETT placement
What is an advantage of the Shikani Optical Stylet?
A. allows more C-spine movement than conventional laryngoscopy
B. trachea is visualized
C. increase incidence of sore throat
D. harder for easy intubations
B. Trachea is visualized. Esophageal intubation should not occur
- Easy to use for routine and difficult intubations
- Decreased incidence of sore throat
- Results in less C-spine movement over conventional laryngoscopy
What is a disadvantage of the Shikani Optical Stylet?
A. too flexible
B. might cause nasal intubation
C. longer intubation time
D. too similar to a traditional malleable stylet
C. Longer intubation time
* Cannot be used with nasal intubation. (not flexible)
* Cannot be adjusted into a precise direction compared to a traditional malleable stylet
Name the four most common Video Laryngoscopes.
- Glidescope
- Co-Pilot
- King
- McGrath
Go, Cut, King, Mhmm
What are some advantages of using a video laryngoscope? Select 2.
A. operator and assistant can see
B. minimized anatomy
C. may result in decreased C spine movement
D. cannot be used in legal cases
E. closer distance to patient
A. Operator and assistant can see
C. May result in decreased c-spine movement
Also:
* Magnified anatomy
* Some scopes have curved/straight blades to mimic laryngoscopes
* Further distance from infectious patients
* Demonstrates correct technique in legal cases
What are the limitations of using a video laryngoscope?
- Requires video system
- Portability varies (Glidescope needs to be plugged in)
What is the strongest predictor of failure when using a video laryngoscope?
A. a longer intubation time
B. altered neck anatomy with presence of a mass
C. worse visualization of epiglottis
D. increased c-spine movement
B. Altered neck anatomy with the presence of a surgical scar, radiation changes, or mass
so like a failed intubation may still happen w/ a video laryngscope
Complications of Laryngoscopy
- Dental Injuries
- Cervical Spinal Cord Injury
- Swallowing of foreign body (lightbulbs, teeth)
- Abrasions/Hematoma
- Lingual/ Hypoglossal nerve injury
- Arytenoid Subluxation
- Anterior TMJ dislocation
What is the most frequent anesthesia-related claim?
A. cut lip
B. dental injury
C. c-spine injury
D. lingual abrasion
B. Dental Injury
LIKELY TO BE A TEST QUESTION LOL
What is most likely damaged during laryngoscopy? Select 2.
A. Tongue
B. C spine
C. Upper incisors
D. buccal
E. restored or weakend teeth
F. arytenoid subluxation
C. Upper incisors
E. Restored or weakened teeth
What can help mitigate laryngoscopy-related dental injury?
A. scissoring appropriately
B. tooth protectors
C. using video
D. ask them which teeth are damaged
D. Tooth protectors - placed on upper teeth during DL
it protects from blade causing direct surface damage!
Does not guarantee safety from dental trauma
How do you prevent cervical spinal cord injury during a laryngoscopy?
A. place a c collar
B. stabilize the head in-line and let nsgy intubate patient
C. remove the c collar
D. do not aggressively position the head
D. Do not aggressively position the head
* Manual in-line stabilization (remove C-collar before intubation, BUT have neurosurgeon remove C-collar!)
* DO NOT let nsgy intubate the patient!
How many teeth does a healthy adult patient have?
- 32 teeth
What ETT properties will contribute to the change in resistance in the breathing system? Select 2.
A. connectors
B. outer diameter of the tube
C. less corrugated tubing
D. tube length
A. Connectors
D. Tube Length
ALSO:
* INTERNAL Diameter of the tube
* Configuration changes (if tube knots up)
Manufacturing Requirments of ETT
- Low cost
- Lack of tissue toxicity
- Easy sterilization
- Non-flammability
- Smooth, non-porous surface
- Sufficient body to maintain its shape
- Sufficient wall strength
- Conforms to patient anatomy
- Lack of reaction with anesthetic agents and lubricants
- Latex-free
What is the function of having a smooth, non-porous surface of the ETT?
A. prevent secretion buildup
B. allow passage of suction catheter
C. prevent trauma
D. all of the above
D. all of the above
* Prevent/mitigate trauma
* Prevent/mitigate secretion buildup
* Allow passage of suction catheter or bronchoscope
Why is the slanted bevel (patient end) of the ETT important?
A. can be shortened for shorter necks
B. decreases kinking
C. helps view larynx
D. provides alternate pathway for gas flow
C. helps view larynx
What part of the ETT provides an alternate pathway for gas flow?
A. circular walls
B. murphy eye
C. slanted bevel
D. machine end
B. Murphy eye
What does RAE Tube stand for?
A. Ring-Air-Erwin
B. Ring-Adair-Elwin
C. Ring-Air-Elwin
D. Ring-Adair-Erwin
B. Ring-Adair-Elwin (RAE) Tube
What are the advantages of RAE Tubes?
A. useful for open belly cases
B. decreased tube diameter
C. can be placed without administration of muscle relaxer
D. facilitate surgery around head and neck
D. Facilitate surgery around the head and neck
Also:
* Temporarily straightened during insertion
* Increased tube diameter… increased distance from tip to curve
* Easy to secure
* Nasal fiberoptic intubation.
What are the disadvantages of RAE Tubes? Select 2.
A. difficult to pass suction/scope
B. suction/scope may slide too deep
C. decreases airway resistance
D. increases airway resistance
A. Difficult to pass suction/scope
D. Increases airway resistance
What are other names for Armored Tubes?
- Reinforced Tube
- Anode Tube
- Spiral Embedded Tubes
RAS
What are the advantages of Armored Tubes?
- Useful when tube is likely to be bent or compressed b/c it is Resistance to kinking and compression
- Useful in head, neck, tracheal surgeries
What are the disadvantages of Armored Tubes? Select 2.
A. can’t be shortened
B. tube can be damaged if bitten
C. harder to secure
D. can’t be used during head, neck, or tracheal surgeries
E. resistant to kinking
A. Cannot be shortened
B. Tube can be damaged if bitten
Also:
* Need a stylet or forceps
* Difficult to use during nasal intubation!!
Which type of ETT requires stylet or forceps?
armored tubes
AKA reinforced / amode / spiral embedded tubes
which 2 types of ETT can be used for head and neck surgeries?
A. RAE tube
B. laser-resistant tube
C. reinforced tube
D. slanted tube
A. RAE tube
C. reinforced tube (aka armored, amode, or spiral embedded tubes)
What mixture makes up the laser-resistant tubes?
- Metallic or silicone/ metal mixture
What 2 kinds of laser beams do laser-resistant tubes reflect?
A. CO laser
B. CO2 laser
C. ATP laser
D. KTP laser
E. MTP laser
B. CO2 Laser
D. KTP (Potassium-titanyl-phosphate) Laser
What are the Laser-Resistant Tube’s cuff filled with? Select 2
A. methylene violet
B. methylene blue
C. lactated ringers
D. saline
E. ethyl violet
F. ethyl blue
The cuff is filled with B. methylene blue crystals and D. saline so that, if the laser bursts the cuff, this will be detected quickly by the surgeon.
Which cuff is filled first in the Laser-Resistant Tube?
- Distal Cuff = first
- Proximal Cuff = second
Location of ETT markings
- Bevel side above the cuff
How do you read the ETT markings?
- From patient side (balloon) to machine side
What are the safety standards of the ETT markings?
- The word oral or nasal or oral/nasal
- Tube size in Internal Diameter in mm (7.0, 7.5, etc)
- Name of manufacturer
- Graduated markings in centimeters from patient’s end
- Cautionary note… single use only if disposable
- Radiopaque marker at patient’s end (CXR for positioning)