Equipment Flashcards
Oral Airway Sizes
Small 80mm
Medium 90mm
Large 100mm
Oral Airway Contraindications
Prone positioning
Light sedation → gag reflex, cough, emesis, laryngospasm, or bronchospasm
Nasal Airway Sizes
INTERNAL diameter
NP Contraindications
Coagulopathy or hemorrhagic disorders Anticoagulant therapy Pregnancy Basilar skull fractures Nasal infections Nasal deformities History epistaxis requiring treatment
Nasopharyngeal Airway
Light to moderate sedation
Less stimulating
Face Masks
Uses smallest mask possible
↓dead space
Easier to hold
↓risk corneal abrasion or injury
Standard opening 15mm (internal diameter)
22mm external connects w/ anesthesia circuit
Mask Ventilation
Head-tilt chin lift
C-E
Place fingers on boney prominences
Pull mandible up into the mask
Unable to Ventilate?
Reposition
Place oral airway or NP
Two-handed technique
Difficult Mask Ventilation
Beards Obesity Neck circumference Edentulous Snoring Mask seal Age >55yo Facial edema Prominent nares Receding jaw Tumor(s) OG/NG tubes
Face Mask Advantages
↓incidence sore throat
Less anesthetic depth required
No muscle relaxants
Short cases = cost effective
Face Mask Disadvantages
Hands tied up Use fatigue Requires higher FGF More difficult to maintain airway vs. LMA Unprotected airway
Complications - skin problems, nerve injury, aspiration, corneal injury, cervical spine movement, latex allergy, lack PaCO2 & ETCO2 correlation environmental pollution
Laryngeal Mask Airway
LMA
Supraglottic airway device
Circumferential seal around the laryngeal inlet w/ an inflatable cuff
*Airway reflexes must be obtunded prior to insertion attempt
*Keep airway pressures <20cmH2O
Aperture Bars
Prevent epiglottis from obstructing the mask in LMA
LMA Sizes
3 (30-50kg) 20cc/30cc
4 (50-70kg) 30cc/45cc
5 (70-99kg) 40cc/60cc
LMA Contraindications
Aspiration risk Patient w/ delayed gastric emptying Hiatal hernia Morbid obesity >14wks pregnant Glottic or subglottic obstruction Limited mouth opening Trauma Acute abdomen Thoracic injury ↓pulmonary compliance
ETT Sizes
Number according to internal diameter 2.5-9.0mm
Male 8.0 or 9.0 at 24-26cm at the lip
Female 7.0 or 8.0 at 20-22cm at the lip
Nasal intubation + 3-4cm
Endotracheal Tubes
Polyvinyl chloride (PVC) Cuff provides seal b/w ETT & tracheal wall Recommended pressure 20-25mmHg Uncuffed ETT <8yo Ensure stylet does not pass Murphy eye
Mac (Blade)
Curved blade
Enter on the R & sweep the tongue
Indirectly lifts epiglottis
Miller (Blade)
Straight blade
Place the blade midline
Directly lifts epiglottis
Ideal choice w/ floppy epiglottis or anterior airway
Cormack-Lehane
Grade I
Grade II
Grade III
Grade IV
ETT Placement Confirmation
Chest rise & fall Equal, bilateral breath sounds No gurgling over stomach Condensation (fogging) presenting in ETT Continuous ETCO2 Anesthesia reservoir bag refilling w/ exhalation
Deep Extubation
Muscle relaxants fully reversed
Patient breathing spontaneously w/ adequate minute ventilation
No response to suctioning
Deep Extubation Contraindications
Patients w/ difficult airway, aspiration risk, & surgeries that produce airway edema
Awake Extubation
Patient able to maintain & protect airway
Purposeful movement
Eyes open
Reaction to suctioning
Awake Extubation SUBJECTIVE Criteria
Follows commands
Clear oropharynx (no active bleeding & secretions cleared)
Intact gag reflex
Sustained head lift for 5 seconds
Sustained hand grasp
Adequate pain control
Minimal end expiratory concentration inhaled anesthetics
Awake Extubation OBJECTIVE Criteria
Vital capacity >15mL/kg Peak voluntary negative inspiratory pressure >25cmH2O Vt >6mL/kg Sustained tetanic contraction SpO2 >90% PaO2 >60mmHg RR <35bpm PaCO2 <45mmHg
Nasal Intubation
Maxillofacial or mandibular surgery
Oral/dental surgery
Facial trauma
Nasal Intubation Contraindications
Coagulopathy Basilar skull fracture Severe intranasal disorder CSF leak Extensive facial fractures
Nasal Intubation Supplies
Laryngoscope handle & blades MAGILL FORCEPS Oral & NP airways Neo-synephrine spray Nasal tubes Tape Suction Stethoscope
Nasal Intubation Complications
Epistaxis Tracheal or esophageal trauma Displaced adenoids or polyps → bleeding & airway obstruction Bacteremia Sinusitis (long-term nasal intubation)
Airway Emergency
Cannot ventilate, cannot intubate
Difficult Airway Adjuncts
Intubating LMA (Fastrach) Video laryngoscope (Glidescope) C-mac or McGrath Fiberoptic intubation Bullard scope Wu scope UpsherScope Lightwand Bougie Combitube Transtracheal jet ventilation Retrograde intubation Cricothyrotomy
Airway Management Pearls
BE PREPARED
Perform thorough preop interview & detailed airway exam
1st view = best view
Plan A, B, C… Z
Practice adjuncts before an emergency situation
Continuous monitoring
VIGILENCE
Assess, intervention, & REASSESS
Unable to ventilate or intubate → wake up the patient
When unsure about able to secure airway keep the patient breathing
