ETTs Flashcards
Exam 4
Who is considered the first to perform intubation anesthetic?
Sir William Macewen in 1880
What did Franz Kuhn contribute to endotracheal intubation?
in what year?
Modified the ETT and made it easier for intubation
1901
What are the primary reasons for intubation?
- Oxygenation
- Positive pressure ventilation
- Airway protection
- Pulmonary toilet
What is considered the ‘gold standard’ for airway protection?
Endotracheal intubation
What are absolute indications for endotracheal intubation?
7 of them
- Full stomach (At risk for aspiration)
- Lung isolation and one-lung ventilation
- Critically ill patients
- Surgery of the head and neck where SGA would be in the way
- Failed placement of a SGA
Lung disease or abnormalities
Postop intubation/vent support is needed
NMBDs needed for surgery
What is an endotracheal tube (ETT) primarily made of?
Plastic, disposable, single-use materials
What is the purpose of the Murphy eye in an ETT?
Allows ventilation if the end is occluded by soft tissue or secretions
What are the two types of cuffs in endotracheal tubes?
- High pressure, low volume
- Low pressure, high volume
Name 5 differences in pediatric airways compared to adult airways:
Larger tongue can cause airway obstruction
larynx is higher in the neck
epiglottis is shorter/stubbier
vocal cords are angled
funnel-shaped larynx
What is the formula for pediatric ETT sizing?
Internal diameter in mm = (age in years)/4 + 4 (for uncuffed tube)
What does the ‘leak test’ confirm in uncuffed tubes?
Gas leak is heard at 15-20 cm H2O; no leak means tube is too big, excessive leak means tube is too small
What is the recommended cuff pressure during intubation?
Less than 25 cm H2O
What factors can alter cuff pressure?
- Volume of air
- Cuff diameter
- Compliance of trachea and cuff
- Intrathoracic pressure
- Diffusion of N2O into the cuff
Increased cuff pressure can cause what 3 things?
- Sore throat
- Vocal cord dysfunction
- Recurrent laryngeal nerve injury
what is the Green (ideal range) of a cuff manometer reading for an ETT and LMA?
ETT- 22-32 (or a max of 30)
LMA- 32-60
What is the insertion depth for male and female ETTs?
- Male: 22-23 cm at teeth
- Female: 21 cm at teeth
What is the three measurements in the 3-3-2 rule used for?
Predicting difficult intubation
What are the three measurements of the 3-3-2 rule?
- Three fingers between upper and lower teeth (interincisor distance)
- Three fingers from anterior mandible to anterior neck (hyoid-mental distance)
- Two fingers between floor of mandible and thyroid notch (hyoid-thyroid cartilage distance)
What are the advantages of a fiberoptic bronchoscope (FOB) during intubation?
Provides confirmation of ETT placement and better visualization of the airway
no need to align the axes
What is a double-lumen tube used for?
Single-lung ventilation
What are the contraindications for retrograde intubation?
- Abnormal anatomy
- Infection at the site
- Difficulty accessing the cricothyroid membrane
- Coagulopathy
- Stenosis of the trachea
What is transtracheal jet ventilation used for?
Emergency airway management when intubation and ventilation fail
What complications can arise from transtracheal jet ventilation?
- Barotrauma
- Pneumothorax
What is a needle cricothyrotomy?
An emergency procedure to establish an airway through the cricothyroid membrane using a needle and cannula.
It is used when traditional intubation is not possible.