Exam 1 Intro Advanced Airway Techniques Flashcards
Most common cause of upper airway obstruction
Soft tissue obstruction (relaxation of tongue/jaw)
Tx upper airway obstruction
if tongue/jaw –> jaw thrust forward
prolonged intense glottic closure in response to direct glottic/supraglottic stimulation
laryngospasm
tx laryngospasm
displace mandible/extend neck
strong manual + pressure of O2 via mask/bag
if severe: 10-20mg sux
intubation
3 indicators of endobronchial intubation
- One sided chest rise
- Increased PIP
- ETCO2 waveform changed: mimics obstructive pathway
Indicators of bronchospasm
*biggest: airway disease
Loss of EtCO2, lack of chest excursion, desaturation, bradycardia
Tx Bronchospasm
- Place on 100% O2
- Deepen anesthetic (propofol)
- hold + pressure ventilation to break spasm
- administer Beta 2 agonist (albuterol)
- epi subQ 0.4 mL of 1:1000 solution
- can consider terbutaline/aminophylline/corticosteroids
Muscle relaxants work for _____spasm
laryngospasm
NOT bronchospasm
Flexing head causes
advances the tube down
(‘head down=tube down’)
right main stem
Difficult airway algorithm- can’t mask ventilate
LMA, combitube, TTJV
or
Surgical airway
Sounds heard during laryngospasm
ranges from high-pitched squeaky sound to total absence of sound
terbutaline dosage
SQ 0.25 mg
q 15-30 min
Max: 0.5 mg in 4h
complications of prolonged intubation
Edema
Cuff pressure - vocal cord paralysis
tracheal erosion, tracheomalacia or stenosis
*also for too large tube for brief period
Deep extubation C/I
difficult mask ventilation, intubation
risk of aspiration
surgery that produces airway edema
Extubation criteria
TOF 4/4 w/ sustained tetanus sustained head/leg/arm lift > 5s tongue protrusion NIF > - 20 cm H20 Ability to hand grasp/follow commands
