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Mar: Sem 3 - Principles I > Exam 2 Airway Equipment II [6/27/24] > Flashcards

Exam 2 Airway Equipment II [6/27/24] Flashcards

1
Q

Describe a Shikani Optical Stylet.

A
  • Stainless steel lighted stylet with a malleable distal tip
  • Design utilizes an eyepiece for DL
  • Oxygen port for oxygen insufflation

S43

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2
Q

What kind of position will the patient have for a Shikani Optical Stylet?

A
  • Neutral Position
  • Stylet Inserted Midline
  • available ins adult and peds sizes

S43

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3
Q

How is the Shikani Optical Stylet inserted?

A
  • advance into the trachea with light pressure
  • tip should remain anterior [pointed up] at all times to avoid injury.

S43

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4
Q

Shikani Optical Stylet can be used for what?

A
  • can be used as a light wand
  • check ETT placement
  • or placement of double-lumen ETT

S43

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5
Q

Advantages of the Shikani Optical Stylet

A
  • Easy to use for routine and difficult intubations
  • Trachea is visualized. Esophageal intubation should not occur
  • Decreased incidence of sore throat
  • Results in less C-spine movement over conventional laryngoscopy

Timeout for a SEC! lets list the advantages of shikani

S44

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6
Q

Disadvantages of the Shikani Optical Stylet

A
  • Longer intubation time
  • Cannot be used with nasal intubation. (not flexible)
  • Cannot be adjusted into a precise direction compared to a traditional malleable stylet

S44

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7
Q

Name the four most common Video Laryngoscopes.

A
  • Glidescope
  • Co-Pilot
  • King
  • McGrath

S45

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8
Q

What are the advantages of using a video laryngoscope?

A
  • Magnified anatomy
  • Some scopes have curved/straight blades to mimic laryngoscopes
  • Operator and assistant can see
  • May result in decreased c-spine movement
  • Further distance from infectious patients
  • Demonstrates correct technique in legal cases

laryngoscopes Magnify Some Of My Flawed Doctors

S45

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9
Q

What are the limitations of using a video laryngoscope?

A
  • Requires video system
  • Portability varies (Glidescope needs to be plugged in)

S45

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10
Q

What is the strongest predictor of failure when using a video laryngoscope?

A
  • Altered neck anatomy with the presence of a surgical scar, radiation changes, or mass

S45

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11
Q

Complications of Laryngoscopy

A
  • Dental Injuries
  • Cervical Spinal Cord Injury
  • Damage to other structures:
    • Abrasions/Hematoma
    • Lingual/ Hypoglossal nerve injury
    • Arytenoid Subluxation
    • Anterior TMJ dislocation
  • Swallowing of foreign body (lightbulbs, teeth)

Laryngoscopy Complications SAAAD

S47-48

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12
Q

What is the most frequent anesthesia-related claim?

A
  • Dental Injury

S47

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13
Q

What is most likely damaged during laryngoscopy?

A
  • Upper incisors
  • Restored or weakened teeth

S47

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14
Q
  • where are tooth protectors placed to mitigate laryngoscopy-related dental injury?
  • what does it protect?
  • does it guarantee safety from dental trauma?
A
  • placed on upper teeth during DL
  • Protects from blade causing direct surface damage
  • Does not guarantee safety from dental trauma

S47

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15
Q

What two teeth have the highest incidence of dental injuries?

A

Left Central Incisor (47%)
Left Lateral Incisor (20%)

recall info from health assessment

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16
Q

How do you prevent cervical spinal cord injury during a laryngoscopy?

A
  • Do not aggressively position the head
  • Manual in-line stabilization (remove C-collar before intubation, have neurosurgeon remove C-collar)

S48

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17
Q

how do abrasions/hematomas occur as a complication of laryngoscopy?

A
  • upper lip gets pinched between teeth and blade.

S48 lecture

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18
Q
  • how do lingual &/or hypoglossal nerve injury occur as a complication of laryngoscopy
A
  • due to placing the blade and hitting soft tissue. so, go in slowly, recognize all the structure. Dont be forceful.

S48- lecture

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19
Q
  • What is arytenoid subluxation as a complication of laryngoscopy?
  • How do we prevent?
A
  • Arytenoid subluxation or dislocation is a rare laryngeal injury that occurs as a result of airway instrumentation or direct trauma to the cricoarytenoid joint, leading to the partial (subluxation) or total (dislocation) displacement of the arytenoid cartilage within the cricoarytenoid joint.
  • dont hit the aryenoid with the blade

S48- lecture/looked up on our friend Google

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20
Q

If pt has TMJ what should we NOT do?

A
  • if pt has TMJ, dont force the mouth open can cause anterior TMJ dislocation

S48-lecture

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21
Q

How many teeth does a healthy adult patient have?

A
  • 32 teeth

S49

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22
Q

What ETT properties will contribute to the change in resistance in the breathing system?

A
  • Internal Diameter of the tube
  • Tube Length
  • Configuration changes (if tube knots up)
  • Connectors

S51

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23
Q

What is the most important factor in determining resistat to gas flow?

A
  • internal diameter of tube
  • as ID changes & adding more connections = ↑ in resistance

S51- lecture

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24
Q

How does tube length change resistance?

A
  • short tube = ↓ resistance
  • long tube = ↑ resistance

S51 lecture

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25
Manufacturing Requirments of ETT
* Conforms to patient anatomy * Low cost * Lack of tissue toxicity * Lack of reaction with anesthetic agents and lubricants * Latex-free * Easy sterilization * Non-flammability * Smooth, non-porous surface * Sufficient body to maintain its shape * Sufficient wall strength C-L[4]-E-N-S[3] | S52
26
What is the function of having a smooth, non-porous surface of the ETT?
* Prevent/mitigate trauma * Prevent/mitigate secretion buildup * Allow passage of suction catheter or bronchoscope | S52
27
How does the ETT design decrease kinking?
* Circular internal and external walls | S53
28
What part of the ETT provides an alternate pathway for gas flow?
* Murphy eye | S53
29
Can the ETT be shortened?
yes, can be shortened at machine end | S53
30
Why does the patient end of ETT have slanted bevel?
helps view the larynx | S53
31
What does RAE Tube stand for?
* Ring-Adair-Elwin (RAE) Tube | S54
32
What are the advantages of RAE Tubes?
* Facilitate surgery around the head and neck * Temporarily straightened during insertion * Increased tube diameter * increased distance from tip to curve [*longedr than standard ETT*] * Easy to secure | S54
33
What are the disadvantages of RAE Tubes?
* Difficult to pass suction/scope * Increases airway resistance | S54
34
What are other names for Armored Tubes?
* Reinforced Tube * Anode Tube * Spiral Embedded Tubes Think of someone in the military wearing armor and saying yes "SAR" to their higher ranking officer! | S55
35
What are the advantages of Armored Tubes?
* Useful when tube is likely to be bent or compressed * Resistance to kinking and compression * Useful in head, neck, tracheal surgeries | S55
36
What are the disadvantages of Armored Tubes?
* Need a stylet or forceps * Difficult to use during nasal intubation * Cannot be shortened * Tube can be damaged if bitten | S55
37
What material can a laser-resistant tube be?
* Metallic or silicone/ metal mixture | S56
38
When would you want to use laser resistant tubes?
* if surgery needs to burn something in the oral cavity. * If surgery requires laser, use this tube not a regular tube. | S56
39
⭐️What kind of laser's do laser-resistant tubes reflect?
* CO2 Laser * KTP (Potassium-titanyl-phosphate) Laser | S56
40
What is Laser-Resistant Tube's cuff filled with? why?
* The cuff is filled with methylene blue crystals and saline * The cuff is NOT laser resistant * if the laser bursts the cuff, it will be detected quickly by the surgeon d/t methlene blue | S56
41
Which cuff is filled first in the Laser-Resistant Tube?
* **First:** Distal Cuff [*until seal occurs*] * **Second:** Proximal Cuff * *if proximal cuff is damaged, the surgery can continue bc the distal is still present*] | S56
42
Location of ETT markings
* Bevel side above the cuff | S57
43
How do you read the ETT markings?
* From patient side (balloon) to machine side | S57
44
What are the safety standards of the ETT markings?
* **M**anufacturer name * **M**easurements (2) -Tube size in internal diameter in *mm* (7.0, 7.5, etc) -Graduated markings in *centimeters* from patient's end * **W**ord: oral or nasal or oral/nasal * **R**adiopaque marker at patient's end (CXR for positioning) * Cautionary note… **s**ingle use only if disposable My Mom Writes Radio Singles | S57
45
What is the inflatable balloon near patient's end of the tube?
* Cuffs | S58
46
Characteristics of an ETT Cuff.
* Strong * Tear-resistant * Thin * Soft * Pliable | S58
47
The cuff must not herniate over what part of the ETT?
* Muphy eye * Bevel | S58
48
* What is the recommended cuff pressure? * How much air is that?
* 18-25 mmHg * 8-10 mL of air | S58
49
* Monitor cuff pressure frequently with a manometer if using ____. * Why?
* Nitrous * b/c N2O causes cuff inflation/expansion. | S58
50
⭐️if you've had an increase in cuff pressure over 30 min, what might be the cause?
nitrous | S58
51
* What are the two different types of cuffs? * Which one is more common?
* **High-volume, Low-pressure Cuff** *(more common)* * low-volume, high-pressure | S59/60
52
all tracheal tubes have what kind of cuff?
high volume low pressure cuff | S59 lecutre
53
Describe the High-Volume, Low-Pressure Cuffs.
* Thin compliant wall * Occludes trachea without stretching tracheal wall * Area of contact larger but cuff adapts shape to tracheal wall shape | S59
54
Advantages of High-Volume, Low-Pressure Cuffs
* Easy to regulate pressure * Pressure applied to trachea less than mucosal perfusion pressure. (maintains circulation) * Low Risk to Tracheal Mucosa | S59
55
Disadvantages of High-Volume, Low-Pressure Cuffs
* More difficult to insert * May obscure the view of the tube tip and larynx * Cuff is more likely to be torn during intubation * More likely to have a sore throat * May not prevent fluid leakage * Easy to pass NGT, esophageal stethoscopes around cuff | S59
56
Describe the Low-Volume, High-Pressure Cuffs.
* Has small area of contact with trachea * Requires large amount of pressure to achieve a seal * Distends and deforms the trachea to a circular shape | S60
57
Advantages of Low-Volume, High-Pressure Cuffs.
* Better protection against aspiration * Better visibility during intubation * Lower incidence of sore throat | S60
58
Disdvantages of Low-Volume, High-Pressure Cuffs.
* Pressure exerted on trachea probably above mucosal perfusion pressure * Can cause mucosal damage * Should be replaced with a low-pressure cuff if postoperative intubation is required | S60
59
* ⭐️4 Factors that can cause changes in cuff pressure. * do they cause an ↑ or ↓ in pressure?
* Use of nitrous (↑ pressure) * Hypothermic cardiopulmonary bypass (↓ pressure *d/t cold induced vasocnostriction*) * Increases in altitude (↑ pressure *Boyles Law*) * Coughing, straining, and changes in muscle tone (↑ pressure) | S61
60
What are common controversies involving airway equipment?
* Use of a stylets * Securing ETT * Use of Bite blocks/airways while intubated * *not recommended when pt is lateral or prone d/t mucosal damage* * Is it bad to intubate the esophagus? | S62 ## Footnote just for thinking, wont be asked about on test
61
List endotracheal tube complications
* Trauma * Inadvertent bronchial intubation * Fluid accumulation above the cuff * Upper airway edema * Vocal cord granuloma | S63-65
62
* How does trauma occur d/t ETT complications?
* excessive force * repeated attempts * varies with skill, difficulty of airway, and amount of muscle relaxtion | S63
63
* How to prevent trauma as a compilcation of ETT?
* keep stylet inside tube [*above the murphys eye*] * Use vasoconstrictors (Afrin/Cocaine) for nasal intubation to mitigate bleeding and pre-dilate nasal passage. | S63
64
Inadvertent bronchial intubations are most common in:
* Emergencies (Code Blue) * Pediatrics (shorter distance to carina) * Females (shorter right mainstem) **typically in right mainstem bronchus** | S64
65
Inadvertent bronchial intubation can lead to ____ if left in place for too long.
* atelectasis | S64
66
The distance to the carina ____(decreases/increases) with Trendelenburg and laparoscopy.
* Decreases | S64
67
* What marking would you secure an ETT on a male patient? * Female patient?
* Male: 23 cm at the teeth * Female: 21 cm at the teeth | S64
68
inadvertet broncial intubation during a bronch or endoscopy occurs d/t?
dislodgment with instrumentation | S64-lecture
69
What can accumulate above the cuff of the ETT?
* Fluids * *blood or saliva* | S64
70
* Why is upper airway edema dangerous in young children? * Peak incidence age?
* Cricoid cartilage completely surrounds the subglottic area * *if there is edema there is no external expansion* * 1-4 years old | S65
71
Complications of airway edema can occur as early as ____ hours post to 48 hours postop.
* 1-2 hours | S65
72
* upper airway edema can be where? * how do you prevent?
* anywhere along path of tube * Prevention: * avoid irritating stimuli * if active URI wait 6 weeks * anesthetic depth | S65
73
What are vocal cord granulomas?
Vocal cord granulomas are masses that result from irritation. | S65-lecture
74
Who is more prone to vocal cord granuloma?
* Adults * Females | S65
75
What are the causes of Vocal Cord Granuloma?
* Trauma * ETT too large * Infection * Excessive cuff pressure | S65
76
Signs and Symptoms of Vocal Cord Granuloma?
* Persistent hoarseness * Fullness * Chronic cough * Intermittent loss of voice | S65
77
Treatment of Vocal Cord Granuloma
* Laryngeal evaluation (ENT appt) * Voice rest | S65
78
What are airway adjuncts?
* bougie * magill forceps * | S66-67
79
When is a bougie used?
* blind intubation if glottic exposure is absent * ETT passage is difficult | S66
80
What kind of base and coating does the bougie have?
The bougie has a polyester base with resin coating. | S66
81
The distal end of the bougie is angled ____- degrees.
* 30-45 degrees | S66
82
How do you use the bougie?
* Introduce Bougie with anterior positioning of the tip. * Be Gentle. * You should feel the clicks of the tracheal rings. | S66- lecture
83
* What are these called? * What are they used for? * Considerations?
* Magill forceps * Used primarily with nasal intubations to directs tube into the larynx * Considerations: Possible damage to tube cuffs and lodged in Murphy eye. Shold be immediately available | S67
84
3 indications for lung isolation?
* thoracic procedure * control of contamination or hemorrhage * unilateral pathology | S69
85
The rationale for lung isolation in thoracic procedure
* Deflating the lung to increase safety profile and surgical exposure | S69
86
The rationale for lung isolation to control contamination or hemorrhage
* Can prevent material in one lung from contaminating other * Allows one lung to be ventilated while other hemorrhages | S69
87
The rationale for lung isolation in unilateral pathology
* Isolate fistulas, ruptured cysts, or other issues with the diseased lung while allowing unilateral ventilation | S69
88
Anatomy of the Right Mainstem
* Shorter, straighter, **larger diameter** * 25 degree takeoff from trachea * RUL tracheal takeoff very close to origin * Avg length 2.5 cm from carina to take-off | S70
89
Anatomy of the Left Mainstem
* 45 degree takeoff from trachea * LUL tracheal takeoff more distal * Avg length 5.5 cm from carina to take-off | S70
90
What are the adult sizes for the double-lumen tube?
* 35 Fr * 37 Fr * 39 Fr * 41 Fr | S71 ## Footnote all are odd numbers
91
What are the pediatric sizes for the double-lumen tube?
* 26 Fr * 28 Fr * 32 Fr | S71 ## Footnote all are even numbers
92
Which Double-Lumen Tube (DLT) is commonly used?
* Left Double-Lumen Tube | S71
93
⭐️Procedures that will require a Right Double-Lumen Tube.
* Left pneumonectomy * Left lung transplantation * Left mainstem bronchus stent in place * Left tracheo-bronchus disruption | S71 ## Footnote know that if one of these sx are being done, use a right DLT
94
Insertion of DLT is placed similarly as a standard ETT, but more difficult due to what?
* Stiffness * Size | S72
95
The DLT is advance through the larynx with angled tip anterior into the ____.
* Trachea | S72
96
Difficulties with Bronchial-blockers
* Right upper lobe bronchus takeoff is high * Tracheal bronchus * Fixation by staples during surgery * Perforation by suture needle or instrumentation | S77
97
When inserting the DLT, when the bronchial cuff passes the cords, the tube is turned ____ degrees
* 90 degrees * *Bronchial portion points toward the appropriate bronchus* | S72
98
DLT verification of the location of the bronchial port with a ____.
* fiberoptic scope | S72
99
The blue bronchial cuff of the DLT is just below the ____ in the appropriate bronchus.
* carina | S72
100
Inflate DLT's bronchial balloon under ____to verify proper placement
* direct visualization | S72
101
Ensure DLT's bronchial cuff does not herniate over the ____.
* carina | S72
102
How can you isolate a lung with the DLT?
* Clamping either the tracheal or bronchial connector | S72
103
picture or insertion of double lumen tube in right main and left main
| S73
104
What are some DLT complications?
* Tube malpositions * Hypoxemia | S74
105
What can cause DLT malposition and unsatisfactory lung collapse?
* Bronchial lumen in the wrong mainstem (needs reinsertion) * Tube too proximal in airway (correct with fiberoptic) | S74
106
What can cause hypoxemia with a DLT?
* Malpositioning of DLT (needs reinsertion) * Patient comorbidities (may need PEEP or intermittent 2-lung ventilation) | S74
107
What are the indications for Bronchial-Blockers?
* When DLT is not advisable * Nasal intubation * Difficult intubation * Patients with tracheostomy * Subglottic stenosis * Need for continued postoperative intubation * If a single-lumen tube is already in place (critically ill pts) | S76
108
The function of the Bronchial Blocker.
* Can block a segment of the lung without isolating the entire lung * **cannot be done with DLT** | S77

Mar: Sem 3 - Principles I (29 decks)

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