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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
Q

Manufacturing Requirments of ETT

A
  • 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

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26
Q

What is the function of having a smooth, non-porous surface of the ETT?

A
  • Prevent/mitigate trauma
  • Prevent/mitigate secretion buildup
  • Allow passage of suction catheter or bronchoscope

S52

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27
Q

How does the ETT design decrease kinking?

A
  • Circular internal and external walls

S53

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28
Q

What part of the ETT provides an alternate pathway for gas flow?

A
  • Murphy eye

S53

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29
Q

Can the ETT be shortened?

A

yes, can be shortened at machine end

S53

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30
Q

Why does the patient end of ETT have slanted bevel?

A

helps view the larynx

S53

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31
Q

What does RAE Tube stand for?

A
  • Ring-Adair-Elwin (RAE) Tube

S54

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32
Q

What are the advantages of RAE Tubes?

A
  • 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

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33
Q

What are the disadvantages of RAE Tubes?

A
  • Difficult to pass suction/scope
  • Increases airway resistance

S54

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34
Q

What are other names for Armored Tubes?

A
  • 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

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35
Q

What are the advantages of Armored Tubes?

A
  • Useful when tube is likely to be bent or compressed
  • Resistance to kinking and compression
  • Useful in head, neck, tracheal surgeries

S55

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36
Q

What are the disadvantages of Armored Tubes?

A
  • Need a stylet or forceps
  • Difficult to use during nasal intubation
  • Cannot be shortened
  • Tube can be damaged if bitten

S55

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37
Q

What material can a laser-resistant tube be?

A
  • Metallic or silicone/ metal mixture

S56

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38
Q

When would you want to use laser resistant tubes?

A
  • if surgery needs to burn something in the oral cavity.
  • If surgery requires laser, use this tube not a regular tube.

S56

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39
Q

⭐️What kind of laser’s do laser-resistant tubes reflect?

A
  • CO2 Laser
  • KTP (Potassium-titanyl-phosphate) Laser

S56

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40
Q

What is Laser-Resistant Tube’s cuff filled with? why?

A
  • 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

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41
Q

Which cuff is filled first in the Laser-Resistant Tube?

A
  • 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

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42
Q

Location of ETT markings

A
  • Bevel side above the cuff

S57

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43
Q

How do you read the ETT markings?

A
  • From patient side (balloon) to machine side

S57

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44
Q

What are the safety standards of the ETT markings?

A
  • Manufacturer name
  • Measurements (2)
    -Tube size in internal diameter in mm (7.0, 7.5, etc)
    -Graduated markings in centimeters from patient’s end
  • Word: oral or nasal or oral/nasal
  • Radiopaque marker at patient’s end (CXR for positioning)
  • Cautionary note… single use only if disposable

My Mom Writes Radio Singles

S57

45
Q

What is the inflatable balloon near patient’s end of the tube?

A
  • Cuffs

S58

46
Q

Characteristics of an ETT Cuff.

A
  • Strong
  • Tear-resistant
  • Thin
  • Soft
  • Pliable

S58

47
Q

The cuff must not herniate over what part of the ETT?

A
  • Muphy eye
  • Bevel

S58

48
Q
  • What is the recommended cuff pressure?
  • How much air is that?
A
  • 18-25 mmHg
  • 8-10 mL of air

S58

49
Q
  • Monitor cuff pressure frequently with a manometer if using ____.
  • Why?
A
  • Nitrous
  • b/c N2O causes cuff inflation/expansion.

S58

50
Q

⭐️if you’ve had an increase in cuff pressure over 30 min, what might be the cause?

A

nitrous

S58

51
Q
  • What are the two different types of cuffs?
  • Which one is more common?
A
  • High-volume, Low-pressure Cuff (more common)
  • low-volume, high-pressure

S59/60

52
Q

all tracheal tubes have what kind of cuff?

A

high volume low pressure cuff

S59 lecutre

53
Q

Describe the High-Volume, Low-Pressure Cuffs.

A
  • Thin compliant wall
  • Occludes trachea without stretching tracheal wall
  • Area of contact larger but cuff adapts shape to tracheal wall shape

S59

54
Q

Advantages of High-Volume, Low-Pressure Cuffs

A
  • Easy to regulate pressure
  • Pressure applied to trachea less than mucosal perfusion pressure. (maintains circulation)
  • Low Risk to Tracheal Mucosa

S59

55
Q

Disadvantages of High-Volume, Low-Pressure Cuffs

A
  • 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
Q

Describe the Low-Volume, High-Pressure Cuffs.

A
  • 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
Q

Advantages of Low-Volume, High-Pressure Cuffs.

A
  • Better protection against aspiration
  • Better visibility during intubation
  • Lower incidence of sore throat

S60

58
Q

Disdvantages of Low-Volume, High-Pressure Cuffs.

A
  • 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
Q
  • ⭐️4 Factors that can cause changes in cuff pressure.
  • do they cause an ↑ or ↓ in pressure?
A
  • 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
Q

What are common controversies involving airway equipment?

A
  • 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

just for thinking, wont be asked about on test

61
Q

List endotracheal tube complications

A
  • Trauma
  • Inadvertent bronchial intubation
  • Fluid accumulation above the cuff
  • Upper airway edema
  • Vocal cord granuloma

S63-65

62
Q
  • How does trauma occur d/t ETT complications?
A
  • excessive force
  • repeated attempts
  • varies with skill, difficulty of airway, and amount of muscle relaxtion

S63

63
Q
  • How to prevent trauma as a compilcation of ETT?
A
  • 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
Q

Inadvertent bronchial intubations are most common in:

A
  • Emergencies (Code Blue)
  • Pediatrics (shorter distance to carina)
  • Females (shorter right mainstem)

typically in right mainstem bronchus

S64

65
Q

Inadvertent bronchial intubation can lead to ____ if left in place for too long.

A
  • atelectasis

S64

66
Q

The distance to the carina ____(decreases/increases) with Trendelenburg and laparoscopy.

A
  • Decreases

S64

67
Q
  • What marking would you secure an ETT on a male patient?
  • Female patient?
A
  • Male: 23 cm at the teeth
  • Female: 21 cm at the teeth

S64

68
Q

inadvertet broncial intubation during a bronch or endoscopy occurs d/t?

A

dislodgment with instrumentation

S64-lecture

69
Q

What can accumulate above the cuff of the ETT?

A
  • Fluids
  • blood or saliva

S64

70
Q
  • Why is upper airway edema dangerous in young children?
  • Peak incidence age?
A
  • Cricoid cartilage completely surrounds the subglottic area
    • if there is edema there is no external expansion
  • 1-4 years old

S65

71
Q

Complications of airway edema can occur as early as ____ hours post to 48 hours postop.

A
  • 1-2 hours

S65

72
Q
  • upper airway edema can be where?
  • how do you prevent?
A
  • anywhere along path of tube
  • Prevention:
    • avoid irritating stimuli
    • if active URI wait 6 weeks
    • anesthetic depth

S65

73
Q

What are vocal cord granulomas?

A

Vocal cord granulomas are masses that result from irritation.

S65-lecture

74
Q

Who is more prone to vocal cord granuloma?

A
  • Adults
  • Females

S65

75
Q

What are the causes of Vocal Cord Granuloma?

A
  • Trauma
  • ETT too large
  • Infection
  • Excessive cuff pressure

S65

76
Q

Signs and Symptoms of Vocal Cord Granuloma?

A
  • Persistent hoarseness
  • Fullness
  • Chronic cough
  • Intermittent loss of voice

S65

77
Q

Treatment of Vocal Cord Granuloma

A
  • Laryngeal evaluation (ENT appt)
  • Voice rest

S65

78
Q

What are airway adjuncts?

A
  • bougie
  • magill forceps
    *

S66-67

79
Q

When is a bougie used?

A
  • blind intubation if glottic exposure is absent
  • ETT passage is difficult

S66

80
Q

What kind of base and coating does the bougie have?

A

The bougie has a polyester base with resin coating.

S66

81
Q

The distal end of the bougie is angled ____- degrees.

A
  • 30-45 degrees

S66

82
Q

How do you use the bougie?

A
  • Introduce Bougie with anterior positioning of the tip.
  • Be Gentle.
  • You should feel the clicks of the tracheal rings.

S66- lecture

83
Q
  • What are these called?
  • What are they used for?
  • Considerations?
A
  • 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
Q

3 indications for lung isolation?

A
  • thoracic procedure
  • control of contamination or hemorrhage
  • unilateral pathology

S69

85
Q

The rationale for lung isolation in thoracic procedure

A
  • Deflating the lung to increase safety profile and surgical exposure

S69

86
Q

The rationale for lung isolation to control contamination or hemorrhage

A
  • Can prevent material in one lung from contaminating other
  • Allows one lung to be ventilated while other hemorrhages

S69

87
Q

The rationale for lung isolation in unilateral pathology

A
  • Isolate fistulas, ruptured cysts, or other issues with the diseased lung while allowing unilateral ventilation

S69

88
Q

Anatomy of the Right Mainstem

A
  • 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
Q

Anatomy of the Left Mainstem

A
  • 45 degree takeoff from trachea
  • LUL tracheal takeoff more distal
  • Avg length 5.5 cm from carina to take-off

S70

90
Q

What are the adult sizes for the double-lumen tube?

A
  • 35 Fr
  • 37 Fr
  • 39 Fr
  • 41 Fr

S71

all are odd numbers

91
Q

What are the pediatric sizes for the double-lumen tube?

A
  • 26 Fr
  • 28 Fr
  • 32 Fr

S71

all are even numbers

92
Q

Which Double-Lumen Tube (DLT) is commonly used?

A
  • Left Double-Lumen Tube

S71

93
Q

⭐️Procedures that will require a Right Double-Lumen Tube.

A
  • Left pneumonectomy
  • Left lung transplantation
  • Left mainstem bronchus stent in place
  • Left tracheo-bronchus disruption

S71

know that if one of these sx are being done, use a right DLT

94
Q

Insertion of DLT is placed similarly as a standard ETT, but more difficult due to what?

A
  • Stiffness
  • Size

S72

95
Q

The DLT is advance through the larynx with angled tip anterior into the ____.

A
  • Trachea

S72

96
Q

Difficulties with Bronchial-blockers

A
  • Right upper lobe bronchus takeoff is high
  • Tracheal bronchus
  • Fixation by staples during surgery
  • Perforation by suture needle or instrumentation

S77

97
Q

When inserting the DLT, when the bronchial cuff passes the cords, the tube is turned ____ degrees

A
  • 90 degrees
  • Bronchial portion points toward the appropriate bronchus

S72

98
Q

DLT verification of the location of the bronchial port with a ____.

A
  • fiberoptic scope

S72

99
Q

The blue bronchial cuff of the DLT is just below the ____ in the appropriate bronchus.

A
  • carina

S72

100
Q

Inflate DLT’s bronchial balloon under ____to verify proper placement

A
  • direct visualization

S72

101
Q

Ensure DLT’s bronchial cuff does not herniate over the ____.

A
  • carina

S72

102
Q

How can you isolate a lung with the DLT?

A
  • Clamping either the tracheal or bronchial connector

S72

103
Q

picture or insertion of double lumen tube in right main and left main

A

S73

104
Q

What are some DLT complications?

A
  • Tube malpositions
  • Hypoxemia

S74

105
Q

What can cause DLT malposition and unsatisfactory lung collapse?

A
  • Bronchial lumen in the wrong mainstem (needs reinsertion)
  • Tube too proximal in airway (correct with fiberoptic)

S74

106
Q

What can cause hypoxemia with a DLT?

A
  • Malpositioning of DLT (needs reinsertion)
  • Patient comorbidities (may need PEEP or intermittent 2-lung ventilation)

S74

107
Q

What are the indications for Bronchial-Blockers?

A
  • 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
Q

The function of the Bronchial Blocker.

A
  • 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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