Exam 2- Airway Equipment II (7/6/23) Flashcards
Name the components of the laryngoscope.
- Handle
- Blade
- Light source (usually fiberoptic)
Manufactured as a single piece or detachable blade/handle
Which hand should handle the laryngoscope?
- Left Hand
Source of power for the laryngoscope light.
- Disposable batteries in the handle of the laryngoscope
- Typically C-Size Batteries
Most laryngoscope blades form a ________ angle to blade when ready for use.
- right
What does the blade of the laryngoscope do to the tongue and epiglottis?
- Tongue: Manipulates and compresses soft tissue
- Epiglottis: Tip of blade will directly or indirectly elevates epiglottis
What are the two types of laryngoscope blades?
- Mac (Curved)
- Miller (Straight)
What is the purpose of the blade spatula?
- Compresses the tongue into the mandibular space
What is the purpose of the flange?
- The flange (if present) is used to move the tongue laterally and create a visual lumen
Typical Mac sizes for adults
- Mac #3 (most common)
- Mac #4
Describe the tongue of a Mac blade compared to a Miller blade.
- Mac blade tongue has a gentle curve
- Miller blade has a straight tongue with a slight upward tip
Typical Miller sizes for adults
- Miller #2 (most common)
- Miller #3
Which laryngoscope blade has been shown to cause greater cervical spine movement?
- Macintosh Blade
Which laryngoscope blade is great for smaller mouths and longer necks?
- Miller Blade
Which laryngoscope blade will be used to minimize the movement of the cervical spine?
- Miller Blade
Which laryngoscope blade makes intubation easier because the blade requires adequate mouth opening.
- Macintosh Blade
When would you want to use a Miller #3 blade?
- Tall person
- Long neck
The laryngoscope blade requires less force, less head extension, and less cervical spine movement.
- Miller Blade
When using a Mac Blade, after epiglottis is visualized, the tip advanced into the _________.
Vallecula
When using a Mac Blade, the pressure applied at the right angle of the blade and the handle moves the ______ and ________forward.
- Base of the tongue
- Epiglottis
The Miller Blade will lift the ______.
- Epiglottis
If the Miller Blade is inserted too far, what structures can it elevate?
- Larynx
- Esophagus
What can happen if the Miller Blade is withdrawn too far?
- Epiglottis flips down and covers the glottis
How can the Miller Blade be used as a Macintosh?
- Miller Blade can also be inserted into the vallecula
What is the optimal position for the patient undergoing direct laryngoscopy?
- Sniffing position
The sniffing position will have a ______ degree neck flexion (lower cervical).
The sniffing position will have a ______ degree head extension at the atlanto-occiptal level.
- 35 degree
- 80-90 degree
In the sniffing position, there should be an imaginary horizontal line that connects the _______ and ________.
- external auditory meatus
- sternal notch
Steps to inserting laryngoscope blade.
- Right hand opens mouth (“scissor”) to keep the lips free to accommodate blade insertion
- Insert blade on right side of the mouth
- Advance blade, keeping tongue to the left and elevated
- Epiglottis comes into view
What are some interventions for difficult airways?
- Maintain a neutral position and use an OPA
- Flexible fiberoptic scope
- Video laryngoscope
What is the maneuver to displace the larynx to get the glottis in view?
- BURP (Backwards Upward Rightward Pressure)
___________ patients will require elevation of the shoulder and upper back.
- Obese
Use ramping technique for these patients so they can have a horiztonal ear to sternal notch line.
What can be used to ramp a patient?
- Troop Elevation Pillow
- Folded Blankets
Describe a Shikani Optical Stylet.
- Stainless steel lighted stylet with a malleable distal tip
- Design utilizes an eyepiece for DL
- Oxygen port for oxygen insufflation
What kind of position will the patient have for a Shikani Optical Stylet?
- Neutral Position
Stylet Inserted Midline.
Shikani Optical Stylet will advance into the trachea with light pressure, and the tip should remain _________ at all times to avoid injury.
- Anterior (pointed up)
Shikani Optical Stylet can be used as a ________, check ETT placement, or placement of double-lumen ETT
- Light wand
Advantages of the Shikani Optical Stylet
- 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
Disadvantages of the Shikani Optical Stylet
- Longer intubation time
- Cannot be used with nasal intubation. (not flexible)
- Cannot be adjusted into a precise direction compared to a traditional malleable stylet
Name the four most common Video Laryngoscopes.
- Glidescope
- Co-Pilot
- King
- McGrath
What are the advantages of using a video laryngoscope?
- 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
What are the limitations of using a video laryngoscope?
- Requires video system
- Portability varies (Glidescope needs to be plugged in)
What is the strongest predictor of failure when using a video laryngoscope?
- Altered neck anatomy with the presence of a surgical scar, radiation changes, or mass
Complications of Laryngoscopy
- Dental Injuries
- Cervical Spinal Cord Injury
- Swallowing of foreign body (lightbulbs, teeth)
- Abrasions/Hematoma
- Lingual/ Hypoglossal nerve injury
- Arytenoid Subluxation
- Anterior TMJ dislocation
What is the most frequent anesthesia-related claim?
- Dental Injury
What is most likely damaged during laryngoscopy?
- Upper incisors
- Restored or weakened teeth
What can help mitigate laryngoscopy-related dental injury?
- Tooth protectors (placed on upper teeth during DL)
- Protects from blade causing direct surface damage
- Does not guarantee safety from dental trauma
How do you prevent cervical spinal cord injury during a laryngoscopy?
- Do not aggressively position the head
- Manual in-line stabilization (remove C-collar before intubation, have neurosurgeon remove C-collar)
What will happen to the tongue if there is a hypoglossal nerve injury?
- Tongue will deviate to the side when it is stuck out
- Tongue will look wrinkled on the side that it is deviated to
How many teeth does a healthy adult patient have?
- 32 teeth
What does RAE Tube stand for?
- Ring-Adair-Elwin (RAE) Tube
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
- Easy to secure
- Nasal fiberoptic intubation.
What are the disadvantages of RAE Tubes?
- Difficult to pass suction/scope
- Increases airway resistance
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
What makes up the laser-resistant tubes?
- Metallic or silicone/ metal mixture
Which cuff is filled first in the Laser-Resistant Tube?
- Distal Cuff first
- Proximal Cuff second
What are the safety standards of the ETT markings?
- The word oral or nasal or oral/nasal
- Tube size in ID in mm (7.0, 7.5, etc)
- Name of manufacturer
- Graduated markings in centimeters from patient’s end
- Cautionary note… single use only if disposable
- Radiopaque marker at patient’s end (CXR for positioning)
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
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
Why is upper airway edema dangerous in young children?
Peak incidence age?
- Cricoid cartilage completely surrounds the subglottic area
- 1-4 years old
This airway adjunct is typically used to aid tracheal intubation in poor laryngoscopic views or diffcult ETT passage.
- Bougie
The bougie has a polyester base with resin coating.
The distal end of the bougie is angled _______- degrees.
- 30-45 degrees
Introduce Bougie with anterior positioning of the tip.
Be Gentle.
You should feel the clicks of the tracheal rings.
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
The blue bronchial cuff of the DLT is just below the _______ in the appropriate bronchus.
- carina
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)
Difficulties with Bronchial-blockers
- Right upper lobe bronchus takeoff is high
- Tracheal bronchus
- Fixation by staples during surgery
- Perforation by suture needle or instrumentation
What two teeth have the highest incidence of dental injuries?
Left Central Incisor (47%)
Left Lateral Incisor (20%)
