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KDH: Principles (EXAM 2) > Exam 2 Airway Equipment: Part 2 (6/27/24) > Flashcards

Exam 2 Airway Equipment: Part 2 (6/27/24) Flashcards

1
Q

This rigid indirect laryngoscope is stainless steel, lighted stylet with malleable distal tip; and design utilizes eye piece

A

Shikani Optical Stylet

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2
Q

Optical Stylet Advantages: (4)

A
  • Easy to use for routine and difficult intubations
  • Decr. Risk esophageal intub./Trachea is visualized
  • Decr. incidence of sore throat
  • Decr. c-spine movement over conventional laryngoscopy
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3
Q

Optical Stylet Disadvantages: (3)

A
  • Longer intubation time
  • Cannot be used with nasal intubation
  • Cannot be adjusted into a precise direction compared to a traditional malleable stylet
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4
Q

Examples of Video Laryngoscopes: (4)

A
  • Glidescope
  • Co-Pilot
  • King
  • McGrath
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5
Q

Increased or Decreased C-Spine movement with video laryngoscopes?

A

Decreased C-Spine movement

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6
Q

What are the strongest predictors of failure while using a video laryngoscope?

A
  • Altered neck anatomy
  • Radiation changes
  • Presence of a mass
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7
Q

What is the most frequent anesthesia-related claim?

A

Dental Injury

(Upper Incisors, restored/weak teeth)

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8
Q

Complications of Laryngoscopy:(4)

A
  • Dental Injury
  • Cervical Spinal cord injury
  • Damage to “other structures”
  • Swallowing/aspirating of foreign body
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9
Q

What “other structures” could be damaged during laryngoscopy? (4)

A
  • Abrasions/Hematomas - oral cavity (lips/mouth)
  • Lingual/hypoglossal nerve injury
  • Arytenoid subluxation (dislocation)
  • Anterior TMJ dislocation
    If they have TMJ, try not to force it (use adjuncts).
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10
Q

What are some factors in regard to tracheal tubes that can change the resistance in the breathing system: (4)

A

* Internal Diameter (MOST!)
* Tube Length
* Configuration changes
* Connectors

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11
Q

What is the reasoning behind having the Internal and external walls be circular?

A

Decreases Kinking

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12
Q

At which end of the ETT can it be shortened?

A

Machine End

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13
Q

Because the ETT has a slanted bevel we can view the ___ easier.

A

Larynx

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14
Q

What is the purpose of the Murphy Eye?

A

Provides an alternate pathway for gas flow

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15
Q

Advantages/Diasadvantages to RAE tube use

Increased or Decreased with the use of a RAE Tube:

Tube Diameter:
Distance from tip to curve:
Ease of securement:
Ability to pass a suction device or scope:
Airway Resistance:

A

Tube Diameter: Increased
Distance from tip to curve: Increased
Ease of securement: Increased
Ability to pass suction/scope: Decreased
Airway Resistance: Increased

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16
Q

3 other names for “Armored Tubes”

A
  1. Reinforced
  2. Anode
  3. Spiral Embedded
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17
Q

With what surgeries may armored tubes be used?

A

Head, Neck, Tracheal Surgeries

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18
Q

Disadvantages to Armored tube use: (4)

A
  • Need a stylet or forceps
  • Difficult to use during nasal intubation
  • Cannot be shortened
  • Damaged when biting
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19
Q

Your surgeon walks into the OR and says they need to use this fancy new device on the patient’s mouth…
What tube should we use?
What do we fill these tubes with?

A

Laser-Resistant Tubes

Inflate distal cuff first with saline so it combines with the methylene blue crystals, followed by the proximal cuff.

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20
Q

Where are the tube markings located at?

A

On the bevel side above the cuff

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21
Q

Is the ETT size based on internal or external diameter?

A

Internal Diameter

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22
Q

Apropriate cuff pressure and volume of air for optimal ETT placement:

A

18-25 mmHg
8-10 mls of air

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23
Q

What is an important cuff consideration if we are using nitrous for a procedure?

A

Monitor the cuff pressure frequently because the nitrous can cause cuff inflation and expansion.

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24
Q

What kind of cuff is this?

A

High Volume, Low pressure

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25
What kind of cuff is this?
Low volume, high pressure
26
# Which cuff? Larger area of contact: More likely to have sore throat: Better visibility during intubation: Pressure to trachea < Mucosal Perfusion pressure: Needs to be replaced if post-op intubation is required: Requires large amount of pressure to achieve a seal: Easier to pass NGT into trachea:
Larger area of contact: **High V, Low P** More likely to have sore throat: **High V, Low P** Better visibility during intubation: **Low V, High P** Pressure to trachea < Mucosal Perfusion pressure: **High V, Low P** Needs to be replaced if post-op intubation is required: **Low V, High P** Requires large amount of pressure to achieve a seal: **Low V, High P** Easier to pass NGT into trachea: **High V, Low P**
27
# Increased or Decreased cuff pressures: Use of Nitrous: Hypothermic CPB: Decrease in Altitude: Coughing, Straining, muscle tone changes:
Use of Nitrous: **Increase** Hypothermic CPB: **Decrease** Decrease in Altitude: **Decrease** Coughing, Straining, muscle tone changes: **Increase**
28
List of complications that can occur with ETT placement:
1. Inadvertent bronchial intubation 2. Fluid accumulation above the cuff 3. Upper airway edema 4. Vocal cord granuloma
29
In which 2 patient populations may we encounter inadvertent bronchial intubation? Why?
* Peds: Straighter trachea * Females: Shorter trachea
30
Inadvertent bronchial intubation leads to ___ and is typically in which bronchus?
Leads to atelectasis (if we are only ventilating on one-side) Typically right mainstem
31
Approximate ETT marking at the teeth for males and females:
Males: 23 cm at the teeth Females: 21 cm at the teeth
32
Upper airway edema is particularly dangerous in this population: When is the "Peak incidence"? When are the earliest signs seen?
Young children Peak: 1-4 years old Signs: 1 or 2 hrs - 48 hrs post-op
33
Vocal cord granuloma is common in ___
female adult patients
34
What are some cause of vocal cord granuloma? (4)
Trauma ETT Too large Infection Excessive cuff pressure
35
Signs and Symptoms of vocal cord granuloma: | Treatment?
* Persistent hoarseness * Fullness * Chronic cough * Intermittent loss of voice | Laryngeal eval and voice rest
36
If using a bougie as an airway adjunct, we want to introduce it with the tip positioned ____. The distal end should be angled ___ to ___ degrees.
Anteriorly 30-45 degrees
37
If we are intubating "blind" we should still know where we are with bougie use because...?
We should be able to feel the **clicking sensation across the tracheal rings**
38
Describe the uses of the Magill forceps: What is one possible adverse effect of using Magill forceps?
* Primarily used for nasal intubations * Directs the tube into the larynx Possible damage to tube cuffs and lodged in murphy eye
39
What are some indications for "Lung Isolation"? (3)
* Thoracic Procedures * Hemorrhage control * Unilateral Pathology
40
Anatomical description of the Right Mainstem: (5)
* Shorter, Straighter, Larger diameter * 25 degree takeoff from trachea * Right Upper lobe tracheal takeoff is very close to origin
41
What is the degree of takeoff from the trachea for the Left mainstem? LUL tracheal takeoff is more ____.
45 degrees Distal
42
Average length from carina to take off on both the Right and Left Mainstems?
Right: 2.5 cm Left: 5.5 cm
43
Adult/Pediatric Double-Lumen Tube sizes
Adult: 35, 37, 39, 41 Fr Peds: 26, 28, 32 Fr | Adults = odd, Peds = even
44
Primarily we use Double-Lumen tubes on which side?
LEFT To avoid blockage of Right Bronchus (higher)
45
What are some procedures in which we would use a Right Double-Lumen tube? (4)
* Left pneumonectomy * Left lung transplantation * Left mainstem bronchus stent in place * Left tracheo-bronchus disruption
46
Are double-lumen tubes harder or easier to place? Why?
They are **more difficult** to place **due to the stiffness and size.**
47
Describe the process of inserting a DLT:
1. Advance through the larynx, tip angled anteriorly into the trachea 2. Bronchial cuff passes the cords 3. Bronchial portion is turned 90 degrees TOWARD the apropriate bronchus 4. Verify correct placement of bronchial port with a fiberoptic scope 5. Visualize the blue bronchial cuff just below the carina in the correct bronchus 6. Inflate bronchial balloon under direct visualization
48
Once correct placement of a DLT has been visualized directly, what do want to ensure regarding the bronchial cuff?
Ensure bronchial cuff does not herniate over the carina
49
How do we isolate one lung with a DLT?
By clamping either the tracheal or bronchial connector
50
While using a DLT, if the bronchial lumen is in the wrong mainstem, what should we do?
Reinsert the DLT
51
While using a DLT, if the tube is too proximal in the airway, what should we do?
Correct with fiberoptic
52
With hypoxemia as a complication for DLT placement, what are some considerations for us? Especially if the patient has comorbidities.
* May need PEEP in the dependent lung * May need to consider intermittent 2 lung ventilation (prevents worsening V/Q mismatch)
53
What are these devices called?
Bronchial-Blocking Devices
54
Indications For Bronchial-Blockers: (6)
* Nasal intubation * Difficult intubation * Patients with tracheostomy * Subglottic stenosis * Need for continued postoperative intubation * If a single-lumen tube is already in place
55
What can be done with a bronchial blocker that can NOT be done with a DLT?
They can block a segment of lung without isolating entire lung
56
What kind of video Laryngoscope?
King
57
What is this?
Glidescope
58
What is this?
McGrath
59
What is this?
Co-Pilot
60
Advantages of Video Laryngoscope (6)
1. Magnified anatomy 2. Assistant can also visualize (Screen) 3. Further away from the patient (infectious disease) 4. Decreased C-Spine movement. 5. Curved and Straight blades mimicking laryngoscope. 6. Legal Cases: Demo correct technique.
61
Disadvantages of Video Laryngoscope (3)
1. Requires Video system 2. Portability varies 3. Radical Neck, scarring, radiation, or masses (limitation).
62
Who performs manual in-line stabilization?
The Neurosurgeon from the patient in the C-Collar at risk for Cervical Spinal cord injury during DL.
63
What types of procedures are RAE tubes used? What is a RAE tube?
Head and Neck procedures to keep ETT out of the way. Ring-Adair-Elwin Tube.
64
Which Tracheal tube is okay and meant to be bent?
Armored Tubes AKA Reinforced, Anode, & Spiral embedded.
65
ETT size is measured in ____ ; graduated markings are measured in ____.
Mm Cm
66
Overinflating the cuff on an ETT increases the risk of _____.
Mucosal Necrosis
67
If you have an increase in pressure in your ETT cuff, what might be the culprit?
Nitrous
68
How can we avoid trauma with ETT placement? (4)
1. Avoid repeated attempts/aggressive 2. Keep stylet inside the tube (Above the Murphy’s Eye) 3. Use of Afrin/vasoconstrictors and pre-dilate passage. 4. Amt of muscle relaxants
69
Risk for inadvertent bronchial intubation increases with what position? And procedure?
Trendelenburg & Laparoscopy Abdominal insufflation.

KDH: Principles (EXAM 2) (11 decks)

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