Exam 3 Flashcards
Indication for esophageal obturator airway/combitube
Failure to intubate; introduced as a substitution for intubation
Where does the distal lumen of the esophageal obturator airway enter? Where should the proximal lumen terminate?
Distal lumen is intended to enter the esophagus and the proximal lumen should terminate at the tracheal level for patient ventilation
What type of ventilation and pressures can esophageal obturators/combitubes be used?
Positive pressure ventilation to 50 cmH20 for SHORT periods
What type of angle do laryngoscopes form?
Right angle (90 degrees if you forgot what maths is)
What do most alterations of laryngoscope blades change?
The angle from tongue to handle and there are differences as noted in how they are used
Size of macintosh blade that is useful for adults?
3 and #4
What view do we see with a macintosh blade?
Valecula is visualize and see epiglottis hanging
What patient would we prefer a miller blade over a macintosh blade for safety purposes?
Those with C-spine injury as macintosh have been show to cause greater cervical spine movement than miller
What does the tongue of a macintosh look like?
tongue has a gentle curve
What does the tongue of a miller look like?
Tongue is straight with slight upward tip
What do we do with a miller to get our view?
looking at the epiglottis, we lift the tip of the epiglottis
What is less with miller blades?
Force, head extension and cervical spine movement
What type of patients are miller blades great for?
Smaller mouths and longer necks
Where do we advance the tip of a macintosh once the epiglottis is visualized?
the vallecula
What occurs if we insert a miller too far?
Elevation of the larynx or espophagus
What occurs if we withdraw a miller too far?
Epiglottis flips down and covers glottis
Describe the sniffing position
35 degrees cervical flexion, 85 degree extension of atlanta-occipital level imaginary line between external auditor meatus and sternal notch
What does scissoring help with?
Keeps lips free to accommodate blade insertion
Which side of the mouth is the laryngoscope inserted?
Right side of the mouth, keeping tongue to left and elevated
What is the BURP acronym and what is it used for
Backward, upward, rightward, pressure; used for displacing the larynx
What feature does the bullard laryngoscope have?
working port for oxygen and suction
3 advantages of bullard scope
- Helpful in difficult intubations
- Causes less cervical spine movement than direct laryngoscopy
- More rugged than fiberoptic scope
4 disadvantages to bulled scopes
- requires experience
- somewhat expensive
- cleaning more involved
- laser ETT and double lumen will not fit
What has replaced bullard scopes?
video laryngoscopes
Describe a Wu scope
- Rigid tubular blade and flexible fiberscope
- ETT and suction thread through 2 blades
- Insert like an OPA - midline
- Back blade removed first, then remainder of unit second
Advantages of a Wu scope (5)
- Double lumen placement possible
- Fiberoptic lens is protected from blood, secretions, and redundant tissue
- No stylet needed
- Minimal jaw opening is necessary
- Better hand/blade angle for large breasts or barrel chests
2 disadvantages of the Wu scope
- High initial cost
2. Requires experience
Describe the Shikani optical stylet
- Lighted with malleable distal tip, design utilizes eye piece
- Oxygen port for insufflation
- Neutral position, inserted midline, available in adult and peds sizes
- Stainless steel stylet advanced into trachea; light anteriorly at all times to avoid injury
What is the difference between a shikani and lightwand?
the lightwand has no eye piece
Advantages of video laryngoscopes (6)
- Magnified anatomy
- Rigid scopes have angled blade to mimic laryngoscopes
- Operator and assistant can see
- May result in decreased cervical spine movement
- Further distance from infectious patients
- Demonstrates correct technique in legal cases
2 Limitations of video laryngoscopes
- Requires video system
2. Portability varies
What should you do with video laryngoscopes if intubation is difficult
Withdraw slightly, may want to use tooth protector
4 complications of laryngoscopy
- Dental injury
- Cervical spine injury
- Damage to other structures
- Swallowing or aspirating foreign body
Dental injury with laryngoscopy (3)
- Most frequent anesthesia-related claim
- Most lily damaged: upper incisor, teeth restored or weakened teeth
- Teeth protectors may be needed
Cervical spine injury with laryngoscopy (2)
- Aggressive head positioning especially neck extension
2. Manual in-line stabilization; do not rely on c-collars
Damage to other structures with laryngoscopy (4)
- Abrasions/hematomas
- Lingual and or hypoglossal nerve injury
- Arytenoid subluxation
- TMJ dislocation
Swallowing or aspirating foreign body and laryngoscopy
light bulbs
With direct laryngoscopy which teeth are the most likely damaged?
Front 4 ( 7, 8, 9, 20) and back 4 (23, 24, 25, 26)
4 general principles that change resistance in breathing systems
- ID of tube
- Tube length
- Configuration changes
- Connectors
What does the murphy eye provide?
Alternate pathway for gas flow
What do the internal and external circular walls of ETT help with?
Decrease kinking
Advantages of ring-adar-elqin (RAE) tubes (4)
- Facilitate surgery around here and neck
- Temporarily straightened during insertion
- Large diameter, longer distance from tip to curve
- Easy to secure
2 disadvantages of RAE tubes
- Difficult to pass suction/scope
2. Increase airway resistance
