Intubation Flashcards
Direct laryngoscopy classification: define grade I
Most or full view of the glottic opening
Direct laryngoscopy classification: define grade II
Only the posterior portion of the glottic opening can be visualized; anterior commissure not seen
Direct laryngoscopy classification: define grade III
Only the epiglottis can be visualized; not portion of the glottic opening can be seen
Direct laryngoscopy classification: define grade IV
Epiglottis cannot be seen; only view is of the soft palate
What are some examples of airway adjuncts? (9)
- Fiberoptic scopes
- Retrograde intubation
- Transtracheal/Cricothyrotomy
- Airway exchange catheter
- Light wand
- Bougie
- GlideScope Video Intubation System
- Laryngeal Mask Airway (LMA)
- Combitube
What are the components of the LMA airway?
It consists of an inflatable silicone mask and rubber connecting tube.
The Laryngeal Mask Airway is an alternative airway device used for _______ and ______ support.
anesthesia and airway support
How is the LMA inserted?
It is inserted blindly into the pharynx, forming a low-pressure seal around the laryngeal inlet and permitting gentle positive pressure ventilation.
Can LMA be used on someone with a latex allergy?
Yes, All parts are latex-free.
What is the indication for the LMA?
The Laryngeal Mask Airway is an appropriate airway choice when mask ventilation can be used but endotracheal intubation is not necessary.
What are the contraindications for the LMA? (5)
- Non-fasted patients
- Morbidly obese patients
- Obstructive or abnormal lesions of the oropharynx
- Certain surgical procedures
- Certain medical conditions
What are some advantages to LMA (5)?
- Allows rapid access
- Does not require laryngoscope
- Relaxants not needed
- Provides airway for spontaneous or controlled ventilation
- Tolerated at lighter anesthetic planes
When might an LMA be used?
May be used as a rescue airway and fiberoptic conduit when intubation is difficult, hazardous or unsuccessful
Can LMA be used during bronchoscopy?
It can be used for bronchoscopy in the awake or asleep patient
What are some disadvantages to LMA? (3)
- Does not fully protect against aspiration in the non-fasted patient
- Standard LMA does not allow high positive pressure ventilation
- Requires re-sterilization if disposable not used
Review sizing of LMA.
Slide 99
Where should LMA’s be lubricated?
only the back side
What head position should the pt be in for LMAs?
sniffing position
What is the correct amount of air to inflate an LMA?
no greater than 60 mm H2O
What should be avoided with LMAs? (3)
Avoid pharyngeal suction, cuff deflation, or laryngeal mask removal until patient is awake (i.e.., opening mouth on command)
What is the use for the LMA-flexible?
Softer tubing. Not used in the emergency setting
What is the use for the LMA-unique?
Disposable. Ideal for use in pre-hospital and emergency settings
What is the use for the LMA-proseal?
Additional channel for suctioning of gastric contents. Does not permit blind intubation
What is the use for the LMA-fastrach?
Intubating LMA designed to serve as a conduit to intubation
What is the use for the LMA-supreme?
Similar to the ProSeal and has a built in bite block
What is the use for the LMA-ctrach?
Inserts like the LMA Fastrach and has built in fiberoptics with a video screen that allows direct visualizaton of the larynx
What is the use for the LMA-classic?
Original reuseable design
What is the structure of fastrach LMA and how does it help with intubation?
Rigid, anatomically curved to optimize alignment with glottis
What size ETT can a Fastrach LMA fit?
8 mm ETT
The fastrach LMA is short enough to ensure passage of ETT cuff beyond the _________
vocal cords
What is the epiglottic elevating bar found on the Fastrach lma?
dista end unattached, to elevate the epiglottis when an ett is passed through the aperture
What is the shape of the Fastrach LMA? What does this help?
V-shaped ramp in aperture to guide ETT toward glottis
What is the specific characteristics of the LMA proseal? How does this impact seal pressure?
Double cuff design enables seal pressures of 30cm H2O and greater to be achieved.
What does the drain tube seperate into in the LMA proseal?
The drain tube separates the alimentary and respiratory tracts.
What do the characteristics of the LMA proseal allow for?
These features, together with the flexible airway tube, enable longer periods of ventilation with minimal posterior pharyngeal wall damage, therefore expanding the types of procedures where an LMA airway can be used.
What does the back cuff on the LMA proseal provide?
Back cuff on adult sizes provides increased seal pressures with minimal mucosal pressure
What does the LMA proseal drain tube provide?
- Drain tube allows easy clinical confirmation of correct mask position
- Drain tube provides direct access to stomach contents
How does the LMA proseal protect against aspiration?
Designed to protect against aspiration by providing an escape for unexpected regurgitation
What does the drain tube prevent? What is this ideal for?
gastric insufflation, This is Ideal for PPV and spontaneous ventilation
What does the red plug on the LMA proseal protect?
Red plug protects the cuff during re-sterilization
What does the introducer tool on the LMA proseal allow?
allows insertion without the need to place fingers in the patient’s mouth
How many times can the LMA proseal be reused?
Reusable device that can be cleaned and steam sterilized up to 40 times
From a study completed in 2018, use of a bougie for intubation allowed for?
significantly higherfirst-attemptintubationsuccess
amongpatientsundergoing
emergencyendotrachealintubation
What is the combitube?
is a double-lumen tube with one blind end which functions as an esophageal obturator airway and the other as a standard cuffed ET tube.
How is the combitube inserted?
It is inserted blindly and “seals” the oral and nasal pharyngeal cavities.
What are the indications for the combitube? (3)
- Ventilation in normal and abnormal airways
- Failed intubation
- Airway management in trapped patients
When is combitube contraindicated? (4)
- Patients with intact gag reflexes
- Patients with known esophageal pathology
- Use in patients under 5 feet with standard Combitube™, under 4 feet with Combitube™ SA (small adult)
- Ingestion of caustic substances
What are some things that needed to do for Cricothyrotomy preparation?
- Identify anatomic landmarks with dominant hand
- Mark and prepare the neck
What can be given at the cricothyrotomy site?
Inject local anesthetic (e.g. lidocaine, if conscious)
Needle cricothyrotomy: What size catheter do you use?
Attach 14g IV catheter to 10cc syringe half filled with saline
Needle cricothyrotomy: what must be done after you id the cricothyroid membrane?
sterilize the site, and immobilize the larynx
Needle cricothyrotomy: How should the needle be inserted?
Insert 14g needle caudally through membrane at a 30 degree angle, aspirating for air
Needle cricothyrotomy: Once inserted what do you do to the catheter?
Slide IV catheter over needle and into the airway.
Needle cricothyrotomy: once catheter is in what do you do?
Connect 9mm adapter from ETT to 3cc syringe and attached to IV catheter in airway
Needle cricothyrotomy: How do you oxygenate? (2)
- Attach ambu bag
- Alternatively can use hand held jet ventilator
The ______________ uses the same technique as was used for needle cricothyrotomy
surgical cricothyrotomy
Surgical cricothyrotomy: where do u put the wire?
- through IV placed through the membrane
- Remove IV catheter over the guidewire
Surgical cricothyrotomy: After the wire is inserted what do you do next?
Make a 1-2cm vertical incision at the skin down to the cricothyroid membrane at the entry point of the guidewire
Surgical cricothyrotomy: after the incision what do you do?
Thread the tissue dilator over the wire and insert tracheostomy tube»» Alternatively at 6.0 ETT can be inserted
