Laryngoscopes

Question 1

name the 4 steps of airway management during pre oxygenation:

Answer 1

100% o2 at 10-12 Lmin
no leaks around mask
3 min normal breathing or 4 vital capacity breaths over 30 seconds
head up position for obese or anyone with decreased functional reserve capacity

Question 2

name the NPO guidelines for:
clear liquids-
breast milk-
infant formula, nonhuman milk, solid food
fried or fatty foods

Answer 2

2 hours
4 hours
6 hours
8 hours

Question 3

the two steps of aspiration prophylaxis:

Answer 3

gastric volume <25mL
gastric pH >2.5

Question 4

Glottic closure reflex
* Strong adduction of the vocal cords * Exaggerated response of this reflex

Answer 4

LARYNGOSPASM

Question 5

name the 5 treatment methods to laryngospasm

Answer 5

-Removal of the irritant
* Deepen anesthesia
* Succinylcholine
* Rapid onset neuromuscular blocking drug (NMBD)
* Continuous airway pressure with 100% O 2
* Apply pressure to the “laryngospasm notch”

Question 6

Lower airway irritated causing a vagal reflex-mediated constriction * Untreated leads to inability to ventilate

Answer 6

bronchospasm

Question 7

treatment for bronchospasm

Answer 7

Deepen anesthetic – propofol, volatile agent, β-2 agonist (inhaler)

Question 8

name the years for these historic facts on the laryngoscope:
light bulb on the blade
light source provided illumination at the distal end
batteries in the handle

Answer 8

1902
1907
1913

Question 9

what is “DL” short for

Answer 9

direct laryngoscopy

Question 10

Most common technique for intubation since the 1940s * Technique used to facilitate tracheal intubation

Answer 10

laryngoscopy

Question 11

name the components of the laryngoscope

Answer 11

handle
blade
light source

Question 12

name all the components of the physical examination of the airway:

Answer 12

-visual inspection of face and neck
-assessment of mouth opening
-eval of oropharyngeal anatomy and dentition
-assessment of neck ROM
-assess of submandibular space
assess pts ability to slide the mandible anteriorly

Question 13

name allthe intubating equipment needed within your reach

Answer 13

Laryngoscope * ETT * Stylet * 10 mL syringe * Suction * Tape

Question 14

name some predictors of a difficult laryngoscopy:

Answer 14

-long upper incisors
- promininent overbite
-inability to protrude mandible
-small mouth
-mallampati III or IV
-high arched palate
- short thick neck
-short thyromental distance
-limited cervical mobility

Question 15

Right thumb pushes caudally on
bottom molars * Index finger pushes up on the upper
molars

Answer 15

scissor technique

Question 16

It is a Curved blade * Most commonly used blade for
adults * Provides more room for inserting an
ETT * Larger flange to displace tongue * Less likely to cause dental damage

Answer 16

macintosh laryngoscope blade

Question 17

name the steps of using a macintosh blade:

Answer 17

Hold in left hand
* Insert into the right side of the
mouth * Sweep tongue to the left with the
flange * Advance the blade and insert the tip
into the vallecula * Lift up and away at a 45° angle to expose the glottic opening

Question 18

It is a Straight blade * Used frequently for:
* Pediatric patients
* Patients with a shorter thyromental
distance * Floppy epiglottis

Answer 18

Miller Laryngoscope blade

Question 19

name the steps to using a miller blade:

Answer 19

The Paraglossal technique
* Insert the blade into the right side of
the tongue, between the tongue and
the lower molars * Keep advancing the blade along the
tongue into the grove between the
tonsillar pillar and tongue * Continue advancing until the
epiglottis is visualized * Lift the epiglottis anteriorly * Insert the ETT then gently remove
the blade

Question 20

name the 5 Rusch standard reusable blades:

Answer 20

macintosh
improved view macintosh
miller
phillips
wisconsin

Question 21

what are some things to do prior to performing a nasotracheal intubation?

Answer 21

• Constrict nasal mucosa with nasal spray * Lubricate a warmed ETT * Insert with bevel facing away from
  midline * DL once in the oropharynx * Guide ETT with Magill forcep

Question 22

Contains thousands of flexible glass fibers; transmits light from an external light source to the
distal end of the scope; the light reflects off an object and is transmitted back to an eyepiece or
monitor

Answer 22

flexible fiberoptic bronchoscope

Question 23

______ is
the gold standard for difficult
airways

Answer 23

awake, spontaneous breathing

Question 24

Indications for Fiberoptic Intubation

Answer 24

• Anticipated or known difficult intubation
• Neck extension is contraindicated:
• Unstable cervical neck, cervical stenosis, vertebral artery insufficiency * Poor dentition * Limited mouth opening
• TMJ
• Fixation of the mandible (jaw wired shut)
• Burns or radiation to the neck

Question 25

true or false: there are contraindications for the use of a bronchoscope

Answer 25

FALSE no contraindications

Question 26

true or false: raise the bed to sternum level when performing a fiberoptic intubation

Answer 26

false- lower the damn bed to keep the scope straight

Question 27

Advantages for use of flexible fiberoptic bronchoscope over direct laryngoscopy:

Answer 27

* Better and more complete visualization of the airway * Able to confirm passage of ETT through vocal cords * No need for extension of the neck * Is tolerated in awake patients * Less likelihood of damage to teeth and the airway * Patient can be in multiple position

Question 28

name the two positions a patient can be in for a fiberoptic bronch

Answer 28

sitting or supine

Question 29

name the dose of glycopyrolate you would prep for before a fiberoptic bronch

Answer 29

0.2mg IV if not contraindicated about 20 min prior

Question 30

* L-shaped * Metal stylet * Working channel for suction, O 2, or injection of local anesthetic * Good for patients with limited neck movement or mouth opening

Answer 30

bullard elite rigid indirect laryngoscope

Question 31

* Disposable, portable optic laryngoscope * Magnifies the view of the glottis * Guided channel to hold and advance the ETT

Answer 31

airtraq SP

Question 32

* Use is becoming standard for difficult, as well as routine airways * Good for the unexpected difficult airway * Can be used for awake intubation

Answer 32

glide AH scope LOL

Question 33

a type of video laryngoscope where * Blade and handle are one continuous piece and single-patient use

Answer 33

C MAC

Question 34

name another type of video laryngoscope that has a narrow blade profile

Answer 34

McGrath- very popular

Question 35

* Used for blind intubation * Good for when blood or secretions are in the airway * Should not be used with airway trauma * Not good for morbidly obese patient

Answer 35

the light wand

Question 36

* Hollow airway exchange catheter * Fits over a fiberoptic bronchoscope * Left in place as fiberoptic bronchoscope is removed and ETT is advanced into the airwa

Answer 36

aintree intubation catheter

Question 37

* Able to be advanced through vocal cords * Angular tip – coudé tip – to help position up to glottic opening * Should be able to feel tracheal rings * ETT is advanced over it through the vocal cords

Answer 37

gum elastic bougie

Question 38

what in the world is a retrograde intubation

Answer 38

Percutaneous guidewire inserted through the cricothyroid membrane and advanced through the mouth * ETT is advanced over the wire and through the vocal cords

Question 39

what is a rare side effect of prilocaine

Answer 39

methemoglobiinemia

Question 40

what is the normal range for methemoglobinemia

Answer 40

0-3%

Question 41

what happens when your methemoglobin ranges: 3-15%? 15-20%? 25-50%? 50-70%? >70%?

Answer 41

Change in skin color, blue, gray, pale Cyanosis Lightheadedness, weakness, headache, confusion, chest pain, palpitations, dyspnea Altered mental status, arrhythmias, delirium, coma, seizures, acidosis Death (usually)