Laryngoscopes Flashcards
name the 4 steps of airway management during pre oxygenation:
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
name the NPO guidelines for:
clear liquids-
breast milk-
infant formula, nonhuman milk, solid food
fried or fatty foods
2 hours
4 hours
6 hours
8 hours
the two steps of aspiration prophylaxis:
gastric volume <25mL
gastric pH >2.5
Glottic closure reflex
* Strong adduction of the vocal cords * Exaggerated response of this reflex
LARYNGOSPASM
name the 5 treatment methods to laryngospasm
-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”
Lower airway irritated causing a vagal reflex-mediated constriction * Untreated leads to inability to ventilate
bronchospasm
treatment for bronchospasm
Deepen anesthetic – propofol, volatile agent, β-2 agonist (inhaler)
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
1902
1907
1913
what is “DL” short for
direct laryngoscopy
Most common technique for intubation since the 1940s * Technique used to facilitate tracheal intubation
laryngoscopy
name the components of the laryngoscope
handle
blade
light source
name all the components of the physical examination of the airway:
-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
name allthe intubating equipment needed within your reach
Laryngoscope * ETT * Stylet * 10 mL syringe * Suction * Tape
name some predictors of a difficult laryngoscopy:
-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
Right thumb pushes caudally on
bottom molars * Index finger pushes up on the upper
molars
scissor technique
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
macintosh laryngoscope blade
name the steps of using a macintosh blade:
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
It is a Straight blade * Used frequently for:
* Pediatric patients
* Patients with a shorter thyromental
distance * Floppy epiglottis
Miller Laryngoscope blade
name the steps to using a miller blade:
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
name the 5 Rusch standard reusable blades:
macintosh
improved view macintosh
miller
phillips
wisconsin
what are some things to do prior to performing a nasotracheal intubation?
- 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
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
flexible fiberoptic bronchoscope
______ is
the gold standard for difficult
airways
awake, spontaneous breathing
Indications for Fiberoptic Intubation
- 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
true or false: there are contraindications for the use of a bronchoscope
FALSE no contraindications
true or false: raise the bed to sternum level when performing a fiberoptic intubation
false- lower the damn bed to keep the scope straight
Advantages for use of flexible fiberoptic bronchoscope over direct laryngoscopy:
- 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
name the two positions a patient can be in for a fiberoptic bronch
sitting or supine
name the dose of glycopyrolate you would prep for before a fiberoptic bronch
0.2mg IV if not contraindicated about 20 min prior
- 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
bullard elite rigid indirect laryngoscope
- Disposable, portable optic laryngoscope * Magnifies the view of the glottis * Guided channel to hold and advance the
ETT
airtraq SP
- Use is becoming standard for difficult,
as well as routine airways * Good for the unexpected difficult airway * Can be used for awake intubation
glide AH scope LOL
a type of video laryngoscope where * Blade and handle are one continuous
piece and single-patient use
C MAC
name another type of video laryngoscope that has a narrow blade profile
McGrath- very popular
- 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
the light wand
- Hollow airway exchange catheter * Fits over a fiberoptic bronchoscope * Left in place as fiberoptic
bronchoscope is removed and ETT is
advanced into the airwa
aintree intubation catheter
- 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
gum elastic bougie
what in the world is a retrograde intubation
Percutaneous guidewire inserted through
the cricothyroid membrane and advanced
through the mouth * ETT is advanced over the wire and through
the vocal cords
what is a rare side effect of prilocaine
methemoglobiinemia
what is the normal range for methemoglobinemia
0-3%
what happens when your methemoglobin ranges:
3-15%?
15-20%?
25-50%?
50-70%?
>70%?
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)
