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laryngoscopy/endotracheal intubation Flashcards

1
Q

What is the gold standard of airway management

A

Endotracheal intubation

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2
Q

Tubes are numbered according to their

A

Internal diameter

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3
Q

What are ETT constructed of

A

Polyvinyl choliride (pvc)

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4
Q

What is the body that governs the construction of ETTs

A

ASTM standard 21

American society of testing and materials

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5
Q

Size selection and depth of ETT insertion for men

A

8.0 or 9.0 at 24-26 at lip

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6
Q

Size selection and depth of ETT insertion for women

A

7.0 or 8.0 at 20-22 at lip

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7
Q

Size selection and depth of ETT insertion for children

A

Size: 4 + age/4
Depth: 12 + age/2

So for a 12 year old you would choose 7.0 to 18cm

**later slide - in children, advance tube until 2nd dark line on distal tube sits at or just below cords

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8
Q

What lowers resistance of a tube

A

Shorter tube

Wider tube *** most important factor is internal diameter of the tube

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9
Q

What is the purpose of the Murphy’s eye?

A

To allow for another path of air flow in case of distal occlusion

***don’t put stylet below level of murpy’s eye

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10
Q

What is the purpose of the pilot balloon

A

Helps you to gauge the pressure/air in the cuff

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11
Q

What is the purpose of the cuff

A

Provides a seal between ETT and tracheal wall - prevents aspiration and gas escape, centers tube in trachea and prevents tracheal trauma from bevel of ETT

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12
Q

High volume low pressure cuff

A

Compliant cuffs - larger area of contact with trachea but more adaptable to wall so less chance of tracheal damage

Can handle higher volumes without causing a huge increase in pressure

Used for long term intubation

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13
Q

Low volume high pressure cuff

A

Small area of tracheal contact, can distend trachea and cause tissue necrosis/mucosal damage

These are only used for short term intubation ideally

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14
Q

What is ideal cuff pressure to create a seal but avoid tissue damage

A

20-25mmHg

**tracheal mucosa perfusion pressure is 25-30mmHg

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15
Q

Uncuffed tubes

Who do we use them on and how do we test for air leak

A

Children <8yo

We test for airleak at pressure 15-20 cm H20

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16
Q

When would you use a laser safe ETT

A

ENT cases or other cases with a laser close to the tube/airway

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17
Q

Preparing your ETT for intubation

A

Make sure your 15mm connector is snug

Place the stylet - hockey stick formation

Check cuff

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18
Q

When would you use a double lumen ETT

A

Thoracic/lung cases where you may need to isolate a lung

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19
Q

Which laryngoscopes is curved and where do you place it

A

McIntosh. Tip advanced to valleculae = indirectly lifts epiglottis

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20
Q

Which laryngoscope has a straight blade

A

Miller
Lifts epiglottis directly
Usually requires less force and you enter midline

21
Q

What is the distance from the teeth to the vocal cords

22
Q

What is the distance from the vocal cords to the carina

23
Q

How many cm do you add to tube depth with nasal intubation

24
Q

Where is the carina located (spinal cord level)

25
Q

What happens to ETT with head flexion

A

1.9 cm advance (hose follows nose)

26
Q

What happens to ETT with head extension

A

1.9 cm withdraw (hose follows nose)

27
Q

How much dose an ETT move with rotation of head

28
Q

How to confirm ETT placement

A

Visualize ETT through cords
ETCO2 - “continuous”/3 consecutive breaths
Absence of gurgling sounds over stomach with vent
Equal bilateral breath sounds (or whatever baseline is)
Fogging ETT
Refilling of reservoir bag with exhalation

29
Q

Mainstem bronchus intubation S/S

A

Unilateral breath sounds
Unilateral chest expansion
ETT too deep
Increased airway pressure

30
Q

Esophageal intubation S/S

A 
Gastric contents in ETT
ETCO2 waveform but will drop off
Reservoir bag collapses, because no return
Gurgling in stomach
Gastric distention
No chest wall movement
31
Q

Physiologic responses to laryngoscopy

A 
Hypertension
Tachycardia/reflex bradycardia
Arrhythmia
Myocardial ischemia
Increased IOP/ICP
Bronchospasm
32
Q

Deep extubation

A

Muscle relaxants fully reversed, pt spontaneously breathing with adequate minute ventilation, no response to suctioning

CONTRAINDICATED in patients with a difficult airway, are an aspiration risk, or surgery that may produce airway edema

33
Q

Awake intubation

A

Pt can maintain and protect airway

Purposeful movement, eyes open, react to suctioning

34
Q

Can you extubate in phase 2

35
Q

Subjective criteria for awake extubation

A 
Follows commands
Clear oropharynx
Intact gag reflex
Head lift > 5 seconds
Sustained grasp
Pain controlled
Minimal end expiratory concentration of inhaled anesthetics
36
Q

Objective criteria for awake extubation

A 
Vital capacity >15ml/kg
Peak voluntary negative Inspirators pressure >25 cm O2
Tidal volume >6ml/kg
Sustained tetanic contraction
Spo2>90% 
RR<35
PACO2 <45
37
Q

How do we extubate

A 
100% O2 - debatable
Suction oropharynx and hypopharynx
Close APL
Deflate cuff
Remove ETT while applying positive pressure on bag

Apply positive pressure and 100% with face mask immediately following extubation

38
Q

Potential causes of ventilatory compromise during tracheal extubation

A 
Residual anesthetic
Poor central effort
Decreased resp drive to CO2
Reduced muscle tone
Reduced gag/swallow reflex
Vocal cord paralysis
Edema
Laryngospasm/bronchospasm
39
Q

Acute complications after extubation

A

Laryngospasm, vomiting, aspiration, sore throat, hoarseness, laryngeal or subglottic edema

40
Q

Chronic complications after extubation

A

Mucosal ulceration, tracheitis, tracheal stenosis, vocal cord paralysis, arytenoid cartilage dislocation

41
Q

What happens with arytenoid cartilage dislocation

A

Leads to flaccid cords and airway edema

42
Q

Nasal intubation indications

A

Maxillofacial or mandicular surgery

Oral/dental surgery

43
Q

Contraindications of a nasal intubation

A 
Coaguplopathy
Basilar skull fracture
Severer intranasal disorder
CSF leak
Extensive facial fractures
44
Q

Which tonsils are the ones that are at most increased risk for bleeding with nasal intubation

A

Pharyngeal tonsils

45
Q

What do you need for nasal intubation

A

Magill forceps

Neosynephrine spray

46
Q

How do you dilate the nares for NT intubation

A

NP tubes in both nares (X3 times up a size each time to gradually dilate, while mask ventilating in between each placement)

47
Q

Which blade should you use in a NT intubation

A

MAC - this leaves more room in your mouth for the Magill forceps

48
Q

Do you use a stylet during an NT intubation

A

NO that’s mean

49
Q

Complications of NT intubation

A

Epistaxis
Tracheal/esophageal trauma
Bacteremia/sinusitis
Displaced adenoids or polyps = bleeding and airway obstruction

Principles (11 decks)

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