Management of the Difficult Airway Flashcards
What are the criteria for inability to ventilate a patient?
Anesthetist cannot cause a life-sustaining amount of gas exchange to occur with a jaw thrust, oral or nasal airway
What are the criterial for the inability to intubate a patient?
Anesthetist cannot place an ETT through the vocal cords within a life-sustaining period of time
What are the causes of inability to ventilate?
Laryngospasm Supraglottic soft tissue relaxation Chest wall rigidity Pathologic, glottic and subglottic Equipment failure
What are the causes of a laryngospasm?
Nerve injury or light anesthesia
What are the structures of the supraglottic soft tissues that can cause an obstruction?
Tongue, epiglottis, soft palate and pharyngeal walls
What factors can cause chest wall rigidity?
Breath holding and narcotic induced
What pathological processes can result in an inability to ventilate?
Foreign body, edema, infection, vocal cord palsy, stenosis and compression
According to the ASA closed case reports, what factor contributed to the decline in respiratory claims?
The use of pulse oximeters and CO2 monitoring
What major problem were providers more likely to recognize with CO2 monitoring and pulse oximetry?
Identifying esophageal intubation
What is the most common adverse respiratory event according to ASA closed claims database?
Failure to ventilate
What is another name for the intubating LMA?
Fastrach LMA
What are the typical uses for a glidescope?
Known difficult airway
Rescue
Anterior Larynx
Poor neck mobility
What are common requirements for a fiberoptic intubation?
Difficult airway or C spine injury
Assessment of double lumen ETT
Airway evaluation
Rigid laryngoscope that has an anatomically shaped scope with fiberoptic bundle and eye piece
Bullard scope
Rigid anatomically shaped blade with separate flexible fiberoptic scope
Wu scope
Rigid blade shaped in form of oropharynx will attach eye piece
Upsher scope
What is another name for the bougie?
Eschmann introducer
When is a bougie useful?
When laryngoscopic view is poor grade III or IV
What is the size and shape of a typical bougie?
15fr 60cm long and angled 40 degrees at the tip
What is the purpose of the lighted intubating wand?
Transillumination of the neck to guide ETT
Which lateral position is easier to intubate?
Left lateral, the tongue is pushed out of the way by gravity
Which supraglottic airway has two lumens and will function whether placed in the trachea or esophagus?
Combitube, used in the emergency airway
What determines the tidal volume of transtracheal jet ventilation?
Inspiratory time
Chest wall and lung compliance
Catheter size
What catheter sizes and tidal volumes are typically used with transtracheal jet ventilation?
14g 1600mL/s
16g 500mL/s
What is the most common complication of transtracheal jet ventilation?
Tracheal mucosa damage and thickened secretions blocking the airway, resulting from inadequate humidification of inspired gases
How long should TTJV be used?
Short term, should be used as a bridge device
What is the technique for retrograde intubation?
Puncture cricothyroid membrane with 18g needle towards the head at 45 degree angle
Thread a j-wire through the needle and out through the mouth
Follow ETT over wire guide into trachea
What size needle should be used for a cricothyrotomy?
12-14g needle
How can we ventilate once the catheter is in place?
Attach a 3mL syringe with no plunger, attach a 15mm ETT adaptor and connect to breathing circuit
