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Interventions 3 > Mod 2 Difficult Airway Management > Flashcards

Mod 2 Difficult Airway Management Flashcards

1
Q

4 Types of Assessments for a Difficult Airways?

A
  1. Difficult Bag Mask (Roman)
  2. Difficult Laryngoscopy and Intubation (Lemon)
  3. Difficult Extraglottic Device (Rods)
  4. Difficult Cricothyotomy (smart)
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2
Q

Why is difficult Bag Mask Ventilation important?

A
  1. Ventilates patient
  2. Oxygenation; buys time for other treatments
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3
Q

What is classified as a Failed Airway?

A

Failure to maintain oxygen sats during or after 1 or more laryngoscopy attempts (C.I.C.O)

  • CICO = Can’t intubate, Can’t oxygenate
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4
Q

What are 3 main stays/signs for a failed airway?

A
  1. CICO (bagging no longer viable)
  2. 2 failed attempts at orotracheal intubation by exp person
  3. Single best attempt at intubation fails in the forced to act situation
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5
Q

What are 3 golden rules for Bag Mask Ventilation (BMV)?

Edit don’t like this card

A
  1. Manual vent skills w/proper equipment
  2. Anybody can be oxygenated and ventilated w/bag and mask (usually)
  3. Bagging should be mastered before intubation
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6
Q

What does successful Bag Mask Ventilation (BMV) largely depend on? (3)

A
  • Patent airway
  • Adequate mask seal
  • Proper ventilation
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7
Q

Indicators of difficult Bag Mask Ventilation?

A

MOANS or ROMAN (updated version of MOANS)

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8
Q

What does the abbreviation ROMAN assess?

A

Difficulty of airway management

  • R: Radiation/Restriction
  • O: Obesity/Obstruction/OSA (triple O)
  • M: Mask seal
  • A: Age
  • N: No teeth
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9
Q

What type of “O” categories would cause airway management to be difficult? (Roman)

A

O in Roman measures obstruction level, factors that would affect quality of oxygenation and ventilation would be:

  • Increased weight of chest
  • Decreased diagrammatic excursion
  • Increased resistance secondary to swelling or adipose tissue
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10
Q

What “Radiation or Restriction” considerations would cause airway management to be difficult?

A
  1. Radiation would involve burns?
  2. Restrictions would involve resistance to ventilation, high vent pressures (restrictive disease), or hyperinflation (obstructive disease)
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11
Q

What considerations could affect the mask seal?

A

Trauma or beards

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12
Q

What age group is considered harder to intubate?

A

Older than 55

  • Floppier airways
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13
Q

should dentures be taken out or left in during intubation?

A

Left in because the face will cave in without the structure of teeth or dentures

  • would this apply to BMV or Intubation?
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14
Q

How does LEMON assess a difficult airway?

A
  • L: Look externally
  • E: Evaluate 332 rule
  • M: Mallampati score
  • O: Obstruction/obesity
  • N: Neck mobility
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15
Q

When “looking externally” at the neck and mouth. what should be assessed? (5)

A
  • DCAP BLS TIC
    (Deformities, contusions, abrasions, penetrations, burns, lacerations, swelling, tenderness, instability, crepitus)
  • Excessive Bleeding
  • Tracheal Deviation
  • JVD
  • Obvious Masses
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16
Q

Caudad vs Saudad?

  • Probably not important to know?
A
  • Saudad towards the head
  • Caudad towards the tail bone
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17
Q

What does the Mallapati score assess?

A

It grades the view of how much of the back of the mouth can be seen

  • The tonged and the pharynx are the main objects of comparison
  • has 4 grades, 3&4 are potential difficulty airways
  • inset pic from slide 14
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18
Q

What are the 4 cardinal signs of airway obstruction?

A
  • Muffled (hot potato voice)
  • Difficulty swelling secretions
  • Stridor; insp particularly
  • Sensation of dyspnea
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19
Q

How is Neck Mobility assessed?

A

C Spine is measures the distance between the lower border of mandible to thyroid notch at full neck extension

  • Distance should be greater than 4 fingers in adults at full extension
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20
Q

What does extraglotitis mean?

A

Airways outside of the epiglottis

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21
Q

What does RODS assess?

A

Difficulty with extraglottic devices

  • R- Restriction (Like in ROMAN)
  • O- Obesity/Obstruction
  • D- Disrupted or Distorted Airway
  • S- Short Thyromental distance (less than 6 cm indicates potential difficulty)
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22
Q

What does SMART assess?

A

Difficult Cricothyrotomy

  • S- Surgery or other airway disruption (Eg. Radical neck/jaw etc.)
  • M- Mass (hematoma and/or infection, abscesses)
  • A– Access/Anatomy (inability to access or assess the structures/landmarks )
  • R- Radiation distortion (scar tissue)
  • T- Tumors
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23
Q

Why aren’t Cricothrytomies typically performed on kids?

A

There isn’t enough access via the cricoid

  • trachestomies are still performed, just usually not via cricoid.
  • Access in “smart” also refers to kids
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24
Q

Why are Cricothyrotomies performed if tracheostomies are used for the same if not similar function?

A

To provide oxygen and ventilation, its a rescue technique.

  • performed if no other access is available
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25
Q

What does the Cormack and Lebanese Laryngeal view grades assess?

A

How much of the glottis opening you can see with a laryngoscope blade

  • 4 grades
  • insert image from slide 23
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26
Q

How do you know if you have a difficult airway?

A
  • Can’t ventilate, can’t oxygenate
  • Cormack and Lebanese laryngeal view
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27
Q

DAM Cart?

A

Difficult Airway Management Cart

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28
Q

How many kinds of artificial airways are there?

A

slide 2

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29
Q

What is the function of Pharyngeal Airways?

A

Used to elevate the tounge off the posterior pharyngeal wall and away from the hard/soft palates

  • Establishes patent airway by allowing spontaneous ventilation
  • basically facilitates flow
  • OPA and NPA
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30
Q

How many types of tracheal airways are there?

A

4

  1. orotracheal
  2. Nasotracheal
  3. Cricothyrotomy
  4. Tracheostomy
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31
Q

What are 2 extraglottic airway types

A

Supraglottic and Infraglottic

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32
Q

Where do Oropharyngeal Airways (OPAs) rest?

A

Keeps the passage open at the mouth.

  • Sits distal to the tongue above the glottis opening
  • insert slide 4
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33
Q

Indications for Oropharyngeal Airways (OPA)

A
  • Used in pts w/decreased submandibular tone
  • When manually ventilating
  • Used as aid for deep suctioning
  • Bite block
  • Some can facilitate intubation
  • Bilateral Choanal Atresia in neonates
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34
Q

What would causes of decreased submandibular tone be?

  • solution?
A

Use a OPA to address problem. Causes would be:

  • Obtunded secondary to central causes of airway obstruction
  • Anaesthesia
  • Deep sedation
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35
Q

Contraindications for OPA use?

A

Patients with obvious oral trauma or awake/semi awake

  • can cause gagging/vomiting
  • It pt is awake enough to shut or tongue the device, they’re too awake from this OPA
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36
Q

What are some complications with OPA use?

A

May cause trauma to lips, mouth, and/or teeth

  • May cause pressure necrosis
  • Difficult to perform mouth care
  • May cause gagging and vomiting
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37
Q

Where do Nasopharyngeal Airways (NPAs) rest?

A

Tip lays distal to the tongue above the glottis opening

  • length is more critical than diameter
  • measure corner of out to jaw angle (roughly 2 cm)
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38
Q

Indications for NPAs?

A

Pt is intolerance to OPA

  • Can facilitate deep suctioning
  • Pierre-Robin Syndrome in neonates (micrognathia, mandibular hypoplasia)
39
Q

Contraindications for NPA?

A

Obvious nasal trauma or deformities of the nose

  • Basal skull fractures (raccoon eyes or battle signs)
  • Coagulation disorders
40
Q

What is Littles area?

  • Keissel becks plexus?
A

Area where nose bleeds happen most often

  • stay away from the septum if you’re inserting something in the nose, it could cause bleeding.
  • guide it to the outside of the nose
41
Q

Complications of NPA use

A

If too long, it could enter esophagus causing gastric distension and hypoventilation

  • could cause vomiting and laryngospasm in semi awake pt
  • injury of nasal mucosa w/bleeding
  • sinusitis and otitis media
  • occlusion of airway be secretions
  • tissue necrosis
42
Q

General indications for use for Extraglottic airways?

A

As an airway rescue when BMV is difficult and intubation has failed (seal on the inside, over the glottis rather than over the face with a mask) i.e beard.

  • In preparation for another device bc CICO aka failed airway
  • alt to endotracheal intubation (i.e if procedure is short, don’t risk damaging the vocal cords)
  • Can guide endotracheal intubation
43
Q

Supraglottic vs Infraglottic (retroglottic)

A
  • Supraglottic = above the glottis
  • Infraglottic = behind/beyond the glottis (intended to be placed in the esophagus)
44
Q

What are common Supraglottic airways?

A
  • LMA classic
  • LMA FastTrach
  • LMA Proseal
  • Perilaryngeal Airway
  • iGel
45
Q

How does the “classic” Laryngeal Mask Airways work (LMA)

A

Closes off the opening so air can’t go into the stomach and can’t escape into the mouth. ‘

  • Placed in posterior pharynx, seals region of base of tongue and laryngeal opening
  • Air can only go into the mouth
  • Similar to ETT w/small mask and inflatable circumferential cuff
46
Q

Contraindications of LMAs?

A

Establish airways, but don’t protect the airways. so the following are affected:

  • Pts with full stomachs
  • Pts w/hiatal hernia (abdominal contents pushing into the chest aka bulging)
  • Pts more than 14 weeks pregnant
  • Trauma patients
47
Q

Classic LMA sizes?

A

insert image 20

48
Q

What are advantages of LMAs?

A

Good for short procedures requiring anesthesia or deep sedation. and they’re simple and easy to use (easy to insert).

  • Does not require airway manipulation or extreme head positioning
  • Hands free airway mana magnet
  • some protection of airway from aspiration
  • can aid in difficult intubation
  • Provides route for fibre optic laryngoscopy or bronchoscope
49
Q

What is a main drawback of LMA use?

A

Does not prevent aspiration completely

  • Pressures > 20 cmH2O can lead to ventilation volume loss and gas leak around mask/cuff
  • Expensive and sizing may not be correct
50
Q

Complications of LMA use?

A

Gag reflexes that are intact will cause coughing, straining, and spasm (solved by anesthesia)

  • Regurgitation and aspirations
  • insert image of others
51
Q

What is a Fastrach?

A

A intubating LMA (ILMA)

  • combines the high insertion and ventilation success rate of other LMAs w/specifically designed features to facilitate blind intubation
  • An epiglottis elevating bar
  • A rigid guide channel that directs an ETT anteriorly into the larynx
52
Q

How does a igel LMA differ from other extraglottic devices like proseals?

A

They use a gel material and has a non inflatable cuff.

  • reduces trauma and easier to insert
  • has a gastric channel, beside the connector
  • has a bite block, so the pt can’t deflate it
53
Q

How do you know if you’re in the esophagus or the trachea with a infra(retro)glottis airway (Combitube)

A

Depends on which tube you can ventilate with and if you get chest rise.

  • First tube is number 1 (blue) = sitting in the esophagus
  • Second tube is clear/white = in the trachea
54
Q

What purpose does the second lumen/connector serve if the infraglottic airway is confirmed to be in the esophagus?

A

It can be used to insert a ng tube

55
Q

What is the difference between a combitude vs easy tube?

  • both are infraglottic airways?
A

EasyTube has a non-latex distal cuff or lumen

56
Q

what is a Biannual laryngoscopy?

A

Involves manipulated the BURP technique (from the intubators perspective)

  • involves manipulating the assistings hands
57
Q

What can you do if basic laryngoscopy is difficult (assuming direct laryngoscopy is the only method available)?

A
  1. BURP
  2. McCoy Blade (laryngoscopy blade that flexes at the tip)
  3. Gum Elastic Bougie (place ETT over it)
58
Q

What is the benefit of using a McCoy Blade?

A

Allows greater lift of the hypoepiglottic ligament

  • Lifts epiglottis further out of your field of view
59
Q

What does a blind nasal intubation require if performed?

A

Patient needs to be spontaneously breathing

60
Q

Start reviewing and reading in slide 34

What would you choose a Proseal LMA?

A
61
Q

Why is an independent open drain tube desirable?

A

The opening at the upper esophageal sphincter does provides an escape route for any inadvertently inspired gas, thus preventing gastric insufflation

  • Allows drainage of gastric fluids and access to GI tract
  • protects the pt against regurgitation and prevents aspiration
  • allows blind insertion
62
Q

What is the primary function of infraglottic (retro) airways?

A

Allows blind insertion into the esophagus, but still provides an airway inserted into trachea

  • 3 types
  • Double lumen
63
Q

What are the 2 categories for endotracheal intubation?

A
  1. Visualization (direct or indirect)
  2. Blind
64
Q

What is direct visualization technique for endotracheal intubation?

A

A direct line of sight between the vocal cords and your eyes

65
Q

What is indirect visualization intubation technique?

A

Using a instrument to provide the view of the cords

  • Fiberoptics (bronchoscope or stylet)
  • Video Laryngoscope (glidescope)
  • Optically enhanced laryngoscope (Airtraq)
66
Q

What are the benefits of using Flexible fiberoptics via bronchoscope or stylet?

A

Can be used for both oral and nasal routes

  • Can visualize laryngeal structures prior to intubation
  • Can confirm tracheal position
67
Q

What type of device is a Aintree Catheter?

A

Flexible fiberoptic bronchoscope

68
Q

What kind of device is a Airway RIFL?

A

Fiberoptic Stylet

69
Q

What are 2 types of Optically enhanced laryngoscopes?

A

AirTraq and King Vision video laryngoscope

70
Q

What kind of device is a glidescope?

A

A laryngoscope with a fiberoptic camera

71
Q

What is transillumination?

A

A visualization technique for intubation that involves a lighted stylet and a trach light

  • Not in practice anymore
  • Don’t worry about this slides
72
Q

What are 3 blind indirect indicators for intubation placement?

A
  1. Transillumination of the neck
  2. Bind nasal intubation (listen and feel air movement)
  3. Feel structures of the oropharynx via Tactile digital intubation
73
Q

What is the purpose of evac tube?

A

Have a port that opens above the cuff to remove secretions above the cuff

  • Reduces ventilator acquired pneumonia
  • Port connected to 20-30 mmHg suction
74
Q

What is the suction pressure of the EVAC tube?

A

30 mmHg suction

75
Q

What is a anode tube and when is it used when in place of a ETT?

A

Has metal rings inside the tube that allows blind of tube w/o occlusion aka armoured tube

  • Used during surgery
  • Available in different sizes, cuffed and uncuffed
76
Q

What are advantages of Anode Tubes?

A

Prevents kinking and collapse of tube under external pressure

77
Q

Disadvantage of Anode Tubes?

A

Once kinked it does not rebound to original shape

78
Q

What are Endotrol Tube (Trigger tube)?

A

Has a small trigger to angle end of tube anterioly during intubation

  • Particularly well suited for blind nasal intubation or w/c spine precautions
  • Has a small ring that wraps around the pinky
79
Q

What are Rae Tubes?

A

Intended for facial surge; has 2 types

  • Can be difficult to pass a suction through tight bends
  • Has a preformed curve that directs airway connection away from surgical field w/o kinking tube
  • 2nd type is a nasal type
80
Q

Double Lumen Endotracheal Tube (DLET)

A

Designed to be inserted into either the right or left main bronchus (or main stem as well ofc)

  • Has a distal and bronchial cuff
  • Has 2 connectors; each lung can be attached to separate ventilators (1 lung is sicker than the other)
81
Q

Why do you want smaller tubes when considering evac tubes?

A

The outer diameters are bigger, so you want to go down half a size

82
Q

When is DLET used?

A

When it is desirable to isolate 1 lung such as thoracic surgery

  • Independent lung ventilation
  • Lug lovage for thick tenacious secretions (alveolar proteinosis)
83
Q

What conditions or pathophysiologies would benefit from DLET?

A
  • Necrotizing pneumonia
  • Lung abscess
  • Pulmonary embolus
  • Lungs with markedly different compliance and resistance (such as single lung transplant)
84
Q

What are Laser Tubes

A

Used for upper airway laser surgery where conventional ETTs may ignite or cuff may be perforated

  • Metal Tubes
  • cuffs inflated w/water or saline to reduce fire hazard, not air
  • Has 2 cuffs in series in case 1 perforates
85
Q

How do you know if a laser tube has perforated?

A

Some cuffs have blue markers to indicate perforation

86
Q

What are some disadvantages to Laser Tubes?

A

Stiff, bulky, and less stable

  • They’re more likely to cause tissue damage when inserted
87
Q

What is a Bronchial Blocking Tube

A

Single lumen tube with extra channel fused along its length containing a separate directable bronchus blocking cuff to isolate a lung.

  • Blocker cuff can be advanced or retracted on its separate tube which has both pilot and suction channels
  • used during surgery when 1 lung is collapsed while other is maintained for oxygenation and ventilation
  • Has a stylet that can move around
88
Q

What are some advantages of Bronchial Blocking Tubes?

A

Allows for active lung deflation by syringe or suction on blocker lumen

  • Can be used to maintain oxygenation and ventialtion if 1 lung collapses
  • Allows greater visualization and less movement within the operative hemithorax
  • Can be used to block/isolate sections like hemoptysis (ruptured pulmonary artery) so repairs can be made
89
Q

What is a disadvantage of Bronchial Blocking Tubes?

A

Increased risk of CO2 retention compared to DLET because it blocks sections of the lungs

90
Q

What are Jet Tubes?

A

Allow for Jet ventilation

  • Has a monitoring/irrigation lumen that enters tube at the tip
  • 3rd port allows for ventilation?
  • See if RSV12 has more info
91
Q

What are additional ports could ETT potential have?

A
  • Medication ports
  • Ports to provide supplemental O2 or measure distal airway pressures
92
Q

When would you use a medication port in the ETT?

A

Emergencies where vascular access no established

  • meds can be instilled w/o interrupting ventialtion
93
Q

What are Foam Cuff tubes?

  • not commonly used or current
A

Similar to ETT; Have a foam ball in the inside of the cuff; Self sealing, self regulating (supposed to)

  • is not reliable to keep a good cuff pressure and does not reliably protect from aspirations
  • Is gentle tho

Interventions 3 (19 decks)

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