Mod 2 Difficult airways 2

Question 1

What are Cricothyrotomy’s

Answer 1

Establishment of a surgical airway through the cricothyroid membrane

• open incision and insertion of a cuffed tracheostomy tube (or ET)

Question 2

What is the Seldinger technique?

Answer 2

Using a guide wire to establish a airway via needle.

• could dilate with the wire
• Tube is guided the wire
• uses a large bore needle (12-26 gauge) catheter

Question 3

Is sizing of hole larger based on a larger needle gauge size?

Answer 3

No. For needle gauges, the smaller the number the bigger the hole

Question 4

How long should a Cricothyrotomy be left in as a airway?

Answer 4

Less than 24hrs

• within that 24hrs a alternate airway should be established

Question 5

surgical vs percutaneous Cricothyrotomy?

Question 6

Indications for Cricothyrotomy? (3)

Answer 6

1. Can’t intubate, can’t oxygenate (CICO)
2. Can’t intubate, can oxygenate but all other available methods of intubation have failed or deemed likely to fail
3. Intubation is contraindicated or believed to be impossible

Question 7

Absolute contradications Cricothyrotomy?

Answer 7

Younge age < 10 years of age

• needle cric is the technique of choice if.they are less than 10

Question 8

Cricothyrotomy technique for pts 5-10yrs?

Answer 8

Seldinger technique

Question 9

Cricothyrotomy technique for pts <5?

Answer 9

Needle only

Question 10

Relative contradications Cricothyrotomy? (4)

Answer 10

1. Pre-existing laryngeal or tracheal pathology
2. Hematoma
3. Coagulopathy (pt doesn’t clot)
4. Lack of operator expertise

Question 11

What is the primary and more recent preferred technique for Cricothyrotomys in adults?

Answer 11

Scalpel finer bougie procedure

• make incisions, palpate w/finger, insert via finger in place of bougie, replace bougie w/ett

Question 12

What is Percutaneous Procedure (needle circthryotomy)

Answer 12

1. Identify the landmarks
2. Immobilize the larynx
3. Insert transtracheal needle
4. Advance catheter
5. Confirm location
6. Connect to bag or jet ventilation
7. Perform jet ventilation

Question 13

For needle cricothyrotomys, why does the needle have saline when inserting?

Answer 13

Saline will bubble and will help confirm placement

Question 14

Why might a needle or seldinger technique be chosen over a regular incision

Question 15

What ventilation method is used if a percutaneous trach is inserted?

Answer 15

Jet ventilation

• connected to a 50 psi source
• 1 second insp: 3 seconds exp

Question 16

How does exhaled gas vent (escape) to atmosphere in percutaneous jet ventilation?

• insert slide 22
• Important to know

Answer 16

Relies on the patients own airway being patent bc percutaneous jet ventilation has a 1 way valves system

Question 17

What are vt goals in jet ventilation?

Answer 17

Lowest possible settings to achieve chest rise

• Ideally pressure can be titrated to lowest pressure (required to deliver a tidal volume)

Question 18

What are low flow tracheal devices that deliver jet ventilation?

Answer 18

Transtracheal Jet Ventilation (TTJV)

• uses a low flow oxygen source

Question 19

Contraindications for jet ventilation?

Answer 19

Children < 5

• A bag valve resuscitator is used to deliver vt
• ETT adaptor from a 3 mmID is inserted into catheter

Question 20

What are immediate/short term complications associated with cricothyrotomys?

Answer 20

• Hemorrhage
• Laryngeal/tracheal injury
• Subcutanous emphysema
• Pneumomediastinum
• Infection
• Barotrauma/volutrauma

Question 21

What are long term complications associated with cricothyrotomys?

Answer 21

• Subglottic stenosis
• voice change

Question 22

IBW calculation

Answer 22

Women: IBW = 45.5 kg + 2.3 kg x (height in inches - 60)

Men: IBW = 50 kg + 2.3 kg x (height in inches - 60

• Ft to inches = 1 x 12.
• i.e 5’4 = 64 inches