Mod 2 Difficult airways 2 Flashcards

1
Q

What are Cricothyrotomy’s

A

Establishment of a surgical airway through the cricothyroid membrane

  • open incision and insertion of a cuffed tracheostomy tube (or ET)
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2
Q

What is the Seldinger technique?

A

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
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3
Q

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

A

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

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4
Q

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

A

Less than 24hrs

  • within that 24hrs a alternate airway should be established
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5
Q

surgical vs percutaneous Cricothyrotomy?

A
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6
Q

Indications for Cricothyrotomy? (3)

A
  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
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7
Q

Absolute contradications Cricothyrotomy?

A

Younge age < 10 years of age

  • needle cric is the technique of choice if.they are less than 10
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8
Q

Cricothyrotomy technique for pts 5-10yrs?

A

Seldinger technique

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9
Q

Cricothyrotomy technique for pts <5?

A

Needle only

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10
Q

Relative contradications Cricothyrotomy? (4)

A
  1. Pre-existing laryngeal or tracheal pathology
  2. Hematoma
  3. Coagulopathy (pt doesn’t clot)
  4. Lack of operator expertise
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11
Q

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

A

Scalpel finer bougie procedure

  • make incisions, palpate w/finger, insert via finger in place of bougie, replace bougie w/ett
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12
Q

What is Percutaneous Procedure (needle circthryotomy)

A
  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
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13
Q

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

A

Saline will bubble and will help confirm placement

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14
Q

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

A
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15
Q

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

A

Jet ventilation

  • connected to a 50 psi source
  • 1 second insp: 3 seconds exp
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16
Q

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

  • insert slide 22
  • Important to know
A

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

17
Q

What are vt goals in jet ventilation?

A

Lowest possible settings to achieve chest rise

  • Ideally pressure can be titrated to lowest pressure (required to deliver a tidal volume)
18
Q

What are low flow tracheal devices that deliver jet ventilation?

A

Transtracheal Jet Ventilation (TTJV)

  • uses a low flow oxygen source
19
Q

Contraindications for jet ventilation?

A

Children < 5

  • A bag valve resuscitator is used to deliver vt
  • ETT adaptor from a 3 mmID is inserted into catheter
20
Q

What are immediate/short term complications associated with cricothyrotomys?

A
  • Hemorrhage
  • Laryngeal/tracheal injury
  • Subcutanous emphysema
  • Pneumomediastinum
  • Infection
  • Barotrauma/volutrauma
21
Q

What are long term complications associated with cricothyrotomys?

A
  • Subglottic stenosis
  • voice change