Mod 2 Difficult airways 2 Flashcards
What are Cricothyrotomy’s
Establishment of a surgical airway through the cricothyroid membrane
- open incision and insertion of a cuffed tracheostomy tube (or ET)
What is the Seldinger technique?
Using a guide wire to establish a airway via needle.
- could dilate with the wire
- Tube is guided by the wire
- uses a large bore needle (12-26 gauge) catheter
Is sizing of a needle hole larger based on a larger needleb or gauge size?
For needle gauges, the smaller the number the bigger the hole
How long should a Cricothyrotomy be left in as a airway?
Less than 24hrs
- within that 24hrs a alternate airway should be established
surgical vs percutaneous Cricothyrotomy?
- edit
- Surgical = incision made to insert tube
- perc = needle insertion to guide trach insertion
Indications for Cricothyrotomy? (3)
- Can’t intubate, can’t oxygenate (CICO)
- Can’t intubate, can oxygenate but all other available methods of intubation have failed or deemed likely to fail
- Intubation is contraindicated or believed to be impossible
Absolute contradications Cricothyrotomy?
Younge age < 10 years of age
- needle cric is the technique of choice if.they are less than 10
Cricothyrotomy technique for pts 5-10yrs?
Seldinger technique
Cricothyrotomy technique for pts <5?
Needle only
Relative contradications Cricothyrotomy? (4)
- Pre-existing laryngeal or tracheal pathology
- Hematoma
- Coagulopathy (pt doesn’t clot)
- Lack of operator expertise
What is the primary and most recent preferred technique for Cricothyrotomys in adults?
Scalpel finer bougie procedure
- make incisions, palpate w/finger, insert via finger in place of bougie, replace bougie w/ett
What is Percutaneous Procedure (needle circthryotomy)
- Identify the landmarks
- Immobilize the larynx
- Insert transtracheal needle
- Advance catheter
- Confirm location
- Connect to bag or jet ventilation
- Perform jet ventilation
For needle cricothyrotomys, why does the needle have saline when inserting?
Saline will bubble and will help confirm placement
Why might a needle or seldinger technique be chosen over a regular incision
Less invasive and faster. There is less risk of bleeding as well
What ventilation method is used if a percutaneous trach is inserted?
Jet ventilation
- connected to a 50 psi source
- 1 second insp: 3 seconds exp
How does exhaled gas vent (escape) to atmosphere in percutaneous jet ventilation?
- insert slide 22
- Important to know
Relies on the patients own airway being patent bc percutaneous jet ventilation has a 1 way valves system
What are vt goals in jet ventilation?
Lowest possible settings to achieve chest rise
- Ideally pressure can be titrated to lowest pressure (required to deliver a tidal volume)
What are low flow tracheal devices that deliver jet ventilation?
Transtracheal Jet Ventilation (TTJV)
- uses a low flow oxygen source
Contraindications for jet ventilation?
Children < 5
- A bag valve resuscitator is used to deliver vt
- ETT adaptor from a 3 mmID is inserted into catheter
What are immediate/short term complications associated with cricothyrotomys?
- Hemorrhage
- Laryngeal/tracheal injury
- Subcutanous emphysema
- Pneumomediastinum
- Infection
- Barotrauma/volutrauma
What are long term complications associated with cricothyrotomys?
- Subglottic stenosis
- voice change
IBW calculation
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
Why are denture wires preferred as securement devices for patients with high surface burn ratio?
Burns may become edematous which could move the tube (or extubation)
- Burns also make tapes wet/slippery
- If burns are severe enough, early trach may be required
How does a Larry tube differ from a normal trach
The upper airway is lost as the tube is placed in the larynx.
- Larry’s are permanent and patients have to breath via the stoma
