Preparation Flashcards
What mnemonic is used to anticipate a challenging intubation?
L
E
M
O
N
LEMON mnemonic for challenging intubation
Look externally
- obesity
- trauma
- short neck
- previous surgery/radiotherapy
- trismus
Evaluate 3:3:2 rule
- 3: interincisor distance less than 3 of patients own fingers
- 3: mental process to thyroid cartilage (hyomental distance) less than 3 fingers
- 2: thyrohyoid distance less than 2 fingers
Mallampati score
Obstruction
- stridor etc
Neck mobility
- spinal immobilisation
- impaired by chronic/acute medical condition
What is the Mallampati examination
- Position patient sitting upright, head neutral, mouth fully open, tongue extended and not talking
- Class 1: soft palate, fauces, uvula, anterior + posterior pillars
- Class 2: soft palate, fauces, uvula
- Class 3: soft palate and base of uvula
- Class 4: hard palate only seen
For: nasal prongs: outline:
- FiO2
- Flow
- Considerations
- FiO2: 0.24-0.4
- Rates: 1-5L/min
- Drying and uncomfortable with flow rates >2 in conscious patients
- Can be used for apnoeic oxygenation
For: humidified high flow nasal prongs: outline:
- FiO2 + PEEP
- Flow
- Considerations
- FiO2: 1.0, PEEP: 7.4
- Flow: 60L/min
- Warming and humidifying allow for greater comfort
- Greater set up time required
For: oxygen mask: outline:
- FiO2
- Flow
- Considerations
- FiO2: 0.35-0.6
- Flow: 6-14L/min
- Delivered O2 falls as RR, TV and peak inspiratory flow rate rise
For: non-rebreather mask: outline:
- FiO2
- Flow
- Considerations
- FiO2: up to 0.9
- Flow: 15L/min
- O2 flow must be sufficient to keep reservoir bag inflated at all times to achieve higher FiO2
- Higher FiO2 can only be achieved with spontaneously breathing patient
When is the NRBM used?
- When RR or effort are/anticipated to be inadequate
- Must be used to assist ventilations otherwise patient will not generate enough negative inspiratory pressure to open the one way valve in circuit and receive O2
How does OPA maintain patent airway?
- Lifts tongue away from oropharynx and provides patent airway
What size OPAs are used for an adult?
4: small adult
5: large adult
What size OPA is used for a newborn?
00: small/premature newborn
0: newborn
1: Neonate up to 1 year (10kg)
What size OPA is used for a child?
2: 2-4 years (10-20kg)
3: 6-12 years (20-30kg)
Outline all OPA sizes for paediatric patients
00: small/premature newborn
0: newborn
1: neonate up to 1 year (10kg)
2: 2-4 years (10-20kg)
3: 6-12 years (20-30kg)
How do you measure OPA?
Angle of jaw to central incisors
What are the two insertion methods for an OPA?
- Direct
- depress tongue with tongue depressor - Rotation
How do you measure NPA?
Tip of nose to tragus of ear
What size NPA is used in adults?
6-8
How do you insert NPA?
- Lubricate tip
- Advance along floor of nose
How does ETT maintain patent airway?
- Maintains airway from mouth to trachea below vocal cords
What does the murphys eye on the ETT do?
- In case of mainstem bronchial intubation (tube too far in) side port distal to cuff allows some ventilation via non-intubated bronchus
What does the pilot tube on the ETT do?
- Cuff inflation
What size ETT for adults?
Standard adult male: 7.5-9
Standard adult female: 7-8.5
What is the general depth an ETT is inserted to?
~21-23cm at teeth
When are uncuffed ETTs used
- Paediatric patients
–> Due to funnel shaped trachea a cuffed tube will cause ischaemia and necrosis due to high pressure of cuff at narrowest point of airway
What issues arise from the use of uncuffed ETTs
- Gas leak
How does LMA maintain airway patency?
- mouth to above laryngeal opening
What size LMA is used for adults?
4: females
5: males
What size LMAs are used for neonates?
Size 1 (up to 5kg/<6 months)
What size LMAs are used for infants?
Size 1.5 - (5-10kg/ 6-12 months)
What size LMAs are used for children?
Size 2 (10-20kg / 1-5 years)
Size 2.5 (20-30kg / 5-10 years)
Size 4 (30-50kg / (10-15 years)
How is the LMA inserted?
- Deflate cuff fully
- Apply lube to outer surface of cuff
- Hold LMA like pen
- Insert until resistance is felt
- Inflate cuff
What is the direct laryngoscope used for?
- Lifts tongue to allow visualisation of oropharynx/larynx
What shape blades are available for laryngoscope?
- Straight (miller): children <2
- Curved (Mac): adults
- Hyperangulated blade (d / mccoy): for difficult airways
What is a stylet used for?
- Rigid stick which is inserted into ETT and then allows for end of ETT distal to cuff to be moulded to desired shape
! Lubricate stylet prior to insertion into ETT
What is a bougie used for?
- Semi rigid tube that is passed into cords and allows ETT to be threaded over
- Used when it is impossible to achieve direct intubation due to inability to see cords or difficulty directing ETT between cords
What is video laryngoscope used for?
- Laryngoscope blade with camera attached to distal end of blade
