Quiz 1 Flashcards
Name the cartilages of the larynx
3 Unpaired:
Thyroid
Cricoid
Epiglottis
3 Paired:
Arytenoid
Cuniform
Corniculate
Which cartilage of the trachea is the only complete ring?
Cricoid
Who founded the 1st anesthesia school & where/year?
Agatha Hodgins founded the Lakeside Hospital, School of Anesthesia in 1915
Cleveland, Ohio
She was also the 1st AANA President
What is the Thyro-Mental distance/measurements?
Measurement from upper edge of thyroid to chin with the head fully extended
A short thyromental distance= an anterior larynx
>7cm = usually easy intubation
<6cm= difficult airway
Mallampati Class 1
Full view of soft palate: uvula, tonsillar pillars, soft/hard palate
Mallampati Class 2
Full/partial view of uvula, soft and hard palate
Mallampati Class 3
Base of uvula only, soft and hard palate
Mallampati Class 4
Hard palate only
Name the 3 primary valves on the AGM
1) Ball and Spring Valve
2) Free Floating Valve
3) Diaphragm Valve
What is the PSI of oxygen and what color is the cylinder?
Green
1900-2200 PSI
What is the cylinder capacity of Oxygen?
660L
What is the PSI of Nitrous Oxide and what color is the cylinder?
Blue
745 PSI
What is the cylinder capacity of Nitrous Oxide?
1600L
What is the PSI of Air and what color is the cylinder?
Yellow
1800 PSI
What is the cylinder capacity of Air?
600L
LMA Size 1
Patient Guidelines and Cuff Inflation Volume?
Neonates/infants up to 5kg
4mL max
LMA Size 1.5
Patient Guidelines and Cuff Inflation Volume?
Infants 5-10kg
7mL max
LMA Size 2
Patient Guidelines and Cuff Inflation Volume
Infants/Children 10-20kg
10mL max
LMA Size 2.5
Patient Guidelines and Cuff Inflation Volume
Children 20-30kg
14mL max
LMA Size 3
Patient Guidelines and Cuff Inflation Volume
Children 30-50kg
20mL max
LMA Size 4
Patient Guidelines and Cuff Inflation Volume
Adults 50-70kg
30mL max
LMA Size 5
Patient Guidelines and Cuff Inflation Volume
Adults 70-100kg
40mL max
LMA Size 6
Patient Guidelines and Cuff Inflation Volume
Adults over 100kg
50mL max
ASA Class I
Healthy patient, no disease
ASA Class II
Mild to moderate systemic disturbance- well controlled disease of ONE BODY SYSTEM such as:
- Heart disease that slightly limits physical activity
- HTN- controlled
- Diabetes- controlled*
- Chronic bronchitis
- Anemia
- Morbid obesity
- Smoker/ frequent social drinker
- Age extremes*
ASA Class III
Severe systemic disease that limits activity (or >1 controlled disease):
- Heart or chronic pulmonary disease that limits activity
- HTN- uncontrolled
- Diabetes- uncontrolled (with vascular c/o)*
- Angina pectoris
- Hx of previous MI
- Pacemaker
ASA Class IV
Severe systemic disease that is a constant threat to life*
- CHF
- Persistent angina pectoris
- Advanced pulmonary, renal, or hepatic dysfunction
ASA Class V
Near death patient, undergoing surgery as resuscitative effort, despite limited change of survival
- Uncontrolled hemorrhage from ruptured AAA
- PE
- Head injury with increased ICP
ASA Class VI
Declared brain dead patient- retrieval for organ donation
Emergency Operation (E)
Emergency surgery required
-Otherwise healthy 30y/o D&C for moderate persistent hemorrhage
Following an airway assessment what are the 3 options for intubation?
1) Awake intubation
2) “A quick look”
3) Induction and paralysis
Why would an awake intubation be performed?
For a difficult airway, if there is a significant risk of complications if sedatives and/or muscle relaxants are given prior to airway control
What is a “quick look?”
The patient may be sedated for an attempt at direct laryngoscopy WITHOUT muscle relaxation
Because there is some risk with failed laryngoscopy, but a low risk of failed mask ventilation
Under what conditions would a traditional intubation after induction and paralysis be selected?
The patient must be assessed as having a low risk of difficult laryngoscopy and/or mask ventilation
What should be done throughout the process of difficult airway management (Step 2)?
Actively pursue opportunities to deliver supplemental oxygen
ASA Difficult Airway Algorithm, Step 1:
Assess the likelihood and clinical impact of what 4 basic management problems?
1) Difficult Ventilation
2) Difficult Intubation
3) Difficulty with Patient Cooperation or Consent
4) Difficult Tracheostomy
What should be done if you suspect a cricothyroidotomy is going to be difficult?
The cricothyroid membrane should be marked BEFORE an intervention is undertaken
What are the 2 techniques for pre-oxygenation?
1) Tidal volume breathing for 3-5 minutes
2) 4x deep breaths in 30 seconds
Both are equally effective in increasing PaO2
What is invasive airway access?
Surgical or percutaneous tracheostomy or cricothyroidotomy
After a failed attempt at awake non-invasive intubation, what are the options?
1) Cancel the case/ awaken patient
2) Invasive airway access
3) Consider other options:
- face mask or LMA anesthesia
- local anesthesia or regional nerve blockade (IF mask ventilation not problematic)
If intubation is unsuccessful after induction of general anesthesia, what are the 3 things to consider?
1) Call for help
2) Return to spontaneous ventilation
3) Awaken the patient
*meanwhile, mask ventilate
In the Difficult Airway Algorithm, if mask ventilation (or SGA) is adequate, which pathway is followed?
Nonemergency Pathway
- if you can ventilate your patient, it’s not a true emergency
- utilize difficult airway cart
What do you do if mask ventilation is not adequate?
Consider/attempt a supraglottic airway (SGA)
- LMA
What if mask ventilation AND SGA is not adequate/feasible?
Follow Emergency Pathway
- Emergency non-invasive airway ventilation
- Call for help
- Emergency invasive airway access (trach/cric/jet/ retrograde intubation)
What is in the gallery of tools?
- LMA/SGA
- Different laryngoscope blades
- LMA as intubation conduit
- Fiberoptic intubation
- Intubating stylet
- Tube change- bougie
- Light wand
- Blind oral/nasal intubation
- Invasive airway access: jer, perc/surgical airway, retrograde intubation
