RESPIRATORY airway management Flashcards
What is angioedema
Swelling to face, tongue, and airway as a result of increased vascular permeability
What are 3 causes of angioedema
Anaphylaxis
ACE inhibitors
Hereditary angioedema
What is the cause of ACE inhibitor angioedema
Treatment
ACE inhibitors prevent breakdown of bradykinin
Treatment Bradykinin receptor antagonist Plasma kallidrein inhibitor FFP C1 esterase concentrate
What is the cause of hereditary angioedema
Treatment
Cause = C1 esterase deficiency
Treatment = C1 esterase concentrate FFP Bradykinin receptor antagonist Plasma kallidrein inhibitor
Best method to secure an airway in patient with Ludwigs angina
Awake nasal intubation
Awake tracheostomy
What is the sniff position
Cervical flexion
Atlanto-occipital joint extension
IT brings the oral, pharyngeal, and laryngeal axes into alignment
How to measure an oropharyngeal airway
From the corner of the mouth to the earlobe or the angle of the mandible
How to measure a nasopharyngeal airway
From the nare to the earlobe or angle of mandible
Which airway adjunct is tolerated in a lightly anesthetized patient?
NPA
OPA can cause vomiting and laryngospasm
How can an OPA that is too short or too long affect the airway
Short = obstructing the airway by pushing tongue to the roof of the mouth
Long = obstruct airway by displacing epiglottis toward glolttis
What bone separates the nasal cavity from the anterior cranial fossa
Cribriform plate
In what conditions should NPAs be avoided
Cribriform plate injury (FACE trauma)
Coagulopathy
Transsphenoidal hypophysectomy
Nasal fracture
5 complications of OPA
Laryngospasm Vomiting Dental injury Oropharyngeal trauma Soft tissue ischemia
When can tracheal ischemia occur
When the cuff pressure exceeds tracheal mucosal perfusion pressure
Pressure should be <25 cmH2O
Formulas to calculate pediatric ETT size
ETT w/o cuff = (age/4) + 4
ETT w/ cuff = (age/4) + 3.5
Depth = ID x 3
What are predictors of difficult video-assisted laryngoscopy
Neck pathology (radiation, tumor, surgical scar) Short TMD Limited cervical motion Thick neck Class 3 upper lip bite
What is the max positive pressure ventilation pressure via LMA
20 cmH2O
What is the mas cuff pressure of an LMA
60 cmH2O (goal 40 - 60)
What nerves are at risk of injury with LMA overinflation >60 cmH2O
Lingual, hypoglossal and RLN
What could be the explanation for poor LMA seal with a pressure >60 cmH2O
LMA improperly positioned
Patient inadequately anesthetized
Partial or complete laryngospasm
What situations should an LMA be avoided
- Risk of gastric regurg and aspiration
- -Hiatal hernia, full stomach, SBO - Airway obstruction at level of glottis or below
- Poor lung compliance (requires high PIP)
- High airway resistance
Should an LMA or ETT be used in the asthmatic patient
If appropriate, LMA use is desired over ETT due to decreased SNS stimulation
What is a combitube
Supraglottic, double lumen device that is blindly placed in hypopharynx
Which airway type is most stimulating from most to least (LMA combitube, DL, FOB)
Combitube
DL
FOB
LMA
Contraindications for a combitube
Intact gag reflex
Prolong use (>2-3 hrs)
Esophageal disease (Zenker’s diverticulum)
Caustic ingestion
What cranial nerves are blocked in airway blocks for awake intubation
Trigeminal (CN V)
Glossopharyngeal (CN IX)
SLN & RLN (CN X)
