RESPIRATORY airway management

Question 1

What is angioedema

Answer 1

Swelling to face, tongue, and airway as a result of increased vascular permeability

Question 2

What are 3 causes of angioedema

Answer 2

Anaphylaxis
ACE inhibitors
Hereditary angioedema

Question 3

What is the cause of ACE inhibitor angioedema

Treatment

Answer 3

ACE inhibitors prevent breakdown of bradykinin

Treatment
Bradykinin receptor antagonist
Plasma kallidrein inhibitor
FFP
C1 esterase concentrate

Question 4

What is the cause of hereditary angioedema

Treatment

Answer 4

Cause = C1 esterase deficiency

Treatment = 
C1 esterase concentrate
FFP
Bradykinin receptor antagonist
Plasma kallidrein inhibitor

Question 5

Best method to secure an airway in patient with Ludwigs angina

Answer 5

Awake nasal intubation

Awake tracheostomy

Question 6

What is the sniff position

Answer 6

Cervical flexion
Atlanto-occipital joint extension

IT brings the oral, pharyngeal, and laryngeal axes into alignment

Question 7

How to measure an oropharyngeal airway

Answer 7

From the corner of the mouth to the earlobe or the angle of the mandible

Question 8

How to measure a nasopharyngeal airway

Answer 8

From the nare to the earlobe or angle of mandible

Question 9

Which airway adjunct is tolerated in a lightly anesthetized patient?

Answer 9

NPA

OPA can cause vomiting and laryngospasm

Question 10

How can an OPA that is too short or too long affect the airway

Answer 10

Short = obstructing the airway by pushing tongue to the roof of the mouth

Long = obstruct airway by displacing epiglottis toward glolttis

Question 11

What bone separates the nasal cavity from the anterior cranial fossa

Answer 11

Cribriform plate

Question 12

In what conditions should NPAs be avoided

Answer 12

Cribriform plate injury (FACE trauma)
Coagulopathy
Transsphenoidal hypophysectomy
Nasal fracture

Question 13

5 complications of OPA

Answer 13

Laryngospasm
Vomiting
Dental injury
Oropharyngeal trauma
Soft tissue ischemia

Question 14

When can tracheal ischemia occur

Answer 14

When the cuff pressure exceeds tracheal mucosal perfusion pressure
Pressure should be <25 cmH2O

Question 15

Formulas to calculate pediatric ETT size

Answer 15

ETT w/o cuff = (age/4) + 4
ETT w/ cuff = (age/4) + 3.5

Depth = ID x 3

Question 16

What are predictors of difficult video-assisted laryngoscopy

Answer 16

Neck pathology (radiation, tumor, surgical scar)
Short TMD
Limited cervical motion
Thick neck
Class 3 upper lip bite

Question 17

What is the max positive pressure ventilation pressure via LMA

Answer 17

20 cmH2O

Question 18

What is the mas cuff pressure of an LMA

Answer 18

60 cmH2O (goal 40 - 60)

Question 19

What nerves are at risk of injury with LMA overinflation >60 cmH2O

Answer 19

Lingual, hypoglossal and RLN

Question 20

What could be the explanation for poor LMA seal with a pressure >60 cmH2O

Answer 20

LMA improperly positioned
Patient inadequately anesthetized
Partial or complete laryngospasm

Question 21

What situations should an LMA be avoided

Answer 21

1. Risk of gastric regurg and aspiration
   - -Hiatal hernia, full stomach, SBO
2. Airway obstruction at level of glottis or below
3. Poor lung compliance (requires high PIP)
4. High airway resistance

Question 22

Should an LMA or ETT be used in the asthmatic patient

Answer 22

If appropriate, LMA use is desired over ETT due to decreased SNS stimulation

Question 23

What is a combitube

Answer 23

Supraglottic, double lumen device that is blindly placed in hypopharynx

Question 24

Which airway type is most stimulating from most to least (LMA combitube, DL, FOB)

Answer 24

Combitube
DL
FOB
LMA

Question 25

Contraindications for a combitube

Answer 25

Intact gag reflex
Prolong use (>2-3 hrs)
Esophageal disease (Zenker’s diverticulum)
Caustic ingestion

Question 26

What cranial nerves are blocked in airway blocks for awake intubation

Answer 26

Trigeminal (CN V)
Glossopharyngeal (CN IX)
SLN & RLN (CN X)