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Sp: Sim Lab 1 > Session 2: Direct Laryngoscopy > Flashcards

Session 2: Direct Laryngoscopy Flashcards

1
Q

LEMON Score

A

preoperative assessment for difficult airway

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2
Q

L

A

Look extermally

facial trauma
lg incisors
beard/moustache
large tongue

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3
Q

E

A

Evaluate the 3-3-2 rule

incisor distance - 3 finger

hyoid-mental dist - 3 finger

thyroid-to-mouth distance- 2 finger breadths

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4
Q

M

A

Mallampati Score >= 3

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5
Q

O

A

obstruction

presence of any condition like:
epiglottitis
peritonsillar abscess
trauma

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6
Q

N

A

Neck mobility

limited neck mobility

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7
Q

Mallampati Class 1

A

complete visualization of soft palate, uvula, fauces, pillars

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8
Q

Mallampati Class 2

A

complete visualization of the soft palate, uvula, and fauces

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9
Q

Mallampati Class 3

A

only partial view of soft palate and uvula

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10
Q

Mallampati Class 4

A

soft palate not visible

only hard palate/tongue

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11
Q

Mallampati conditions

A

patient sitting upright
open mouth wide
stick tongue out

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12
Q

epiglottitis

A

severely inflamed airway
airway emergency

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13
Q

upper incisor nonreassuring sign

A

large/protruding

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14
Q

occlusion (bite) nonreassuring sign

A

overbite

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15
Q

mandibular protrusion nonreassuring sign

A

cannot protrude mandible incisors beyond maxillary incisors

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16
Q

mouth opening (interincisal distance) nonreassuring sign

A

less than 3 cm

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17
Q

mallampati score nonreassuring sign

A

score of 3 or 4

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18
Q

hard palate shape nonreassuring sign

A

high/arched/narrow

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19
Q

mandibular soft tissue nonreassuring sign

A

tense/radiated/deviated

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20
Q

neck size nonreassuring sign

A

short/thick

21
Q

range of motion nonreassuring sign

A

limited degree of flexion or extension

22
Q

nonreassuring sign

A

what you do not want to see in preoperative assessment (potential for difficult airway)

23
Q

congenital conditions that impair laryngoscopy

A

Goldenhar
Klippel-Feil
Pierre Robin
Treacher Collins
Turner
Trisomy 21

24
Q

Pathological states that impair laryngoscopy

A

Epiglottitis
Abscess/Ludwig Angina
Croup/Bronchitis
Papillomatosis
Tetanus
Traumatic Foreign Body
Cervical Spine Injury
Basilar skull fracture
maxillary/mandible injury
Laryngeal Fracture
Laryngeal edema
Soft tissue neck injury
Upper airway tumor
Lower airway tumor
Radiation therapy
Rheumatoid Arthritis
Ankylosing spondylitis
TMJ
Scleroderma
Sarcoidosis
Angioedema
Acromegaly
Diabetes mellitus
Hypothyroid
Thyromegaly (Goiter)
Obesity

25
Q

Sensitivity

A

prediction of positive assessment

26
Q

specificity

A

prediction of negative assessment

27
Q

Cormack Lehane grade 1

A

full view of glottis / vocal cords

28
Q

Cormack Lehane grade 2

A

Partial cords are visible

29
Q

Cormack Lehane grade 3

A

only epiglottis visible
no cords visible

30
Q

Cormack Lehane grade 4

A

no glottis structure visible (no cords visible)

31
Q

Laryngoscopy indications
(PPALADINS)

A

Paralytics/laparoscopy
Poor lung physiology
Airway mx
Lack of access
Aspiration prevention
Diffucult ventilation/PPV needed
Ill (critically)
Non supine positioning
Suctioning frequently

32
Q

Laryngoscopy tools

A

laryngoscope w/blade
stylets (lube)
bougie
pillow
ETT
suctioning
syringe
PPV
monitors to confirm

33
Q

macintosh

A

beginner curved blade
less likely to break teeth

34
Q

miller

A

straight blade
more potential for damage
potentially better view

35
Q

syringe and cuff

A

10mL syringe (adults)
test cuff for integrity prior to insertion
deflate cuff fully after test

36
Q

sniff postion

A

aligns axis
provides LOS
OA
PA
LA

37
Q

sniffing position setup

A

place pillow under occiput

Extend atlanto-occipital joint

elevate the head

38
Q

correctly placed pillow

A

aligns the PA and LA axis

39
Q

Laryngoscopic Process (Macintosh)

A
  1. sniff postion
  2. elevate bed (pts nose to xiphoid cartilage)
  3. ensure asleep w/max muscle relaxation
  4. scissor mouth open
  5. insert blade right
  6. sweep tongue left to midline
  7. adv blade elevating the handle to view epiglottis
  8. adv blade tip into vallecula
  9. elevate handle to extend hyoepiglottic ligament (visualize glottic opening)
    • right hand to lift head
  10. visualize glottis and ask for ETT
  11. adv ETT into glottic opening
  12. ask for stylet removal once ETT past vocal cords
  13. adv ETT until cuff no longer seen (twist if catching)
  14. gently remove blade
  15. inflate cuff
  16. confirm correct placement
  17. secure with holder or tape
40
Q

securing ETT

A

courtesy tabes
taped low to mouth
avoid vermillion border
clean skin (mastitol)
tube/trach tie

41
Q

ETT tie

A

useful if patient is dirty
oily skin/makeup
keep wrap/tie close to mouth
tight knot

42
Q

ETT holder

A

most often used in ICU/ED
can be adjusted if swelling occurs

lung isolation or keeping pt intubated in post op

43
Q

Intubation confirmation

A

Capnography
- gold std
sustained CO2
- stomach wont have
sustained CO2
Chest rise
- not specific
Auscultation over chest v abdomen
- not specific
Fog in ETT
- not specific
Feel of bag
- not specific

44
Q

Capnography

A

the noninvasive measurement of the partial pressure of carbon dioxide (CO2) in exhaled breath expressed as the CO2 concentration over time.

gold std to confirm tube placement

45
Q

Intubation Verbalize

A
  1. testing eyelid reflex
  2. masking pt
  3. scissoring mouth open
  4. inserting blade
  5. sweeping tongue
  6. adving blade into vallecula
  7. lifting
  8. I have a grade __ view, I can see_________.
  9. please provide cricoid pressure (if needed)
  10. please hadn me tube
  11. tip of tube through cords
  12. please remove stylet
46
Q

ramping

A

used if pillow didnt help
positions pt into forced sniffing position
aligns 3 axis

47
Q

Laryngoscopic intubation complications
(ATEDIOUS)

A
  • dental damage
  • oral/laryngeal soft tissue damage
  • tracheal/cord damage
  • aspiration
  • incorrect location of cuff on cords
  • scraping ETT on cords
  • endobronchial intubation
  • unnoticed esophageal intubation
48
Q

common intubation failure reasons

A

improper pt height
improper sniff posn
minimal neck extension
not sweeping tongue
rocking blade back
not verbalizing needs

Sp: Sim Lab 1 (23 decks)

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