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Sp: Sim Lab 1 > Session 3: Airway Management - LCC > Flashcards

Session 3: Airway Management - LCC Flashcards

1
Q

how many axis’ does the airway have

A

3

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2
Q

types of airway axis

A

oral (OA)
pharyngeal (PA)
laryngeal (LA)

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3
Q

axis’ alignments laying flat on back

A

unaligned

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4
Q

problems with laying pt flat on back

A

do not have a clear path for ventilation

potentially harder to breath

tongue falls against back of throat - obstruct airway

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5
Q

snoring obstruction type

A

partial obstruction

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6
Q

sleep apnea obstruction type

A

total obstruction

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7
Q

which pts typically struggle breathing on backs?

A

obese pts due to unaligned axis and more soft tissue mass in airway

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8
Q

methods to align airway axis’

A
  1. sniff position
  2. head tilt/chin lift
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9
Q

how to maximally align airways

A

sniff position and neck extension

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10
Q

sniff position benefits

A

better passage for air
less likely to obstruct
easier to ventilate
better view of vocal cords

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11
Q

anesthesia drugs will do either of these 2 things

A

make pt stop breathing

cause airway to obstruct

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12
Q

how can we breathe for pts?

A

breathing bag
ventilator

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13
Q

4 types of airway obstruction

A
  1. soft tissue (tongue) obstruction
  2. laryngospasm
  3. bronchospasm
  4. airway swelling
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14
Q

soft tissue (tongue) obstruction

A
  • most common type of airway obstruction
  • tongue falls against back of pharynx
  • obese pts more prone to severe obstruction
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15
Q

laryngospasm

A

can occur with every extubation

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16
Q

bronchospasm
causes

A
  • most common cause is too lightly anesthetized
  • can also occur w/anaphylaxis
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17
Q

airway swelling

A

seen following trauma, burn injury, pregnancy , etc

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18
Q

soft tissue obstruction situations

A
  1. MAC anesthesia
  2. right after GA induction before LMA/ETT inserted
  3. after extubation if pt is not quite awake
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19
Q

treatments for soft tissue obstruction

A

chin lift
jaw thrust
oral airway
nasal airway

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20
Q

chin lift

A

can relieve airway obstruction by aligning the 3 axis’ of the airway

indicated for minor airway obstruction

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21
Q

jaw thrust

A

opens airway
stimulates respirations (Painful)
try after chin lift
push HARD

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22
Q

oral airways

A
  • more likely to cause gagging in awake pts
  • dental injuries
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23
Q

nasal airways

A
  • better tolerated in conscious pts
  • can cause nosebleeds
  • contraindicated in pts w/facial fractures and blood thinners
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24
Q

how do oral/nasal airways work?

A

relieve airway obstruction by lifting tongue off posterior pharynx

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25
Q

laryngospasm

A

sudden muscle spasm and closure of vocal cords

life threatening medical emergency - pt cannot ventilate

26
Q

what triggers laryngospasm

A

stimulation of the superior laryngeal nerve

stimulation of vocal cords during stage II (light) anesthesia

27
Q

causes of laryngospasm stimulation

A
  • ETT during extubation
  • airway secretions
28
Q

stage 2 anesthesia

A

pt half awake/half asleep

29
Q

never extubate during stage

A

2

30
Q

can you laryngospasm in stage 1

A

unlikely because pt has airway protection from cough/talk reflexes

31
Q

can pt laryngospasm in stage III

A

unlikely because laryngeal muscles are deeply anesthetized

32
Q

diagnosis of laryngospasm after extubation

A
  • absence of ventilation
  • difficult providing positive pressure ventilation after extubation
33
Q

diagnosis of laryngospasm during procedure w/o intubation

A
  • pt too lightly anesthetized
  • sudden loss of end tidal CO2 and inability to ventilate
34
Q

laryngospasm treatment

A
  1. high jaw thrust behind ear w/positive pressure breathing
  2. propofol
    • relaxes vocal cords
    • takes pt to stage III
  3. succinylcholine
    • muscle relaxant
    • IM dose 4-6 mg/kg
35
Q

bronchospasm

A

narrowing of the bronchioles that is caused by inflammation/constriction

can occur if lungs get irritated

36
Q

what type of pts are more prone to bonchospasm

A

smokers
asthmatics

37
Q

causes of bronchospasm

A
  1. endotracheal tubes
  2. light anesthesia
  3. emergence
  4. Desflurane
  5. Anaphylaxis
38
Q

how do ETTs cause bronchospasm

A

lungs/trachea/airway are always irritated by tube

39
Q

how does light anesthesia cause bronchospasm

A

ETT will irritate airway making pt cough if not anesthetized enough

40
Q

how does emergence cause bronchospasm

A

as pt emerges, they notice the ETT and will typically cough

41
Q

how does desflurane cause bronchospasm

A
  • most pungent/irritating volatile agent
42
Q

does anaphylaxis cause bronchospasm

A
  • rare but possible
43
Q

diagnosis of bronchospasm

A

sudden difficult to ventilate due to increase resistance to lung expansion

difficult to squeeze bag

high pressure in lungs

most likely observed during light anesthesia

44
Q

treatment for bronchospasm cause by light anesthesia

A

give propofol and/or higher concentrations of volatile agent to anesthetize more deeply

45
Q

treatment for bronchospasm caused during emergence

A

give albuterol inhaler via ETT

albuterol is a beta 2 agonist/bronchodilator

46
Q

treatment for bronchospasm caused by anaphylaxis

A

give bronchodilators:
1) epinephrine
- (300 mcg IM)
2) beta 2 agonists
- albuterol inhaler
- subcutaneous
terbutaline injection
(0.25mg)
3) volatile agent
- isoflurane or
sevoflurane

47
Q

prevention of coughing on ETT

A
  1. anesthetize trachea w/lidocaine jelly or LTA kit
  2. keep patient paralyzed or deeply anesthetized
48
Q

LTA Kit

A

device that allows you to spray 4% lidocine into the trachea during laryngoscopy and prior to intubation

anesthetizes trachea

can reduce coughing during procedure and during emergence

49
Q

treatment of coughing on endotracheal tube

A
  1. turn off ventilator
  2. dose muscle relaxant or deepen anesthetic w/narcotics or volatile gases
50
Q

edema

A

swelling

51
Q

vasodilation induced edema

A

when blood vessels vasodilate, they become leaky and allow more blood to leak into interstitial space

increased fluid in interstitial space causes edema

52
Q

common causes of vasodilation induced edema

A

injury
anaphylaxis

53
Q

causes of airway swelling

A
  1. burns
  2. traumatic intubation / multiple laryngoscopies
  3. pregnancy
  4. allergic rxn / anaphylaxis
54
Q

traumatic intubation swelling

A

consider leaving pt intubated until swelling decreases

extubation in presence of significant airway swelling could be catastrophic

55
Q

regurge

A

passive reflux

56
Q

cause of regurge

A

reduction in tone of the lower esophageal sphincter (LES)

57
Q

prevention of regurge

A

cricoid pressure
(sellicks maneauver)

58
Q

benefits of cricoid pressure

A
  1. occludes the esophagus
  2. improves intubation view
59
Q

vomiting

A

active reflux

60
Q

vomiting treatment

A

suction pt
place in trendelenburg with head tilted to side

61
Q

aspiration

A

gastric contents entering trachea/lungs

62
Q

aspiration treatment

A

intubation
send to ICU

potentially prophylactic antibiotics and/or steroids

Sp: Sim Lab 1 (23 decks)

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