Session 5: Ancillary Airway

Question 1

Difficult airway algorigthm

Answer 1

utilized to drive actions during difficult airway scenarios

Question 2

if initial intubation attempts unsuccessful
consider:

Answer 2

calling for help
returning to spontaneous ventilation
awakening pt

Question 3

if face mask ventilation is adequate,

Answer 3

nonemergency

try alternative options to intubat
glidescope
videoscope
cmac

Question 4

if facemask ventilation no adequate, consider

Answer 4

using a LMA

Question 5

if LMA not adequate/feasible,

Answer 5

this is an emergency

call for help
emergency noninvasive airway ventilation
emergency invasive airway access

Question 6

video larygoscopy view

Answer 6

indirect

Question 7

video laryngoscopy indications

Answer 7

limited mouth opening
inability to flex neck
dont want to flex neck (cervical surgery)

Question 8

video laryngoscopy limitations

Answer 8

upper secretion (Plegm)
blood
vomit
false sense of security

Question 9

glidescope

Answer 9

specific brand of videoscope
fixed angle
disposible outer clear blade

Question 10

glidescope line of sight

Answer 10

none required

Question 11

CMAC

Answer 11

different brand of glidescope
comes in disposable and reusable variety

Question 12

CMAC reusable uses

Answer 12

thinner profile
easier to use for limited mouth opening
very ueseful with certain conditions

Question 13

McGrath

Answer 13

handheld
battery operated
smaller screen
portable
disposable cover/blade

Question 14

Other types of scopes

Answer 14

Bullard
WuScope
Upsherscope

irrelevant with advent of video-laryngoscopy

Question 15

Airtraq

Answer 15

utilizes mirrors to see anterior larynx
disposable
80% effective after failed DL
battery operated

Question 16

Truview

Answer 16

regular laryngoscope handle attachment
optical port
light source
oxygenating port
exagerated angle distal tip

Question 17

Differences between video and DL

Answer 17

insertion can be challenging w/cord/handle
little elevation with handle necessary
(less next extension/manipulation)

Question 18

video laryngoscopy complications

Answer 18

potential for oral trauma
potential for great visualization w/o ability to intubate

Question 19

Fastrach LMA

Answer 19

intubate through the LMA

Question 20

Bougie Catheter

Answer 20

solid exchanger
15Fr (5mm)
cuff replacements
initial intubation guide

Question 21

Bougie Process - Initial Intubation

Answer 21

1. normal DL
2. intubate trachea w/bougie
3. remove blade/hold bougie
4. place ETT over bougie
5. slide ETT into trachea
   
   • if resistance, slight twist/forward pressure
6. remove bougie
7. inflate cuff
8. test ventilate

Question 22

Bougie Process - Tube Exchange

Answer 22

1. disconnect circuit
2. advance bougie past end of ETT
   
   • 3cm beyond tube depth at teeth
3. deflate cuff/remove ETT
4. advance new ETT over bougie
5. remove bougie
6. inflate cuff
7. test ventilate

Question 23

ETT size

Answer 23

larger size = larger length

Question 24

Frova Catheter

Answer 24

cannulated Bougie
(has hole in end)
15mm airway adapter
allows for vent connection/passive oxygenation
Sizes: 8, 14 Fr

Question 25

Cook Catheter

Answer 25

larger than Frova
allows for more oxygen flow
Sizes: 8, 11, 14, 19 Fr

Question 26

Aintree Tube Exchanger/Catheter

Answer 26

allows for bronchoscope insertion through exchanger
oxygenating capable
6.5mm OD
use ETT 7+

Question 27

Arndt Airway exchanger/catheter

Answer 27

retrograde intubation
tapered tip to help facilitate with seldinder wire assistance

Question 28

LTA

Answer 28

apply local anesthetic on cords, carina, trachea
lidocaine 4% topical solution
Adult dose: 160mg or 4mL

remove protective reflex of epiglottis
- no food/drink 1 hr post-LTA