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Equipment II > Test 1 > Flashcards

Test 1 Flashcards

1
Q

5 absolute indications for OLV

A

Isolation of 1 lung r/t infection/hemorrhage

Unilateral bronchopulmonary lavage

Bronchopleural fistula

Large ruptured bullae

Tracheobronchial tree disruption (TEF)

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2
Q

5 surgeries necessitating lung separation

A

Thoracic procedure (lobectomy, transplant, thoracoscopy)

Mediastinal procedures w/ sternotomy

Descending thoracic aortic aneurysm

Pulmonary embolectomy

Esophagogastrectomy

Anterior thoracic spine sg

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3
Q

3 methods of selective lung ventilation

A

Single lumen tube with endobronchial intubation

Selective bronchial intubation with MLT

Single lumen tube with endobronchial blocker (Univent, WEB)

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4
Q

Most common method of OLV

Why?

A

Left sided DLT

More distance to LUL (5 cm)so less likely to isolate upper lobes. With RLT there is only 2 cm from carina to RUL

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5
Q

Insertion depths for left DLT

A

27.5 to 31.2 cm

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6
Q

Most common used DLT

A

Robertshaw

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7
Q

Cuffs of Robertshaw tube (DLT)

Color

Inflation amt

A

Trachea cuff is clear
- 10-20cc

Bronchial cuff is blue
- 2-3 cc

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8
Q

Tracheal cuff ventilates which lung

How

A

Ventilate both lungs if blue is not clamped

To ventilate only right lung clamp blue (bronchial) lumen

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9
Q

DLT side for large male

A

41 French (each lumen 6.5mm)

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10
Q

DLT for normal male

A

39 French (6.0mm ID)

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11
Q

DLT size normal female, small male

A

37 French (5.5mm ID)

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12
Q

DLT size small female

A

28 French (5.0mm ID each)

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13
Q

DLT size not usually used, smallest

A

28French (4.5mm ID each)

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14
Q

Placement of DLT

  • blade
  • insertion
A

MAC blade easiest

Insert with tube end facing right.
Pass bronchial cuff through cords.
Remove stylet
Turn exactly 90 degrees forward

Pull up on chin helps

Advance until resistance felt

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15
Q

Where do you tape DLT

A

Middle of mouth

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16
Q

If bronchial lumen too deep where is tube

A

Left mainstem bronchus

Not ventilating LUL

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17
Q

Bronchial cuff herniated at carina what occurs

A

Too much air in cuff

Ventilating both lungs

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18
Q

Bronchial lumen above carina what occurs

A

Ventilate both lungs

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19
Q

Right main stem bronchial intubation with left DLT

A

Only ventilate R lung (not including RUL)

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20
Q

4 methods of checking placement of DLT

A
  • check bilateral breath sounds and chest excursion
  • selectively clamp lumens one at a time and listen
  • open port and listed for air flow through clamped lung
  • check placement with fiberoptic bronchoscope
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21
Q

How do you verify placement with fiberoptic bronchoscope

A

Insert into tracheal lumen and look for bronchial cuff placement

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22
Q

When verifying placement of DLT with FOB what should you see?

  • through tracheal lumen
  • through bronchial lumen

If not there?

A

Tracheal lumen
Bronchial cuff should be visualized as crescent shaped

If see too much not in far enough
If don’t see at all, in too far

Bronchial lumen
ID left upper and lower bronchus

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23
Q

3 uses of FOB in OLV

A

Verify tube placement
Suction
???

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24
Q

6 indications for right side DLT

A

Left pneumonectomy

Left tracheobronchial disruption or TEF

Mediastinal lesion compressing L mainstem

L bronchial stent

L lung transplant

Descending thoracic aortic aneurysm compressing L main bronchus

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25
Q

4 advantages of inhalation anesthetic on OLV

A

Bronchodilation

Decreases HPV

Ensures amnesia

Rapidly eliminated, less hemodynamic response

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26
Q

3 advantages of opiod use in OLV anesthetic

A

No sig. hemodynamic compression

Smooth transition to emergence

Minimal decrease in HPV

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27
Q

Effect of 1 MAC of volatile agent during OLV

A

Decrease HPV response from 50% to 40%

Increases Qs/Qt (flow to nondependent lung) 4%. Sats on 100% FiO2 96-98%

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28
Q

Proportion of blood flow to each lung during OLV in lateral decubitus position

A

Without inhalation agent
Dependent- 80%

Non-dependent- 20%

With inhalation agent
Dependent 76%

Non-dependent 24%

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29
Q

5 factors that may increase shunt during OLV and effect on HPV

A

Atelectasis (increase HPV)
Systemic vasodilators(inhibits HPV)
High PA pressures (inhibits HPV0
Low FiO2 (inhibits HPV)

Surgical interference/compression of operative lung

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30
Q

Management of hypoxia in OLV

A 
Notify surgeon sat < 90%
Suction
Recheck tube position with FOB
Oxygen from sidearm to operative lung via insufflation
Change vent mode
Change I:E ratio
PEEP 5 cmH2O to dependent
CPAP 5 cm H2O to non-dependent
150ml Oxygen into non-ventilated lung
Intermittent ventilation of non-dependent lung
Early clamping of PA if pneumonectomy
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31
Q

Goal of management of hypoxia during OLV

A

Decrease shunt

32
Q

Benefit and disadvantages of PEEP and CPAP to lung during OLV

A

PEEP alone makes sat worse bc Less blood to dependent lung worsening shunt

Add 2.5 CPAP to non depending lung improves sat by providing O2 to blood going to nondependent lung

Add 5 CPAP to non dependent lung improves sat even more

33
Q

4 contraindications for DLT

A
  • Unable to replace existing ETT
  • unable to maintain adequate PO2 w OLV
  • technically difficult- anatomy, size
  • full stomach
34
Q

4 complications of DLT

A
  • hypoxemia
  • tracheobronchial tree disruption
  • traumatic laryngitis
  • DLT becomes temporary part of suture line
35
Q

2 main disadvantages of bronchial blockers

A

Slow deflation time

Blockage of bronchial blocker by blood/pus

36
Q

7 indications for wire-guided endobronchial blocker

A
  • ETT or trach in place
  • RSI and OLV
  • known and unknown difficult airway
  • nasotracheal intubation
  • small adult pt
  • selective lobar ventilation
  • trauma
37
Q

What is the most versatile method for OLV

38
Q

12 steps of mgmt of hypoxia with OLV

A
  • notifies surgeon of low sat, interventions, exact sat
  • ask for help
  • decrease volatile agent
  • increase FIO2
  • change vent to PC
  • manipulate PEEP
  • manipulates MV
  • administer inhaler
  • suction ventilated lung
  • insufflates with O2
  • PEEP down lung, CPAP up lung
39
Q

8 indications for securing pt airway

A 
Anesthesia
Hemodynamic instability
Decreased LOC
Pain mgmt
Severe dyspnea- Acc muscle use
Severe hypoxemia/hypercarbia
Severe acidosis
Inability to protect airway
40
Q

Normal TMD

A

> 6cm (more than 3 fingerbreadths)

41
Q

Normal mouth opening

A

> 4cm

2-3 fingerbreadths

42
Q

Neck circumference > ______ predicts difficult airway

43
Q

LEMON assessment

A

Look
- facial trauma, large incisiors, beard, large tongue
Evaluate (3-3-2)
- interincisor gap, hyomental distance, TMD
Mallampati
Obstruction
Neck mobility

44
Q

7 risk factors for aspiration

A 
Short tasting times
Pregnancy
Increased abdominal pressure
GI disease
GERD
Bowel obstruction
NM disease or nervous system dysfunction
45
Q

6 complications of airway mgmt

A 
Failed intubation
CVCI
Airway trauma
Aspiration
Mainstem intubation
Bronchospasm
46
Q

6 disadvantages of face mask for general

A 
Ties up hands
Higher FGF
Access difficult
More desat than LMA
Higher work of breathing
Poor correlation of ETCO2 and PCO2
47
Q

4 complications from using face mask

A

Pressure necrosis
Nerve injury
Gastric insufflation
Pollution

48
Q

8 complications of LMA

A 
Aspiration
Gastric distention
Airway obstruction
Trauma (uvula edema)
Laryngospasm
Dislodgement
Nerve injury
49
Q

5 advantages of LMA

A 
Ease of insertion
Smooth emergence
Low pollution
Avoid complications of face mask and intubation
Protect from barotrauma
50
Q

3 advantages of LMA compared to face mask

A

Hands free
Better seal in bearded
Lass facial nerve and eye trauma

51
Q

5 advantages of LMA compared to ETT

A 
Useful for difficult intubation
Less coughing on emergence
Ability to ventilate until airway reflexes restored
Reduced CV response
Less laryngospasm and bronchospasm
52
Q

2 disadvantages of LMA vs ETT

A

Less safe in prone or jackknife position

Less secure airway

53
Q

Machine end of ETT has a ______ connector (size)

54
Q

6 uses of FOB

A 
Intubation (awake/asleep, nasal, oral)
Confirm ETT placement
Confirm placement of DLT
Clear secretions
Bronch with lovage for aspiration or blood in ETT
Bronch exam with intervention
55
Q

3 advantages of FOB

A

Useful if difficult or impossible to intubate with rigid laryngoscopes

Onstable Cspine

Overcome anatomic variations

56
Q

7 disadvantages of FOB

A
  • expensive, fragile, difficult to use
  • more time and prep required
  • difficult or impossible with blood, secretions, hypoxemia
  • gastric distension, rupture
  • laryngeal trauma
  • technical issues (fogging, anatomy, light source)
57
Q

4 structures at risk of damage from DL

A

Dental injury
Cspine injury
Lips, tongue, palate, Laryngospasm, esophagus

58
Q

2 uses of reinforced ETT

A
  • kinking possible (prone, neck sg)

- ETT placed in tracheostomy

59
Q

3 differences in microlaryngeal tracheal tube and conventional ETT

A

Larger cuff
Narrow body
Longer body

60
Q

3 safety features of laser ETT

A
  • cuff filled with blue indicator so see if hit
  • saline in cuff helps put out fire
  • ???
61
Q

Type of oral airway used for awake fiberoptic intubation orally

A

Williams, ovassapian, ROTIG

62
Q

4 standard monitors for the intubated pt undergoing general anesthetic

A

ECG
BP
Capnometry
Pulseox

63
Q

Role of oxygen analyzer in avoiding hypoxic mix of gases

A

Continuously measure and indicate FIO2 in breathing system. Indicate when inspired O2 deviates from desired limits

64
Q

Single monitor which provides most clinical information

A

Pulse oximeter

65
Q

Which law?
Absorption of a given thickness of a solution of a given concentration is the same as twice the thickness of half the concentration

66
Q

Which law? Each layer of equal thickness absorbs an equal fraction of radiation which passes through it

A

Lamberts law

67
Q

Absorption of red and infared light

Oxygenated blood

deoxygenated blood

A

Oxygenated- 960 mm

Deoxygenated- 660 mm

68
Q

How do differences in oxygenated and deoxygenated blood absorption generates pulse ox reading?

A

Change in light absorption when passing through vascular bed during arterial pulsation

69
Q

5 clinical scenarios which may result in decreased oxygen saturation

A 
VQ mismatch
Disconnect
Inadequate MV
Misplaced ETT
Diffusion abnormality
70
Q

7 location which may be used to monitor oxygen saturation

A 
Finger
Nose
Earlobe
Forehead
Lip 
Tongue
Check
Forehead
71
Q

11 Factors affecting pulse ox accuracy

A 
Electrocautery
Motion, venous pulsation
Ambient light/radiant warmers
Nail polish, acrylic nails
Low perfusion
CO2 methemoglobin
Methylene blue/indigo carmine
Hypothermia
Tourniquet
Nonpulsatile flow (CPB)
IABP (2 systole)
72
Q

Accuracy standard of oximeter

A

Accuracy bw 70-100%

73
Q

Mandatory sat alarm for oximeter

74
Q

4 uses for pulse oximeter other than oxygen saturation

A
  • Estimate systolic BP
  • Monitor peripheral circulation (mediastinoscopy, shoulder sg)
  • Locating arteries
  • Warning of fluid extravasation
75
Q

Most commonly used technology for gas monitoring

A

Diverting gas monitoring

76
Q

How does nondiverting gas monitor works

A

Diverts some gas to monitor to interpret CO2, volatile anesthetics, N2O

77
Q

How does infared technology for anesthetic gas concentration works?

A

Gases with 2 or more dissimilar atoms have specific infared light absorption

Amount of IR light absorbed is proportional to concentration of the absorbing molecules

Compare IT light absorption to known standard

Equipment II (2 decks)

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