Test 3 Part 6 Flashcards
stridor usually indicates what?
some type of obstruction
patient has stridor, how do you tx?
- should the patient be intubated or can it be delayed?
- heliox (70% helium w/ 30% O2)
- Nebulized Epi
- Decadron 4-8 mg q 8-12 hr
how does DM have airway implications?
- juvenile DM relationship with stiff joint syndrome
- limited atlanto-axial joint motion
if patient presents with DM, you could have them do a prayer sign test to determine if they have “stiff joints” how is this done?
put hands in praying position; if palmar surfaces of the phalangeal joints cannot be approximate despite maximal effort –> prayer sign is +
STOP - BANG for OSA
- snoring
- tiredness
- observed apnea
- high blood pressure
- BMI > 35
- Age > 50
- Neck circumfrence (> 43 males; 41 females)
- male gender
preoperative recommendations for OSA
- develop protocol so at risk pts are evaluated prior to day of surgery
- thorough H&P
- inform pt and family of increased risk
- pre and post-op use of CPAP/BIPAP
- evaluate for potential difficult airway
- consider inpatient surgery rather than outpatient
airway and respiratory issues d/t obesity
- decreased FRC
- increased O2 consumption and CO2 production, even at rest
- Requirement for higher minute volume to maintain normocarbia
- decreased chest wall compliance
- chronic hypoxemia, polycythemia, pulmonary HTN
- difficult surgical airway if necessary - ensure/mark crcioid
perioperative issues with obese pts with implications for airway managaement
- preop eval
- significantly r/t difficult intubation
- judicious admin of narcotics/sedative
- optimal positioning with extra padding
- masking, oral, and nasal airways
- consider regional anesthesia when applicable
- extubate fully awake after full reversal of NMB
Airway preparation/setup: MAIDENS
- machine check, including O2 tank
- Airways, including oral, nasal, and tongue depressor
- intubation supplies: handles, blades, tubes, stylets, magill
- Drugs including emergency drugs
- Emergency supplies - ambu, bougie, LMA
- Nerve stimulator
- suction - yankaur, catheters, stethoscope
flexing the neck and neck extension using a pad will put the pt in ________________ position; and lines up the _____________, __________, & ___________
sniffing position; oral axis; pharyngeal axis, laryngeal axis
extension of the neck without head elevation aligns the ____________ & __________, but not the _____________
pharyngeal axis and laryngeal axis; oral axis
_______________ position will improve ability to __________ & _________
sniffing; ventilate; intubate
chin lift/jaw thrust is a manual position method that does what?
moves the tongue and epiglottis off the pharynx
what is the most common positioning method used for obese patients for optimal ventilation and intubation
pillow method
T/F: it is okay to use an oral airway with awake pt
false; gag reflex still intact –> vomiting and aspiration
how do you fit a pt for an oral airway
measure corner of mouth to tip of ear lobe
most adults will use a ____ mm oral airway; very large adults will need a _____mm
9; 10
oral airway can be effective for ventilation in a sedated pt because it functions to….
displace the relaxed tongue
how do you pick the correct size nasal airway?
measure from tip of nose to tip of earlobe
for nasal airway, sizes range from __________ - __________
26; 34 fr
nasal airway size for smaller adults will be ______ Fr, and larger adults will need ______Fr
30; 34
which nare do you usually insert the nasal airway?
right –> usually larger and straighter
when you insert a nasal airway, what way should the tip be aimed
posterior
T/F: semi-awake pts will tolerate a nasal airway
true
