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APEX/BOARD STUDY > UNIT 1 - RESPIRATORY > Flashcards

UNIT 1 - RESPIRATORY Flashcards

1
Q

What are the sensory functions of the Ophthalmic branch (V1) of the Trigeminal nerve (CN 5)?

A

Nares, & anterior 1/3 of nasal septum

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2
Q

What is the motor function of the Mandibular branch (V3) of the Trigeminal nerve (CN 5)?

A

Mastication

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3
Q

Which cranial nerve is responsible for the sensory innervation of the soft palate and oropharynx?

A

Glossopharyngeal (CN 9)

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4
Q

What is the primary motor function of the Vagus nerve (CN 10)?

A

Innervates intrinsic muscles of the larynx

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5
Q

What anatomical structures are included in the laryngeal cartilages?

A
  • Epiglottis
  • Thyroid
  • Cuneiform (Pair)
  • Corniculate (Pair)
  • Arytenoids (Pair)
  • Cricoid
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6
Q

What is the purpose of anesthetizing the airway during awake intubation?

A

To minimize discomfort and facilitate intubation

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7
Q

True or False: A unilateral recurrent laryngeal nerve injury causes respiratory distress.

A

False

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8
Q

What are the intrinsic muscles of the larynx involved in phonation?

A
  • Posterior Cricoarytenoid
  • Lateral Cricoarytenoid
  • Cricothyroid
  • Thyroarytenoid
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9
Q

Fill in the blank: The primary function of the upper airway is _______.

A

Warming, humidifying, filtering particles, and preventing aspiration

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10
Q

What anatomical structures mark the beginning and end of the lower airway?

A

Begins at the trachea & ends at the alveoli

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11
Q

What is the primary determinant of CO2 elimination?

A

Alveolar ventilation

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12
Q

What is the formula for minute ventilation?

A

Minute ventilation = TV x RR

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13
Q

What happens to intrapleural pressure during forced expiration?

A

It becomes positive

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14
Q

Which type of pneumocyte provides the surface for gas exchange?

A

Type 1 Pneumocyte

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15
Q

What is the relationship defined by the Law of Laplace in alveoli?

A

P = 2T/R

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16
Q

What is the consequence of a right-to-left shunt in terms of hypoxia?

A

It leads to hypoxia due to poorly ventilated areas

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17
Q

What does the A-a gradient help diagnose?

A

The cause of hypoxia

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18
Q

What is the normal P50 value for the oxyhemoglobin dissociation curve?

A

26-27 mmHg

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19
Q

Fill in the blank: The formula for oxygen content in blood is CaO2 = _______.

A

(1.34 • Hgb • SaO2) + (PaO2 • 0.003)

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20
Q

What is the effect of increased 2-3 DPG on the oxygen dissociation curve?

A

It causes a right shift, facilitating oxygen unloading

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21
Q

What factors can increase the A-a gradient?

A
  • Aging
  • Vasodilators
  • Right to left shunt
  • Diffusion limitations
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22
Q

True or False: Supplemental O2 is effective in reversing hypoxemia caused by shunt.

A

False

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23
Q

What condition is the most common cause of hypoxia in the PACU?

A

Atelectasis

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24
Q

What type of lung volume cannot be directly measured through spirometry?

A

Residual Volume (RV)

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25
Q

What does the term ‘compliance’ refer to in respiratory physiology?

A

ΔV/ΔP

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26
Q

What is the primary function of surfactant in the alveoli?

A

To reduce surface tension and prevent alveolar collapse

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27
Q

What is the effect of the Haldane effect in terms of CO2 transport?

A

↑PaO2 displaces CO2 from hemoglobin

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28
Q

What is the significance of the transpulmonary pressure?

A

It determines lung expansion

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29
Q

What is the difference between anatomical and physiological dead space?

A

Anatomical dead space includes conducting airways, while physiological dead space includes both anatomical and alveolar dead space

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30
Q

What is produced during RBC glycolysis?

A

2-3 DPG

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31
Q

What happens to Hgb when PaO2 is above 100 mmHg?

A

Hgb is fully saturated; increasing FiO2 increases dissolved O2 but not O2 binding to Hgb

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32
Q

What is the Bohr effect?

A

↑PaCO2 & H+ cause Hgb to release O2

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33
Q

What is the Haldane effect?

A

↑PaO2 displaces CO2 from Hgb

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34
Q

What is the Hamburger shift?

A

Cl- exchanges for HCO3- in RBCs to maintain electroneutrality

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35
Q

What is the normal SaO2 and corresponding PaO2 for 90% saturation?

A

PaO2 60 mmHg

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36
Q

What is the affinity of CO for Hgb compared to O2?

A

CO has a 200-250 X greater affinity for Hgb than O2

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37
Q

What is the net gain of ATP from glycolysis?

A

2 ATP

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38
Q

What is the net gain of ATP from oxidative phosphorylation?

A

34 ATP

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39
Q

What happens to pyruvate acid in the absence of O2?

A

It is converted into lactic acid

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40
Q

How is CO2 carried in the blood? List the three ways.

A
  • Bicarbonate Ion (HCO3-) - 70%
  • Bound to Hgb as carbamino compound - 23%
  • Dissolved in plasma - 7%
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41
Q

What is hypercapnia?

A

PaCO2 > 45 mmHg

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42
Q

What are the consequences of hypercapnia?

A
  • Hypoxemia
  • Acidosis
  • Cardiac/smooth muscle depression
  • SNS stimulation
  • ↑P50
  • ↑K+
  • ↑Ca++
  • ↑PVR
  • ↑ ICP
  • ↓ LOC
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43
Q

What happens to minute ventilation with PaCO2 between 20-80 mmHg?

A

Minute ventilation increases linearly

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44
Q

What is the apneic threshold?

A

The highest PaCO2 where a person will not breathe

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45
Q

Fill in the blank: CO2 is ______ more soluble than O2.

A

20 X

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46
Q

What is the total CO2 content of arterial blood?

A

48 ml CO2/100 ml blood

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47
Q

What is the primary respiratory center located in the medulla?

A

Dorsal Respiratory Group (DRG)

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48
Q

What is the role of the pneumotaxic center?

A

Inhibits DRG and shuts off inspiration

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49
Q

What reflex prevents over-stretching of the lungs?

A

Hering-Breuer Inflation Reflex

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50
Q

What do central chemoreceptors respond to?

A

↑ H+ in the CSF

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51
Q

Where are peripheral chemoreceptors located?

A

At the carotid bodies and transverse aortic arch

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52
Q

What is HPV?

A

A local reaction to reduction in alveolar O2 tension

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53
Q

What is the primary mechanism of bronchoconstriction?

A

PNS stimulation of M3 receptor

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54
Q

List two direct acting bronchodilators.

A
  • Beta-2 agonists (e.g., Albuterol, Salmeterol)
  • Anticholinergics (e.g., Atropine, Ipratropium)
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55
Q

What does PFT stand for?

A

Pulmonary Function Test

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56
Q

What does FEV1/FVC ratio help diagnose?

A

Restrictive vs obstructive lung disease

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57
Q

What is the most common finding in asthma?

A

Respiratory alkalosis with hypocarbia

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58
Q

What is a common treatment for bronchospasm?

A

Short acting inhaled beta-2 agonist (e.g., Albuterol)

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59
Q

What can trigger bronchospasm besides asthma?

A
  • Mechanical obstruction of ETT
  • Light anesthesia
  • Pulmonary aspiration
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60
Q

What is the effect of sub-anesthetic doses of gas and IV drugs on the hypoxic ventilatory drive?

A

They depress the hypoxic ventilatory drive

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61
Q

What is bronchospasm?

A

A sudden constriction of the muscles in the walls of the bronchioles.

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62
Q

What is an acute asthma attack?

A

A sudden worsening of asthma symptoms due to increased airway inflammation and constriction.

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63
Q

What is endobronchial intubation?

A

Insertion of a tube into the bronchus to secure an airway.

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64
Q

What is pneumothorax?

A

A collection of air in the pleural space that can cause lung collapse.

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65
Q

What is pulmonary aspiration?

A

Inhalation of food, liquid, or other substances into the lungs.

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66
Q

What is pulmonary edema?

A

Fluid accumulation in the lung tissue, affecting gas exchange.

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67
Q

What does PE stand for?

A

Pulmonary Embolism.

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68
Q

List common presentations of bronchospasm.

A
  • Wheezing
  • Decreased breath sounds
  • Increased airway resistance
  • Increased peak inspiratory pressure (PIP) with normal plateau pressure
  • Increased alpha angle on capnography
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69
Q

What is the initial treatment for bronchospasm?

A
  • 100% FiO2
  • Deepen anesthetic (Volatiles, propofol, lidocaine, ketamine)
  • Short acting inhaled beta-2 agonist (Albuterol)
  • Inhaled ipratropium
  • Epinephrine 1 mcg/kg IV
  • Hydrocortisone 2-4 mg/kg IV
  • Aminophylline
  • Helium-oxygen (Heliox)
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70
Q

What characterizes COPD?

A

A reduction in maximal expiratory flow and slower forced emptying of the lungs.

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71
Q

What are the two main components of COPD?

A
  • Chronic bronchitis
  • Emphysema
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72
Q

What are the key characteristics of chronic bronchitis?

A
  • Hypertrophied bronchial mucus glands
  • Chronic inflammation
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73
Q

What are the key characteristics of emphysema?

A
  • Enlargement and destruction of the airways distal to the terminal bronchioles.
74
Q

What are common etiologies of COPD?

A
  • Smoking
  • Respiratory infection
  • Environmental pollutants
  • Alpha-1 antitrypsin deficiency
75
Q

Describe the presentation of chronic bronchitis.

A
  • Copious sputum
  • Increased hematocrit
  • ‘Blue Bloater’
  • Increased pulmonary vascular resistance (PVR) leading to right heart failure
76
Q

Describe the presentation of emphysema.

A
  • Cough with exertion
  • Scant sputum
  • ‘Pink Puffer’
  • Normal/slightly reduced PaCO2
  • Increased PVR leading to right heart failure
77
Q

What is alpha-1 antitrypsin deficiency?

A

A genetic disorder that can lead to panlobular emphysema due to unchecked alveolar elastase.

78
Q

What occurs with inability to exhale in COPD?

A

Gas trapping leading to increased residual volume (RV).

79
Q

What is the effect of chronic elevated PaCO2 in COPD?

A

It causes respiratory acidosis, and kidneys reabsorb bicarbonate, leading to compensatory metabolic alkalosis.

80
Q

What is the recommended SaO2 target for patients with severe COPD?

A

Maintain SaO2 between 88-92% to minimize the risk of O2-induced hypercapnia.

81
Q

What spirometry findings are indicative of COPD?

A
  • Increased RV, FRC, TLC
  • Decreased FEV1, FEV1/FVC ratio, FEF 25-75%
82
Q

What FEV1/FVC ratio after bronchodilator therapy indicates COPD?

A

An FEV1/FVC of <70%.

83
Q

What are key considerations for anesthesia in COPD patients?

A
  • Consider regional anesthesia for extremities & lower abdomen
  • Avoid neuraxial anesthesia if sensory blockade >T6
  • Be cautious with excessive sedation and ventilatory depression
84
Q

What are ventilation considerations for patients with COPD?

A
  • Large tidal volumes (10-15 ml/kg)
  • Use 6-8 ml/kg IBW
  • Short inspiratory rate and longer expiratory time
  • Slow respiratory rate, add PEEP but observe for dynamic hyperinflation
85
Q

What is dynamic hyperinflation?

A

Breath stacking due to high minute ventilation and reduced expiratory flow.

86
Q

What are the consequences of dynamic hyperinflation?

A
  • Hypotension
  • Barotrauma
  • Pneumothorax
87
Q

What are common causes of restrictive lung disease?

A
  • Acute intrinsic (Pulmonary edema)
  • Chronic intrinsic (Interstitial lung disease)
  • Chest wall diseases
  • Other (Obesity, ascites, pregnancy)
88
Q

What are the characteristics of restrictive lung disease?

A
  • Decreased lung volumes and capacities
  • Decreased compliance
  • Intact pulmonary flow rates
89
Q

What is the diagnostic criterion for restrictive lung disease based on FEV1 and FVC?

A

An FEV1 and FVC <70%.

90
Q

What are ventilation considerations for restrictive lung disease?

A
  • Smaller tidal volume (6 mL/kg IBW)
  • Faster respiratory rate (14-18 bpm)
  • Keep peak inspiratory pressure < 30 cm H2O
  • Prolong inspiration time (I:E ratio 1:1)
91
Q

What is aspiration pneumonitis?

A

Inflammation of the lungs due to inhalation of foreign materials.

92
Q

What are the common risk factors for aspiration pneumonitis?

A
  • Pregnancy
  • Trauma
  • Emergency surgery
  • GI obstruction
93
Q

What are the signs and symptoms of aspiration pneumonitis?

A
  • Hypoxemia
  • Dyspnea
  • Tachypnea
  • Cyanosis
  • Tachycardia
  • Hypertension
94
Q

What is the primary treatment for aspiration pneumonitis?

A
  • Tilting head downward
  • Suctioning
  • Securing airway
  • Applying PEEP
95
Q

What are the criteria for safe discharge after aspiration?

A
  • No new cough or wheeze
  • No radiographic evidence of pulmonary injury
  • SpO2 decrease ≤10% from preoperative values on room air
  • A-a gradient ≤ 300 mmHg
96
Q

What is Mendelson’s syndrome?

A

Chemical aspiration pneumonitis due to aspiration of gastric contents.

97
Q

What is the most common cause of ventilator-associated pneumonia (VAP)?

A

Introduction of bacteria to the airway via endotracheal tube (ETT).

98
Q

List the prevention strategies for VAP.

A
  • Hand washing
  • Keeping head of bed > 30 degrees
  • Daily spontaneous breathing trials
  • Limiting sedation
  • Oropharyngeal decontamination
  • Subglottic suctioning
99
Q

What are the common culprits of VAP?

A
  • Pseudomonas aeruginosa
  • Staphylococcus aureus
100
Q

What is the treatment for VAP?

A

Start broad-spectrum antibiotics and then switch to targeted antibiotics once the organism is identified.

101
Q

What are the types of pneumothorax?

A
  • Closed
  • Open
  • Tension
102
Q

What are the signs and symptoms of tension pneumothorax?

A
  • Hypoxemia
  • Increased PIP
  • Asymmetric chest wall movement
  • Absence of unilateral breath sounds
  • Tracheal shift to opposite side
  • Tachycardia
  • Hypotension
103
Q

What is the emergency treatment for tension pneumothorax?

A

Insert a 14G angiocath into the second intercostal space mid-clavicular line or the 4th/5th intercostal space at the anterior axillary line.

104
Q

What is flail chest?

A

A consequence of blunt chest trauma characterized by paradoxical movement of the chest wall.

105
Q

What are the consequences of flail chest?

A
  • Alveolar collapse
  • Hypoventilation
  • Hypercarbia
  • Hypoxia
106
Q

What is venous air embolism (VAE)?

A

Gas embolism that travels to the right heart and lodges in the pulmonary outflow tract or pulmonary artery.

107
Q

What are the signs and symptoms of VAE?

A
  • Air observed in TEE
  • Mill Wheel murmur on precordial Doppler
  • Decreased EtCO2
  • Increased EtN2
  • Increased pulmonary artery pressure (PAP)
  • Hypotension
108
Q

What is the treatment for VAE?

A
  • Administer 100% FiO2
  • Flood surgical field with normal saline
  • Discontinue gas insufflation
  • Place patient in left lateral decubitus position
  • Aspirate from central line
109
Q

What defines pulmonary hypertension?

A

Mean pulmonary artery pressure (PAP) >25 mmHg.

110
Q

What increases pulmonary vascular resistance (PVR)?

A
  • Hypoxia
  • Hypercarbia
  • Acidosis
  • Sympathetic nervous system stimulation
  • Pain
  • Hypothermia
  • Increased intrathoracic pressure
111
Q

What decreases pulmonary vascular resistance (PVR)?

A
  • Increased PaO2
  • Hypocarbia
  • Alkalosis
112
Q

What are the anesthetic considerations for pulmonary hypertension?

A
  • Do not hold preoperative medications that reduce PVR
  • Treat hypotension aggressively
  • Epidural anesthesia is better tolerated than spinal anesthesia
113
Q

What is carboxyhemoglobin?

A

A compound formed when carbon monoxide binds to hemoglobin, causing a left shift in the O2 dissociation curve.

114
Q

What is the treatment goal for carbon monoxide poisoning?

A

Reduce carboxyhemoglobin levels to < 5%.

115
Q

What are the indications for hyperbaric oxygen therapy?

A
  • CO poisoning
  • Gas embolism
  • Anaerobic infections (Gas gangrene)
  • Decompression sickness
116
Q

What drugs can be administered via endotracheal tube (ETT)?

A

NAVEL: Narcan, Atropine, Vasopressin, Epinephrine, Lidocaine.

117
Q

What are the benefits of endotracheal intubation?

A
  • Patent airway
  • Controlled ventilation
  • Ventilation with high airway pressure
  • Secured airway
  • Removal of secretions
118
Q

What are the anatomical characteristics of a difficult intubation?

A
  • Short, muscular neck
  • Receding mandible
  • Protruding maxillary incisors
  • Inability to visualize uvula
  • Limited temporomandibular joint mobility
  • Limited cervical mobility
119
Q

What are the contraindications to fiberoptic bronchoscopy?

A
  • Hypoxia
  • Heavy airway secretions
  • Bleeding not relieved with suction
  • Local anesthetic allergy
  • Inability to cooperate
120
Q

What are the best predictors of postoperative pulmonary complications?

A
  • FEV1 < 40%
  • DLCO < 40%
  • VO2 Max < 15 mL/kg/min
121
Q

What is the most common problem with one-lung ventilation (OLV)?

A

Intrapulmonary shunt.

122
Q

What should be done to manage hypoxemia during OLV?

A
  • Verify delivery of 100% FiO2
  • Check double-lumen tube (DLT) position
  • Apply CPAP to non-dependent lung
  • Apply PEEP to dependent lung
  • Reinflate collapse lung if necessary
123
Q

What are the potential complications of DLT positioning?

A
  • DLT in too far leading to upper lobe not being ventilated
  • DLT not deep enough leading to failure to achieve lung separation
  • DLT in the wrong bronchus causing wrong lung collapse
124
Q

What are the sizes for double-lumen tubes in adults?

A
  • Female: 35-37 Fr
  • Male: 39-41 Fr
125
Q

What is a bronchial blocker?

A

A device used for lung isolation during one-lung ventilation.

126
Q

What are the benefits of using a bronchial blocker?

A
  • No need to exchange ETT after surgery
  • Can be passed through single lumen ETT for OLV
127
Q

What are the downsides of using a bronchial blocker?

A
  • Operative lung slow to collapse
  • Balloon can slip into trachea leading to contamination
128
Q

What is a Bronchial Blocker?

A

A device advanced into the main bronchus to assist in one-lung ventilation (OLV) without needing to exchange the endotracheal tube (ETT) after surgery.

Benefits include the ability to insufflate oxygen into the non-ventilating lung and suction air from it, but cannot suction blood or secretions.

129
Q

What is the absolute contraindication for mediastinoscopy?

A

Previous mediastinoscopy due to scarring.

The most common reason for performing this procedure is bronchogenic carcinoma.

130
Q

What complications can arise from mediastinoscopy?

A
  • Hemorrhage
  • Pneumothorax
  • Tearing of great vessels
  • Chylothorax
  • Bronchospasm from airway manipulation
  • Air embolism
  • Arrhythmias
  • Esophageal laceration

Large bore IV and PRBCs should be ready due to the risk of hemorrhage.

131
Q

What are the indications for tracheal resection?

A
  • Tracheal stenosis
  • Tracheomalacia
  • Tumor
  • Vascular lesions
  • Congenital malformations

Postoperatively, the patient’s neck should be flexed for several days to reduce tension on the anastomosis.

132
Q

What is ARDS?

A

A form of non-cardiogenic pulmonary edema caused by inflammation injury leading to diffuse alveolar destruction.

Hypoxia is the #1 manifestation of ARDS.

133
Q

What are the key pathological features of ARDS?

A
  • Protein rich pulmonary edema
  • Loss of surfactant
  • Hyaline membrane formation
  • Possible long-term lung injury

CXR reveals bilateral opacities and diffuse patchy alveolar infiltrates.

134
Q

What are the five types of hypoxia?

A
  • Hypoxic hypoxia
  • Anemic hypoxia
  • Stagnant hypoxia
  • Histotoxic hypoxia
  • Hypoxia due to pulmonary disease

Hypoxic hypoxia is also referred to as diffusional hypoxia.

135
Q

What does the Mallampati score assess?

A

The oropharyngeal space to predict intubation difficulty.

A score of 3 or 4 indicates a more difficult intubation.

136
Q

What is the normal range for the inter-incisor gap?

A

2-3 finger breadths (4 cm).

A smaller gap increases intubation difficulty.

137
Q

What does a Thyromental Distance (TMD) of less than 6 cm indicate?

A

Increased risk of difficult intubation.

A TMD greater than 9 cm also indicates increased risk.

138
Q

What is assessed in the Mandibular Protrusion Test (MPT)?

A

The function of the temporomandibular joint.

Class 3 correlates with an increased risk of difficult intubation.

139
Q

What is the significance of the Cormack & Lehane Score?

A

Grades 1 & 2A indicate easier intubation while grades 2B, 3, and 4 indicate harder intubation.

Grade 4 requires an alternative approach to intubation.

140
Q

What are the risk factors associated with Difficult Mask Management?

A
  • Beard
  • Obesity (BMI > 26 kg/m2)
  • No teeth
  • Elderly (> 55 years)
  • Snoring

These factors increase the difficulty of mask ventilation.

141
Q

What is the narrowest region in adults and pediatric airways?

A

Adult: glottic opening; Pediatric: cricoid ring (fixed) and vocal cords (dynamic).

Pediatric larynx is funnel-shaped (<5 years).

142
Q

What is the first-line treatment for laryngospasm?

A
  • FiO2 100%
  • Remove noxious stimuli
  • Deepen anesthesia
  • Larson’s maneuver
  • Chin lift
  • CPAP 15-20 cmH2O

Consider succinylcholine for severe cases.

143
Q

What are the NPO guidelines for fasting before surgery?

A
  • 2 hours = Clear liquids
  • 4 hours = Breast milk
  • 6 hours = Nonhuman milk, infant formula, solid food
  • 8 hours = Fried or fatty foods

These guidelines help minimize aspiration risk.

144
Q

What is the cricoid pressure applied during Rapid Sequence Intubation (RSI)?

A

20 Newtons (~2 kg) before loss of consciousness, 40 Newtons (~4 kg) after.

Cricoid pressure can cause airway obstruction and impair direct laryngoscopy.

145
Q

What are the three key causes of angioedema?

A
  • Anaphylaxis
  • ACE inhibitors
  • C1 esterase deficiency (hereditary)

Treatment varies by cause, including epinephrine for anaphylaxis.

146
Q

What is Ludwig’s Angina?

A

A bacterial infection that leads to cellulitis in the floor of the mouth, risking airway obstruction.

Best airway management is awake intubation or awake tracheostomy.

147
Q

What congenital conditions are associated with cervical spine abnormalities?

A
  • Klippel Feil
  • Trisomy 21 (Down syndrome)
  • Goldenhar

These conditions can affect airway management.

148
Q

What is the sniffing position and its relevance?

A

Cervical flexion and atlanto-occipital extension to align the oral, pharyngeal, and laryngeal axes.

Particularly important for intubation.

149
Q

What is the maximum cuff pressure for an LMA?

A

60 cm H2O (target 40-60 cm H2O).

Excessive cuff pressure can lead to nerve injuries.

150
Q

What is the purpose of the Combitube?

A

A double lumen device used for blind placement in the hypopharynx, providing secure airway and aspiration protection.

Size is determined by the patient’s height.

151
Q

What is the King Laryngeal Tube?

A

A single lumen device similar to the Combitube, with child sizes available.

It has a single inflation port and is disposable.

152
Q

What is the purpose of the technique to decompress the stomach?

A

Useful for the obese population

Minimal training required.

153
Q

What are contraindications for stomach decompression?

A
  • Intact gag reflex
  • Prolonged use >2-3 hours
  • Esophageal disease (Zenker’s diverticulum)
  • Ingestion of caustic substances
154
Q

What distinguishes the King Laryngeal Tube from the Combitube?

A

Single lumen for ventilation & single inflation port

Child sizes are available.

155
Q

What is the King LTS-D?

A

A disposable device that includes a second lumen to pass a gastric tube for suctioning the stomach.

156
Q

What is the primary use of a Flexible Fiberoptic Bronchoscope?

A

Used for indirect laryngoscopy in awake or asleep patients.

157
Q

What are relative contraindications for using a Flexible Fiberoptic Bronchoscope?

A
  • Hypoxia
  • Bleeding
  • Lack of patient cooperation
158
Q

What should be used before the insertion of a Flexible Fiberoptic Bronchoscope?

A
  • Defogger
  • Antisialagogue
  • Vasoconstrictor (Nasal approach)
159
Q

How do you control the movements of the Flexible Fiberoptic Bronchoscope?

A
  • Non-dominant hand moves the lever (Controls)
  • Dominant hand holds the cord
160
Q

What are the best drug choices for awake Fiberoptic Bronchoscope intubation?

A
  • Precedex
  • Remi
  • Ketamine
  • Versed
161
Q

What is the Bullard Laryngoscope used for?

A

It is a rigid, fiberoptic device used for indirect laryngoscopy.

162
Q

What are the indications for using the Bullard Laryngoscope?

A
  • Small mouth opening (Minimum mouth opening = 7mm)
  • Impaired cervical spine mobility
  • Short, thick neck
  • Treacher Collins syndrome
  • Pierre Robin syndrome
163
Q

What is an Intubating Stylet also known as?

A

Eschmann introducer (IE) or Gum Elastic Bougie.

164
Q

How can proper placement of an Intubating Stylet be confirmed?

A

By feeling clicks of the tracheal rings.

165
Q

What is the worst time to use an Intubating Stylet?

A

With a CL class 4 view.

166
Q

What is the purpose of a Lighted Stylet?

A

A blind intubation technique that transilluminates the anterior neck to facilitate endotracheal intubation.

167
Q

What are the benefits of using a Lighted Stylet?

A
  • Useful for anterior airway
  • Useful with small mouth opening
  • Requires very little neck manipulation
  • Less stimulating than DL
  • Less sore throat than DL
168
Q

What are the disadvantages of using a Lighted Stylet?

A
  • Difficult to use in patients with a short, thick neck
  • Should not be used in emergencies or can’t ventilate can’t intubate situations
  • Not to be used in the presence of a tumor, foreign body, airway injury, or epiglottitis
169
Q

What is Retrograde Intubation?

A

A blind procedure where tracheal intubation is accomplished by passing the ETT over a wire inserted via the cricothyroid membrane puncture.

170
Q

What are the indications for Retrograde Intubation?

A
  • Unstable C-spine
  • Upper airway bleeding
  • Best used when intubation has failed but ventilation is still possible
171
Q

What are contraindications for Retrograde Intubation?

A
  • Unable to identify neck landmarks (Severe obesity)
  • Pretracheal mass (Thyroid goiter)
  • Neck flexion deformity
  • Tracheal stenosis or tumor obstructing the wire path
  • Coagulopathy
  • Infection
172
Q

What are potential complications of Retrograde Intubation?

A
  • Bleeding
  • Pneumomediastinum
  • Pneumothorax
  • Trigeminal nerve trauma
  • Breath-holding
  • Wire travels in the wrong direction
173
Q

What is a Percutaneous Cricothyroidotomy used for?

A

Used in emergent situations with transtracheal jet ventilation.

174
Q

What are contraindications for Percutaneous Cricothyroidotomy?

A
  • Upper airway obstructions
  • Laryngeal injury
175
Q

What is the difference between Cricothyroidotomy and Tracheostomy?

A

Cricothyroidotomy is created via a small incision through the cricothyroid membrane; Tracheostomy takes time and is less attractive for emergencies.

176
Q

What does the ASA Difficult Airway Algorithm emphasize?

A

Optimizing oxygenation, limiting attempts, and being aware of time and O2 saturation.

177
Q

What is the primary goal in a ‘Can’t ventilate & can’t intubate’ scenario?

A

Calling for help, placing a supraglottic airway device, and possibly waking the patient.

178
Q

What strategies are suggested for extubation?

A
  • Enlisting skilled help
  • Optimizing oxygenation
  • Using an airway exchange catheter (in adults)
  • Consideration of elective tracheostomy
179
Q

What is the importance of the airway reflexes during extubation?

A

Should be intact to protect the airway and reduce the risk of aspiration.

180
Q

What is an Airway Exchange Catheter (AEC)?

A

A long, thin, flexible tube that maintains direct access to the airway after extubation.

181
Q

What are the complications associated with using an AEC?

A
  • Barotrauma/pneumothorax
  • Inability to replace ETT

APEX/BOARD STUDY (5 decks)

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