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Principles 2 > Airway Management/Mask/Intubation > Flashcards

Airway Management/Mask/Intubation Flashcards

1
Q

Release jaw during expiration to prevent

A

ballvalve

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2
Q

describe One-handed bag-mask Ventilation

[EC clamp]

A

Mask is held with left hand, bag in right hand
Downward pressure using thumb and index finger
Middle & ring fingers on mandible not soft tissue extending jaw

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3
Q

describe Two-handed mask ventilation

[TE clamp]

A

Both hands on mask, bag handled by 2nd person
Thumbs pressing mask downward against face
Index fingers on mandible moving it anteriorly
Jaw thrust
Atlanto-occipital joint extention

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4
Q

What is a very IMPORTANT value to monitor during ventilation?

A

CO2

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5
Q

4 disadvantages of MAC without Artificial Airway

A

-Airway tone reduced
-Tongue obstructs
-Difficult to detect apnea
-Difficult to detect reduced airflow and volume
Rocking and reduced chest wall movement

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6
Q

where is the tongue when airway is obstructed?

A

the tongue and epiglottis fall back to the anterior posterior wall

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7
Q

What leads to obstruction in an anesthetized patient?

A

loss of airway muscle tone

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8
Q

7 Indications for Tracheal Intubation

A
  1. Airway protection
  2. Initiate and maintain patent airway
  3. Pulmonary toilet needed
  4. Positive pressure ventilation
  5. Long surgical procedures
  6. Airway compromise, inaccessible/shared airway
  7. Inability to maintain control with mask
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9
Q

what type of patients are in need of tracheal intubation for Airway protection purposes?

A

Full stomach, pregnancy, aspiration risk

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10
Q

do Paralyzed patients need tracheal intubation?

A

yes! Positive pressure ventilation

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11
Q

why do you need two laryngoscope handles?w

A

in case the battery is out on one of them

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12
Q

Laryngoscope straight blade?

A

miller

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13
Q

laryngoscope curved blade?

A

macintosh

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14
Q

Lifts the epiglottis directly

Epiglottis is lifted out of the line of vision; better for “anterior” larynx

A

miller blade

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15
Q

compare miller to mac blade in regards to size

A

Smaller than the curved “Mac” and fits in mouths with smaller opening

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16
Q

Tip placed in the vallecula to indirectly lift the epiglottis, thus minimizing trauma

A

macintosh blade

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17
Q

what does a mac blade do to the tongue

A

Better displacement of the tongue leftward for better visualization
Less temptation to “lever” against the upper teeth

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18
Q

Transparent, non-irritating polyvinyl chloride

Softens and molds to contour of airway

A

Endotracheal Tubes

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19
Q

how are Endotracheal Tubes measured

A

mm and measures the internal diameter of the tube

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20
Q

High volume cuff =

A

greater seal area, less pressure, less injury

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21
Q

you want the cuff pressure to be inflated __ why?

A

<20 torr, trachea capillary perfusion pressure 30 torr

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22
Q

low volume cuff =

A

Low seal area, high pressure seal, more effective, more ischemia

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23
Q

what are the 4 American National Standard for Anesthetic Equipment Markings on the ETT

A

Internal diameter (I.D.) in mm
External diameter (O.D.) in mm
Certification of “Implantation Testing” (I.T.)
Radiopaque line to allow visualization on x-ray

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24
Q

what has greatest effect on ETT to the resistance to flow

A

Radius of ETT

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25
Q

why choose small ETT?

A

to minimize trauma, short term intubations

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26
Q

other than cause tracheal seal, what does ET cuff do?

A

Allows positive-pressure ventilation

Minimizes aspiration risk

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27
Q

Hi-Lo = High volume Low Pressure cuff characteristics

A

Larger mucosal contact
Lower incidence of mucosal damage
Higher incidence of sore throat, aspiration, spontaneous extubation, and difficult intubation (bigger, floppy cuff)
“Minimal leak” – pressures of 15-25 torr

28
Q

Low volume, High Pressure cuff characteristics

A

Higher incidence of tracheal mucosal ischemic damage
Only for use in short duration
Can have pressures up to 250 torr on tissues

29
Q

4 Factors affecting Cuff pressure

A

Volume of air used to inflate cuff
Diameter of the cuff in relation to the trachea
Tracheal and cuff compliance
Intrathoracic pressure – cuff pressures increase with coughing

30
Q

what can diffuse into the air-filled cuff to increase the pressure?

A

nitrous

31
Q

Factors to consider ETT size?

A 
Size of patient’s glottis
Reason for intubation
Pathology of the airway
Attempts allowed (only one attempt – smaller)
Length of intubation
Maturity of airway
32
Q

average ETT size female?

A

7-7.5 mm

33
Q

average male ETT size?

A

7.5-9 mm

34
Q

Reinforced with wire in the wall of the ETT to resist kinking
Head and neck surgeries, prone cases

A

Anode or armored tube

35
Q

what happens if wall of anode or armored tube becomes bent?

A

you have to replace it

36
Q

Very floppy, requires stylet for insertion

A

Anode or armored tube

37
Q

Preformed with angles placed at the site of emergence from the nose or mouth to minimize kinking and obstruction to flow.

A

Nasal Rae and Oral Rae TT

38
Q

tube directed toward the forehead

A

nasal rae

39
Q

tube directed toward the chin

A

oral rae

40
Q

Made of silicone impregnated with metal particles, spiral wound stainless steel ETT, or wrapped with metal foil
Prevent puncture or ignition by laser heat

A

Laser-shielded tubes

41
Q

how should you fill cuffs of laser shielded tubes?

A

The cuff remains unprotected and should be filled with methylene blue stained saline so that perforation may be quickly recognized.

42
Q

Double lumen used for selective one-lung ventilation
The bronchial tip is placed in a main bronchus.
Has both a tracheal cuff and a bronchial cuff.

A

endobronchial tube

43
Q

nasal ETT characteristics

A
  • Softer plastic to minimize trauma to nasal mucosa
  • Ring on connector end; tension causes the cuffed end to angle upward to direct the tip anteriorly during nasal intubation.
44
Q

use for Uncuffed ETT?

A

Pediatric use

Minimize postintubation croup

45
Q

why use a bougie?

A

Inability to visualize glottis or guide ETT into proper position – insert distal tip of bougie over arytenoids – slide ETT over guide as CVL are slid over a guidewire into a vessel

46
Q

Anesthetizes airway blunting stimulation of laryngoscopy, reflexes. Minimizes irritation of propofol

A

2% lidocaine, local anesthetic

47
Q

Blunt stimulation and reflexes and SNS outflow due to laryngoscopy

A

IV narcotics

48
Q

patient is unconscious with suppression of reflexes

A

IV anesthetic: (propofol, thiopental)

49
Q

Facilitates ventilation bag mask by relaxing muscles of neck, jaw and thoracic cage. Allows atraumatic tracheal intubation by opening cords

A

paralytic

50
Q

goal of positioning for tracheal intubation

A

align 3 airway axes; oral, pharyngeal and laryngeal (some refer to as tracheal axis)

smallest intubation triangle possible

51
Q

where do you insert blade of laryngoscope?

A

right side

52
Q

grade 1

A

no difficulty seeing structures

53
Q

grade 2

A

only posterior extremity of glottis seen

54
Q

grade 3

A

only epiglottis seen

55
Q

grade 4

A

no recognizable structures

56
Q

what does BURP stand for and why would you do this

A

Backward – posteriorly against vertebrae
Upward - cephalad
Right
Pressure

improve view of cords

57
Q

average ETT positioning marking?

A

20 for female, 22 male

58
Q

most reliable way to verify ETT placement?

A

ventilation

59
Q

ways to verify ETT placement?

A

Chest rise
ETT fogging
Bilateral breath sounds, also listen over epigastrium
ETCO2 – does not rule out endobronchial intubation

60
Q

Indications, advantages for nasal intubations

A

Oral intubation difficult – awake patient
Oral placement would interfere with surgical site
Anticipate prolonged intubation
More stable ETT fixation
More tolerable technique to conscious patient

61
Q

Disadvantages nasal intubations

A

Tissue trauma – nasal mucosa, epistaxis, incidental adenoid damage
Transmission of infection (URI) to trachea and lungs
If smaller tube, increased resistance and secretions more difficult to suction.

62
Q

patients that nasal intubation contraindicated

A

mid-facial trauma, fracture nose, nasal obstruction, or basilar skull fracture

63
Q

cetacaine (benzocaine) can cause methemeglobin with doses

A

> 200-300 mg (1.5 ml)

64
Q

cetacaine (benzocaine) use

A

Effective only on mucus membranes

Controls pain, gag reflex

65
Q

how do you introduce tube during nasal intubation?

A

with bevel directed laterally to avoid damage to turbinates

66
Q

describe angles of tube during nasal intubation

A

Insert the ETT along the floor of the nose – the angle should be perpendicular to the face and the proximal end should be angled from the cephalad side.

Principles 2 (5 decks)

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