Session 23. Fiberoptic Intubation/Bronchoscopy

Question 1

fiberoptic power cord

Answer 1

light source
video

Question 2

fiberoptic channel port

Answer 2

O2
meds
suctioning

Question 3

fiberoptic scope eyepiece

Answer 3

video adapter
direct viewing (older scopes)

Question 4

control section/lever

Answer 4

moves tip up and down relative to scope

Question 5

directionality of fiberoptic scope

Answer 5

counterclockwise = left
clockwise = right

Question 6

what hand do you hold fiberoptic scope

Answer 6

left

Question 7

diopter ring

Answer 7

focuses view

Question 8

insertion cord avg length

Answer 8

600mm

(range: 500-650mm)

Question 9

fiberoptic light source

Answer 9

battery powered source
LED
or Incadescnet

Question 10

moving lever down

Answer 10

moves tip up

Question 11

moving lever up

Answer 11

moves tip down

Question 12

fiberoptic scope cost

Answer 12

20K

Question 13

cost to fix broken fiberoptic scope

Answer 13

9K

Question 14

fiberotic strands are

Answer 14

glass
(dont bend)

Question 15

fiberoptic indications

Answer 15

anticipated difficult tracheal intubation
anticipated difficult mask ventilation
very small mouth opening
unstable cervical spine
upper airway trauma (false passage)
tube placement verification (double lumen)

Question 16

fiberoptic absolute contraindications

Answer 16

lack of time

Question 17

fiberoptic relative contratindications

Answer 17

active profuse bleeding
active vomiting
uncooperative pt

Question 18

what might obscure visualization of fiberoptic scope?

Answer 18

secretions
blood
vomit

Question 19

oral fiberoptic mthod

Answer 19

facial/skull injury
gagging likely

Question 20

nasal fiberoptic method

Answer 20

small mouth opening
conduit to guide scope

Question 21

sedated fiberoptic method

Answer 21

deep sedation
- ketamine
- glyco
- precedex
hypoventilation/apenic risk

Question 22

what pts are best for sedated fiberoptic scopes

Answer 22

uncooperative pts

Question 23

awake fiberoptic method

Answer 23

most preferred
maintains ventilation
preserves airway reflexes

Question 24

equiment for fiberoptic scope

Answer 24

sedation/pre-meds
LMA/ETT/CMAC
localization
bronchoscope
supp O2
ENT on standby

Question 25

what do you premedicate w/ prior to fiberoptic scope

Answer 25

glycopyrrolate (0.2mg)
15-20min prior

Question 26

best drugs for fiberoptic scope

Answer 26

glycopyrrolate (antisalagogoue)
precedex
versed
ketamine

Question 27

other drugs for fiberoptic scope

Answer 27

propofol
remi

Question 28

what is the most important step for fiberoptic scope prep?

Answer 28

localization

Question 29

localization (FO prep)

Answer 29

nebulize 4% lidocaine during pre-ox

nasal: phenylephine/lido in nares
oral: incrementally spray onto tongue/oropharynx

Question 30

what is easily stimulated in the airway?

Answer 30

vocal cords
carina

Question 31

when do you use fiberoptic airway?

Answer 31

oral route

Question 32

type of fiberoptic airways

Answer 32

ovassapian
williams
bermann II

Question 33

what can happen if you run scope into carina?

Answer 33

coughing

Question 34

tracheal rings are located

Answer 34

anterior

Question 35

pt education for F.O scope

Answer 35

not comfortable experience
give hand to hold

Question 36

how much lido should you give for F.O scope?

Answer 36

be mindful of toxic dose
ensure accurate total documented to provide to surgeon

Question 37

how does lidocaine work>

Answer 37

Na+ antagonist

Question 38

too much lidocaine can cause

Answer 38

decreased HR

Question 39

lidocaine toxic dosages

Answer 39

4 mg/kg
7mg/kg w/epi

Question 40

F.O. suction port

Answer 40

not helpful due to small size
best to avoid secretions