190617_Airway Flashcards

Question

Cormack and Lehane Score

Answer 1

laryngoscopic view of the glottis •Grade I: most of the glottis visible •Grade II: Only the posterior portion of glottis visible •Grade III: Only epiglottis visible •Grade IV: No airway structures visualized

Answer 2

▪Distance from lower border of mandible to thyroid notch with neck fully extended ▪Normal 6-6.5 cm or 4 Fingerbreadths ▪Difficult intubation < 3 fingers, receding mandible; “anterior airway” ~min space to move tongue forward

Answer 3

Class A: Lower incisors can be brought forward past the upper insicors (bite upper lip) Class B: Lower incisors can be brought forward to upper incisors Class C: Lower incisors can NOT be brought forward to upper incisors

Answer 4

* Monitors on and settings appropriate * Suction on and at head of bed * Machine checked, means of positive pressure ventilation * Airway * IV * Drugs (emergency and case/pt specific) * Special equipment

Answer 5

Goal = Increase O2 concentration in functional residual capacity (FRC) by “washing out” nitrogen (79% in RA) in the FRC with oxygen (FRC= volume of air left in the lung at end of passive expiration) •3-5 minutes of “tight” mask fit during normal tidal breathing with100% FiO2 at> 6L/min flow = 10 minutes of safe apnea time •4 vital capacity breaths within 30 seconds with 100% FiO2 at >6L/min= 5 minutes of safe apnea time (8 breaths over 60 seconds will > effectiveness over 4br/ 30sec) •An end-tidal concentration of oxygen greater than 90% is considered to maximize apnea time.

Answer 6

* Loss of AW reflexes has major risk of aspiration * Premise of NPO guidelines * High risk: full stomach, symptomatic gastroesophageal reflux disease (GERD), hiatal hernia, presence of a nasogastric tube, morbid obesity, diabetic gastroparesis, or pregnancy * Aspiration prophylaxis: decrease gastric volume and to increase gastric fluid pH (nonparticulate antacids (e.g., Bicitra), promotility drugs (e.g., metoclopramide), and H2-receptor antagonists. These drugs may be used alone or in combination)

Answer 7

* Appropriate sized face mask* * Means of Positive Pressure Ventilation (PPV)-> ambu-bag, machine circuit; O2 source * Suction on and easily accessible * Tongue depressor * Appropriate sized oral and nasal airways* * Laryngoscope handle* * 2 different blades* * Endotracheal Tube (ETT)- 2 sizes* * Stylet * Syringe * Appropriate sized Laryngeal Mask Airway (LMA) (difficult airway)* * Tape

Answer 8

``` OSA / snoring > 55 y/o Male BMI >/= 30 kg/m^2 Mallampati classification III or IV Beard Edentulousness (missing teeth or dentures) ```

Answer 9

•Effectiveness assessed by: chest rise, exhaled tidal volumes, pulse oximetry, and capnography •Adequate tidal volumes should be achieved with peak inspiratory pressures less than 20 cm H2O •higher pressures should be avoided to prevent gastric insufflation ?•NOT ADEQUATE @ <20 cm H2O? •airway patency and pulmonary compliance should be assessed

Answer 10

``` ❑ Dental damage ❑ Soft tissue/mechanical injury ❑ Laryngospasm ❑ Bronchospasm ❑ Vomiting/Aspiration ❑ Hypoxemia/Hypercarbia ❑ SNS stimulation ❑ Esophageal/Endobronchial intubation ```

Answer 11

- long upper incisors - prominent overbite - inability to protrude mandible - small mouth opening - Mallampati classification III or IV - high / arched palate - short thyromental distance - shorth / thick neck (>17in) - limited cervical mobility

Answer 12

Gold standard for AW management Absolute indications: • full stomach • high risk for aspiration of gastric secretions or blood • critically ill • significant lung abnormalities (e.g., low lung compliance, high airway resistance, impaired oxygenation) • surgery requiring lung isolation • otorhinolaryngologic surgery where an SGA would interfere with surgical access (AW management discussed w/ surgeon) • anticipated need for postoperative ventilatory support • failed SGA placement Others • surgical requirement for NMBDs • positioning that does not allow quick access to the AW (e.g., prone, etc) • predicted difficult airway • prolonged procedures

Answer 13

A variety of types based on pt needs and surgical requirements Common features: • Standard 15-mm adapter • high-volume, low-pressure cuff - Purpose: create a seal to protect against gastric aspiration - Ensures tidal volume delivered reached the lungs • beveled tip: facilitates passage through the vocal cords • “Murphy eye” additional distal opening in the side wall - Back-up portal for ventilation should the distal end of the lumen become obstructed by either soft tissue or secretions • Pilot balloon with one-way valve - Cuff inflation & assessment of cuff pressure - Minimal inflation volume to attain air leak ~20- 25cm H2O

Answer 14

ETT size based on internal diameter (ID) Adult ETT want 2 sizes available • - Female: 6.5-7.0 mm id - Male: 7.5-8.0 mm id Ideal position: distal end in mid-trachea - 4 cm above the carina and 2 cm below the vocal cords *Males approximately 23 cm *Females approximately 21 cm *IDx3= approximate depth Nasal vs. Oral Securement to maxilla (fixed) ***ALWAYS listen for bilateral breath sounds, look for bilateral chest rise and presence of endtidal CO2!

Answer 15

``` Cuffed Un-cuffed Oral RAE NASAL RAE Reinforced tubes Double lumen ETT ```

Answer 16

* shaping the ETT with a malleable stylet into a hockey stick shape * 60-degree angle formed 4 to 5 cm from the distal end * removed when the tip of the ETT is right at the level of the vocal cords * limits trauma to the tracheal mucosa

Answer 17

``` A supraglottic airway device •“perilaryngeal sealer” Multipurpose: • primary airway management device • a rescue airway device • conduit for endotracheal intubation. Appropriate Size is based on patient weight • Adult sizes • 30-50 Kg→ LMA 3 • 50-70 Kg→ LMA 4 • 70-100 Kg→ LMA 5 • >100 Kg→ LMA 6 ``` Classic vs. Supreme LMA ***MUST HAVE BITE BLOCK!!!

Answer 18

Equipment • 20 or 50 cc syringe, • lubricant, suction, stethoscope, tape, soft bite block Adequate depth of anesthesia is critical for successful insertion Deflate cuff (+/-), lubricate posterior aspect After insertion, inflate with minimum effective volume of air • target cuff pressure of 40 to 60 cm H2O Confirmation: gentle PPV, capnography, and auscultation • leak audible at inspiratory pressure ~18 to 20 cm H2O

Answer 19

* increased speed and ease of placement by inexperienced personnel * improved hemodynamic stability at induction and during emergence * reduced anesthetic requirements for airway tolerance •lower frequency of coughing during emergence * lower incidence of sore throats in adults (10% vs 30%) * avoids “foreign body” in the trachea

Answer 20

* NOT a definitive AW * lower seal pressure (inability to use mechanical ventilation* (at higher peak pressures)) * higher frequency of gastric insufflation * does not maximally protect against aspiration * no protection against laryngospasm

190617_Airway Flashcards

(44 cards)