2 Airway Management

Question 1

Goals of Airway Management

Answer 1

Ventilation - if you can ventilate, it’s not an emergency

Oxygenation

Question 2

7 P’s

Answer 2

Preparation
Pre-oxygenation
Pre-treatment
Paralysis w/ induction
Positioning
Placement w/ proof
Post-Intubation management

Question 3

Pharynx

Answer 3

oro-, naso-, hypo-

• glossopharyngeal nerve innervates posterior wall of pharynx
• vagus nerve for gag reflex

Question 4

Hypopharynx location & innervation

Answer 4

C5-6, vagus nerve, RLV, SLN

epiglottis to inferior cricoid cartilage

Question 5

Larynx Functions

Answer 5

• protects lower airway
• patency
• gag & cough reflex
• phonation

Question 6

3 single cartilages of Larynx

Answer 6

Epiglottis
Thyroid
Cricoid

Question 7

3 unpaired cartilages of Larynx

Answer 7

Arytenoid
Cuneiform
Carniculate

Question 8

Intrinsic & Extrinsic Muscles of Larynx control…

Answer 8

Extrinsic control - move entire larynx, elevators & depressors
Intrinsic control -

Question 9

Lower Respiratory Tract

Answer 9

structures below cricoid cartilage

Question 10

Trachea

Answer 10

inferior cricoid cartilage down to carina (10-20cm)

Question 11

Only full ring of cartilage in trachea…

Answer 11

cricoid, then 16-20 c-shaped rings

Question 12

Airway Evaluation

Answer 12

• central to any plan, must be thorough

- consider equipment, staff experience

Question 13

Potential causes of difficult intubation

Answer 13

• inadequate pre-op assessment
• anesthetist
• equipment
• inexperience

Question 14

ASA definition of difficult to ventilate

Answer 14

when signs of inadequate ventilation cannot be reversed by mask ventilation
OR
the pts oxygen saturation cannot be maintained above 90% with mask ventilation

Question 15

ASA definition of difficult to intubate

Answer 15

a trained anesthetist provider, using conventional laryngoscopy, requires more than 3 attempts or more than 10 minutes to complete tracheal intubation

Question 16

ASA definition of difficult airway

Answer 16

a trained anesthetist experiences difficulty with facemask ventilation, laryngoscopy, intubation or all of the above

Question 17

LEMON

Answer 17

Look externally
Evaluate 3-3-2 rule
Mallampati
Obstruction/Obesity 
Neck mobility--> atlanto-occipital range

Question 18

BONES

Answer 18

*mnemonic for if mask ventilation will be difficult
Beard
Obesity
No teeth
Elderly (>55y/o, loose airway elasticity)
Snoring

Question 19

4 D’s

Answer 19

*predict how difficult laryngeal visualization may be
Disproportion
Distortion
Dismobility
Dentition

Question 20

Anticipated Difficult Airway…

Answer 20

-cricothyroid membrane should be identified and marked prior to surgery

Question 21

Anticipated Difficult Airway…

Answer 21

-cricothyroid membrane should be identified and marked prior to surgery

Question 22

Cricothyrotomy

Answer 22

• cricothyroid membrane
• 14F angiocath, 3.0 ETT adapter + bag
• needle vs surgical

Question 23

3 options for airway management…

Answer 23

1. ) awake intubation
2. ) quick look - sedated, no paralytic, decreased risk of failed BVM
3. ) induction & paralysis - classic

Question 24

Pre-oxygenation technique

Answer 24

1. ) tidal volume breathing for 3-5 min
2. ) deep breaths x4 within 30 seconds (preferred)

**increase arterial oxygen tension, good for pts with limited FRC

Question 25

Initial intubation attempts after GA unsuccessful -->

Answer 25

1. ) call for help 2. ) return of spontaneous ventilation - sux, prop, LMA 3. ) awakening patient

Question 26

Initial intubation attempts after GA unsuccessful -->

Answer 26

1. ) call for help 2. ) return of spontaneous ventilation - sux, prop, LMA 3. ) awakening patient

Question 27

LMA/SGA

Answer 27

- intubation conduit | - size based on ideal weight, typically sz 4

Question 28

Laryngeal Scope Blades

Answer 28

Mac Miller Wis Heine

Question 29

Fiberoptic Intubation

Answer 29

- nasal or oral | - useful for tricky intubation or when putting in double lumen tube

Question 30

Video Assits

Answer 30

glidescope | McGrath

Question 31

Tube Changer

Answer 31

bougie- helpful if you can't see cords at all - feel tracheal cartilage

Question 32

Light wand

Answer 32

Eschmann stylet

Question 33

Invasive Airway Access

Answer 33

Jet ventilation percutaneous intubation retrograde intubation surgical airway

Question 34

Plan A

Answer 34

Initial Strategy elective intubation RSI -bougie, blade, video scope

Question 35

Plan B

Answer 35

Secondary intubation strategy - NOT appropriate for elective RSI - classic LMA - fiberoptic intubation through LMA

Question 36

Plan C

Answer 36

Maintain oxygenation & ventilation - attempt to wake pt up, consider suggamedex if available - facemask, NP airway, LMA

Question 37

Plan D

Answer 37

rescue techniques --> can't intubate, can't ventilate | -needle cricothyroidotomy

Question 38

Upper Airway Obstruction

Answer 38

- emergent | - s/s hoarse, muffled voice, difficulty swallowing, secretions, stridor, dyspnea

Question 39

Lower Airway Obstruction

Answer 39

management- optimize ventilation & oxygenation | -high peak pressure, low TV, impaired ventilation

Question 40

Pts with OSA...

Answer 40

bring CPAP to PACU

Question 41

Obese pts...

Answer 41

- position - pre-oxygenate (limited FRC) - have alternate plans - will desat quicker, limit delays

Question 42

Extubation Criteria

Answer 42

- hemodynamic stability - normothermia - ability to maintain airway (TOF >0.9, lift head for 5 sec) capacity >15ml/kg - ability to oxygenate - acceptable analgesia