22. Nasal Intubation

Question 1

where does the pituitary gland sit

Answer 1

in the sphenoid bone

Question 2

what causes increased bleeding in the nasal cavity

Answer 2

adenoid pad
(very vascular)

Question 3

nasal intubation indications

Answer 3

oral not available
- jaw wired shut
- severe oral cavity swelling
impedance
- dental surgery
- OMFS surgery
better tolerated in extended care

Question 4

why are nasal intubations better tolerated for extended care pts?

Answer 4

decreases sedation requirements

Question 5

nasal intubation absolute contraindications

Answer 5

epiglottitis
midface instability
hx of basal skull fracture/surgery
bleeding disorders
choanal atresial

Question 6

basal skul fractures/surgeries

Answer 6

pituitary tumors
meningiomas
chordomas
trigeminal neuralgia surgery

Question 7

bleeding disorders

Answer 7

thalassemia
anti-coagulants

Question 8

choanal atresia

Answer 8

failure for nare to open

Question 9

nasal intubation relative contraindications

Answer 9

obstruction of nasal airway
-lg polyps
- foreign bodies
recent nasal surgery
frequent epistaxis

Question 10

epistaxis

Answer 10

nose bleeds

Question 11

prolonged nasal intubation: issues

Answer 11

nasal damage
local abscesses
otitis media (cant drain ears)
sinusitis

Question 12

nasal intubation complications

Answer 12

epistaxis
fractured turbinate
avulsed nasal polyps
septal abscess
avulsed adenoids
bacteremia

Question 13

nasal intubation equipment

Answer 13

magic forceps
nasal RAW endotracheal tube
red robinson catheter
warming (towels/saline)
laryngoscope

Question 14

why do you need to warm nasal tubes

Answer 14

tubes are stiff
need to make more pliable

Question 15

nasal dilators

Answer 15

28Fr
30Fr
32Fr
34F

work up sequentially

Question 16

increase diameter of Nasal Rae

Answer 16

increase length of nasal Rae

Question 17

nasal rae sizing limiting factor

Answer 17

overall diameter
preformed bend (RAE)

Question 18

which nasal rae tubes can be inserted deeper?

Answer 18

larger diameters

Question 19

what should you do prior to rolling pt back for nasal intubation?

Answer 19

vasoconstrict both nares

Question 20

nasal vasoconstrictors

Answer 20

1% phenylephrine
afrin/oxymetazoline
4% cocaine pledget
epinephrine pledget

Question 21

which nasal vasoconstrictor provides analgesia?

Answer 21

4% cocaine pledget

Question 22

most common nasal vasoconstrictors

Answer 22

pehnylephrine
afrin

Question 23

nasal rae insertion

Answer 23

along floor of nasal passage
perpehndicular to face
bevel directed laterally

Question 24

which way is bevel during nasal rae insertion

Answer 24

bevel directed laterally

Question 25

why do we need to cover the murphy eye during nasal intubation?

Answer 25

murphy eye causes scraping, bleeding, trauma

Question 26

how do you direct the nasal Rae into glottic opening?

Answer 26

use the magil forceps

Question 27

what do you need to be cautious off when using magil forceps?

Answer 27

do not grab onto the tube cuff it could tear

Question 28

securing nasal rae

Answer 28

pad connector dont fishhook nare tape circumferential

Question 29

fishhooking the nare can cause

Answer 29

cut off blood flow blanching tissue tissue necrosis

Question 30

head flexion with nasal rae

Answer 30

pushes NETT deeper into trachea risk mainstem or carina stimulation

Question 31

head extension with nasal rae

Answer 31

withdraws NETT out of trachea risk tube popping out of airway

Question 32

retrograde intubation

Answer 32

place needle through cricothyroid membrane thread seldingwire through neck and out of mouth place arndt catheter over seldingwire remove selding wire ETT over catheter remove catheter

Question 33

retrograde intubation requires

Answer 33

time proper MV definitive pre-ox

Question 34

jet ventilation indications

Answer 34

removal of foreign bodies evaluation of airway dynamics removal of lesions

Question 35

jet ventilation limitations

Answer 35

airway pollution (open airway) no end-tidal measuring possible loss of airway limits ability to multitask

Question 36

jet ventilation anesthetics

Answer 36

TIVA only

Question 37

when is jet ventilation used?

Answer 37

typically with rigid bronchoscope

Question 38

types of jet ventilation

Answer 38

supraglottic subglottic

Question 39

supraglottic jet ventilation

Answer 39

air introduced above glottic opening rigid bronchoscope accessory port

Question 40

subglottic jet ventilation

Answer 40

typically emergency only small catheter intriduced through glottic or through cricothyroid membrane

Question 41

jet ventilator hooks up to what air supply?

Answer 41

wall supply DISS 50 psi

Question 42

what should you ask surgical team about prior to starting jet ventilation?

Answer 42

ask to see the O2 jet adapter

Question 43

do you use an ETT or LMA prior to jet ventilation

Answer 43

LMA (typically Igel) w/100% FiO2

Question 44

jet ventilation handle squeeze frequency/duration

Answer 44

8 times/min duration <1 second

Question 45

jet ventilation pressure

Answer 45

15 psi (ideal) 25-50 psi may be needed depends on level of compliance

Question 46

how do you verify adequate pressure during jet ventilation

Answer 46

watch for chest rise

Question 47

ventilation includes

Answer 47

O2 IN CO2 OUT

Question 48

do you paralyze during jet ventilation

Answer 48

yes

Question 49

what are common symptoms post-jet ventilation?

Answer 49

coughing irritation treat w/narcotics and humidified air