460: Airway Assessment Flashcards Preview

MSA S2015 > 460: Airway Assessment > Flashcards

Flashcards in 460: Airway Assessment Deck (15):
1

Three mechanisms of injury

1. Esophageal intubation
2. Failure to ventilate
3. Difficult intubation

2

Complications

1. Chipped/ broken teeth
2. Oropharyngeal lacerations
3. Facial trauma
4. Upper airway trauma
5. Ocular trauma
6. Hypoxia
7. Hypercapnia
8. Aspiration
9. Cardiovascular collapse
10. Cardiovascular activation
11. Cerebral insult
12. Edema
13. Hemorrhage
14. Infection
15. Cervical spine injury

3

History and physical consists of...

1. CC - chief complaint
2. HPI - history of present illness
3. PMH - past medical history
4. PSH - past surgical history
5. ROS - review of systems
6. Vital signs
7. PE - physical exam
8. A/P - assessment and plan

4

NPO status

Clear liquids - 2h (incl coffee, apple juice)
Breast milk - 4h
Infant formula - 6h (more fat)
Non-human milk - 6h
Light meal - 6h
Full meal - 8h

5

Dentition numbering system

Adult teeth is numbered from upper right to upper left (1-16) and from bottom left to bottom right (17-32). The most commonly damaged teeth during intubation are 7, 8, 9, 10 and following those, 23, 24, 25, 26.

6

Airway examination --> LEMON

Look
Evaluate
Mallampati score
Obstruction
Neck mobility

7

Look
LEMON

Obesity
Short thick immobile neck
Facial hair
High arched palate
Macroglossia/ large tongue
Neck scars
Cosmetic changes of oral opening
Prominent teeth
Receding mandible
Poor mouth opening
Inability to sublux jaw
Mallampati score
Thyromental distance (6-7cm)
Sternomental distance (12-13cm)

8

Evaluate
LEMON

3:3:2 rule
- normal mouth opening is 3 patient fingerbreadths
- normal mandibular dimensions is 3 fingers between mentum and hyoid bone
- normal neck dimenision is 2 fingers between hyoid bone and thyroid cartilage

9

Mallampati score

Have patient extend neck, open mouth fully, protrude tongue, and act as if saying "ahhh"
- 1: hard & soft palate, fauces, pillars, entire uvula
- 2: soft palate, fauces, part of uvula
- 3: soft palate and base of uvula
- 4: only hard palate

10

Obstruction
LEMON

Look for foreign bodies in mouth, growths/masses in mouth or neck, tracheal deviation, as well as stridor (high pitched sound due to turbulent airflow in airway)

11

Difficult bag-mask ventilation

Facial hair
Facial deformities
Large head
Obesity (soft tissue of neck collapses during induction of anesthesia)
Large tongue (gets in way of airflow)
OSA - obstructive sleep apnea

12

Nasal trumpet sizing

Equal distance from nares to meatus of ear (opening to auditory canal)

13

Oral airway sizing

Equal distance from mouth to angle of mandible. In most adults, size 8 or 9.

14

ETT sizing

Adults: most males are 7.5-8 while females are 7.0

Pediatrics: 4 + Age/4
- tubes come in half sizes, so found up or down to nearest tube size

15

Risk assessment for intubation

1. Mouth opening less than 4cm
2. Thyromental distance less than 6cm
3. Sternomental distance less than 12.5cm
4. Mallampati scores III and IV
5. Decreased subluxation of mandible