Airway assessment Flashcards
(77 cards)
1
Q
Nasal passages are also called ______
A
fossae
2
Q
The nasal passages include 3 _______ that divide the nasal passage into 3 scroll-shaped meatuses
A
turbinates
3
Q
The preferred pathway for nasal airway devices
A
Inferior meatus - between inferior turbinate and floor of nasal cavity
4
Q
Nasal vasoconstrictors include
A
- Cocaine
- Oxymetazoline (Afrin)
- phenylephrine
5
Q
The cribriform plate is
A
roof of nasal passage/floor of cranial fossa
6
Q
The hard palate is formed by parts of the _______ and _______, makes up which part of the roof of the mouth?
A
maxilla and palatine bone
makes up anterior 2/3rds roof of mouth
7
Q
Pharyngeal musculature in the awake patient helps maintain
A
airway patency
8
Q
One of the primary causes of upper airway obstruction during anesthesia
A
loss of pharyngeal muscle tone
9
Q
What is a method of counteracting the tendency of the pharyngeal airway to collapse
A
Chin lift with mouth closure, increases longitudinal tension in the pharyngeal muscles
10
Q
Where does the nasopharynx end?
A
at the soft palate; this region is termed velopharynx
11
Q
What is the common site of airway obstruction in both awake and anesthetized patients?
A
velopharynx
12
Q
What are the 3 regions of the pharynx
A
Nasopharynx, oropharynx, hypopharynx
13
Q
The pharynx extends from
A
base of the skull to lower border of cricoid cartilage
14
Q
The oropharynx includes
A
soft palate to epiglottis
15
Q
The hypopharynx includes
A
epiglottis to cricoid cartilage
16
Q
The larynx extends from
A
epiglottis to lower end of cricoid cartilage; 6th cervical vertebrae
17
Q
The larynx includes which structures
A
- epiglottis
- supraglottis
- vocal cords
- glottis
- subglottis
18
Q
Functions of the larynx includes
A
- inlet to trachea
- phonation
- airway protection
19
Q
The larynx is suspended from the ___________ by the __________
A
hyoid bone, thyrohyoid membrane
20
Q
Which laryngeal cartilages are paired
A
- arytenoids
- corniculate
- cuneiform
21
Q
Which laryngeal cartilages are unpaired
A
- thyroid
- cricoid
- epiglottis
22
Q
Which is the only complete ring cartilage
A
cricoid cartilage
23
Q
The true vocal cords attach to
A
arytenoids and the thyroid notch on thyroid cartilage
24
Q
Which is the largest of the laryngeal cartilages
A
thyroid cartilage
25
The trachea extends from
inferior cricoid membrane to carina
26
Normal trachea length in adults
10-15cm
27
The trachea is anteriorly bound by _________, and posteriorly by the ___________
anterior = C-shaped tracheal rings
posterior= longitudinal trachealis muscle
28
What should be conducted before initiation in all patients thoroughly
basic airway assessment
can i ventilate/intubate?
29
What airway assessment is the most valuable, more than any testing
Reviewing history
- Asking the patient if they have had history of difficulty with anesthesia. (complaints of jaw soreness or hoarseness may indicate difficulty masking or intubating)
- review of past medical records
- report of cut lip/broken tooth
- history of OSA
- intraoral lesions present
30
Most predictive factor of difficult intubation
past difficult intubation
31
OSA screening tool
STOP BANG
snoring, tired, obese, pressure (htn), BMI >35, age >50, neck circum >40cm, gender=male
32
Airway evaluation includes
- visual inspection of face and neck
- Assessment of mouth opening
- Evaluation of oropharyngeal anatomy and dentition
- assessment of neck ROM (sniffing position)
- assessment of submandibular space
- mandible movement (bulldog face, upper teeth behind lower)
33
Visual inspection findings that would indicate potentially difficult airway
- facial deformities
- head/neck cancers
- burns (singed facial hair)
- Goiter
- short or thick neck >43cm, more predictive than bmi
- Receding mandible/recessed jaw
- beard
- c-collar
34
Ideal mouth opening (interincisor distance) should be
>6cm or (3 patient finger-widths)
35
Treatment of angioedema from ACE-i include
FFP and transexamic acid (TXA)
36
Lack of teeth may make what more difficult?
masking, teeth provide structure
edentulous= teethless
37
25% of insurance claims against anesthesia are because of
dental injuries
38
Which teeth are most common to damage during intubation
frontal and left side (due to where we insert blade)
anterior maxillary central and lateral incisors
39
The sniffing position incorporates
cervical flexion and atlanto-occipital extension
aligns oral, pharyngeal and laryngeal axis
40
Proper sniffing position should align the ____ and _____
ears to sternum
41
Ideal sternomental distance
>12.5cm
distance between sternal notch and chin
42
Ideal thyromental distance
>6.5cm (3 finger)
tip of chin to thyroid notch
43
Mallampati test includes
Visibility of oropharyngeal structures
class 1-4
patient seated upright, head neutral, mouth open, tongue protruded, no phonation
44
Mallampati class 1 can visualize
fauces, pillars, entire uvula, soft palate
45
mallampati class 2 can visualize
fauces, portion of uvula, soft palate
46
Mallampati class 3 can visualize
Base of uvula and soft palate only
47
Mallampati class 4 can visualize
only hard palate
48
Proper cricoid manipulation
BURP
backward, upward, rightward pressure
49
Classification of laryngeal view is called
Cormack-Lehane classification, grades 1-4
50
Cormack-Lehane grade 1 can visualize
entire glottis
51
Cormack-Lehane grade 2 can visualize
Only posterior portion of the glottis
sometimes classified as 2a or 2b
2a= partial view of glottis
2b= only posterior extremity of glottis or only arytenoid cartilages seen
52
Cormack-Lehane grade 3 can visualize
No part of the glottis and only epiglottis
53
Cormack-Lehane grade 4 can visualize
No visualization of epiglottis
54
Criteria for difficult mask ventilation include
OBESE
- O -Obesity, BMI >30
- B - beard
- E - Edentulous (no teeth)
- S - Snorer, OSA
- E - Elderly (>55), male
Mallampati 3 or 4
55
An awake intubation may be appropriate when
difficult airway, allows patient to maintain their own airway during intubation. Should be thoroughly planned
56
If your attempt to intubate fails, what should be done next
- Limit attempts, call for help
- mask ventilate if possible
- if masking not adequate, consider supraglottic airway (LMA)
- consider waking the patient up and canceling case
57
Emergency invasive airway should be performed
if still cant ventilate with mask or supraglottic airway
58
Intubating early is best in which conditions
dynamic airways: only going to get worse over time
- bullets, neck trauma
- bites, anaphylaxis/angioedema
- burns, thermal and caustic airway injuries
59
Which conditions would RSI be favorable compared to awake intubation
- Urgency: peri-arrest, airway deteriorating
- Airway features: known easy airway, normal anatomy
- Vomiting risk: upper GI bleed, bowel obstruction, vomiting in ED
- Sympatholysis risk
- Apnea risk
paralyzed patients easy to intubate but cannot easily un-paralyze
60
Medications to give with awake intubation
- Glycopyrolate 0.2mg or Atropine 0.01mg/kg, 15min prior
- Nebulized lidocane (WITHOUT EPI), 4mL 4% lido, or 8mL 2% lido
- Atomized lidocaine
- Viscous lidocaine
- light sedation, Versed 2-4mg or Ketamine 20mg, precedex 20mcg
61
The black stripe on a bougie is marked at _____ cm
25cm, should be at lips, mid trachea in adult male
62
A risk of giving lots of opioids quickly is
stiff, rigid chest. difficulty ventilating
63
When should succinylcholine be avoided
- rhabdo/trauma patients
- hyperkalemia
- MS
- muscular dystrophies
- denervating injuries > 72hrs old (stroke, spinal cord inj)
- burns >72hrs
- Tetanus, botulism, and exotoxins
- severe infections (esp. intra-abdominal)
- predisposition to MH
- bradycardia
- increased ICP
64
Contraindications for rocuronium
true allergy only
65
Succinylcholine vs Rocuronium DOA
Sux= 5-10min
Rocuronium= 30-90min
66
The 3 physiologic killers are
hypoxemia, hypotension, metabolic acidosis
67
Succinylcholine onset
45seconds
68
What dose of rocuronium gives the same onset of succinylcholine
1.6mg/kg
69
What is appropriate dose of succinylcholine
2mg/kg IV
70
In emergent situations, which vasopressor should be the agent of choice
epinephrine, vasopressin good alternative if patient not responding to epi
71
Why is phenylephrine less ideal to be used in emergent situations
increases vascular resistance and BP, but decreases cardiac output and venous return. Can cause reflex bradycardia
72
Intervention 1 in emergency ventilating
Apneic CPAP recruitment
NC 15LPM+ BVM 15PM + PEEP Valve 5-15cmH20
If they're breathing, just keep good seal
73
In critically ill patients in which you cannot get O2 sats >95%, you should consider what?
shunt pathology, use Apneic CPAP recruitment
74
Intervention 2 in emergency ventilating
Delayed sequence intubation (DSI)
Used for uncooperative or combative patient
- Ketamine 1mg/kg IV -> preoxygenate -> paralyze -> Apneic oxygenation -> intubate
75
Treatment of acidosis
Tenuous at best= bicarb (lowers H+ but increases CO2)
already tachypnic= increasing CO2 would worsen
VAPOX= ventilator assisted pre-oxygenation
76
Ventilator Assisted Pre-oxygenation (VAPOX) includes:
- Nasal cannula 15LPM
- SIMV+PSV
- RR 0
- Vt 8mL/kg predicted body weight
- PS 5-10cmH20
- PEEP 5
- inspiratory flow rate= 30LPM (normal vent set 60LPM; we want slower breaths to avoid insufflation of stomach)
- decrease flow rate to avoid stomach insufflation
- increase flow to compensate for mask leak
77
If patient is high aspiration risk, what should be done prior to intubation
NGT to suction
