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N928- Anesthesia Basics > Airway Equipment > Flashcards

Airway Equipment Flashcards

1
Q

How do oral airways work?

A

Lift the tongue & epiglottis away from the posterior pharyngeal wall thereby preventing obstruction

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2
Q

What are the oral airway sizes?

A 
Green = 80 mm
Yellow = 90 mm
Red = 100 mm
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3
Q

Contraindications to oral airways

A

prone, aspiration risk

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4
Q

How do you measure oral airways?

A

corner of mouth –> pt earlobe

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5
Q

What are the types of oral airways? (4)

A

Guedel, Berman, Ovassapian (fiberoptic int.), CPA

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6
Q

How do nasal airways work?

A

Relieve upper airway obstruction and rests just above epiglottis

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7
Q

How are nasal airways sized and measured?

A

Internal diameter in mm

Measured from nare to ear lobe

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8
Q

Nasal airway contraindications (6)

A 
anticoag therapy or coagulopathy d/o
basilar skull fracture
deformities
nasal infections
nose bleed hx requiring tx
pregnancy
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9
Q

How do you decrease dead space in a face mask?

A

choose the smallest appropriate size; increase FGF

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10
Q

Head-tilt chin lift c/i

A

C-Spine precautions

Pediatric population

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11
Q

Mandibular displacement + upper cervical extension + chin lift =

A

pull tongue soft tissues off posterior pharyngeal wall relieving the obstruction

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12
Q

Difficult mask ventilation RF: (9)

A 
beard
obesity > 26 kg/m2
age > 55
no teeth, no chin, nose is big
s
Others: edema, tumors
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13
Q

What are the advantages of a face mask?

A

low incidence of sore throat
less anesthesia
no relaxants
less $$

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14
Q

What are the disadvantages of a face mask?

A

no hands
fatigue
high FGF
unprotected airway

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15
Q

Complications of a face mask

A 
skin problems
nerve injury (VII)
aspiration
eye injury
lack of correlationb tw PaCO2 and ETCO2 d/t FGF dilute
environmental pollution
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16
Q

LMA

A
  • do not exceed peak pressure 20 cm H2O
  • airway reflexes must be obtunded before insertion
  • never exceed cuff pressure of 60 cm H2O
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17
Q

what do the aperture bars do on the LMA?

A

prevent the epiglottis from obstructing the mask

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18
Q

Size 3

A

Weight: 30-50 kg
Test volume: 30cc
Maximum cuff volume: 20 cc
6.0 cuff

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19
Q

Size 4

A

Weight: 50-70 kg
Test volume: 45 cc
Maximum cuff volume: 30 cc
6.0 cuff

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20
Q

Size 5

A

Weight: 70-99 kg
Test volume: 60 cc
Maximum cuff volume: 40 cc
7.0 cuff

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21
Q

Size 6

A

> 100 kg
Test volume: 75 cc
Maximum cuff volume: 50 cc
7.0 cuff

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22
Q

LMA styles (3)

A

Proseal (gastric lumen to suction)
FasTrach (intubating LMA up to 8.0 ETT)
Regular

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23
Q

How long should the LMA hold its cuff volume?

A

2 minutes (50% more than its maximum)

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24
Q

What can cause the tip of the LMA mask to fold over on itself?

A

failure to press the mask against the hard palate or inadequate lubrication

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25
Q

LMA contraindications

A
  • aspiration risk
  • glottic/subglottic obstruction or pathology
  • limited mouth opening
  • trauma
  • acute abdomen
  • thoracic injury
  • decreased pulmonary compliance
  • peak airway pressures > 20 cm H2O
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26
Q

LDA ADR (4)

A

aspiration
sore throat (most common)
hypoglossal nerve injury, tongue cyanosis, VC paralysis
*laryngospasm if pt is light or in stage II

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27
Q

ETT indications (6)

A
  • aspiration
  • airway anomaly
  • intracranial or intrathoracic or intraabdominal
  • head/neck
  • mechanical ventilation
  • positioning where airway unavailable to CRNA
28
Q

What is the ETT constructed of? Who monitors this?

A

polyvinylchloride

American Society for Testing Material (standard 21)

29
Q

What does F-29, Z-79, or I.T. on an ETT mean

A

it has been tested and does not cause any toxicity

30
Q

Tube length

A

measured in cm

31
Q

Internal diameter

A

measured in mm (0.5 mm increments from 2.5-9)

32
Q

Men size & insertion depth

A

8 or 9 at 24-26cm

33
Q

Women size & insertion depth

A

7 or 8 at 20-22cm

34
Q

Peds

A

size: 4 + age/4
depth: 12 + age/2

35
Q

What is the cuff pressure?

A

Recommended: 20-25 mm Hg
Tracheal perfusion pressure: 25-30 mmHg
Air leak: 15-20 mm Hg

36
Q

Head extension

A

8-10 cm

aligns p/l axes

37
Q

Proper positioning for ETT

A

meatus of ear aligns w/sternal notch

38
Q

Distance from teeth to vocal cords

A

12-15 cm

39
Q

Distance from vocal cords to carina

A

10-15 cm

40
Q

Distance from vocal cords to the carina

A

10-15 cm

41
Q

Where should the cuff be located?

A

the midpoint between vocal cords and carina (T5)

42
Q

Head flexion =

A

1.9 cm advance

43
Q

Head extension =

A

1.9 cm withdrawal

44
Q

Left or right head movment =

A

0.7cm

45
Q

Left or right head movement =

A

0.7cm

46
Q

Physiologic responses to DVL

A

CV: htn, tachy/bradycardia, arrhtymia, MI
IOP/ICP increased
bronchospasm, laryngospasm

47
Q

Deep extubation

A

c/i if pt have difficult airway, aspiration risk, airway edema
no response to suctioning, but spontaneous breathing

48
Q

Awake extubation

A

pt maintains & protects airway, purposeful movement, eyes open, reaction to suctioning

49
Q

Subjective Criteria for Extubation (6)

A 
follows commands
clear oropharynx
gag reflex
head lift > 5s
hand grasp
minimal end expiratory % of IA
50
Q

Objective criteria for extubation (7)

A 
VC > 15 mL/kg
peak voluntary negative insp. pressure > 25 cm H2O
tidal volume > 6mL/kg
sustained tetanic contraction
spo2 > 90% and paO2> 60 mm Hg
RR < 35
PaCO2 < 45
51
Q

Extubation steps (5)

A
  • 100% (maybe) O2
  • suction oropharynx/hypopharynx
  • close APL
  • deflate cuff
  • remove ETT w/positive pressure
52
Q

Causes of compromise post-extubation

A 
residual anesthetic
poor central effort
reduced tone
reduced gag
edema
vocal cord paralysis
laryngo/bronchospasm
53
Q

Nasal intubation indications

A

maxillofacial surgery/oral surgery/dental

54
Q

Nasal intubation c/i

A 
coagulopathy
basil skull fx
intranasal d/o
CSF leak
extensive facial fractures
55
Q

What are the causes of inability to ventilate?

A
  • laryngospasm (nerve injury; light anesthesia)
  • supraglottic soft tissue relaxation
  • chest wall rigidity
  • pathologic glottic/subglottic (edema, stenosis)
  • equipment failure (insp/exp valves)
56
Q

What is glidescope good for?

A
  • difficult airway
  • anterior larynx
  • poor neck mobility
57
Q

Fiberoptic intubation

A
  • difficult airway

- C-spine precautions

58
Q

Bullard scope

A

rigid, useful for difficult airway
$$$$
slow learning curve
attached eyepiece

59
Q

Wu

A

rigid
O2 and suctioning
slow learning curve

60
Q

Upsher

A

rigid

attached eyepiece

61
Q

Bougie

A

eschmann introducer

15Fr, 60 cm long, angled @ 40 degrees

62
Q

Combitube

A

supraglottic airway device; two lumens

63
Q

TTJV

A

need high pressure source (50 PIS)
TV dependent on I:E ratio, compliance, catheter size
use 14g (1600mL/s) or 16g (500 mL/s)

64
Q

TTJV complications

A
  • thick secretions and tracheal mucosal damage blocking airway b/c inadequate humidification of gasses
  • hematoma
  • inadequate delivery of gases
  • barotrauma*
65
Q

Retrograde intubation

A

18G needle @ 45 degree angle

66
Q

Cricothyrotomy components

A 
12-14G needle + 3ml syringe
3 ml syringe-- no plunger
15 mm ETT adaptor from 7 ETT
TTJV
breathing circuit
67
Q

Cricothyrotomy complications

A 
pneumo
emphysema sq
bleeding
esophageal puncture
aspiration
respiratory acidosis

N928- Anesthesia Basics (3 decks)

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