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N928- Anesthesia Basics > Airway Equipment > Flashcards

Airway Equipment Flashcards

(67 cards)

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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
LMA contraindications
- aspiration risk - glottic/subglottic obstruction or pathology - limited mouth opening - trauma - acute abdomen - thoracic injury - decreased pulmonary compliance - peak airway pressures > 20 cm H2O
26
LDA ADR (4)
aspiration sore throat (most common) hypoglossal nerve injury, tongue cyanosis, VC paralysis *laryngospasm if pt is light or in stage II
27
ETT indications (6)
- aspiration - airway anomaly - intracranial or intrathoracic or intraabdominal - head/neck - mechanical ventilation - positioning where airway unavailable to CRNA
28
What is the ETT constructed of? Who monitors this?
polyvinylchloride | American Society for Testing Material (standard 21)
29
What does F-29, Z-79, or I.T. on an ETT mean
it has been tested and does not cause any toxicity
30
Tube length
measured in cm
31
Internal diameter
measured in mm (0.5 mm increments from 2.5-9)
32
Men size & insertion depth
8 or 9 at 24-26cm
33
Women size & insertion depth
7 or 8 at 20-22cm
34
Peds
size: 4 + age/4 depth: 12 + age/2
35
What is the cuff pressure?
Recommended: 20-25 mm Hg Tracheal perfusion pressure: 25-30 mmHg Air leak: 15-20 mm Hg
36
Head extension
8-10 cm | aligns p/l axes
37
Proper positioning for ETT
meatus of ear aligns w/sternal notch
38
Distance from teeth to vocal cords
12-15 cm
39
Distance from vocal cords to carina
10-15 cm
40
Distance from vocal cords to the carina
10-15 cm
41
Where should the cuff be located?
the midpoint between vocal cords and carina (T5)
42
Head flexion =
1.9 cm advance
43
Head extension =
1.9 cm withdrawal
44
Left or right head movment =
0.7cm
45
Left or right head movement =
0.7cm
46
Physiologic responses to DVL
CV: htn, tachy/bradycardia, arrhtymia, MI IOP/ICP increased bronchospasm, laryngospasm
47
Deep extubation
c/i if pt have difficult airway, aspiration risk, airway edema *no response to suctioning, but spontaneous breathing*
48
Awake extubation
pt maintains & protects airway, purposeful movement, eyes open, reaction to suctioning
49
Subjective Criteria for Extubation (6)
``` follows commands clear oropharynx gag reflex head lift > 5s hand grasp minimal end expiratory % of IA ```
50
Objective criteria for extubation (7)
``` 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
Extubation steps (5)
- 100% (maybe) O2 - suction oropharynx/hypopharynx - close APL - deflate cuff - remove ETT w/positive pressure
52
Causes of compromise post-extubation
``` residual anesthetic poor central effort reduced tone reduced gag edema vocal cord paralysis laryngo/bronchospasm ```
53
Nasal intubation indications
maxillofacial surgery/oral surgery/dental
54
Nasal intubation c/i
``` coagulopathy basil skull fx intranasal d/o CSF leak extensive facial fractures ```
55
What are the causes of inability to ventilate?
- laryngospasm (nerve injury; light anesthesia) - supraglottic soft tissue relaxation - chest wall rigidity - pathologic glottic/subglottic (edema, stenosis) - equipment failure (insp/exp valves)
56
What is glidescope good for?
- difficult airway - anterior larynx - poor neck mobility
57
Fiberoptic intubation
- difficult airway | - C-spine precautions
58
Bullard scope
rigid, useful for difficult airway $$$$ slow learning curve attached eyepiece
59
Wu
rigid O2 and suctioning slow learning curve
60
Upsher
rigid | attached eyepiece
61
Bougie
eschmann introducer | 15Fr, 60 cm long, angled @ 40 degrees
62
Combitube
supraglottic airway device; two lumens
63
TTJV
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
TTJV complications
- thick secretions and tracheal mucosal damage blocking airway b/c inadequate humidification of gasses - hematoma - inadequate delivery of gases * barotrauma*
65
Retrograde intubation
18G needle @ 45 degree angle
66
Cricothyrotomy components
``` 12-14G needle + 3ml syringe 3 ml syringe-- no plunger 15 mm ETT adaptor from 7 ETT TTJV breathing circuit ```
67
Cricothyrotomy complications
``` pneumo emphysema sq bleeding esophageal puncture aspiration respiratory acidosis ```

N928- Anesthesia Basics (3 decks)

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