Airway indications CC Flashcards
1
Q
Supraglottic airways (laryngeal mask airways or LMAs) indications
A
- Alternative to ET intubation (not as a replacement) or mask ventilation
- Rescue device in expected/unexpected difficult airway
- Conduit for intubating stylet, flexible fiberoptic bronchoscopy/intubation (FOB), or small diameter ETT
2
Q
Contraindications to supraglottic airways
A
- Pharyngeal pathology
- Obstruction
- High aspiration risk
- Low pulmonary compliance (need PIP >20 cm H2O)
- Long surgeries
3
Q
Flexible fiberoptic bronchoscopes indications
A
- Potentially difficult laryngoscopy/mask ventilation
- Unstable cervical spines
- Poor cervical range of motion
- TMJ dysfunction
- Congenital/acquired upper airway anomalies
4
Q
Awake flexible fiberoptic intubation indications
A
- Cervical spine pathology
- Obesity
- Head & neck tumors
- Hx of a difficult airway
- Presence of anterior mediastinal mass
5
Q
Indications of fiberoptic bronchoscopy in intubated patients
A
- Obtain lower respiratory tract secretions for diagnosis of pneumonia
- Clearing of secretions that are not adequately cleared by more conservative methods
- Persistent atelectasis that fails to respond to conservative treatment
- Assess upper airway patency
- Assess hemoptysis
- Determine the location and extent of injury from toxic inhalation or aspiration
- Perform difficult intubation
- Remove aspirated foreign body
6
Q
Indications for tracheal intubation
A
- Upper airway obstruction
- Emergency drug delivery in cardiac arrest (epinephrine, atropine, lidocaine, naloxone)
- Respiratory failure
- Shock or hemodynamic instability
- Neuromuscular weakness with progressive respiratory compromise
- Absent protective airway reflexes (cough, gag)
- Inadequate respiratory drive
- Need to maintain normocarbia in pt with increased ICP
- GCS <8 for trauma pt
7
Q
Endotracheal intubation in COPD indications
A
- PaO2 < 55-60
- Increasing PaCO2
- Decreasing pH
- High RR
- Respiratory fatigue
- Change in MS
- Hemodynamic instability
8
Q
Nasotracheal intubation indications
A
- Intraoral, facial/mandibular procedures
9
Q
Contraindications to nasotracheal intubation
A
- Basilar skull fx
- Nasal fx
- Polyps or tumors
- Underlying coagulopathies
- Upper airway foreign body obstruction
10
Q
Rapid sequence intubation indications
A
- Pt at high risk for aspiration
- Full stomach
- Pregnant
- GERD
- Morbidly obese
- Bowel obstruction
- Delayed gastric emptying—pain/diabetic gastroparesis
11
Q
Transtracheal procedures indications
A
- Emergency tracheal access when an airway cannot be secured via nasal/oral route
12
Q
Contraindications to transtracheal procedures
A
- Pt <6 yr old (upper part of trachea not fully developed) → incision through cricothyroid membrane increase the risk of subglottic stenosis
13
Q
Tracheotomy indications
A
- Prolonged tracheal intubation
- Neurologic impairment
- Congenital airway malformations
- Craniofacial syndromes
- Vocal cord paralysis
14
Q
Cuff-leak test indications
A
- Traumatic intubation
- Intubation >6 days
- Large endotracheal tube
- Those who have been repeatedly reintubated and extubated
- Women
15
Q
Readiness for a Spontaneous Breathing Trial (SBT) indications
A
- Underlying cause of respiratory failure has improved
- Hemodynamically stable: systolic BP >90 mm Hg without vasopressor support
- Ventilator parameters: PaO2/FiO2 > 200, PEEP ≤ 5 cmH2O, FiO2 ≤ 40%, Rapid Shallow Breathing Index (RSBI: f/Vt) < 105 breaths/min/L
- No administration of neuromuscular blocking agents
- Minimal secretions with an adequate cough
- Stable mental status: successful daily awakening trial (off sedation, able to follow commands)
- No severe acidosis: arterial blood pH ≥ 7.25
- Sufficient cough strength and ability to swallow
