Airway Lectures (Hall)

Question 1

2 types of Endotracheal Intubation

Answer 1

Orotracheal Intubation

Nasotracheal Intubation

Question 2

3 types of Laryngoscope Blades

Answer 2

Macintosh (Mac)
Miller
D-Blade (video laryngoscope)

Question 3

Macintosh Blades

Answer 3

Curved with the tip placed in the vallecula

typically left handed

Question 4

Miller Blades

Answer 4

Straight with the tip lifting the epiglottis

Question 5

D-Blades

Answer 5

Great curvature, resulting in the lack of direct line of sight of the glottis. Requires the use of an intubating stylet.

Question 6

Video Laryngoscopes

Answer 6

Equipped With:
Handle
Blade
Light Source
Viewing Screen
Recording System

Question 7

Conventional Endotracheal Tube (ETT)

Answer 7

Consists of:
Machine end adapter
Tube body
Inflation System
Tip with Bevel and Murphy Eye at distal end

Question 8

Outside Diameter of ETT machine connector

Answer 8

15 mm

Question 9

Purpose of Murphy Eye

Answer 9

Alternate gas pathway in the event that bevel is obstructed by tracheal wall

Question 10

How to prepare the ETT

Answer 10

Seat connector
Check cuff integrity
Deflate cuff
Know how much air is in the syringe (6ml)

Question 11

Magill Forceps

Answer 11

Used for retrieval of foreign bodies and assists with nasotracheal intubation

Question 12

Introducer tubes

Answer 12

Designed to assist with tube placement

Question 13

Intubating Stylets

Answer 13

Provides rigidity in hockey stick shape
Should not be used unless there is a real need
Risk associated with use:
     puncture
     abrasion
     laceration
     cricoarytenoid dislocation
     failure to intubate

Question 14

Steps for DL and ET intubation

Answer 14

Obtain correct height of patient
Operator assumes good position
Create axial alignment
Perform DL
Intubate
Confirm intubation
Secure ETT

Question 15

How to position patient for intubation

Answer 15

Patient head at your waist
Your upper arm loosely held at your side
Your lower arm horizontal

Question 16

Proper intubating positioning allows for

Answer 16

Max endurance
Min energy consumption
Optimal depth of field
Visibility of teeth and vocal cords

Question 17

Proper vector for Laryngoscope during intubation

Answer 17

Lift towards the wall/ceiling intersection

Question 18

Most common error leading to failure to obtain a direct view of the glottis

Answer 18

Failure to correctly use towels in head positioning. The use of towels decreases airway patency.

Question 19

Confirming Endotracheal Intubation

Answer 19

Capnography (repeating wave forms)
Chest Rise
Condensation
Compliance
Auscultation

Question 20

What not to use to confirm ETT intubation

Answer 20

SpO2

Question 21

Where to listen for Auscultation

Answer 21

Farthest from the bronchioles, bilaterally under the arm pits

Question 22

Functions of the Human Airway

Answer 22

Protection (Aspiration, Microorganisms)
Conduction (O2/CO2 exchange, Anesthetic Gases)
Air Conditioning (heat/humidity)

Question 23

Proper vector of jaw thrust maneuver

Answer 23

90° to the long axis of patient

Question 24

Correct finger positioning of jaw thrust maneuver

Answer 24

Fingers behind the angle of the jaw, thumbs on either side of patients nose

Question 25

Muscle that allows jaw thrust maneuver to be effective

Answer 25

Genioglossus

Question 26

How does bag and mask ventilation work?

Answer 26

Positive pressure flow is directed toward patient by unidirectional valves

Question 27

LMA means?

Answer 27

Laryngeal Mask Airway

Question 28

How do LMAs work?

Answer 28

Placed into hypopharynx and is inflated to give a seal above the glottis (a blind technique)

Question 29

Proper LMA insertion

Answer 29

Deflate cuff Fill lip of cuff with KY lubricant Depress tongue with tongue depressor Pass LMA over tongue and seat it in the hypopharynx Inflate the cuff and check for capnography waves

Question 30

Why is airway management so important?

Answer 30

Provides anesthesia for surgical procedures Supports resuscitation Provides long term respiratory care

Question 31

Purpose of preoperative airway examination

Answer 31

In order to: Do no harm during subsequent airway management Determine airway related risks Obtain information necessary for bag/mask, DL, LMA Obtain info needed for post-op management

Question 32

4 key steps to physical examination

Answer 32

Palpation Percussion Inspection Auscultation

Question 33

How many plans of action should you have?

Answer 33

Always have 5 plans and be prepared to execute 3 of them

Question 34

What are you checking for when conducting a ROM exam?

Answer 34

Rotation, Flexion, Extension Rotation of head from left to right Flexion of lower c-spine Extension of atlanto-occipital joint

Question 35

Proper extension of AO joint can be seen as what?

Answer 35

"Closure of the gap" Upper and lower dentition angle should create a 35° angle when going from "horizontal upper to horizontal lower"

Question 36

What is Paresthesias?

Answer 36

An abnormal sensation, typically tingling or prickling feeling, caused chiefly by pressure on or damage to peripheral nerves (pins and needles)

Question 37

Things to look for in a Oropharyngeal Examination

Answer 37

``` Inter-incisor distance Dentition Tongue, gums, and floor of mouth Structures that could cause potential DL difficulty Asses TMJ ```

Question 38

TMJ has two actions. What are they?

Answer 38

Rotation = 50% | Gliding (sliding) = 50%

Question 39

The inter-incisor distance should be what?

Answer 39

Greater than or equal to 4cm

Question 40

When identifying problems with the dentition, always use notation with what?

Answer 40

Tooth numbering system

Question 41

What do you expect to see during an OPE?

Answer 41

``` Hard Palate Soft Palate Uvula Palatine Tonsils or Fossa Palatoglossal Arches Palatopharyngeal Arches ```

Question 42

What is the risk of an incisor opening of less than 4cm ?

Answer 42

A conventional DL may not be possible

Question 43

Thyromental Distance

Answer 43

Should be greater than or equal to 6.5cm If less than 6.5cm, a conventional DL may not be possible

Question 44

Mandibular Length from angle to center jaw

Answer 44

Should be greater than or equal to 9cm If less than 9cm, there is limited space for soft tissue displacement and a conventional DL may not be an option.

Question 45

Dysphagia

Answer 45

Difficulty Swallowing

Question 46

Prevalence

Answer 46

Portion of population that has a condition

Question 47

Incidence

Answer 47

Number of new cases occurring in a population in a given time period

Question 48

Where is the Gastroesophageal (GE) junction located?

Answer 48

Where the semi-hemispheres of the diaphragm join

Question 49

GE junction opening pressure

Answer 49

16 cmH2O = normal 4 cmH2O = Hiatal Hernia 1 cmH2O = GERD

Question 50

Prevalence of Hiatal Hernias

Answer 50

20% to 50% of the population Increases with Age Majority are Asymptomatic

Question 51

Two types of hiatal hernias

Answer 51

Axial (sliding) = 95% | Non-Axial (paraesophageal) = 5%

Question 52

Hiatal Hernia complications

Answer 52

Increased risk of aspiration

Question 53

Esophagitis

Answer 53

Inflammation of the Esophagus

Question 54

GERD

Answer 54

Gastroesophageal Reflux Disease

Question 55

GERD Prevalence and side effects

Answer 55

Increases with age Daily symptoms 7% to 10% Occasional Symptoms 25% to 40% Esophagitis Adenocarcinoma