Airway Management Flashcards by Cameron Hatlevig

What are some conditions that impair AO mobility?

DJD
RA
Ankylosing spondylitis
Trauma
Surgical fixation
Klippel-Feil
Down syndrome
DM

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What is the 3-3-2 rule?

Inter-incisor gap > 3 finger Breaths
Thyromental distance > 3 finger breaths
Thyrohyoid > 2 finger breaths

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What is a grade 1 Cormack and Lehane view?

Complete view of glottic opening

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What is a grade 2 Cormack and Lehane view?

Posterior region of the glottis opening (loss of anterior commissure)

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What is a grade 3 Cormack and Lehane view?

Epiglottis only (loss of any part of the glottic opening)

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What is a grade 4 Cormack and Lehane view?

Soft palate only (loss of any part of the larynx)

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What is a grade 2b Cormack and Lehane view?

You can only see the corniculate cartilages and posterior vocal cords (no glottic opening)

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What are the risk factors to a difficult mask?

BONES

B: beard
O: obese
N: no teeth
E: elderly (> 55years)
S: snoring

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What are some risk factors to difficult intubation?

Small mouth opening
Long incisors
Overbite
High arched palate
Mallampati class 3/4
Retrognathic jaw
Short thick neck
Short TMD
Reduced cervical mobility

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What are some risk factors for LMA placement?

RODS

R: restricted airway
O: obstruction
D: distorted airway
S: stiff neck or C-spine

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What are some risk factors for surgical airway placement?

SHORT

S: surgery (previous scar)
H: hematoma
O: obesity
R: radiation
T: tumor

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What pressure should be given before loss of consciousness during RSI? What about after?

Before: 2 kg (20 newtons)
After: 4 kg (40 Newtons)

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Angioedema r/t anaphylaxis?

Cause: triggering agent
Tx: epi, antihistamine, steroids

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Angioedema r/t ACE Inhibitors

Cause: prevent bradykinin breakdown
Tx: discontinue ACE, Icatibant/Ecallantide, FFP, C1 esterase concentrate

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Angioedema r/t genetics

Cause: genetics/hereditary
Tx: C1 inhibitor concentrate, FFP, ecallantide/icatibant

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What is Ludwig’s angina?

Bacterial infection that causes cellulitis of the floor of the mouth ~ edema and inflammation compress airway structure ~ airway obstruction

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What is the best way to secure an airway for someone with Ludwig’s Angina?

Nasal intubation
Awake trach

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What are syndromes with large tongues?

Big Tongue

B: beckwith syndrome
T: trisomy 21

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What are syndromes with underdeveloped mandibles?

“Please Get That Chin”

P: pierre Robin
G: goldenhar
T: treacher collins
C: cri du Chat

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Which two oral airways are designed to accommodate a fiberoptic bronchoscope or ETT?

Williams and Ovassapian

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What are contraindications to a nasal airway?

Lefort 2or 3 fx
Basilar scull fx
CSF rhinorrhea
Raccoon eyes
Periorbital edema
Coagulopathy
Previous transsphenoidal hypophysectomy
Nasal fx

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How do you size a pediatric tube without a cuff?

(Age/4) +4

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How do you size a pediatric tube with a cuff?

(Age/4) + 3.5

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How do you determine depth placement?

ID x 3

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What is a non-channeled design? In terms of video laryngoscopes.

It’s a device used to expose glottic structures BUT the ETT is passed separate from the laryngoscope McGrath, glide, C-MAC

What is a channeled design? In terms of video laryngoscopes.

Interstates a channel for the endo trachea tube into the device

What are some predictors of a difficult video laryngoscopy?

Radiation Tumor Scar Short TMD Limited cervical motion Thick neck class 3 upper lip bite test

Where does the proximal end of the PMA sit?

Near the base of the tongue

Where do the sides of the LMA sit?

Piriform sinuses

Where does the distal end of the LMA sit?

Along the upper esophageal sphincter

What is the max PPV pressure on an LMA?

20 cm H2O

What is the max cuff pressure of an LMA?

20 cm H2O

What size LMA is appropriate for a pt < 5 kg? What is the mL for inflation? What is the largest size ETT it can fit?

LMA 1 4 mL 3.5 ETT

What size LMA is appropriate for a pt 5-10kg? what volume should be used for the cuff? What is the largest ETT used to fit?

LMA 1.5 7 mL 4.0 ETT

What size LMA should you use for a pt 10 kg- 20kg? How much mL can you inflate the cuff? What is the largest ETT that can fit inside?

LMA 2 10 mL 4.5 ETT

What is the appropriate size LMA for a patient 20kg-30kg? How much cuff volume is accurate? What is the largest size ETT it can accommodate?

LMA 2.5 14 mL 5.0 ETT

What is the appropriate size LMA for a patient of 30-50kg? How much mL is used to insert the cuff? What is the largest ETT it will accommodate?

LMA 3 20 mL ETT 6.0

What is the appropriate LMA size for a patient of 50-70kg? How much volume in the cuff? What size ETT can it accommodate?

LMA size 4 30 mL 6.0 ETT

What size LMA for a patient of 70-100kg? How much volume in the cuff? What is the largest ETT it can accommodate?

LMA 5 40 mL 7.0 ETT

What is the LMA ProSeal?

Adaption of LMA classic. Double lumen Gastric drain tube (for easy gastric decompression) ~ must place an OG first Larger mask Biteblock Better deal Increased max pressure (< 30 cm H2O)

What is the LMA Fastrach and how does it differ?

Intubating LMA Metal handle Specifically designed ETT (high pressure cuff) Tube pusher Epiglottic elevating bar

What is the LMA C-Trach?

C-Trach is similar to the Fastrach, but includes a camera.

What is the LMA flexible?

Flexible Wire-reinforced (not suitable for MRI) Longer use than the LMA classic Narrower than the LMA classic (must use a smaller ETT or bronchoscope) Useful for head and neck surgery

What is the iGel?

It’s an alternative to the LMA No inflatable cuff There is a gastric port It can serve as a conduit for ETT intubation Save for use in MRI Complications: Tongue trauma Mucosal erosion of the cricoid ring Compression of the trachea Nerve injury Airway obstruction Regurgitation and aspiration

When should an LMA not be used?

Risk of regurgitation and aspiration (full stomach, hiatal hernia, small bowel obstruction, symptomatic GERD, delayed gastric emptying) Airway obstruction Tracheomalacia or external trachea compression Poor compliance High airway resistance

What do you do if you observe gastric contents in the LMA?

Leave LMA in place Tberg 100% FiO2 Use low FGF and low Vt Use a flexible suction catheter FOB evaluation gastric contents in trachea…if present, consider intubation.

What airway devices are the most to least stimulating?

Combitube > DVL > Fiberoptic > LMA

What is the combitube?

Supra glottic, double lumen device that is blindly inserted into the hypopharynx (Usually pre-hospital settings)

What is the size of combitube for a 4-6 ft person?

Size 37

What is the size combitube for a patient > 6 ft

Size 41

Where does the proximal and distal cuff sit with a combitube?

Proximal cuff (40-100 mL)sits: hypopharynx Distal cuff (5-12 mL) sits: esophagus (usually)

What are the benefits to the combitube?

Secure airway Decompress the stomach Use in obese Blind insertion technique (min training) No neck extension High vent pressures (< 50) Doesn’t need to be taped

What are some contraindications to the combitube?

Gag reflex Prolonged use Zenker’s diverticulum Ingestion of caustic substances.

What is the King Laryngeal tube?

Similar to combitube Like: can insert blindly, distal cuff obstructs esophagus and proximal obstructs hypopharynx Diff: one lumen, only one inflation port, child sizes available.

What is hand placement for fiberoptic?

Non-dominant: moves the lever Dominant: holds the cord

How do you move the camera in a fiberoptic?

Lever down = tip up Lever up = tip down

What is the gold standard for managing difficult airways?

Fiberoptic bronchoscopy in the awake pt.

What are absolute contraindications to fiberoptic use?

Uncooperative patient Lack of provider skills Near total upper airway obstruction Massive trauma

What is a Bullard Laryngoscope?

It is a rigid, fiberoptic device used for indirect laryngoscopy

What are some indications for a Bullard scope?

Small mouth opening Impaired cervical mobility Short, thick neck Treacher Collins Pierre Robin

What are the contraindications to the Bullard scope?

There are none, but learning curve is high

What is another name for the Eschmann introducer?

Bougie or intubating stylet

When is the best time to use a bougie?

Class IIb or class 3 Worst time to use is during a class 4!!!

When is the best time to use a lighted stylet?

Anterior airways Small mouth opening Cervical spine abnormality Pierre-Robin syndrome Burn contractures

When should you not use a lighted stylet?

Short, thick neck Can’t ventilate, can’t intubate Should be used if there is a tumor, foreign body, airway injury or epiglottitis Do NOT use the lighted stylet in a patient with traumatic laryngeal injury

What are the indications for a retrograde intubation?

Unstable cervical spine Upper airway bleeding Failed awake intubation.

What are the contraindications to a retrograde intubation?

Inability to identify or access the Cricothyroid membrane Pretrachial mass Laryngotracheal disease Tumor Coagulopathy Infection at puncture site

What are the 3 ways to create a surgical airway?

Percutaneous cricothyroidotomy Surgical cricothyroidotomy Tracheostomy

What psi pressure do you need for a percutaneous cricothyroidotomy?

50 psi

What are some contraindications to a percutaneous cricothyroidotomy?

Upper airway obstruction Laryngeal injury

What are the contraindications for a surgical cricothyroidotomy?

Not for children < 6yrs Laryngeal fx/neoplasm

Airway Management Flashcards

(71 cards)