Airway Management Flashcards by Iseoluwa Ojo

Airway must remain patent to ensure adequate _________ and _____________

ventilation and oxygenation

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Advanced airway placement ensures uninterrupted ___________ during ventilation in cardiac arrest

chest compression

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Airway consists of ??

Nasal and oral cavities
Pharynx
Larynx
Trachea
Bronchi

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METHODS OF AIRWAY MAINTENANCE

________________ airway devices
_________________ airway devices
____________ airways

Supraglottic (upper )

Infraglottic (lower)

Surgical

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METHODS OF AIRWAY MAINTENANCE

Supraglottic (upper )airway devices – mention 3

Infraglottic (lower) airway devices – mention 3

Surgical airways – mention 2

oro/ naso-pharyngeal airway, laryngeal mask airway, i-gel

endotracheal tube, combitube, laryngeal tube

cricothyroidotomy ,tracheostomy

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ORO-PHARYNGEAL AIRWAYS (OPA)
e.g Guedel’s airway

•____-shaped device
•Inserted through ______ into _____________
•_________ prevent airway from falling back into mouth
•_______ portion lies between teeth and prevent occlusion by biting

J; mouth; oropharynx

Flanges; Bite

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Oro-pharyngeal airways

•Size from neonate to large adult
•Paediatrics-size _____ to _____
•Adult-size ____ to _____
•May cause ________ on insertion
•May stimulate ________ or _________ if patient is semi-conscious

000 to 2

3 to 5

trauma

gag reflex or vomiting

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SIZING THE ORO -PHARYNGEAL AIRWAY

Angle of ———— to _______

____________ to ______________

mouth to earlobe

Centre of incisor to angle of jaw

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CAUTION WHEN USING OPA

Oro-pharyngeal airways that are too large may _______________ or ____________ to the airway

Oro-pharyngeal airways that are too small or inserted wrongly may ______________________________ and obstruct the airway

obstruct the larynx or cause trauma

push the base of the tongue posteriorly

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Insertion of oro-pharyngeal airway

Open the mouth
Insert airway into oral cavity
Advance airway until _____________________

In _________- do not rotate in oral cavity!

it lies in the pharynx

children

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INSERTION OF ORO-PHARYNGEAL AIRWAY

Open the mouth
Insert airway into oral cavity in the ____________ position as far as the __________________

Rotate it through ______ –minimises chance of ___________________________

Advance airway until it lies in the _______
Fits over tongue and pushes it away from ______________________

Correct placement- improvement in airway reflexes and sitting of bite portion b/w teeth

upside-down; junction between the hard and soft palate

1800; pushing tongue backwards and downwards

pharynx; post. pharyngeal wall

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NASO-PHARYNGEAL AIRWAY

Inserted through the ______ into the ________

Bypasses the _________ and ___________

______________ inserted through flange to prevent migration into the nose

nose; nasopharynx

mouth and oropharynx

Safety-pin

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Naso-Pharyngeal Airway

Contra-indicated in cases of ____________________
Life saving in __________,__________, or _____________ injuries

Caution in children with _________

fracture base of skull

clenched jaw, trismus or maxillofacial

adenoids

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(Oro or Naso?) Pharyngeal Airway is Better tolerated by semi-conscious patients

Naso

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SIZING OF NASO-PHARYNGEAL AIRWAY

_________________ to ___________________

Diameter should be equal or (smaller or larger?) than patients ____________

Compare the outer circumference of the naso- pharyngeal airway with the __________________________

Tip of the nose to the tip of the earlobe

Smaller; little finger

inner aperture of the nares

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INSERTION OF NASO-PHARYNGEAL AIRWAY

Select appropriate size
___________ the nasopharyngeal airway
Insert the _________ end (vertically or horizontally?) along the _______ of the nose with a slight ________ action

The flange should rest against the nasal opening. Maintain head tilt using chin lift or jaw thrust.
Once in place use ______,_________, and ___________ technique to assess patency and adequacy of ventilation

Lubricate; bevel; vertically

floor; twisting

look, listen and feel

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LARYNGEAL MASK AIRWAYS

Alternative to facemasks or tube Inserted through mouth so cuff lies __________________

From neonatal to large adult sizes

above larynx

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Laryngeal mask airway Does not protect against aspiration

T/F

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Devices that are used to maintain the airway patency and provide ventilation by placing just above the glottis opening

They sit outside the __________ and provide a __________ means of gas tight airway

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trachea; hands free

The first commercially available supraglottic airway device was ______- Classic (1988)

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LMA

INDICATION for LMA

Alternative airway during ———- specially in ___________ procedures and ___________ or __________ procedures like radiation therapy, diagnostic and interventional radiology, endoscopy, ECT etc

Also used in _______________________ to secure the airway

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GA; short surgical

Minor therapeutic or diagnostic

Cardiopulmonary resuscitation

Indications for LMA

Essential part of difficult airway trolley

Primary airway device when urgent airway patency is required in __________ position as lesser time required to place LMA in the lateral position as against _________________ in this position

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lateral

endotracheal intubation

CONTRAINDICATION of LMA

Limited _____________ ( _______________ )

_________________ in pharynx, larynx and upper airway

Trismus, facial or upper airway trauma

Increase risk of ___________ – morbid obese, > 14 weeks pregnant, prior opiods medication, delayed gastric empting, acute abdominal or thoracic injury, history of GERD and hiatus hernia
Reduced lung compliance/increase work of breathing

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mouth opening; <2 fingers

Local pathology; aspiration

Advantages of LMA

Increased ___________________________

Less requirement of _________

Improved hemodynamic stability at induction and during emergence of anaesthesia

Minimal ______ and ______ changes during insertion

Increase airway _______

Lower frequency of _______ during emergence
Improved _______________ during emergence

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speed and ease of placement

expertise; aspiration

IOP and ICP

tolerance; coughing

oxygen saturation

Disadvantages of LMA Inadequate ___________ ventilation More chances of ________ of gastric content ____________ ___________ compression and ________ damage

positive pressure Aspiration; Sore throat Vascular; nerve

LARYNGEAL MASK AIRWAY INSERTION Select LMA of appropriate size (Flex or Extend?) neck and (flex or extend?) head Hold LMA like a _______, insert into mouth. Advance tip behind __________ until it reaches the posterior pharyngeal wall Press mask backwards and downwards until resistance is felt at back of pharynx Connect inflating syringe, inflate cuff - 40ml (size 5); 30ml (size 4)

Flex; extend ; pen upper incisor

I-GEL ___________airway device airway device Made from ____, _____-like material Easy to insert, cause reduced trauma Bite-block on ______ Has a Narrow __________________ tube

Supraglottic soft, gel stem oesophageal drain

ProSEAL LMA ___________ , silicon made Modifications; _____________ tube _____________________ cuff Reinforced airway tube ___________ bite block Introducer _______ seal pressure (35cm H20)

Reusable oesophagea drain Posterior inflatable Integral; High

LMA-Surpreme ________ Generation LMA __________________ cuff, no ————- cuff Oesophargeal drain tube, without ——— Preformed semi –rigid tube _____________ to prevent obstruction Pharyngeal seal of 26-30 cmH20

2ND Large inflatable plastic; posterior seal Epiglottic fins

COMBITUBE (Single or Double?) lumen tube Tube enters either _______ or _________ Tracheal channel has open ———— Oesophageal tube has _____ opening.

Double trachea or oesophagus distal end; no

COMBITUBE Oesophageal tube has small _____ cuff and large _______ cuff to be inflated within the ________. Between the two cuffs are several _________ through which larynx is ventilated

distal; proximal pharynx; small side holes

ENDOTRACHEAL INTUBATION Passage of a tube through the ____________ into the _________. Conduit for ventilation Definitive airway

nose or mouth; trachea

Endotracheal intubation Numerous indications – Respiratory insufficiency, severe head injury, cardiac arrest Undertaken by ______ personnel only Intubation attempts must not exceed __________ Intubation is not undertaken on the ______________!!

skilled 30 seconds corridors of A&E

Endotracheal intubation Protects against aspiration T/F

PREPARATION FOR INTUBATION Tiltable trolley _______ supply _____________ bag, ________ _______ apparatus ___________, _________________ tubes – various sizes Stethoscope Assistant to apply _____________ Others – gloves, plaster, 20ml syringe

Oxygen; Self-inflating; face mask Suction; Laryngoscope ; Endotracheal cricoid pressure

ENDOTRACHEAL INTUBATION A - endotracheal tube (blue) B - _________ tube with _________ C – trachea D - oesophagus SECURE THE ETT TO PREVENT DISLODGEMENT

cuff inflation; pilot balloon

NASOTRACHEAL INTUBATION TECHNIQUE Apply __________________________________ drops ____________ tube wall Guide the tube slowly but firmly into the nasal passage, going (up or down?) from the nostril( to avoid the ______________________ ) and then backward and down into the _____________ Proceed with the procedure as an _________ intubation, guiding the tube through the ___________ with a magils forceps

vasoconstrictor nasal; Lubricate Up; large inferior turbinate nasopharynx; orotracheal vocal cords

Most serious complication of endo-tracheal intubation is ???

unrecognised oesophageal intubation

NEEDLE CRICOTHYROTOMY PROCEDURE Place supine, head extended Identify the __________ Puncture the membrane ________ in ________ with large bore intravenous cannula or ________________ attached to a syringe _________________ confirms tracheal location Angle cannula at ______and advance caudally into trachea. Remove needle. Confirm air aspiration Attach cannnula to high pressure oxygen supply

cricothyroid membrane vertically; midline cricothyrotomy needle; Aspiration of air 45

NEEDLE CRICOTHYROIDOTOMY Indication???? Complications ______________ of cannula ______ventilation ____________

Failure to provide an airway by any other means Malposition; Hypo; barotrauma

SELF-INFLATING BAG (AMBU BAG) ___________ Bag, ___________ Valve, ___________ (BVM) Indicated in patients not breathing or breathing inadequately – pt has to be ventilated Bag size – infants, children, adults Can be used with ————- and __________

Self inflating Bag, unidirectional Valve, Mask (BVM) facemask & advanced airways

Ambu bag Delivers room air ____% oxygen if not connected to any oxygen source Disadvantage-______________ with supraglotic devices.

21 gastric inflation

AMBU BAG 1 - flexible mask to seal over the patients face 2 –_____-way valve & _____ (prevents __________ and ____________ ) 3 - bag which is squeezed to expel air to the patient 4-oxygen port for administering supply O2 Self inflates with __________ or from ______ source when released

one; filter rebreathing and bag contamination room air; oxygen

Self-inflating bag with reservoir Delivers up to _______% oxygen

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Airway Management Flashcards

(44 cards)