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Apex Review > Airway management 3 > Flashcards

Airway management 3 Flashcards

1
Q

Which intervention demonstrates the MOST accurate understanding of inflating the cuff on the endotracheal tube?
a. assess the pressure inside the pilot balloon with your fingers
b. add 10 mL air to the pilot balloon
c. attach a manometer to the pilot balloon
d. attach a syringe to the pilot balloon to create a minimal occlusive pressure

A

c. attach a manometer to the pilot balloon

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2
Q

If glottic visualization is difficult during direct vision laryngoscopy, the ________ may improve your view

A

BURP maneuver (backward, upward, and rightward pressure on the thyroid cartilage)

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3
Q

When using an endotracheal tube, tracheal ischemia can occur if

A

the cuff pressure exceeds tracheal mucosal perfusion pressure

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4
Q

The cuff pressure of the endotracheal tube should be less than

A

25 cmH2O

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5
Q

Monitoring cuff pressure with _________ is the best method to reduce the risk of tracheal ischemia

A

manometer

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6
Q

The ___________ is a small hole on the opposite side of the bevel

A

Murphy eye

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7
Q

The purpose of the Murphy eye is to

A

provide an alternate passage for air movement in case the tip of the ETT becomes occluded or abuts the tracheal wall

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8
Q

What is the depth placement for a pediatric ETT?

A

Depth placement= internal diameter x 3

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9
Q

What is the ETT size without a cuff for pediatric formula?

A

(age/4)+4

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10
Q

What is the ETT size with a cuff for peds?

A

(age/4)+3.5

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11
Q

What are the two types of cuffs?

A

low volume, high-pressure
high volume, low pressure

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12
Q

What type of cuff is more common?

A

high volume low pressure- nearly all tubes in modern practice use this except…. red rubber tube, silicon tube for LMA fastrach, & bronchial balloon on a double lumen ETT

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13
Q

What are the benefits of using a low volume, high pressure cuff?

A

better protection against aspiration
lower incidence of sore throat
easier visualization during intubation

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14
Q

What are the benefits to using a high volume, low pressure cuff?

A

cuff pressure closely resembles the pressure exerted on the trachea

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15
Q

What are the risks of using a low-volume, high pressure cuff?

A

prolonged intubation–>tracheal ischemia

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16
Q

What are the risks of using a high-volume, low-pressure cuff?

A

adding too much air to the cuff or using N2O–> tracheal ischemia
easy to pass things around the cuff
protection against aspiration isn’t as good

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17
Q

The ____________ is another type of high-volume, low-pressure cuff

A

microthin cuff

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18
Q

Benefits of the microthin cuff include

A

lower pressure on the tracheal mucosa
better protection against liquid aspiration

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19
Q

Ways to minimize cuff pressure includes:

A

use a manometer
fill the cuff with the same O2/N2O mixture that you will use during the case (assuming you use N2O)
fill the cuff with water or saline (provides a more stable cuff pressure but takes longer to deflate- Bad! if airway fire)
use an ETT with a Lanz pressure-regulating valve

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20
Q

Which findings are MOST strongly associated with difficult video-assisted laryngoscopy? (select 2)
a. history of neck radiation
b. mandibular protrusion score of 3
c. obesity
d. Mallampati 4 classification

A

a. history of neck radiation
b. mandibular protrusion score of 3

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21
Q

Video laryngoscopes can be classified as

A

non-channeled or channeled designs

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22
Q

Non-channeled designs include

A

Glidescope, C-Mac, & McGrath

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23
Q

Channeled designs include

A

Airtraq Avant, King vision

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24
Q

Some video laryngoscopes have an option for an ____________ that facilitates glottic exposure of amore anterior glottic opening

A

acute-angle blade

25
Q

Examples of acute angle blades include

A

Glidescope LoPro
C-Mac D-blade
McGrath X blade

26
Q

Key benefits of video laryngoscopes include

A

usefulness for failed or difficult intubation
less cervical spine movement
decreased SNS response (possibly)
external screen so other providers can see what you see

27
Q

The greatest risk with video laryngoscopy may be

A

pharyngeal injury

28
Q

The risk of pharyngeal injury can be prevented by

A

directly watching the ETT as it’s inserted into the oropharynx and only viewing the screen after the tip of the ETT passes beyond your line of sight

29
Q

A channeled video laryngoscope integrates a channel for the

A

endotracheal tube into the device

30
Q

External interferences can prevent a good view on the screen such as

A

fog, secretions or blood

31
Q

Predictors of difficult video laryngoscope include

A

neck pathology (radiation, tumor or surgical scar)
short TMD
limited cervical motion
thick neck
class 3 upper lip bite test

32
Q

In patients with multiple predictors of difficult VAL, you should consider

A

awake fiberoptic intubation

33
Q

Factors not associated with difficult VAL include

A

high MP score & obesity

34
Q

The ________ is the most commonly used supraglottic airway

A

LMA

35
Q

The LMA can be used as a

A

primary airway
rescue during difficult airway management
conduit for tracheal intubation

36
Q

The max PPV pressure with a LMA is

A

20 cmH2O

37
Q

The max cuff pressure with a LMA is

A

60 cm H2O

38
Q

The most common cause of nerve injury with LMA is

A

cuff overinflation

39
Q

What nerves are at highest risk of injury with a LMA

A

lingual, hypoglossal, & recurrent laryngeal nerves

40
Q

Suppose the cuff pressure exceeds 60 cmH2o and you can’t get a good seal, the LMA is

A

improperly positioned
the patient is inadequately anesthetized
or there’s a partial or complete laryngospasm

41
Q

The two aperture bars across the LMA’s orifice

A

prevent the epiglottis from obstructing the airway tube

42
Q

Other risk factors for nerve injury from LMA include

A

using an LMA that is too small, lidocaine lubrication or traumatic insertion

43
Q

Cuff overinflation with an LMA increases the risk of

A

sore throat and pharyngeal necrosis

44
Q

What is the patient size, cuff inflation, and largest ETT that fits through a LMA 1?

A

<5 kg
5 mL inflation
3.5 ETT

45
Q

What is the patient size, cuff inflation and largest ETT that fits through a LMA 1.5?

A

5-10 kg
7 mL inflation
4.0 ETT

46
Q

What is the patient size, cuff inflation, and largest ETT that fits through a LMA 2?

A

10-20 kg
10 mL inflation
4.5 ETT

47
Q

What is the patient size, cuff inflation, and largest ETT that fits through a LMA 2.5?

A

20-30 kg
14 mL inflation
5.0 ETT

48
Q

What is the patient size, cuff inflation, and largest ETT that fits through a LMA 3?

A

30-50 kg
20 mL inflation
6.0 ETT

49
Q

What is the patient size, cuff inflation, and largest ETT that fits through a LMA 4?

A

50-70 kg
30 mL inflation
6.0 ETT

50
Q

What is the patient size, cuff inflation, and largest ETT that fits through a LMA 5?

A

70-100 kg
40 mL inflation
7.0 ETT

51
Q

What anatomic structures does the LMA abut?

A

base of the tongue- proximal end
piriform sinus- sides
upper esophageal sphincter- distal end

52
Q

The four LMA variations include

A

LMA ProSeal
LMA Fastrach
LMA C-Trach
LMA flexible

53
Q

The LMA Proseal features a

A

gastric drain tube, a larger mask, and a built-in bite block

54
Q

The max PIP for PPV with a LMA ProSeal is

A

<30 cmH2O

55
Q

The _____________ is a disposable version of the ProSeal

A

LMA supreme

56
Q

The LMA Fastrach is an

A

intubating LMA
can be removed after intubation or can remain in place throughout the procedure

57
Q

The LMA C-Trach is very similar to the

A

Fastrach but it includes a camera so you can visualize intubation

58
Q

The LMA flexible has a

A

flexible airway tube
is wire-reinforced
useful for head and neck surgery

Apex Review (224 decks)

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