Airway Management Flashcards
(20 cards)
Who will be difficult to mask ventilate?
B- beard O- obesity N- no teeth E- elderly S- snoring
Who would be difficult to intubate?
D- disproportion: macroglossia, micrognathia, high arched palate, bony abnormalities, short thick neck
D- distortion: airway trauma, epiglottitis, abnormal larynx
D- dysmobility: limited mouth opening, fixed cervical spine, cervical spine injury
D- dentition: passion gap, buck teeth
Which bedside tests are done to predict possibility of difficult intubation?
- Mallamparti classification/ score
- Thyromental distance
- Extension at the Atlanto- occipital joint
What are the classes of the mallamparti classification?
Class I - soft palate, fauces, the whole uvula, anterior and posterior pillars
Class 2- visualization of soft palate, fauces and most of the uvula
Class 3- visualisation of soft palate and base of the uvula
Class 4- only hard palate visible
What thyromental distance may indicate a difficult intubation?
Less than 3 finger breadths or less than 6 cm in adults
When performing facemask ventilation, what maneuvers are necessary to provide a patent airway?
- head tilt, chin lift
- jaw thrust
If this remains ineffective, an oropharyngeal or nasopharyngeal airway maybe used
What are signs of upper airway obstruction?
- stridor
- tracheal tug
- accessory muscle use
- complete airway obstruction with ongoing respiratory effort leads to a see saw movement of the abdomen and chest
What are the advantages and indications for tracheal intubation?
Advantages:
Guaranteed airway
Protection from aspiration of gastric contents
Ability to provide effective positive pressure ventilation
Ability to clear secretions from the respiratory tract by suctioning
Indications: Controlled ventilation Protection of the airway Maintenance of a patent airway Postoperative ventilation in intensive care
What are two possible shapes of the laryngoscopes and names of them?
Straight- Macintosh
Curved- Magill or Miller
When do you use an endotracheal tube without a cuff?
Pediatrics
What size endotracheal tube is used for males and females and for children?
Orotracheal intubation: 7.5- 8 mm of males and 7- 7.5 mm in adult females
Nasotracheal intubation: size reduced by 1 or 0.5 mm
Children: (age in years/4) + 4
Always have a size above and below (0.5 mm) to hand
What should the depth of the endotracheal tube be?
20 +/- 2 cm - females
20 +/- 2 cm - males
Children: (age in years/2) + 12
What equipment is needed for intubation?
I - introducer M- mask, magills forceps A- airways, ambubag, alternate airway L- laryngoscopes E- endotracheal tube S- suction
How do you know if the endotracheal tube has entered the trachea?
- see tube going through vocal cords
- capnography
- oesophageal detector devices
- misting of the endotracheal tube
- chest movement of both sides of the chest
- auscultation: the each axilla, base of the lung, epigastrium
When is nasotracheal intubation used?
ENT, dentistry and maxillo- facial surgery
What should be done prior to nasotracheal intubation ?
Nostril prepared with vasoconstrictor drops (ephedrine and oxymetazoline) and ETT softened in hot water prior to insertion
What is the intubation response?
Tachycardia, hypertension, days rhythmical, bronchospasm, increase in intra cranial and intra ocular pressure
What are the indications for a laryngeal mask airway?
- properly starved patients without gastro- oesophageal reflux
- failed intubation (holding measure)
- plan B for airway management in resuscitation when you cannot intubate
What is the indication for a surgical airway?
- prolonged ventilation in the ICU
- head and neck deformity/ trauma
- impossible airway
- suctioning is easier
- emergency rescue airway
What are the techniques for surgical airway?
Cricothyroidotomy: needle; kits; surgical
Tracheostomy: percutaneous; surgical
