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NSU AA Denver: Summer 2025 (2nd Semester) > Airway Management II: Lecture 1 - Difficult Airway > Flashcards

Airway Management II: Lecture 1 - Difficult Airway Flashcards

1
Q

What blade has lower incidence of difficult intubation?

A

Miller

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2
Q

What is a mnemonic for difficult mask ventilation?

A

MOANS: Mask seal, Obesity, Age, No teeth, Snores or Stiff

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3
Q

What is the mnemonic for difficult laryngoscopy and intubation?

A

LEMON: Look externally, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility

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4
Q

What is the mnemonic for difficult extraglottic devices?

A

RODS: Restricted mouth opening, Obstruction, Disrupted airway, Stiff lungs or cervical spine

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5
Q

What is the mnemonic for a difficult cricothyrotomy?

A

SHORT: Surgery, Hematoma, Obese, Radiation, Tumor

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6
Q

What are the six types of airway management difficulty?

A

Difficulty with patient cooperation, difficult bag-mask ventilation, supraglottic airway placement, laryngoscopy, intubation, surgical airway access

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7
Q

What is an example of difficult patient cooperation?

A

Patient refusing airway manipulation or not following instructions due to anxiety or altered mental status

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8
Q

Why is it important to identify potential difficulty before induction?

A

It allows for proper planning, equipment setup, and personnel coordination to reduce risk

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9
Q

How does the ASA define difficult mask ventilation?

A

When the anesthesiologist cannot maintain oxygen saturation >90% or reverse inadequate ventilation signs with 100% O2 and positive pressure

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10
Q

What defines a difficult laryngoscopy?

A

It is not possible to visualize any portion of the vocal cords with conventional laryngoscopy

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11
Q

What defines a difficult endotracheal intubation?

A

More than 3 attempts or more than 10 minutes required for proper insertion of the tracheal tube

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12
Q

What qualifies as a difficult intubation under ASA guidelines?

A

More than one attempt, need to change blades/techniques, or use alternative equipment beyond direct laryngoscopy

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13
Q

Why is it important to document difficulty per ASA definitions?

A

It helps standardize communication and guides future anesthetic planning for the patient

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14
Q

What is the incidence of a difficult airway?

A

Difficult laryngoscopy: 1.5-8.5%, Difficult intubation: 1-2.5%, Difficult mask ventilation: 0.01%, Failed intubation: 0.3%

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15
Q

What demographic is more likely to experience difficult intubation?

A

Males, adults, and individuals aged 40-59

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16
Q

What makes it hard to access the oropharynx and nasopharynx?

A

Cannot get tools into starting position

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17
Q

What can obstruct visibility of the larynx?

A

Soft tissue

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18
Q

What is a result of a diminished cross-sectional area of the larynx or trachea?

A

Inability to pass tube

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19
Q

What patient factors contribute to difficult intubation?

A

Morbid obesity, facial trauma, anatomical abnormalities, tumors, congenital syndromes

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20
Q

How does morbid obesity complicate airway management?

A

Excess tissue can obstruct airway, make mask seal difficult, and reduce visualization during laryngoscopy

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21
Q

How does a burn victim complicate airway management?

A

Edema

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22
Q

How do tumors affect airway management?

A

They can obstruct nasal or pharyngeal pathways

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23
Q

What is retrognathia and why is it significant?

A

A recessed jaw that makes intubation and mask ventilation more difficult

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24
Q

What are common visual signs of a difficult airway?

A

Large tongue, limited mouth opening, small jaw, short/thick neck, facial trauma, or abnormal dentition, Mallampati classes 3+4, deep/narrow/high arched oropharynx, larynx abnormalities

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25
What are signs of a difficult airway?
Burns, radiation therapy, infection, swelling, hematoma of airway, stridor (air hunger), intolerance of supine position, hoarseness or abnormal voice, mandibular abnormality
26
What are other signs of a difficult airway?
Kyphoscoliosis, prominent chest, term/near term pregnancy, age 40-59, males
27
What are mandibular abnormalities?
Cant open mouth at least 3 finger-breadths, micrognathia/receding chin (treacher collins, pierre robin), <6 cm from tip of mandible to thyroid notch with full neck extension, <9cm form angle of the jaw to symphysis
28
What historical clues might suggest a difficult airway?
Prior difficult intubation, history of sleep apnea, syndromic conditions, long-term intubation, diabetes mellitus, down syndrome, sleep apnea, premature infants or airway surgeries/prior long-term intubation.
29
What attributes are important for optimal laryngoscopy performance?
Optimal sniff position, good complete muscle relaxation, firm forward traction of the laryngoscope, Firm external laryngeal manipulation (optional)
30
How does TMJ disorder affect airway management?
Limits jaw movement and mouth opening
31
Why are premature infants considered a difficult airway population?
Their small anatomy and high oxygen requirements
32
Why is it important to have multiple blade types and sizes available?
To accommodate variations in anatomy and allow for alternative approaches
33
What is the purpose of a bougie in airway management?
To assist in guiding the endotracheal tube when glottic visualization is limited
34
How does a fiberoptic bronchoscope aid in difficult airway management?
Allows visualization and navigation around obstructions
35
What is a jet ventilator (TTJV) used for?
Transtracheal jet ventilation in emergency surgical airway access
36
Why should both nasal and oral airways be readily available?
They serve as adjuncts to relieve upper airway obstruction (2 different sizes of each).
37
Are the jet ventilator and light wand part of the difficult airway card?
No
38
When was the ASA Difficult Airway Algorithm last updated?
2022
39
What is the primary purpose of the ASA Difficult Airway Algorithm?
To provide a structured and safe approach for managing difficult airways
40
What is the first thing to do when airway difficulty is suspected?
Call for help early and prepare equipment and have back up plans
41
What is emphasized throughout the ASA algorithm?
Maintain oxygenation, minimize trauma, transition between plans as needed
42
What are the 3 steps of the emergency cricothyroidotomy technique?
1. Skin incision 2. Cricothyroid membrane incision with bougie placement 3. Tube advancement over bougie
43
When is emergency cricothyroidotomy indicated?
When other airway management techniques have failed and the patient cannot be ventilated or oxygenated.
44
What is the main risk of cricothyroidotomy?
Subcutaneous emphysema, bleeding, or incorrect placement
45
What is percutaneous translaryngeal ventilation technique?
14 g catheter through gap in tracheal cartilage rings
46
What is Plan A in difficult airway management? (conventional equipment)
Use of conventional techniques with standard equipment and proper positioning.
47
What are Plan A assumptions?
Can see glottis and pass an ETT in sniff position with MAC 3 or Miller 3
48
If moving on from Plan A to subsequent plans, what are you trying to do?
Obtaining a direct view of the glottis using a different technique, Establishing the airway without viewing the glottis, Obtaining an indirect view of the glottis, Moving to emergent/supportive measures
49
What is Plan B? (Back-Up Equipment)
Alternative techniques or positioning adjustments (e.g., different blade, modified sniff position).
50
What is Plan C? (Auxiliary equipment)
Use of auxiliary airway tools (e.g., supraglottic airways, fiberoptic scopes, light wand, ETT introducer).
51
What is Plan D?
Obtain an indirect view of the glottis (e.g. FFOB, video laryngoscope)
52
What is Plan E?
Initiation of emergency, life-sustaining techniques (e.g., cricothyrotomy, HPOV).
53
Why is transitioning between plans important?
Ensures timely progression to more aggressive interventions
54
If it is obvious it is going to be a difficult airway, what should you do?
Secure airway awake
55
What should always be done before intubation in a suspected difficult airway?
Preoxygenate thoroughly and optimize positioning
56
If you need help BVMing a patient, what can you do?
Two person mask ventilation
57
What is the BURP maneuver?
Backward, Upward, Rightward Pressure on the thyroid cartilage
58
Why is it important to stay calm during airway emergencies?
Panic impairs judgment and delays action
59
Why should you awaken the patient if airway attempts are failing?
It allows return of spontaneous breathing and avoidance of a can't-intubate-can't-ventilate scenario.
60
What is the 'ramped' position?
Elevation of the upper body and head to align the external auditory meatus with the sternal notch
61
What tools can help with ramping?
Troop elevation pillow, multiple blankets, adjusting the OR table backrest
62
Why is the ramped position important for obese patients?
It improves laryngoscopy view and facilitates ventilation
63
What ASA Difficult Airway Algorithm considerations apply to trauma?
Cannot cancel case, potential full stomach, may need surgical airway from the start
64
What conditions require special modifications of the ASA algorithm?
Closed head injury, cervical spine injury, maxillofacial trauma
65
What is added to the ASA algorithm with a closed head injury?
GCS is added to evaluation
66
Why is awake intubation preferred in trauma patients?
It maintains spontaneous ventilation and avoids worsening neurological injuries.
67
How do you manage a C-spine injury airway?
Use manual in-line stabilization, video laryngoscopy, or fiberoptic intubation without neck movement.
68
What is the biggest risk with maxillofacial trauma?
Airway obstruction from bleeding, swelling, or bone fragments.
69
What should be done immediately after securing a difficult airway?
Confirm placement, secure the tube, document all steps taken
70
What should be documented after difficult airway management?
Techniques attempted, outcomes, complications, what worked/didn't, and recommendations for future care.
71
Should patients with a difficult airway be extubated early?
No—delay extubation until the patient is fully awake and capable of maintaining their own airway.
72
What should be given to the patient after a difficult airway?
A difficult airway letter and inclusion in the hospital’s registry. Family/care givers made aware of situation for potential future needs. A nice extra is a detailed step-by-step of how you secured the airway for them to take to be given to future providers.
73
What is the #1 goal in airway management?
Maintain oxygenation at all times
74
What’s one tool not to forget in difficult airway cases?
The laryngeal mask airway (LMA)
75
When should you call for help in airway management?
As early as possible when difficulty is suspected
76
Who should intubate in a difficult airway?
The most experienced provider available

NSU AA Denver: Summer 2025 (2nd Semester) (12 decks)

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