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NSU AA Denver: Summer 2025 (2nd Semester) > Airway Management II: Lecture 6 - Surgical Airway > Flashcards

Airway Management II: Lecture 6 - Surgical Airway Flashcards

(58 cards)

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1
Q

Which of the following could be quickly used in an emergency situation to buy more time for effective airway management?

A

Cricothyrotomy
Tracheotomy
**Transtracheal Jet Ventilation

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2
Q

In which of the following patients would a surgical
cricothyrotomy be contraindicated?

A

89 y/o female

**7 y/o male?

11 y/o female

42 y/o male

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3
Q

The anesthesiologist’s surgical airway would be
which of the following?

A

Tracheostomy
**Cricothyroidotomy

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4
Q

The surgeon’s surgical airway would be which of the following?

A

**Tracheostomy

Cricothyroidotomy

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5
Q

All of the following may be placed through the anatomy identified below except?

A

Cricothyroidotomy

**TTJV?

Tracheostomy

Retrograde Guidewire intubation

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6
Q

Airway Anatomy – Anterior View

A
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7
Q

Airway Anatomy – Sagittal Section

A
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8
Q

Cricothyrotomy Location

A
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9
Q

What is a surgical airway?

A

All forms of airway management that require the creation of a new opening into the airway

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10
Q

Name two types of surgical airways.

A
  • Cricothyrotomy/cricothyroidotomy
  • Tracheostomy
  • Wire guided techniques
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11
Q

What is cricothyrotomy also known as?

A
  • Coniotomy
  • Cricothyroidotomy
  • Cricothyrostomy
  • Intercricothyrotomy
  • Minitracheostomy
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12
Q

Important considerations for emergency Surgical Airway

A

Those responsible for Surgical Airway Mgmt.
May have limited or no experience

Surgical Airway Mgmt. is often performed on unstable patients
Significantly distorted airway anatomy
Subjected to multiple failed airway attempts

If a surgical approach fails, few, if any options
remain

In sum, emergency cricothyrotomy:
Rarely performed procedure, done under stressful condition by clinicians w/ limited experience, in pts. in whom it is difficult to perform and who are likely to die if it fails.

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13
Q

Cricothyrotomy

A

Categories
Needle or over the needle catheter
transtracheal catheter ventilation

Techniques requiring an initial skin incision followed by guidewire insertion (percutaneous dilational cricothyrotomy)

Techniques involving surgical instruments to create an opening in skin and CTM  Trach or ETT inserted

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14
Q

Steps for transtrachel catheter insertion

A

Palpate CTM
Insert needle w/ catheter (14-16 G Angiocath) in caudad direction
Advance catheter off of needle
Secure catheter w/ hand
Reidentify trachea via air aspiration w/ syringe
Connect to jet ventilation system

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15
Q

What are the emergency situations where a cricothyrotomy might be performed?

A

When endotracheal intubation fails or is contraindicated

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16
Q

Transtracheal Jet Ventilation (TTJV)

A

A relatively safe and easy method to temporarily oxygenate pts that can’t be mask ventilated or intubated

A bridge technique that buys time until pt is
awakened or a definitive airway is secured

MOA: air entrainment and mass movement of gas

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17
Q

TTJV in Action

A

Catheter attached to:
high pressure (50 psig) oxygen source from jet injector powered by either regulated wall or tank pressure

Jet injector powered by unregulated wall or oxygen tank pressure

Or, anesthesia machine flush valve using noncompliant tubing from the fresh gas outlet

Ventilation though catheter

1 second of flush (100% O2)

4 seconds of exhalation
(passive)

See chest rise and fall

Emergency situation to buy more time

Can use Jet ventilator or O2
flush valve on machine

Requires a high pressure (50 psi) O2 source

Activate the jet ventilator for 1 to 1.5 seconds
Observe for adequate chest rise vs. signs of
barotrauma
This system will deliver a VT of 400 to 750 mL through a small catheter (14- or 16-gauge)

At a rate of about 10 to 12 breaths/min

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18
Q

What is the primary goal of transtracheal jet ventilation (TTJV)?

A

To temporarily oxygenate patients that can’t be mask ventilated or intubated

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19
Q

Qualitative signs of ventilation for TTJV

A

Detection of air movement from the mouth and nose

Detection of exhaled CO2

Rise and fall of the chest

Maintenance of cardiovascular stability

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20
Q

Limitations of TTJV

A

Provide temporary oxygenation

Does not provide a secure (protected) airway

Cannot support ventilation

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21
Q

Cricothyrotomy

A

Techniques requiring an initial skin incision followed by guidewire insertion (percutaneous dilational cricothyrotomy)

Also called coniotomy, cricothyroidotomy, cricothyrostomy, intercricothyrotomy, and minitracheostomy, etc.

Our emergency airway

Can be used for retrograde wire intubation or for
special cricothyroid cannula

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22
Q

Retrograde Guidewire Intubation

A
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23
Q

Emergency Cricothyrotomy Kit

A
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24
Q

Cricothyrotomy

25
Early Complications of Cricothyrotomy
Asphyxia Hemorrhage Improper or unsuccessful tube placement subQ and mediastinal emphysema Pneumothorax Airway obstruction Esophageal or mediastinal perforation Vocal cord injury Aspiration Laryngeal disruption Prolonged procedure time
26
Late Complications of Cricothyrotomy
Tracheal and subglottic stenosis Aspiration Swallowing dysfunction Tube obstruction Tracheoesophageal fistula Voice change Infection Late bleeding Persistent stoma Tracheomalacia
27
Trach Descriptive Terms
Techniques involving surgical instruments to create an opening in skin and CTM  Trach or ETT inserted Tracheotomy - a surgical incision between the 2nd and 3rd tracheal rings, designed to provide an airway that bypasses the epiglottis Tracheostomy - the stoma or opening that results from the tracheotomy Decannulation - the process of removing or weaning the patient from tracheostomy dependence. Without the presence of the tracheostomy tube, the stoma will spontaneously close within hours or days
28
Parts of a Tracheostomy Tube
Commonly abbreviated to "trach" or "trach tube“ Inner cannula - the "sleeve" inside of the tracheostomy tube that can be removed for cleaning Neck plate (flange) - site for ties; prevents movement and skin- breakdown secondary to pressure points Obturator - a guide for positioning the actual trach tube Cuff - inflates with air inside the trachea to seal the tracheal airway, preventing aspiration and potential air leak around the cannula. Cuffed trach tubes are used primarily for patients who require mechanical ventilation with high pressures to minimize risk of aspiration and aid management of airway pressures. For patients requiring only nocturnal ventilation, the cuff can be deflated during the day. Uncuffed trach tubes are preferred over cuffed tubes in most cases.
29
Fenestrated Trach Tube
30
Cuffless Trach Tube
31
Completed tracheostomy
1- Vocal cords 2- Thyroid cartilage 3- Cricoid cartilage 4- Tracheal cartilages 5- Balloon cuff
32
Surgical View of Tracheostomy
33
Use for a Tracheotomy
The conditions in which a tracheotomy may be used are: Acute setting - maxillofacial injuries, large tumors of the head and neck, congenital tumors, e.g. bronchial cyst, acute inflammation of head and neck Chronic / elective setting - when there is need for long term mechanical ventilation and tracheal toilet, e.g. comatose patients, surgery to the head and neck. Emergency settings, in the context of failed endotracheal intubation or where intubation is contraindicated, cricothyroidotomy or mini-tracheostomy may be performed in preference to a tracheostomy.
34
What is a key consideration for emergency surgical airway management?
* Limited or no experience * Unstable patients * Distorted airway anatomy * Multiple failed airway attempts
35
True or False: A surgical trach pierces the cricothyroid membrane.
False
36
What is the definition of tracheostomy?
The stoma or opening that results from a tracheotomy
37
What components are part of a tracheostomy tube?
* Inner cannula * Neck plate (flange) * Obturator * Cuff
38
What are early complications of cricothyrotomy?
* Asphyxia * Hemorrhage * Improper tube placement * SubQ and mediastinal emphysema * Pneumothorax
39
Tracheostomy Benefits
Benefits of tracheostomy in pts that require prolonged ventilation Shorter ICU and hospital stays Less need for sedation Improved patient comfort Decreased work of breathing Improved oral hygiene Better long-term laryngeal function Faster weaning from mech. vent. Lower mortality rates
40
Complications of a Tracheostomy
Intraoperative – Hemorrhage, tracheoesophageal fistula, pneumothorax, pneumomediastinum, recurrent laryngeal nerve injury, cricoid cartilage injury, cardiopulmonary arrest Postoperative – Hemorrhage, wound infection, subQ emphysema, swallowing problems, tube obstruction, displaced tracheostomy tube, granuloma, tracheocutaneous fistula, laryngotracheal stenosis
41
Trach Equipment
42
What is decannulation?
The process of removing or weaning the patient from tracheostomy dependence
43
List complications associated with tracheostomy.
* Hemorrhage * Pneumothorax * Tube obstruction * Infection * Tracheoesophageal fistula
44
What is the purpose of a cuff in a tracheostomy tube?
To seal the tracheal airway, preventing aspiration and air leaks
45
Fill in the blank: Transtracheal catheter ventilation is also known as ______.
Needle or over the needle catheter
46
What does TTJV require for operation?
A high pressure (50 psi) oxygen source
47
What are the benefits of tracheostomy for patients requiring prolonged ventilation?
* Shorter ICU and hospital stays * Less need for sedation * Improved patient comfort * Decreased work of breathing
48
What is the primary indication for performing a tracheotomy in an acute setting?
Maxillofacial injuries, large tumors of the head and neck, congenital tumors
49
What is the main difference between tracheotomy and tracheostomy?
Tracheotomy is the surgical incision, while tracheostomy is the resulting stoma
50
List the steps for transtracheal catheter insertion.
* Palpate CTM * Insert needle w/ catheter (14-16 G Angiocath) in caudad direction * Advance catheter off of needle * Secure catheter w/ hand * Reidentify trachea via air aspiration
51
What are the limitations of TTJV?
* Provides temporary oxygenation * Does not provide a secure airway * Cannot support ventilation
52
What should be readily available at the bedside during a tracheostomy procedure?
The obturator
53
What is the mechanism of action for transtracheal jet ventilation?
Air entrainment and mass movement of gas
54
What is the significance of a cuffed tracheostomy tube?
Used primarily for patients requiring mechanical ventilation with high pressures
55
True or False: A cricothyrotomy is a commonly performed procedure.
False
56
When are Trachs performed?
Most commonly in the OR under general or local anesthesia May also be performed: At the bedside in the ICU In the ED in urgent situations
57
Anesthesia During an Elective Tracheostomy
Normally patient is already intubated (prolonged) Pt will come from ICU or Skilled care floor Will come down with RT On 100% O2 when in OR Change to Air or low FIO2 during case – Risk of airway/surgical fire Work with the surgeon We will remove the ETT (with cuff deflated) as they advance the trach cannula Don’t forget to connect the patient up to the circuit and ventilate **Always have the obturator immediately available at the bedside for a fresh trach**
58
CTM and TrachVideos
Needle Cricothyrotomy – http://vimeo.com/32877016 Cricothyrotomy http://www.youtube.com/watch?v=dvWy9NXiZZI&fea ture=related Quicktrach http://www.youtube.com/watch?v=waHwm7QQ17M

NSU AA Denver: Summer 2025 (2nd Semester) (45 decks)

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