Airway Management in the Adult Flashcards

Question

How to perform a glossopharyngeal nerve block?

Answer 1

To block this nerve, the tongue is displaced medially, forming a gutter (glossogingival groove). A 25-gauge spinal needle is inserted at the base of the anterior tonsillar pillar, just lateral to the base of the tongue, to a depth of 0.5 cm. After negative aspiration for blood or air, 2 mL of 2% lidocaine is injected. The process is then repeated on the contralateral side. The same procedure can be performed noninvasively with cotton-tipped swabs soaked in 4% lidocaine; the swabs are held in place for 5 minutes

Answer 2

the lower pharynx and the upper part of the larynx, including the glottic surface of the epiglottis and the aryepiglottic folds

Answer 3

using one of three landmarks: - Using either the superior cornu of the hyoid or the superior cornu of the thyroid cartilage, a 25-gauge spinal needle is walked off the cornu anteriorly toward the thyrohyoid ligament. Resistance is felt as the needle is advanced through the ligament, usually at a depth of 1 to 2 cm. After negative aspiration for blood and air, 1.5 to 2 mL of 2% lidocaine is injected and then repeated on the opposite side. The third landmark for the superior laryngeal nerve block is particularly useful in patients who are obese, in whom palpation of the hyoid or the superior cornu of the thyroid cartilage may be difficult or uncomfortable for the patient. In this approach, the needle is inserted 2 cm lateral to the superior notch of the thyroid cartilage and directed in a posterior and cephalad direction to 1 to 1.5 cm depth, where 2 mL of 2% lidocaine is infiltrated and, again, repeated on the contralateral side

Answer 4

trachea and vocal cords a neurologic examination is needed after intubation 4

Answer 5

4 to 9 mg/kg

Answer 6

□ Obstructive sleep apnea or history of snoring □ Age older than 55 years □ Male gender □ Body mass index of 30 kg/m2 or greater □ Mallampati classification III or IV □ Presence of a beard □ Edentulousness

Answer 7

gastric drainage tube that allows for gastric access with an orogastric tube and channels any regurgitated gastric contents away from the airway, effectively isolating the respiratory and gastrointestinal tracts

Answer 8

upper gastrointestinal endoscopy procedures, simultaneously protecting the airway and facilitating passage of an endoscope

Answer 9

□ Long upper incisors □ Prominent overbite □ Inability to protrude mandible □ Small mouth opening □ Mallampati classification III or IV □ High, arched palate □ Short thyromental distance □ Short, thick neck □ Limited cervical mobility

Answer 10

Equipment □ No. 10 scalpel □ Bougie with a coudé (angled) tip □ Cuffed endotracheal tube (ETT) with a 6-mm internal diameter Technique 1. Stand on the patient’s left-hand side if you are right handed (reverse if left handed). 2. Stabilize the larynx using the left hand. 3. Use the left index finger to identify the cricothyroid membrane (CTM). If the CTM is not palpable, make a 8-10 cm vertical incision in the midline and use blunt dissection with the fingers of both hands to separate tissues and identify and stabilize the larynx with the left hand. 4. Holding the scalpel in your right hand, make a transverse stab incision through the skin and cricothyroid membrane with the cutting edge of the blade facing toward you. 5. Keep the scalpel perpendicular to the skin and turn it through 90° so that the sharp edge points caudally (toward the feet). 6. Swap hands; hold the scalpel with your left hand. 7. Maintain gentle traction, pulling the scalpel toward you (laterally) with the left hand, keeping the scalpel handle vertical to the skin (not slanted). 8. Pick the bougie up with your right hand. 9. Holding the bougie at a right angle to the trachea, slide the coudé tip of the bougie down the side of the scalpel blade furthest from you into the trachea. 10. Rotate and align the bougie with the patient’s trachea and advance gently up to 10-15 cm. 11. Remove the scalpel. 12. Stabilize trachea and tension skin with left hand. 13. Railroad a lubricated size 6.0 mm cuffed tracheal tube over the bougie. 14. Rotate the tube over the bougie as it is advanced. Avoid excessive advancement and endobronchial intubation. 15. Remove the bougie. 16. Inflate the cuff and confirm ventilation with capnography.

Answer 11

□ Laryngospasm and bronchospasm □ Upper airway obstruction □ Hypoventilation □ Hemodynamic changes (hypertension, tachycardia) □ Coughing and straining, leading to surgical wound dehiscence □ Laryngeal or airway edema □ Negative-pressure pulmonary edema □ Paradoxical vocal cord motion □ Arytenoid dislocation □ Aspiration

Answer 12

Airway Risk Factors □ Known difficult airway □ Airway deterioration (bleeding, edema, trauma) □ Restricted airway access □ Obesity and obstructive sleep apnea □ Aspiration risk General Risk Factors □ Cardiovascular disease □ Respiratory disease □ Neuromuscular disease □ Metabolic derangements □ Special surgical requirements

Airway Management in the Adult Flashcards

(36 cards)