Airway Management-SIM Flashcards
(31 cards)
What is the “sniff position”
Supine with a pillow
Airway axes are aligned
Extend neck for maximum alignment
True/false: When a patient is supine and laying flat without a pillow, their airway axes are aligned
False
What are causes of airway obstruction?
Soft tissue obstruction, airway edema, laryngospasm, bronchospasm,
What are advantages of using the “sniff position”
- A patient’s airway is more open (easier to breathe)
- Easier to ventilate
- Better view of vocal cords
When do we encounter soft tissue obstruction?
- MAC anesthesia
- Right after induction for GA, before the ETT is inserted
- After extubation if a patient is not yet awake
What are treatments for soft tissue obstruction?
- Chin lift
- Jaw thrust
- Oral airway
- Nasal airway
What are the downsides to using oral airways?
They can cause gagging in awake patients, so must be placed when they’re unconscious
Can possibly injure teeth if the patient bites down
What are the downsides to using nasal airways?
Can cause nosebleeds (epistaxis)
Cannot be used with facial fractures
How does vasodilation lead to edema?
When the blood vessels vasodilate, they allow blood to leak out into the interstitial space. The increased fluid in the interstitial space causes edema.
What are two common causes of vasodilation induced edema?
Injury and anaphylaxis
What happens when a patient has an anaphylatic reaction?
Mast cells destabilize and release histamine
A massive histamine release causes vasodilation and bronchoconstriction
How does epinephrine treat anaphylaxis?
Causes vasoconstriction and bronchodilation
Also stabilizes mast cells and curbs the future release of histamine
List 5 ways you can treat anaphylaxis
- Epinephrine
- Beta 2 agonists (Bronchodilators)
- Volatile agent (isoflurane or sevoflurane)
- Antihistamines
- Steroids
What are etiologies to airway swelling?
- Burn victims
- Allergic reactions/anaphylaxis
- Traumatic intubation/multiple laryngoscopies
- Pregnancy
What is the etiology of a laryngospasm?**
Stimulation of the superior laryngeal nerve (branch of the vagus nerve/CN X)
What causes simulation of the superior laryngeal nerve?
ETT during extubation
Airway secretions
Why must a patient be suctioned prior to extubation?
Airway secretions can cause a laryngospasm
What stage of anesthesia does a laryngospasm occur in?
Stage II
True/false: You should NEVER extubate a patient during stage II anesthesia
True-the patient is not fully awake and cannot follow commands, they are at risk for a laryngospasm
What are treatments for a laryngospasm?
- High jaw lift at “laryngospasm notch” (jaw thrust)
- Positive airway pressure with bag and mask
- Propofol
- Succinylcholine (4-6 mg/kg if IM)
Who is more prone to airway irritation and bronchospasm?
Smokers and asthmatics
Narrowing of bronchioles caused by inflammation or constriction, can occur if the lungs get “irritated”
Bronchospasm
How do you prevent bronchospasms in a patient that is intubated?
Prior to intubation, coat ETT in lidocaine or LTA
Give more propofol and/or more higher concentrations of the volatile agent
How do you treat bronchospasms at the end of a surgery?
Give an albuterol (beta 2 agonist/bronchodilator) inhaler through the ETT
