Airway Mgmt Secrets Flashcards
(41 cards)
What constitutes the upper airway?
The upper airway consists of the nose, mouth, pharynx, and is separated from the lower airway by the trachea and bronchial tree.
What protects the opening of the larynx?
The epiglottis protects the opening of the larynx, known as the glottis, against aspiration during swallowing.
What is the function of the larynx?
The larynx is involved in phonation and houses and protects the vocal folds.
What is the sensory innervation of the nasal passages?
The mucous membranes of the nasal passages are innervated by the trigeminal nerve (V) and its divisions.
What nerves provide sensation to the tongue?
The lingual nerve (mandibular branch of trigeminal nerve) and the glossopharyngeal nerve provide sensation to the anterior two-thirds and posterior one-third of the tongue, respectively.
What are important components of patient history in airway evaluation?
Important components include previous anesthetic records, prior anesthetics, and medical history related to airway management.
What physical examination features suggest a difficult airway?
Features include morbid obesity, short neck, inability to flex/extend neck, large neck circumference, and abnormal neck masses.
What are predictors of difficult mask ventilation?
Predictors include presence of a beard, lack of teeth, history of obstructive sleep apnea, age over 55, and obesity.
What is the Mallampati classification?
The Mallampati classification is a scoring system used to predict the difficulty of intubation based on visible structures in the oropharynx.
What does a Mallampati score of III or IV indicate?
A score of III or IV indicates a higher risk of difficult intubation.
How is the Mallampati score assessed?
The patient must be sitting upright with the head neutral, mouth open, tongue protruded, and not phonating.
What are the general indications for endotracheal intubation?
There are three main indications to intubate a patient: 1. Inability to protect airway (e.g., altered mental status) 2. Hypercapnic respiratory failure (e.g., chronic obstructive respiratory disease) 3. Hypoxemic respiratory failure (e.g., acute respiratory distress syndrome)
What equipment should I have available when planning to intubate a patient?
Necessary equipment includes: 1. Appropriately fitting mask 2. Direct laryngoscope, video laryngoscope, or flexible intubating scope 3. Endotracheal tube (in multiple sizes) 4. Lubricant 5. Oral and/or nasal airways 6. Adhesive tape 7. Tongue depressor 8. Suction 9. Supraglottic airway (e.g., laryngeal mask airway [LMA]) 10. Bag-valve-mask device 11. Oxygen source
What is the purpose of preoxygenation before the induction of anesthesia?
The goal of preoxygenation is to increase the safe apnea time before intubation. Safe apnea time is the duration after cessation of breathing until arterial oxygen levels begin to decrease below a critical value (i.e., pulse oximetry [SpO2] <90%).
What techniques can be used to effectively mask ventilate a patient?
To successfully mask ventilate, ensure the mask covers both oral and nasal openings for an adequate seal. Use one hand (most common) or two hands for challenging airways. Lift the patient’s face into the mask by thrusting the mandible forward and press the mask to the face to create a seal.
What is a rapid sequence induction of anesthesia and intubation?
Rapid sequence induction (RSI) is a method to rapidly secure an airway in patients at increased risk of aspiration. It involves rapid injection of anesthetic agents and a rapid onset paralytic, avoidance of mask ventilation, and immediate laryngoscopy and intubation.
What patients are at risk of aspiration?
Patients at risk of aspiration include: 1. Acutely ill patients or those whose nothing-by-mouth status cannot be confirmed 2. Pregnant patients 3. Patients with acute intraabdominal processes 4. Delayed gastric emptying 5. Active or recent vomiting 6. Patients who have not adequately fasted 7. Severe gastroesophageal reflux disease
What is cricoid pressure? Does it work?
Cricoid pressure (CP) involves applying pressure to the cricoid cartilage to minimize the risk of aspiration during RSI. Its efficacy is debated, as it may compress the hypopharynx instead of the esophagus and can worsen the view on laryngoscopy.
What is sniffing position?
Sniffing position aligns the upper and lower airway axes to facilitate direct laryngoscopy. It involves cervical flexion and atlantooccipital extension. The patient is in sniffing position if an imaginary line from the external auditory meatus to the sternal notch is parallel to the floor.
How is direct laryngoscopy performed?
Direct laryngoscopy can be performed using various blades, commonly the Macintosh (curved) and Miller (straight). The mouth should be opened wide, and the laryngoscope should be held firmly to provide control. The blade is advanced into the mouth, lifting the tongue and epiglottis to visualize the glottic opening.
What are indications for an awake intubation?
An awake intubation is indicated when there is a high degree of success in placing the endotracheal tube properly.
How is an awake intubation performed?
Awake intubation is performed by using topical anesthetics and blocks to ensure the patient is alert and can tolerate the procedure.
Is it ok to give sedation to facilitate an ‘awake’ intubation?
No, sedation should not be used as the purpose of an ‘awake’ intubation is to keep the patient alert.
What other methods are available for airway management besides endotracheal intubation?
Other methods include supraglottic airway devices, which are less invasive than endotracheal tubes and can facilitate ventilation.
