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ACRM > Broncho/Laryngospasm-Pneumo-AirwayFire > Flashcards

Broncho/Laryngospasm-Pneumo-AirwayFire Flashcards

1
Q

Differential diagnoses for s/s associated with bronchospasm:

A
  • obstructed ETT
  • light anesthesia
  • pneumo
  • aspiration
  • R mainstem
  • anaphylaxis
  • medication
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2
Q

Pathphys of bronchospasm:

A

reflexive bronchiolar constriction (either centrally mediated OR local airway irritation)

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3
Q

Common causes of bronchospasm:

A
  • anaphylactoid drug rxn
  • blood trf rxn
  • histamine releasing drugs
  • smokers
  • chronic bronchitis/COPD
  • light anesthesia
  • noxious stimuli (secretions, intubation, ETT manipulation)
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4
Q

3 compounds mediating bronchoconstriction

A

1) IP3
2) phospholipase C
3) leukotrienes

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5
Q

Process of bronchoconstriction:

A

1) airway innervated by PNS (vagus nerve (X))
2) ACh hits M3 receptors
3) activates phospholipase C
4) activates IP3 (2nd msgr)
5) stimulates Ca2+ release
6) smooth muscle contraction/bronchoconstriction

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6
Q

Compounds mediating bronchodilation:

A
  • cAMP
  • cGMP
  • NO
  • vasoactive intestinal peptide
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7
Q

Process of bronchodilation

A

1) no SNS innervation
2) B2 activated by Epi/NE
3) Gprotein coupled receptor > adenylate cyclase > increase cAMP
4) cAMP (+ phospkinase A) decrease Ca2+ release
5) decreased smooth muscle contraction / bronchodilation

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8
Q

MOA of NO on bronchodilation

A
  • non-cholinergic PNS nerves release vasoactive intestinal peptide into airway smooth muscle > NO production > cGMP stimulation > airway relaxation
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9
Q

Symptoms of bronchspasm

A
  • reduced SaO2
  • shark fin capnography waveform
  • wheezing
  • increased airway resistance (PIP)
  • decreased exp flow rate
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10
Q

Hallmark symptom of both awake and anesthetized patients experiencing bronchospasm

A

wheezing
worse on expiration

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11
Q

Decreased expiratory flow rates leads to…

A
  • air trapping
  • increased intrathoracic pressure
  • decreased VR, CO, BP
  • Auto-PEEP
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12
Q

Treatment for bronchospasm:

A
  • 100% O2
  • confirm ETT position
  • deepen anesthetic
  • inhaled B2 agonist/anti-muscarinic
  • bronchodilators
  • steroids
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13
Q

Possible bronchodilators used to treat bronchospasm

A
  • volatile agents
  • Epi 1-10mcg/kg bolus
  • Ketamine 0.2-1mg/kg
  • Mg
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14
Q

Describe steroid use in bronchospasm

A
  • Hydrocortisone 100mg IV
  • not helpful in acute phase
  • won’t reverse acute bronchospasm
  • used for LT airway irritation
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15
Q

Methods for prevention of bronchospasm

A
  • avoid airway manipulation in at-risk pts (URI, smoker, asthma exacerb)
  • bronchodilators on induct/emerg
  • regional
  • deepen prior to intubation
  • deep extubation
  • monitor P-V loops (early detection)
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16
Q

Complications of bronchospasm

A
  • hypoxemia
  • hypercarbia
  • HoTN
  • arrhythmias
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17
Q

Tx for Auto-PEEP

A
  • disconnect ETT x5-10 sec
  • decrease RR, Vt, inspiratory time
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18
Q

How is Auto-PEEP recognized on ventilator

A

failure of expiratory waveform to return to zero baseline before next inspiration

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19
Q

Vagus nerve forms 2 important branches:

A
  • superior laryngeal nerve
  • recurrent laryngeal nerve
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20
Q

Superior laryngeal nerve EXTERNAL branch provides…

A

motor innervation to the cricothyroid muscle (tenses vocal cords)

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21
Q

Superior laryngeal nerve INTERNAL branch provides…

A

sensory innervation to the larynx between epiglottis and including vocal cords

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22
Q

Recurrent laryngeal nerve provides…

A

motor innervation to all muscles EXCEPT cricothyroid
AND
sensory innervation to the larynx below the vocal cords & trachea

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23
Q

SCAR pneumonic for motor innervation

A

Superior laryngeal nerve ext branch
Cricothyroid muscle
All other muscles
Recurrent laryngeal nerve

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24
Q

Muscle responsible for adduction of glottis

A

lateral cricoarytenoid

25
Q

Muscle responsible for abduction of glottis

A

Posterior CricoArytenoid
pulls cords apart

26
Q

Muscle responsible for tensing vocal cords

A

cricothyroid

27
Q

Muscle responsible for decreasing tension on vocal cords

A

thryroarytenoid

28
Q

Major motor nerve of the larynx

A

recurrent laryngeal nerve

29
Q

Major sensory nerve of the larynx

A

internal branch of the superior laryngeal nerve

30
Q

Location of the adult larynx

A

C3-C6 (usually C4-C5)

31
Q

Define laryngospasm

A

forceful involuntary spasm of the laryngeal musculature

32
Q

Laryngospasm is caused by sensory stimulation of…

A

internal branch of superior laryngeal nerve

33
Q

Laryngospasm is caused by motor stimulation of…

A

external branch of superior laryngeal nerve (cricothyroid muscle)
OR
recurrent laryngeal nerve (lateral cricoarytenoids

34
Q

Laryngospasm is most commonly caused by what?

A

irritative stimulus to the airway during light plane of anesthesia (e.g. secretions, volatiles, DL, OPA, pain, aspiration)

35
Q

Symptoms of laryngospasm

A
  • sudden onset
  • absent EtCO2
  • stridor
  • rocking obstruction pattern
  • can’t ventilate –> desat
  • hypoxia, hypercarbia, acidosis
  • HTN & tachycardia
  • HoTN, bradycardia, arrhythmias
  • cardiac arrest
36
Q

Early s/s of laryngospasm

A

hypoxia, hypercarbia, acidosis, HTN, tachycardia

37
Q

Late s/s of laryngospasm

A

HoTN, bradycardia, ventricular arrhythmias, cardiac arrest

38
Q

Situations when laryngospasm is most likely to occur

A
  • excitement phase on induct/emerg
  • light anesthesia
  • URI in last 2 weeks, smoker, recent asthma attack
  • mask anesthesia, LMAs
  • airway procedures
  • mechanical irritants in airway
39
Q

Methods to prevent laryngospasm

A
  • maintain anesthetic depth
  • deep extubation
  • suction secretions
  • CPAP on induction/emergence
  • IV lidocaine
  • LTA kit
40
Q

Treatment for laryngospasm

A

1) PPV
2) 100% O2
3) succinylcholine
4) atropine

41
Q

Laryngospasm dose of succs for adults and peds

A

Adults: 0.2-0.5mg/kg IV
Peds: 4-5mg/kg IM or 2-3mg/kg IV

42
Q

Laryngospasm dose of atropine

A

0.02mg/kg IV or IM
- minimum dose of 0.1mg

43
Q

What is Larson’s Maneuver? What is it used for?

A
  • pressure applied behind the earlobes on the laryngospasm notch
  • apply bilaterally towards skull base for 3-5 seconds, pausing for 5-10 seconds

used for laryngospasm

44
Q

2 effects of the Larson’s Maneuver

A

1) displaces mandible anteriorly to open airway
2) causes a lightly anesthetized patient to sigh, breaking laryngospasm

45
Q

Complications of laryngospasm

A
  • hypoxemia
  • hypercarbia
  • neg pressure pulm edema
  • bradycardia
  • cardiac arrest
46
Q

Common situations when a pneumothorax can occur:

A
  • CVP placement
  • regional nerve block
  • bronchoscopy, needle biopsy, laparoscopic procedures
  • chest trauma
  • barotrauma
  • spontaneous in pts with bullous lung dz
47
Q

Manifestations of pneumothorax

A

*hypoxemia
*high PIP
*HoTN
*tachycardia
*increased CVP
- asymmetric BS
- tracheal deviation (late)
- neck vein distension

48
Q

Treatment for pneumothorax

A
  • 100% O2
  • turn off N2O
  • support BP (pressors, IVF)
  • lighten anesthetic
  • tell sx team
  • needle compression if significant HoTN
49
Q

Needle decompression process & landmarks

A
  • large bore IV catheter
  • 2nd ICS, MCL or 4th ICS, MAL
  • 90* angle, cephalad to 3rd rib

CT placement is definitive tx

50
Q

3 parts to the fire triangle

A

1) oxygen/oxidixer
2) heat/ignition source
3) fuel source (drapes, sponges, solutions)

51
Q

Most common airway fire fuel source?

A

surgical drapes

52
Q

Most common airway fire ignition source?

A

cautery

53
Q

3 factors that increase the r/f airway fire

A
  • surgical procedure of head/neck
  • MAC cases on upper half of body (tent of O2)
  • bacteria in lungs (staph and pseudomonas)
54
Q

Manifestations of airway fire

A
  • fire/smoke
  • visible burning of ETT
  • odor of burning tissue

later signs:
- decreased SpO2
- airway/pulm edema
- decreased pulm compliance

55
Q

Treatment of airway fire

A
  • extubate the trachea
  • stop flow of O2
  • douse airway with NS or H2)
  • mask ventilate with AIR
56
Q

Post-extubation after airway fire:

A
  • reintubate/ventilate with AIR
  • inspect airway
  • cricothyrotomy or tracheostomy if unable to reintubate
  • high dose steroids
  • fiberoptic bronchoscopy
57
Q

Methods to prevent airway fire

A
  • assess fire risk in every case
  • cuffed ETT in airway procedures
  • low FiO2 (<30%)
  • protect ETT during laser sx (laser proof, fill with NS or dye
  • be prepared
  • vent drapes in MAC cases
58
Q

3 FRA questions:

A

1) is the surgical site at the xiphoid or above?
2) is there an open O2 source?
3) is an ignition source being utilized?

59
Q

What % O2 helps to prevent an airway fire?

A

<30%

ACRM (9 decks)

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