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Maternal Advanced Principles > Difficult Airway > Flashcards

Difficult Airway Flashcards

1
Q

5 Ind. Risk Factors for diff Face mask Ventilation

A 
Age > 55
Beard
Teeth
BMI> 26 kg/m2
Hx of Snoring
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2
Q

What 4 things can define Diff Tracheal Intubation

A

Time taken to intubate
Number of attempts
View at laryngoscopy
Requirement for special equipment

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3
Q

Failed intubation rate is ____ times higher in _______ surgical patients

A

8; obstetrical

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4
Q

Physiologic and anatomical Changes of pregnancy affect:

A

Airway
Oxygenation
Metabolism

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5
Q

2 examples of causes of worsened glottic view in parturients

A

1) Excessive cricoid pressure

2) Left Lateral Tilt positioning

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6
Q

What are the risk factors for airway complications during pregnancy

A 
Airway edema
Dec FRC
Inc O2 consumption 
Weight gain 
Breast enlargement 
Full dentition 
Dec LES tone 
In labor: delayed gastric emptying.
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7
Q

Oral component of the airway

A

Incisors to oropharyngeal junction

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8
Q

Pharyngeal component of airway

A

Oropharyngeal junction to Glottis

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9
Q

Airway narrowing more significant in with Pregnant women with …

A

Preeclampsia

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10
Q

In pregnant women at the end of pregnancy and start of labor they have changes in…

A

Their oral mucosa, usually due to swelling

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11
Q

Always reevaluate the airway before induction of GA rather than prelabor assessment

A

May labor for 12 hrs or so and changed in airway from prelabor assessment on admission happens

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12
Q

Patient is not able to Intubate:

A

Wake them up and discuss fiberoptic intubation.

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13
Q

Pregnancy weight gain

A

10 to 15 kg ( 22 to 33lbs )

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14
Q

3 things that contribute to pregnancy weight gain

A

Fat
Blood and Instertitial fluid volume inc
Uterine and Fetal mass

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15
Q

High BMI means

A

Diff mask and tracheal ventilation
Inc risk for req. emergency c-section
Rapid O2 desaturation during apnea

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16
Q

Full dentition, Protuding Maxillary Incisors and smal TMD

A

Interfere on DL

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17
Q

When does LES tone return to normal postpartum ?

A

1 - 4 weeks postpartum

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18
Q

Two types aspiration Pneumonitis :

A

Solids: asphyxiation

Liquids : more severe when highly acidic

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19
Q

Morbidity and mortality of aspiration depends on 2 things :

A

Chemical nature of aspirate
Physical nature of aspirate
Volume of aspirate

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20
Q

Pts who aspirate while breathing spontaneously will..

A

Breath holding then …tachypnea, tachycardia , slight Resp acidosis ,

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21
Q

Aspiration Pneumonitis aka Mendelson’s syndrome

A

Chemical Injury to the tracheobonchial tree and alveoli by sterile acidic gastric content

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22
Q

Aspiration Pneumonia

A

Infectious , Inhaled colonized oropharyngeal secretions

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23
Q

What causes the slight PO2 dec and inc in shunt seen in Aspiration

A

Bronchospasm ; disruption of surfactant

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24
Q

Large particle aspiration lead to

A

Atelectasis

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25
Smaller particulate matter aspiration lead to ——and resembles ——
Exudative neutrophilic response at bronchioles and alveolar ducts; resembles acidic liquid aspiration
26
3 Management of aspiration
1) Tracheal suction 2) Rigid bronch if large aspiration or solid 3) manage Hypoxemia with C-pap in those not intubated and PEEP in those ventilated= restores FRC, reduce shunting, reverses Hypoxemia
27
Post aspiration : Why C-pap in spont and PEEP in ventilates pts?
Restores FRC Decreases Pulmonary shunt Reverses Hypoxemia
28
For aspiration prophylaxis : Before surgical procedures consider timely admin of
Non-particulate antacid H2 Blockers And/or Reglan
29
Efficacy of non-particulates depend on
Baseline gastric volume | Acidity of gastric fluid.
30
30 ml bicitra will neutralize
225ml of HCl acid with a pH of 1.0 | Duration of bicitra depends on rate of gastric emptying
31
H2 blockers reduce both ___and _____but ______minutes required for max effect when given IV
Acidity And Volume ; 60-90 minutes | * onset 30 mins
32
Advantages of PPI are_____;_______;______.
Long DOA; Low toxicity ; low maternal/fetal blood concentration
33
Metoclopramide great because_____but effect antagonized by ______potential s/e is _____
10 mg can inc LES tone & Inc peristalsis= Dec volume in 15 mins Opioids and atropine Extrapyramidal Effects
34
Elective C-section for prevention of aspiration give : 3 options
P.O. or IV H2B/ Pepcid 20mg 60-120 mins b4 induction And Bicitra 30 ml with 30 mins of surgery Some may give Reglan 10mg PO at the same time as H2B or IV 15mins b4 induction
35
Emergency C-section Under GA
30 ml of Bicitral just after transfer to OR Plus Raniditine 50 or Pepcid 20 or Omeprazole 40 + Reglan 10mg IV when time allows
36
Bicitra short DOA unless given to
Mothers with delayed gastric emptying because of opioids
37
H2 receptor antagonists block____ receptors on the ______ and thus diminishes____
Histamine; Oxyntic cell; gastric production
38
What is Postpartum headache ?
C/O cephalic, neck, and/or shoulder pain during 1st 6 weeks after delivery .
39
Most common postpartum complications of neuraxial anesthesia
PDPH
40
Tension Headache
1) Mild to moderate Headache 2) lasting 30 mins to 7 days 3) Bilateral;Non-Pulsating; not aggravated by physical activity
41
Migraine
1) Recurrent Mod or Severe 2) Lasting 4 to 72 hrs 3) Unilateral ;Pulsating; agg. By physical activity 4) Nausea/Photo and Phonophobia
42
Musculoskeletal Headache
1) Mild to Mod | 2) Neck and Shoulder pain
43
Preeclampsia/Eclampsia headache S/S & Diag.
1) HTN and/or HELLP 2) Bilateral; pulsating; aggravated by physical activity * H&P + labs
44
What labs for pre & eclampsia ? (5)
1) Alanine aminotransferase ( ALT) 2) Aspartate Transminase ( AST) 3) Uric Acid 4) Platelet Count 5) Urine Protein
45
What is HELLP syndrome
Hemolysis, Elevated Liver enzymes, Low Platelet count syndrome
46
PRES syndrome headache S/S and Dx
1) Severe to Diffuse 2) acute or gradual onset 3) Focal neuro deficit and seizures Dx: MRI + H&P
47
What is PRES syndrome
Posterior , Reversible (leuko) Encephalopathy Syndrome
48
Stroke Headache S/S and Dx; 2 types headache
Cerebral ischemia: 1) New headache overshadowed by focal signs and/or disorders of consciousness. Subarachnoid Hemorrhage : 1)Unilateral, abrupt and Intense& Incapacitating 2)Nausea, nuchal rigidity , altered consciousness
49
Dx of Stroke headaches
H&P + CT w/o contrast or MRI ( FLAIR sequence )
50
Subdural Hematoma Headache S/S and Dx
1) without typical features 2) Overshadowed by focal neuro S/S and/or alt. Consciousness Dx: H&P + CT/MRI
51
Carotid Artery Dissection Headache
1) late developing & constant 2) Bilateral or Unilateral Dx: H&P + Carotid US or MRA
52
Cerebral venous and Sinus thrombosis headache S/S and Dx:
1) Non-Specific + may have post Dural component 2) Focal neuro signs & seizures H&P + MRV+ Angiography
53
Brain tumor headache S/S and Dx
1) Progressive Localized 2) Worse in Morning 3) aggravated by cough/straining Dx: H&P + CT or MRI
54
Idiopathic Intracranial HTN headache (pseudotumor cerebri or benign )
1) Progressive non pulsating 2) Aggravated by cough/straining 3) Ass. With Inc CSF pressure ;normal CSF chem
55
Dx of Idiopathic Intracranial HTN
H&P + Lumbar Puncture
56
Spontaneous intracranial Hypotension S/S only (5)
1) No hx of Dural trauma 2) Diffuse, Dull Headache 3) worsen w/n 15 mins of sitting out standing 4) Neck stiffness , nausea, tinnitus, photophobia 5) CSF opening pressure <60 mm H2O in the Sitting position
57
Spontaneous Intracranial Hypotention
H&P + Lumbar Puncture + Radioisoptope cisternography + CT Myelography
58
Pneumocephalus Headache
1) Frontal Headache 2) Abrupt onset immediately after Dural puncture 3) Symptoms worsen w/ upright position
59
Meningitis Headache
1) headache itself most frequent symptom 2) Diffuse 3)Intensity diffuses with time 4) nausea, photo and phonophobia 5) general malaise 6) fever Dx: H& P + Lumbar puncture
60
Sinusitis Headache
1) Frontal Headache w/ facial pain 2) Dev of headache w/ nasal obstruction 3) Purulent nasal discharge , anosmia and fever
61
lactation headache
1) Mild to Mod | 2) Temporarilly with onset of breast feeding or breast engorgement
62
Zofran Headache
Mild to Mod associated w/ zofran intake
63
PDPH headache s/s
1) Headache within 5 days of Dural puncture 2) Worsens w/in 15 minutes sitting or standing 3) Neck stiffness, tinnitus, photophobia , nausea
64
Primary headaches
Recurring activities: coughing, sex etc.. 20 times more common than secondary headaches in women in 1st week postpartum. Tension, Migraine, Trigeminal, cluster , other primary.
65
Secondary Headaches
Underlying pathological process
66
Most common postpartum headaches are :
Tension | Migraine
67
Pregnant with sever Migraine
C-section < Adverse labor and delivery : i.e.preterm, *preeclampsia, LBW
68
Eclampsia
Hypertensive encephalopathy : Headache, Visual dist., N/V, seizures, stupor, coma * Headache serious pre-monitoring sign .
69
Why are Pregos at risk for strokes ?
Venous stasis, hypercoag , edema . Headache common sign of stroke too. 50% strokes within 1st6 weeks postpartum
70
6 risk factors for Gestational Diabetes
``` Age> 30 Prior Hx Large Fetus Prior abortions Still births Obesity ```
71
What H&P & lab seen in Gestational Diabetes ?
1) Fetus LGA and mom asymptomatic in H&P | Lab: Glycosuria, Abnormal hyperglycemia, Abnormal glucose tolerance test
72
Treatment for Gestational DM
Diet Insulin NO ORAL agents= fetal hypoglycemia
73
Preterm labor - Mother
Macrosomia - Fetus
74
Polyhydramnios- Mother
Shoulder dystocia - Fetus
75
C/S for macrosomia- Mother
Perinatal Mortality 2-5%- Fetus
76
Preeclampsia/eclampsia - Mother
Congenital defects - Fetus
77
DM type II- Mother
Hypoglycemia- Fetus

Maternal Advanced Principles (2 decks)

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