Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

N936 Specialty Techniques > Difficult Airway Lecture; Dr. Pitman > Flashcards

Difficult Airway Lecture; Dr. Pitman Flashcards

(112 cards)

Start Studying
1
Q

What is the most common cause of adverse resp events for patients undergoing anesthesia?

A

difficult tracheal intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the common anatomic change in unanticipated difficult airways?

A

anatomic variances of the “middle column”- pharynx behind the tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What % of difficult airway events are unanticipated?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is LEMON

A 
Look at neck
Evaluate thyromental distance / assessment
Mallampati
Old age >55?
Neck anomalies

Difficulty with intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is BONES

A 
Beard / Mask seal
Obesity / Obstructions
No teeth / Neck
Elderly / Edentulous
Snores
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Failed intubations account for what percent of anesthesia related deaths?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Grade 1, 2, 3, 4 views?

A
  1. everything
  2. see posterior portion of glottic opening
  3. see epiglottis
  4. see nothing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a bougie?

5 things

A

feels for tracheal rings “click”

LONG - 60cm
Coude tip: 35-40d bend
Malleable, yet firm

**NO LUMEN FOR INSUFFLATION (cannot ventilate through)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the other name for a bougie?

A

Portex Venn Introducer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are 5 indications for the bougie?

A
  1. unable to pass ETT
  2. Grade 3-4 view
  3. ETT exchange
  4. digital intubation??
  5. adjunct to invasive technique
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you hold the bougie?

A

like a pencil, with coude tip anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you place/advance a bougie?

A 
hold like a pencil
coude tip anterior
"hook" epiglottis
advance & feel "clicks"
DO NOT REMOVE laryngoscope
slide ETT over bougie
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What maneuver can you do if the ETT is difficult to advance through the glottic opening?

A

use counter-clock turn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are 4 PEARLS of using the bougie?

A
  1. leave the laryngoscope in place during procedure
  2. rotate the ETT 90d counter-clockwise if needed
  3. use a flexible tip tube
  4. capnography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the ETT that has less chance of catching on the glottic opening when using a bougie?

A

Parker Flex-Tip Tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are 3 complications of using a bougie?

A
  1. failed intubation
  2. perforation
  3. vocal cord trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When should airway exchange catheters be used?

A

an already secure airway needs to be changed out or temporarily removed, but laryngoscopy is likely to be difficult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are 3 common features of an airway exchange catheter?

A
  1. cm distance markings
  2. central lumen or side ports (can deliver O2 through)
  3. adapter for TTJV or 15mm connector (to circuit)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does an airway exchange catheter relate to a bougie? 3 ways

A
  1. longer than a bougie
  2. less flexible than a bougie
  3. hollow lumen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a big difference between a bougie and an airway exchange catheter (specifically COOK)

A

airway exchange catheters come in pediatric sizes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

4 characteristics of a COOK airway exchange catheter

A
  1. radiopaque
  2. distal AND side ports
  3. rapi-fit adapter: luer lock 15mm
  4. distance markers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 2 sizes of the Sheridan exchange catheter?

A
  1. Adult standard: 81mm, 6-10.0 ETT

2. Adult extended (DLT exchange): 100mm, 35-41F Double Lumen ETT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What airway exchange catheter can be used with a double lumen ETT?

A

Sheridan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is a Frova Intubation Introducer different from a bougie?

A
  1. Hollow lumen to allow for O2 delivery

2. Pediatric versions are available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How is an Endotracheal tube Introducer different from a bougie?
10cm longer & stiffer
26
What does a Parker Flex-It Directional Stylet allow for?
allows provider to elevate the tip of the ETT from the proximal end
27
What are 5 PEARLS of using an airway exchange catheter?
1. HIGH-RISK procedure 2. have plan A, B, C... 3. TWO providers minimum 4. review all previous airway & intubation notes/history 5. perform a direct laryngoscopy FIRST!
28
What is a lighted stylet?
uses the principle of transillumination of soft tissues of the anterior neck to guide the tip of the ETT into the trachea
29
If a lighted stylet is placed into the esophagus, what will happen?
the light will disappear
30
What are 4 indications for use of a lighted stylet?
1. routine use (research shows less trauma?) 2. difficult airway 3. can locate tip of ETT when performing a percutaneous tracheotomy 4. can be used with laryngoscope, LMA, bullard & during retrograde intubation
31
What is special about the preparation of equipment before using a lighted stylet?
BEND IT INTO A HOCKEY STICK!!
32
What are 4 key preparation steps when using a lighted stylet?
1. lubricate the wire stylet 2. lubricate the flexible wand 3. attach ETT, clamp proximal end to handle 4. BEND TIP 90d like a field-hockey stick
33
How is a patient positioned when using a lighted stylet?
LOW!! and you are HIGH!! **do not place the patient in sniffing position!
34
What do you NOT do when using a lighted stylet?
place the patient in sniffing position
35
When using a lighted stylet, when do you retract the wire stylet?
when the light is noted below the laryngeal prominence retract it 10cm
36
How much do you retract the wire stylet when the light of the lighted stylet is noted below the laryngeal prominence?
10cm
37
After retracting the wire stylet of the lighted stylet, what do you do?
advance the wand until glow disappears below the sternal notch (this is about 5 cm above the carina) then unclamp the ETT and advance
38
What are 6 PEARLS of using the trachlight?
1. full muscle relaxation is recommended 2. Jaw-thrust or mandible lift 3. insert device midline 4. when a faint glow is seen above the larynx, lifting the jaw or tongue will raise the epiglottis and facilitate the wand towards the vocal cords 5. when the wand enters the glottic opening, a well-defined light will be observed below the laryngeal prominence 6. if resistance is met when attempting to advance ETT, rotate it 90d
39
When do you perform a needle cricothyrotomy?
CAN'T INTUBATE, CAN'T VENTILATE
40
How long is a needle cric good for?
10min
41
The moment you decide to needle cric, what do you do?
CALL FOR SURGICAL AIRWAY
42
Where is needle cric in the ASA difficult airway algorithm?
the FINAL OPTION
43
What does the needle cric do?
provides rapid access to the airway, able to provide O2 but you cannot remove CO2 through it (ineffective)
44
What equipment do you need to perform a needle cric?
1. 14G needle 2. 3-way stop-cock 3. 3mL syringe with some saline in it 4. oxygen source/ adapter from a 7.5ETT
45
What are the 2 techniques of performing a needle cric?
1. landmark technique | 2. ultra-sound guided
46
What MUST you remember after performing a needle cric?
you must allow for passive exhalation alternate O2 delivery and passive exhalation
47
How is the needle inserted when performing a needle cricothyrotomy?
needle is inserted with dominant hand; 45d angle caudally (towards the patient's feet) aspirating while inserting until bubbles are noted then STOP
48
What are 3 indications for retrograde intubation?
1. failed intubations 2. urgent airway required, but cords CANNOT be visualized 3. elective based upon patient condition
49
What are 5 contraindications for retrograde intubation?
1. unfavorable anatomy 2. laryngotracheal disease 3. coagulopathy 4. infection 5. mass
50
What equipment is needed to perform a retrograde intubation?
1. sedation or local anesthesia 2. cleaning solution 3. wire 4. needle driver 5. needle 6. syringe
51
What is the ideal patient position for performing a retrograde intubation?
sniffing position with the head HYPER-EXTENDED to improve access to the neck
52
How is anesthesia done for a retrograde intubation?
AWAKE - anesthetize the airway 1. translaryngeal & superior laryngeal nerve block (greater cornua of the hyoid bone) 2. translaryngeal with topicalization of the pharynx 3. glossopharyngeal nerve block with superior laryngeal nerve block with nebulized anesthetic
53
Where does the puncture site occur during a retrograde intubation?
can occur above or below cricoid cartilage
54
What is the benefit/downside of puncturing the cricothyroid membrane during retrograde intubation?
less bleeding but greater chance of failed intubation
55
What is the benefit/downside of puncturing the cricotracheal ligament during retrograde intubation?
higher success rate & lower incidence of vocal cord trauma, but higher risk of bleeding
56
What is the size of the cricothyroid membrane?
1cm tall | 2cm wide
57
What becomes insignificant moving from lateral to medial cricothyroid membrane?
the cricothyroid artery
58
What are the 3 techniques of retrograde intubation?
1. classic - epidural catheter 2. J-wire 3 J-wire / introducer
59
What is the most important step when performing a retrograde intubation?
CLAMP the distal end of the wire with hemostats once the proximal end has exited via the naso- or oro-pharynx
60
How is the fiberoptic retrograde intubation technique different from the wire technique?
``` once the wire has been placed, the proximal (face) end is threaded through the suction port of the fiberoptic scope allowing for a direct pathway to the vocal cords ``` ETT is passed over the fiberoptic scope into the glottic opening **continuous O2 can be delivered through the fiberoptic scope during the procedure
61
What is one advantage to using the fiberoptic scope during retrograde intubation?
O2 can be delivered throughout the procedure
62
What are 3 PEARLS of retrograde intubation?
1. CTM is associated with less bleeding but a lower success rate 2. use a smaller ETT (6.5-7.0) 3. J-wire technique: - less traumatic - easier to retrieve - less prone to kinking - can be used with fiberoptic - takes less time to perform
63
What are 4 complications of retrograde intubation?
1. bleeding 2. subcutaneous emphysema 3. nerve injury 4. broken wire
64
What is the GOLD STANDARD for management of a difficult airway?
Awake fiberoptic intubation
65
What are 4 benefits of awake fiberoptic intubation?
1. spontaneous ventilation is maintained 2. airway patency is maintained 3. larynx does not move into an anterior position 4. awake patients can monitor own neurologic status
66
What is the leading cause of patient M&M in the ASA closed claims analysis?
airway management failure
67
What is the universally accepted "gold standard" in the awake, sedated, or anesthetized difficult to intubate patient?
awake fiberoptic intubation
68
What are the 3 main parts of the endoscope?
1. handle 2. insertion tube 3. flexible tip
69
What are the 5 parts of the fiberoptic handle?
1. power source 2. suction/valve 3. working channel 4. angulation control lever 5. lens with focusing capability
70
At what position is the black "notch" located on the fiberoptic scope?
12 o'clock
71
What are the 4 components inside of the fiberoptic insertion tube?
1. light guide bundles 2. transmit source 3. angulation wires 4. working channel
72
What kind of fibers run the length of the fiberoptic insertion tube?
glass
73
How many glass fibers from the fiberoptic scope can fit into a human hair?
20
74
What happens when a glass fiber of the fiberoptic scope is damaged?
a "black spot" will appear in the image
75
How many angulation wires are in a fiberoptic insertion tube?
2
76
In what plane do the angulation wires run in the fiberoptic insertion tube?
the sagittal plane
77
The working channel of the fiberoptic insertion tube can provide what 4 things?
1. oxygen 2. suction 3. medication portal 4. specimen collection
78
What does the flexible tip of the fiberoptic scope provide?
it contains the charged-coupled device (CCD) chip and a second lens
79
What is the field of view of the fiberoptic scope?
75-120d
80
What are the 4 reasons anesthesia is required before performing an awake fiberoptic?
1. prevent discomfort 2. decrease psych stress 3. minimize hemodynamic changes 4. increase pt cooperation
81
Successful airway anesthesia includes what 3 blocks?
1. trigeminal nerve block (nasal intubation/scope) 2. glossopharyngeal nerve block (GPN) 3. laryngeal nerve blocks
82
What CN is the trigeminal nerve?
5
83
What CN is the glossopharyngeal nerve?
9
84
What CN is the vagus nerve?
10
85
The trigeminal nerve provides sensory innervation to:
the face - ophthalmic - maxillary - mandibular
86
The glossopharyngeal nerve provides sensory innervation to, what?
- posterior 1/3 of the tongue - oropharynx - vallecula - anterior epiglottis *AFFERENT branch of the gag reflex
87
If you want to eliminate the gag reflex, which cranial nerve should you target?
CN 9, the glossopharyngeal nerve
88
What are the 2 branches of the Vagus nerve important to the larynx?
Recurrent laryngeal nerve Superior Laryngeal nerve - Internal branch - External branch
89
What does the internal branch of the superior laryngeal nerve innervate?
sensory innervation from the posterior epiglottis to the vocal cord folds
90
What does the external branch of the superior laryngeal nerve innervate?
motor innervation below the vocal cords
91
What does the recurrent laryngeal nerve innervate?
Sensory innervation below the vocal folds & trachea Motor innervation to ALL intrinsic laryngeal muscles
92
Where does the recurrent laryngeal nerve branch off of the Vagus nerve?
in the thorax
93
What does the recurrent laryngeal nerve loop around?
the right side loops under the subclavian artery the left side loops under the aorta
94
What are the advantages to using an oral airway during fiberoptic intubation?
protects the bronchoscope | allows passage of ETT up to 9.0
95
What is a swivel adapter?
allows for continuous ventilation without an airway lead (can put a scope, etc down the ETT with the ventilator attached)
96
Using a flexible-tip ETT protects what anatomic structure?
the arytenoids
97
What are 4 indications for awake fiberoptic intubation?
1. anticipated difficult mask ventilation/intubation 2. difficult airway w/ comorbidities likely to result in poor outcome if intubation not achieved 3. failed asleep intubation 4. small mouth
98
What 6 pieces of equipment are needed to perform an awake fiberoptic intubation?
1. IV access 2. FOB cart & airway cart (test light and movement) 3. O2 delivery system 4. TWO suctions 5. Monitors (SpO2 is MANDATORY) 6. Medications
99
When explaining a FOB intubation to a patient, what should be included?
1. benefits of FOB 2. probable amnesia 3. local airway anesthetic administration 4. patient assistance during the procedure
100
What 3 types of medication should be given to patients for an awake fiberoptic intubation?
1. Antisialagogue 2. Sedation 3. Nasal Drops
101
What type of antisialagogue mediation should be given to patients for an awake fiberoptic intubation and when?
Glycopyrolate 0.2-0.4mg Atropine 0.4-0.6mg 15-20 minutes before procedure
102
What type of sedation medication should be given to patients for an awake fiberoptic intubation and when?
dexmedetomidine to maintain spontaneous ventilation **gold standard**
103
What type of nasal medication should be given to patients for an awake fiberoptic intubation?
Phenylephrine 0.5% mixed with Lidocaine 2-4% spray *used to vasoconstrict
104
Complete local airway anesthesia requires: (4)
1. glossopharyngeal nerve block (GPN) 2. superior laryngeal nerve block (SLN) 3. Transtracheal block 4. Trigeminal / nasal block
105
What nerve innervates the gag reflex?
glossopharyngeal nerve
106
What nerve innervates the cough reflex?
superior laryngeal nerve
107
What is the motion of the FOB when intubating?
"down, up, down" down - through oropharynx up - toward anterior commissure down - through vocal cords
108
What is the most important contraindication for using the FOB for intubation?
lack of skill by the anesthesia provider
109
What are contraindications for performing an awake FOB intubation?
1. lack of skill by the anesthesia provider 2. lack of trained assistant or equipment 3. wild, uncooperative patient 4. near-total upper airway obstruction (retrograde wire preferred)
110
If there is a near-total upper airway obstruction, what type of intubation procedure is preferred?
retrograde wire intubation
111
What are 4 considerations when extubating a difficult airway patient?
1. awake vs deep 2. clinical symptoms that will impair ventilation 3. management plan if unable to maintain adequate ventilation 4. short-term use of an airway exchanger
112
What are 3 parts of follow up documentation for the patient with a difficult airway?
1. differentiate between difficult ventilation and difficult intubation 2. description of management techniques used; what was beneficial vs detrimental 3. provide the patient with information for future care/cases - letter - medical alert bracelet?

N936 Specialty Techniques (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions