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Principles II > Managing the airway > Flashcards

Managing the airway Flashcards

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1
Q

What are anesthesia masks typically made of?

A

Hard, transparent plastic with an inflatable cushion rim. Come in various sizes, shapes to fit many faces

Peds masks are flavored :)

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2
Q

What visual benefit do transparent masks offer?

A

Allow easy visualization of fogging, secretions, or vomit

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3
Q

What size connector fits anesthesia masks?

A

22 mm which fits breathing circuits

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4
Q

With one-handed bag-mask ventilation, which hand is doing what?

A

Left hand on the mask, right hand on the bag

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5
Q

What fingers are used to create a seal in one-handed mask ventilation?

A

Downward pressure using thumb and index finger, then the middle and ring finger on the MANDIBLE not the soft tissue

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6
Q

What technique helps open the airway during one-handed ventilation?

A

Middle & ring can help extend the atlanto-occipital joint, and little finger can do the jaw thrust

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7
Q

What technique is more effective for beginners: EC clamp or Thenar Eminence (TE)?

A

Thenar eminence

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8
Q

What’s the key benefit of two-handed mask ventilation?

A

Allows you to create a better seal and jaw positioning while a second person squeezes the bag

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9
Q

Should edentulous patients leave their dentures in for mask ventilation?

A

Yes! Helps add a little structure

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10
Q

How much positive pressure do you want to use while masking?

A

Positive pressure at 20 cm H2O

Too little will be a poor seal and too much will inflate the abdomen

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11
Q

Bearded patients?

A

Just needed to throw this in here to laugh

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12
Q

What is an ASA standard of care during moderate or deep sedation to ensure adequate ventilation?

A

Carbon dioxide monitoring

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13
Q

Name common indications for tracheal intubation?

A

Airway protection for aspiration risks

Maintain patent airway for weird airway pathology

Pulmonary toilet

Positive pressure ventilation for paralyzed patients, head, neck, chest, abdomen

Long procedures=no LMA

Airway compromise

Inability to maintain control with mask

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14
Q

Why should you always have two laryngoscope handles prepared for intubation?

A

In case the battery in one is dead

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15
Q

What are the two types of laryngoscope blades you should have available for intubation?

A

Miller and Macintosh

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16
Q

Why should two endotracheal tubes be available during intubation?

A

To have a backup in case of failed insertion, damage, or incorrect sizing

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17
Q

What equipment is used to confirm the ETT cuff is functioning properly before intubation?

A

A 5–10 cc syringe to inflate and check for leaks

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18
Q

Why is a rigid suction tip (Yankauer) included in airway setup?

A

To clear secretions, blood, or vomit from the oropharynx for visualization and safety

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19
Q

Why should an LMA be available during intubation setup?

A

As a backup airway in case intubation fails

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20
Q

What is the purpose of having both oral and nasal airways ready for induction?

A

To maintain a patent airway and prevent tongue obstruction during mask ventilation

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21
Q

How does the Miller blade work? Advantages? Is it straight or curved?

A

Lifts the epiglottis directly; better for anterior larynx;

The l’s in miLLer are straight like the blade

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22
Q

How does the Macintosh blade work? Advantages? Straight or curved?

A

Tip is placed in the vallecula which indirectly lifts the epiglottis; better displacement of tongue and less temptation to crank back against the teeth

maCintosh is curved like a “C”

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23
Q

What is the purpose of the Murphy eye on an ETT?

A

Allows ventilation if the main bevel is obstructed

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24
Q

What are endotracheal tubes made out of?

A

Transparent, non-irritating polyvinyl chloride. They are combustible and produces acids/toxins :)

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25
What is the usual cuff pressure to maintain perfusion?
Inflate <20 torr; tracheal capillary perfusion pressure is ~30–32 torr
26
Which ETT cuff type has a larger mucosal contact area and lower risk of mucosal damage?
Hi-Lo=High volume, low pressure
27
Which cuff type increases the risk of sore throat and aspiration?
High-volume, low-pressure due to loose seal or spontaneous extubation
28
Which cuff type is associated with higher mucosal ischemia risk?
Low-volume, high-pressure
29
Which cuff type is preferred for short-duration procedures?
Low-volume, high-pressure
30
What is tracheal capillary perfusion pressure?
Normally 32 torr Hi-Lo can have pressures of 15-20 Lo-Hi can have pressures up to 250
31
Name one physiological factor that can increase ETT cuff pressure.
Coughing raises intrathoracic pressure
32
How does nitrous oxide affect cuff pressure?
It can diffuse into the air-filled cuff and increase pressure
33
What factors determine final cuff pressure?
Air volume, Cuff size vs. trachea, Compliance of trachea and cuff, Intrathoracic pressure
34
What is the average ETT size for adult females?
Females: 7.0-7.5 mm ID
35
What is the average ETT size for adult males?
Males: 7.5-9.0 mm ID
36
What factors affect what size ETT you choose?
Size of glottis Reason for intubation Pathology of the airway Amount of attempts allowed Length of intubation Maturity of airway
37
Why might you use a larger ETT for long-term intubation?
Easier to suction secretions and lower resistance to airflow (Poiseuille literally always shows up)
38
What airway/pathology factors might lead you to choose a smaller ETT?
If you have only one attempt allowed because of airway edema/anticipated swelling use a smaller tube
39
Which ETT is reinforced with wire to prevent kinking?
Anode or armored tube
40
When are armored ETTs commonly used?
Head and neck surgeries, and prone cases
41
If the armored tube gets bent (ex. the patient bites it), do you need to replace the tube?
Yes, this is the downside of the tube
42
What is a Laser-shielded ETT used for?
To prevent puncture or ignition by laser heat
43
What do you fill a laser ETT cuff with and why?
Methylene blue–stained saline to detect cuff rupture and extinguish flame (Fort said this was silly)
44
What are Rae tubes designed for?
Preformed curves to minimize kinking. Oral Rae points down, Nasal Rae points up
45
What kind of ETT is used for one-lung ventilation?
Double lumen used for selective one-lung ventilation.
46
How does the endobronchial tube function?
The bronchial tip is placed in a main bronchus, and has both a tracheal cuff and a bronchial cuff.
47
When are uncuffed tubes used?
Pediatrics
48
What is the purpose of a stylet in an ETT?
Adds stiffness and helps shape the ETT for easier insertion
49
Where should the stylet not protrude from?
The Murphy eye or distal end of the ETT*** Also, pull back on the stylet to allow for more flexibility when entering the glottis and minimize mucosal trauma
50
What is the function of a bougie?
A flexible guide used to insert an ETT when glottic view is limited
51
What landmark might you feel when inserting a bougie correctly?
Tracheal rings--you'll feel a "bumpy" sensation
52
What is the sniffing position?
Flexing the neck in relation to the chest, Extension of the head at the occiputocervical joint, Occiput elevated approximately 10cm on firm pad
53
What is the goal of sniffing position?
Align the oral (OA), pharyngeal (PA), and laryngeal (LA) axes for better glottic view
54
What should be the approximate table height for intubation?
At the level of the your iliac crest
55
What position may be needed for obese patients to optimize the view?
Ramped position with head and shoulders elevated, ear to sternal notch With the "morbidly obese intubating wedge"
56
What is the purpose of preoxygenation?
Replaces nitrogen in the lungs with oxygen to extend safe apnea time
57
What FiO2 should be used during preoxygenation?
100% oxygen (although he hates this so I'm not entirely sure if this is right)
58
What is the target end-tidal O2 level before intubation? End-tidal CO2?
End-tidal O2 85-90% End-tidal CO2 40 mmHg
59
What is seen in a Grade I laryngoscopy view?
Full view of glottic opening
60
What is seen in a Grade II larygoscopy view?
Only posterior extremity of glottis visible
61
What is seen in a Grade III laryngoscopy view?
Only epiglottis seen
62
What is seen in a Grade IV laryngoscopy view?
No recognizable structures
63
What is the purpose of the BURP maneuver?
Improves visualization of the vocal cords during laryngoscopy
64
What does BURP stand for?
Backward (posteriorly against vertebrae) Upward (cephalad) Right Pressure (on thyroid cartilage)
65
When is nasal intubation preferred over oral intubation?
If oral access is limited, surgery involves the mouth, or prolonged intubation is expected
66
What is a benefit of nasal intubation?
Better ETT fixation, more tolerable to awake patients, can't be bitten
67
What are contraindications to nasal intubation?
Mid-face trauma, nasal fractures, basilar skull fracture, nasal obstruction
68
What is the most common mechanical complication of nasal intubation?
Tissue trauma causing epistaxis and nasal-mucosa damage
69
How can nasal intubation increase the risk of lower-respiratory infection?
It can transmit upper-respiratory pathogens (URI flora) directly into the trachea and lungs
70
Why might ventilation and suctioning be harder with a nasally placed ETT?
A smaller-diameter tube is often required, which ↑ airway resistance and makes secretions tougher to clear
71
Before nasal intubation, how do you prepare the nasal passages?
Use vasoconstrictor spray (ex. Afrin) and topical anesthetic (ex. cetacaine) to reduce bleeding and discomfort
72
Which direction should the bevel of the ETT face during nasal intubation?
Laterally to avoid damaging turbinates, and go through the nostril they breath most easily
73
How should you insert the NETT?
Insert along the floor of the nose, perpendicular to the face—not following the bridge!!
74
How can you soften the ETT for easier nasal insertion?
Warm it in sterile water to increase flexibility/pliability
75
What tools can be used to guide the nasal ETT into the glottis after it enters the oropharynx?
Magill forceps (careful to not pop the cuff) Laryngoscope can be used to view the tip in the oropharynx
76
What patient condition must be maintained during blind nasal intubation?
Spontaneous ventilation (so you can hear/feel breath sounds)
77
What position enhances success in blind nasal intubation?
Sniffing
78
What indicates that you're approaching the trachea during blind nasal intubation?
Breath sounds get louder through the tube, and the patient may cough when the trachea is stimulated
79
How should the ETT be advanced through the cords during blind nasal intubation?
Quickly and smoothly during inspiration
80
When inserting the ETT, what is the #1 rule once you see the cords?
Don’t take your eyes off the cords
81
What should you do to avoid hitting the teeth?
Lift the laryngoscope in the direction of the handle while moving (swooping) the tongue to the left. DO NOT LEVER on teeth!!
82
How far should the ETT typically be inserted in adult females? males?
20 cm females 22 cm males
83
What is the one method that is 100% reliable to verify placement?
There is no single method that is 100% reliable, use multiple methods
84
What is the most reliable method to confirm ETT placement?
Sustained end-tidal CO₂ (ETCO₂) and visual confirmation through the cords. Should see 3 consecutive capnograph peaks! And don't lie about seeing the glottis
85
What are some additional ways to confirm proper ETT placement?
Bilateral breath sounds, chest rise, tube fogging, absence of gastric sounds
86
What does right mainstem intubation result in?
Loss of breath sounds on the left side
87
Why is auscultating over the epigastrium important after intubation?
To check for gastric insufflation, which may indicate esophageal intubation
88
Does ETCO₂ confirmation rule out right mainstem bronchus placement?
No! ETCO₂ may still be present even if the ETT is too deep
89
How should the ETT be secured after intubation?
With tape or a securing device
90
What should be documented after intubation?
The depth of the ETT at the teeth or lip
91
What effect does head movement have on ETT position?
ETT moves in the direction the nose or chin moves Nose up=ETT moves up (may extubate or pull out) Nose down=ETT moves down (may cause right mainstem intubation) ALWAYS check your tube when position changes!
92
How should the laryngoscope blade be inserted?
Along the right side of the mouth, sweeping the tongue to the left
93
What hand technique is used to open the mouth before laryngoscopy?
SCISSOR THE MOUTH! Use right hand and put thumb on lower teeth, index/middle fingers on upper teeth

Principles II (3 decks)

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