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Principles 2 > Peds Airway > Flashcards

Peds Airway Flashcards

1
Q

peds vs adult airway

A

larger tongue
smaller pharynx
larger/floppy epiglottis
larynx anterior

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2
Q

where is peds airway narrowest?

A

at cricoid!!

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3
Q

difference in trachea in peds pts?

A

more narrow and less rigid

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4
Q

difference in peds tongue

A

Proportionately larger than adult = increased risk of obstruction. Also more difficult to move with laryngoscope

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5
Q

peds laryngeal position?

A

C3-4 (Adult: C4- C5)

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6
Q

why must we use straight blade in peds?

A

more acute angle to visualize glottic opening

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7
Q

epiglottis difference in peds?

A

Narrow, Ω shaped, angled away from axis of the trachea

[adults flat, parallel, broad]

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8
Q

vocal chords in peds?

A

more caudad on anterior, results in more difficult intubation

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9
Q

most narrow part of infant airway

A

cricoid cartilage or area immediately below

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10
Q

what can be the result cricoid ring being nonexpandable?

A

Tight ETT = edema = reduced luminal diameter = increased airway resistance and post-extubation croup

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11
Q

2 things to remember about cricoid ring?

A

nonexpandable and elliptical

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12
Q

Infant tracheal diameter

A

4mm (adults is 8)

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13
Q

1 mm of circumferential edema =

A

75% cross sectional decrease in the infant - 44% decrease in the adult

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14
Q

when does peds airway reach adult proportions?

A

10-12 yrs

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15
Q

Infants: Obligate nasal breathers, nasal obstruction can cause?

A

hypoxia

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16
Q

when do peds have adequate mouth breathing

A

3-5 months

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17
Q

why are peds More likely to have airway become distended or obstructed

A

↑ compliance of larynx, trachea, bronchi

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18
Q

Loss of spontaneous ventilation (GA) and vigorous crying causes

A

dynamic airway collapse

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19
Q

how do peds compensate for 2x O2 consumption of adults

A

increased RR

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20
Q

Obstruction during Anesthesia mostly caused by

A

loss of airway muscle tone

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21
Q

how to treat obstruction with anesthesia

A

continuous positive airway pressure (CPAP)
chin lift & jaw thrust
lateral position
Most effective overall: Jaw thrust

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22
Q

Upper respiratory infection (URI) can cause

A

↑ risk of laryngospasm, bronchospasm, edema

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23
Q

signs of big adenoids, tonsils, OSA

A

snoring, noisy breathing

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24
Q

sign of subglottic stenosis, foreign body.

A

croupy cough

25
Q

Inspiratory stridor can be

A

laryngomalacia, laryngeal web, foreign body.

26
Q

can be vocal cord palsy, papillomas

A

hoarseness

27
Q

Wheezing can be d/t

A

asthma, bronchitis, foreign body.

28
Q

when should intubation not be delayed

A

for diagnostics when severe hypoxia present

29
Q

use a straight blade until…

A

2 years of age

30
Q

historically what type of tubes were used on children

A

only uncuffed up until 8 yrs

31
Q

Biggest risk factors of post-extubation laryngeal edema

A

Poorly fitted uncuffed ETTs

Repeat laryngoscopy

32
Q

Uncuffed: If no air leak heard at 20-25 cm H2O, ETT should be changed to

A

next half size smaller.

33
Q

minimal seal of cuffed tube?

A

20

34
Q

difference in microcuff and regular cuff ETT

A

Tracheal sealing at lower pressure (<15 cm H2O)
shortened, more distal cuff
no murphy eye

35
Q

disadvantages microcuff

A

expensive

can kink easily when warm

36
Q

how much size does cuff account for

A

.5 - thats why larger uncuffed can be used

37
Q

when can you start using cuffed ETT

A

3 kg!!

38
Q

what size cuffed tube should you use

A

: Use ½ size smaller than uncuffed size. Inflate to minimal seal at ≤ 20 cm H2O

39
Q

if you use nitrous during case with cuffed tube what precautions should you take

A

measure pressure every 10-15 mins for 2 hrs

40
Q

Approximate ETT Size <500 g

A

2.0 uncuffed

41
Q

Approximate ETT Size 500-1000gm

A

2.5 uncuffed

42
Q

Approximate ETT Size 1000-2500 gm

A

3.0 cuffed or uncuffed

43
Q

Approximate ETT Size term NB to 6 mo

A

3.0 cuffed

44
Q

Approximate ETT Size 6 mo - 1 year

A

3.5 cuffed

45
Q

Approximate ETT Size 1 yr - 18 months

A

4.0 cuffed

46
Q

Approximate ETT Size 18 mo - 2 years

A

4-4.5 cuffed

47
Q

> 2 years formula for ETT size

A

age/4 + 3.5

48
Q

how to treat Post-extubation laryngeal edema/croup

A

Treat with steroids, nebulized racemic epinephrine, humidity

49
Q

90% of subglottic stenosis is caused by`

A

prolonged intubation or poorly fitted cuffed or uncuffed ETT

50
Q

Insertion Distance <1 kg

A

6 cm

51
Q

Insertion Distance <2 kg

A

9 cm

52
Q

Insertion Distance full term

A

10 cm

53
Q

Insertion Distance 1 yr

A

11 cm

54
Q

Insertion Distance 2 YR

A

12 cm

55
Q

Insertion Distance formula

A

age/2 + 12

56
Q

Peak inspiratory pressure must stay low to avoid what with lma use

A

abdominal insufflation/regurgitation.

57
Q

what is lma sizing based on

A

weight

58
Q

when should you give relaxant to peds?

A

when airway confirmed

Principles 2 (5 decks)

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