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Equipment II > Test 1 > Flashcards

Test 1 Flashcards

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1
Q

5 absolute indications for OLV

A

Isolation of 1 lung r/t infection/hemorrhage

Unilateral bronchopulmonary lavage

Bronchopleural fistula

Large ruptured bullae

Tracheobronchial tree disruption (TEF)

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2
Q

5 surgeries necessitating lung separation

A

Thoracic procedure (lobectomy, transplant, thoracoscopy)

Mediastinal procedures w/ sternotomy

Descending thoracic aortic aneurysm

Pulmonary embolectomy

Esophagogastrectomy

Anterior thoracic spine sg

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3
Q

3 methods of selective lung ventilation

A

Single lumen tube with endobronchial intubation

Selective bronchial intubation with MLT

Single lumen tube with endobronchial blocker (Univent, WEB)

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4
Q

Most common method of OLV

Why?

A

Left sided DLT

More distance to LUL (5 cm)so less likely to isolate upper lobes. With RLT there is only 2 cm from carina to RUL

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5
Q

Insertion depths for left DLT

A

27.5 to 31.2 cm

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6
Q

Most common used DLT

A

Robertshaw

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7
Q

Cuffs of Robertshaw tube (DLT)

Color

Inflation amt

A

Trachea cuff is clear
- 10-20cc

Bronchial cuff is blue
- 2-3 cc

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8
Q

Tracheal cuff ventilates which lung

How

A

Ventilate both lungs if blue is not clamped

To ventilate only right lung clamp blue (bronchial) lumen

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9
Q

DLT side for large male

A

41 French (each lumen 6.5mm)

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10
Q

DLT for normal male

A

39 French (6.0mm ID)

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11
Q

DLT size normal female, small male

A

37 French (5.5mm ID)

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12
Q

DLT size small female

A

28 French (5.0mm ID each)

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13
Q

DLT size not usually used, smallest

A

28French (4.5mm ID each)

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14
Q

Placement of DLT

  • blade
  • insertion
A

MAC blade easiest

Insert with tube end facing right.
Pass bronchial cuff through cords.
Remove stylet
Turn exactly 90 degrees forward

Pull up on chin helps

Advance until resistance felt

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15
Q

Where do you tape DLT

A

Middle of mouth

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16
Q

If bronchial lumen too deep where is tube

A

Left mainstem bronchus

Not ventilating LUL

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17
Q

Bronchial cuff herniated at carina what occurs

A

Too much air in cuff

Ventilating both lungs

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18
Q

Bronchial lumen above carina what occurs

A

Ventilate both lungs

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19
Q

Right main stem bronchial intubation with left DLT

A

Only ventilate R lung (not including RUL)

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20
Q

4 methods of checking placement of DLT

A
  • check bilateral breath sounds and chest excursion
  • selectively clamp lumens one at a time and listen
  • open port and listed for air flow through clamped lung
  • check placement with fiberoptic bronchoscope
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21
Q

How do you verify placement with fiberoptic bronchoscope

A

Insert into tracheal lumen and look for bronchial cuff placement

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22
Q

When verifying placement of DLT with FOB what should you see?

  • through tracheal lumen
  • through bronchial lumen

If not there?

A

Tracheal lumen
Bronchial cuff should be visualized as crescent shaped

If see too much not in far enough
If don’t see at all, in too far

Bronchial lumen
ID left upper and lower bronchus

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23
Q

3 uses of FOB in OLV

A

Verify tube placement
Suction
???

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24
Q

6 indications for right side DLT

A

Left pneumonectomy

Left tracheobronchial disruption or TEF

Mediastinal lesion compressing L mainstem

L bronchial stent

L lung transplant

Descending thoracic aortic aneurysm compressing L main bronchus

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25
4 advantages of inhalation anesthetic on OLV
Bronchodilation Decreases HPV Ensures amnesia Rapidly eliminated, less hemodynamic response
26
3 advantages of opiod use in OLV anesthetic
No sig. hemodynamic compression Smooth transition to emergence Minimal decrease in HPV
27
Effect of 1 MAC of volatile agent during OLV
Decrease HPV response from 50% to 40% Increases Qs/Qt (flow to nondependent lung) 4%. Sats on 100% FiO2 96-98%
28
Proportion of blood flow to each lung during OLV in lateral decubitus position
Without inhalation agent Dependent- 80% Non-dependent- 20% With inhalation agent Dependent 76% Non-dependent 24%
29
5 factors that may increase shunt during OLV and effect on HPV
Atelectasis (increase HPV) Systemic vasodilators(inhibits HPV) High PA pressures (inhibits HPV0 Low FiO2 (inhibits HPV) Surgical interference/compression of operative lung
30
Management of hypoxia in OLV
``` Notify surgeon sat < 90% Suction Recheck tube position with FOB Oxygen from sidearm to operative lung via insufflation Change vent mode Change I:E ratio PEEP 5 cmH2O to dependent CPAP 5 cm H2O to non-dependent 150ml Oxygen into non-ventilated lung Intermittent ventilation of non-dependent lung Early clamping of PA if pneumonectomy ```
31
Goal of management of hypoxia during OLV
Decrease shunt
32
Benefit and disadvantages of PEEP and CPAP to lung during OLV
PEEP alone makes sat worse bc Less blood to dependent lung worsening shunt Add 2.5 CPAP to non depending lung improves sat by providing O2 to blood going to nondependent lung Add 5 CPAP to non dependent lung improves sat even more
33
4 contraindications for DLT
- Unable to replace existing ETT - unable to maintain adequate PO2 w OLV - technically difficult- anatomy, size - full stomach
34
4 complications of DLT
- hypoxemia - tracheobronchial tree disruption - traumatic laryngitis - DLT becomes temporary part of suture line
35
2 main disadvantages of bronchial blockers
Slow deflation time Blockage of bronchial blocker by blood/pus
36
7 indications for wire-guided endobronchial blocker
- ETT or trach in place - RSI and OLV - known and unknown difficult airway - nasotracheal intubation - small adult pt - selective lobar ventilation - trauma
37
What is the most versatile method for OLV
Left DLT
38
12 steps of mgmt of hypoxia with OLV
- notifies surgeon of low sat, interventions, exact sat - ask for help - decrease volatile agent - increase FIO2 - change vent to PC - manipulate PEEP - manipulates MV - administer inhaler - suction ventilated lung - insufflates with O2 - PEEP down lung, CPAP up lung
39
8 indications for securing pt airway
``` Anesthesia Hemodynamic instability Decreased LOC Pain mgmt Severe dyspnea- Acc muscle use Severe hypoxemia/hypercarbia Severe acidosis Inability to protect airway ```
40
Normal TMD
>6cm (more than 3 fingerbreadths)
41
Normal mouth opening
>4cm | 2-3 fingerbreadths
42
Neck circumference > ______ predicts difficult airway
60cm
43
LEMON assessment
Look - facial trauma, large incisiors, beard, large tongue Evaluate (3-3-2) - interincisor gap, hyomental distance, TMD Mallampati Obstruction Neck mobility
44
7 risk factors for aspiration
``` Short tasting times Pregnancy Increased abdominal pressure GI disease GERD Bowel obstruction NM disease or nervous system dysfunction ```
45
6 complications of airway mgmt
``` Failed intubation CVCI Airway trauma Aspiration Mainstem intubation Bronchospasm ```
46
6 disadvantages of face mask for general
``` Ties up hands Higher FGF Access difficult More desat than LMA Higher work of breathing Poor correlation of ETCO2 and PCO2 ```
47
4 complications from using face mask
Pressure necrosis Nerve injury Gastric insufflation Pollution
48
8 complications of LMA
``` Aspiration Gastric distention Airway obstruction Trauma (uvula edema) Laryngospasm Dislodgement Nerve injury ```
49
5 advantages of LMA
``` Ease of insertion Smooth emergence Low pollution Avoid complications of face mask and intubation Protect from barotrauma ```
50
3 advantages of LMA compared to face mask
Hands free Better seal in bearded Lass facial nerve and eye trauma
51
5 advantages of LMA compared to ETT
``` Useful for difficult intubation Less coughing on emergence Ability to ventilate until airway reflexes restored Reduced CV response Less laryngospasm and bronchospasm ```
52
2 disadvantages of LMA vs ETT
Less safe in prone or jackknife position | Less secure airway
53
Machine end of ETT has a ______ connector (size)
15mm
54
6 uses of FOB
``` Intubation (awake/asleep, nasal, oral) Confirm ETT placement Confirm placement of DLT Clear secretions Bronch with lovage for aspiration or blood in ETT Bronch exam with intervention ```
55
3 advantages of FOB
Useful if difficult or impossible to intubate with rigid laryngoscopes Onstable Cspine Overcome anatomic variations
56
7 disadvantages of FOB
- expensive, fragile, difficult to use - more time and prep required - difficult or impossible with blood, secretions, hypoxemia - gastric distension, rupture - laryngeal trauma - technical issues (fogging, anatomy, light source)
57
4 structures at risk of damage from DL
Dental injury Cspine injury Lips, tongue, palate, Laryngospasm, esophagus
58
2 uses of reinforced ETT
- kinking possible (prone, neck sg) | - ETT placed in tracheostomy
59
3 differences in microlaryngeal tracheal tube and conventional ETT
Larger cuff Narrow body Longer body
60
3 safety features of laser ETT
- cuff filled with blue indicator so see if hit - saline in cuff helps put out fire - ???
61
Type of oral airway used for awake fiberoptic intubation orally
Williams, ovassapian, ROTIG
62
4 standard monitors for the intubated pt undergoing general anesthetic
ECG BP Capnometry Pulseox
63
Role of oxygen analyzer in avoiding hypoxic mix of gases
Continuously measure and indicate FIO2 in breathing system. Indicate when inspired O2 deviates from desired limits
64
Single monitor which provides most clinical information
Pulse oximeter
65
Which law? Absorption of a given thickness of a solution of a given concentration is the same as twice the thickness of half the concentration
Beers law
66
Which law? Each layer of equal thickness absorbs an equal fraction of radiation which passes through it
Lamberts law
67
Absorption of red and infared light Oxygenated blood deoxygenated blood
Oxygenated- 960 mm Deoxygenated- 660 mm
68
How do differences in oxygenated and deoxygenated blood absorption generates pulse ox reading?
Change in light absorption when passing through vascular bed during arterial pulsation
69
5 clinical scenarios which may result in decreased oxygen saturation
``` VQ mismatch Disconnect Inadequate MV Misplaced ETT Diffusion abnormality ```
70
7 location which may be used to monitor oxygen saturation
``` Finger Nose Earlobe Forehead Lip Tongue Check Forehead ```
71
11 Factors affecting pulse ox accuracy
``` Electrocautery Motion, venous pulsation Ambient light/radiant warmers Nail polish, acrylic nails Low perfusion CO2 methemoglobin Methylene blue/indigo carmine Hypothermia Tourniquet Nonpulsatile flow (CPB) IABP (2 systole) ```
72
Accuracy standard of oximeter
Accuracy bw 70-100%
73
Mandatory sat alarm for oximeter
Sat <85%
74
4 uses for pulse oximeter other than oxygen saturation
- Estimate systolic BP - Monitor peripheral circulation (mediastinoscopy, shoulder sg) - Locating arteries - Warning of fluid extravasation
75
Most commonly used technology for gas monitoring
Diverting gas monitoring
76
How does nondiverting gas monitor works
Diverts some gas to monitor to interpret CO2, volatile anesthetics, N2O
77
How does infared technology for anesthetic gas concentration works?
Gases with 2 or more dissimilar atoms have specific infared light absorption Amount of IR light absorbed is proportional to concentration of the absorbing molecules Compare IT light absorption to known standard

Equipment II (2 decks)

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