Unit 1 - Airway Management Flashcards
1
Q
exam that helps quantify the size of the tongue relative to the volume in the mouth
A
Mallampati
2
Q
Mallampati 1
A
Pillars, Uvula, Soft palate Hard palate
(PUSH)
3
Q
Mallampati 2
A
Uvula, Soft palate, Hard palate
(USH)
4
Q
Mallampati 3
A
Soft palate, Hard palate (base of uvula my be seen)
(SH)
5
Q
mallampati 4
A
Hard palate
6
Q
importance of interincisor gap
A
affects ability to align oral, pharyngeal, and larygeal axes
7
Q
normal interincisor gap
A
2-3 fingerbreadths (4 cm)
8
Q
what does a smaller interincisor gap indicate
A
a more acute angle between oral and glottic openings, increasing difficulty of intubation
9
Q
what does the mandibular protrusion test assess
A
function of TMJ
10
Q
borders of the submandibular space
A
superior = mentum
inferior = hyoid bone
lateral = either side of neck
11
Q
use of thyromental distance
A
helps estimate size of submandibular space, which gives an idea of how much space you have to displace the tongue during DL
12
Q
thyromental distance that may indicate difficult DL
A
TMD < 6 cm (3 fingerbreadths) or > 9 cm
13
Q
how does a thyromental distance > 9 cm affect DL
A
the larynx and tongue move more caudally - this shifts the glottic opening beyond the line of sight
14
Q
how to test TMJ joint in airway assessment
A
patient asked to sublux jaw and position of lower incisors compared to position of upper incisors
(mandibular protrusion test)
15
Q
MPT class 1
A
patient can move lower incisors past upper and bite the vermillion of lip
16
Q
MPT class 2
A
patient can move lower incisors in line with upper incisors
17
Q
MTP class 3
A
patient can’t move lower incisors past upper incisors
increased risk of difficult intubation
18
Q
importance of atlanto occipital joint mobility in airway assessment
A
ability to place pt in sniffing position depends on AO joint mobility
19
Q
what is the 3-3-2 rule
A
combines several airway tests to give accurate prediction of airway difficulty
- interincisor gap < 3 fingerbreadths
- thyromental distance < 3 fingerbreadths
- thyrohyoid < 2 fingerbreadths
20
Q
what is the Cormack and lehane score
A
helps quantify view obtained during DL
21
Q
structures seen with grade 1 Cormach and Lehane score
A
complete or nearly complete view of glottic opening
22
Q
structures seen with grade 2 Cormach and Lehane score
A
posterior region of glottic opening
23
Q
structures seen with grade 3 Cormach and Lehane score
A
epiglottis only - can’t see any part of the glottic opening
24
Q
structures seen with grade 4 Cormach and Lehane score
A
soft palate only
25
Cormack and Lehane score 2A & 2B
A: can see posterior region of glottig opening
B: you can only see corniculate cartilages and posterior vocal cords (no part of glottig opening)
26
Cormack & Lehane score that requires alternative approach to intubation
4
27
independent risk factors for difficult mask ventilation
BONES
- Beard
- Obese (BMI > 26)
- No teeth
- Elderly (>55)
- Snoring
28
risk factors for difficult DL & intubation
- small mouth opening
- long incisors
- prominent overbite
- high, arched palate
- MP 3 or 4
- retrognathic jaw
- inability to sublux jaw
- short, thick neck
- short thyromental distance
- reduced cervical mobility
29
risk factors for difficult SGA placement
- limited mouth opening
- upper airway obstruction
- altered pharyngeal anatomy
- poor lung compliance (requires inc. PIP)
- increased airway resistance
- lower airway obstruction
30
risk factors for difficult invasive airway placement
- abnormal neck anatomy (tumor, abscess, hx radiation, etc)
- obesity
- short neck
- laryngeal trauma
- limited access to cricothyroid membrane (halo, neck flexion deformity)
31
current NPO guidelines
clear liquids = 2 hours
breast milk = 4 hours
milk, formula, solid food = 6 hours
fried/fatty foods = 8 hours
32
what is Mendelson syndrome
chemical pneumonitis / aspiration pneumonia
33
how does ingestion of clear liquids decrease risk of Mendelson syndrome
reduces gastric volume and increases gastric pH
34
mnemonic to remember difficult DL and intubation predictors
LEMON
- Look externally (shape of face, morbid obesity, pathology of head and neck)
- Evaluate 3-3-2 rule
- Mallampati score
- Obstructions (upper and lower airway)
- Neck mobility
35
mnemonic to remember predictors of difficult SGA placement
RODS
- Restricted mouth opening
- Distorted airway
- Stiff lungs or cspine
36
mnemonic to remember difficult surgical airway placement predictors
SHORT
- surgery (neck surgery or previous scar)
- hematoma
- obesity
- radiation or other deformities
- tumors
37
cricoid pressure applied for RSI
before LOC = 20 newtons or ~2 kg
after LOC = 40 newtons or ~4 kg
38
6 complications r/t cricoid pressure
1. airway obstruction
2. difficult DL
3. impaired glottic opening
4. difficult intubation
5. lowered esophageal sphincter pressure
6. esophageal rupture
39
3 congenital conditions assoc. with c spine abnormalities
- Goldenhar
- Klippel Fiel
- Trisomy 21
40
3 causes of angioedema
1. anaphylaxis
2. ACE inhibitors
3. hereditary
41
how can ACE inhibitors cause angioedema
they prevent bradykinin breakdown (genetics likely determine who is at risk)
42
treatments for angioedema from ACE inhibitors
- icatbiant (bradykinin receptor antagonist)
- ecallantide (plasma kallidrein inhibitor)
- FFP
- C1 esterase concentrate
43
why is FFP given for angioedema from ACE inhibitors
contains enzymes that metabolize bradykinin
44
why is ecallantide used for treatment of angioedema from ACE inhibitors
stops conversion of kininongen to bradykinin
45
what causes hereditary angioedema & how is it treated
- C1 esterase deficiency
- treat with C1 esterase concentrate, FFP, ecallantide, icatibant
46
management of patients with C1 esterase deficiency requiring upper airway surgery
prophylactic danazol or C1 esterase concentrate
47
what is Ludwig's angina
a bacterial infection characterized by rapidly progressing cellulitis of the floor of the mouth
48
most significant concern with Ludwig's angina
posterior displacement of tongue resulting in complete supraglottic airway obstruction
49
when is retrograde intubation contraindicated
infection above the level of the trachea
cant intubate cant ventilate
50
best way to secure airway in a patient with Ludwig's angina
- awake nasal intubation
- awake trach
51
congenital conditions assoc. with large tongue
"Big Tongue"
- Beckwith syndrome
- Trisomy 21
52
congenital conditions assoc. with small/underdeveloped mandible
"Please Get That Chin"
- Pierre Robin
- Goldenhar
- Treacher Collins
- Cri du chat
53
congenital conditions assoc. with cervical spine anomaly
"Kids Try Gold"
- Klippel-Fiel
- Trisomy 21
- Goldenhar
54
airway considerations in a pt with Pierre Robin
- small/underdeveloped mandible
- tongue that falls back and down
- cleft palate
55
airway considerations in a patient with Treacher collins
- small mouth
- small mandible
- choanal atresia (nasal airway blocked by tissue)
56
airway considerations in Trisomy 21 patients
- small mouth
- large tongue
- AO joint instability
- subglottic stenosis
57
airway consideration with Klippel-Fiel pts
congenital cervical vertebrae fusion
58
airway considerations with Goldenhar syndrome
- small/underdeveloped mandible
- c spine abnormality
59
airway considerations with Cri du Chat
- small mandible
- laryngomalacia
- stridor
60
optimal position for tracheal intubation
sniffing position - cervical flexion and AO joint extension
61
optimal positioning of obese pt for DL
HELP - head elevated laryngoscopy position
sternum and external auditory meatus are in same horizontal plane
62
positioning that may unload diaphragm and prolong time between apnea and desaturation in obese pts
reverse Trendelenburg
63
presentation of nerve damage assoc. with aggressive jaw thrust
affected side of face may sag, pt may drool, chewing affected
facial n. injury
64
presentation of nerve injury with face mask strap that's too tight
difficulty opening and closing lips r/t impaired orbicularis oculi muscle function (buccal branch of facial n. damaged)
65
nerve that can be damaged from ETT connector resting on pt's face
s/s injury
supraorbital nerve - eye pain, forehead numbness, photophobia
66
what axes are aligned when head is lying flat on the bed and extended
1. pharyngeal
2. laryngeal
67
types of oral airways designed to accomodate a fiberoptic bronchoscope and ETT
Williams and ovassapian
68
how to size an oral airway
measure from corner of mouth to earlobe or angle of mandible
69
consequences of using an oral airway that's too short or too long
- too short = obstruction from tongue against the roof of mouth
- too long = obstruction from displacing epiglottis towards glottis
70
how to measure for a nasopharyngeal airway
from nare to earlobe or angle of mandible
71
how to insert nasal airway
gently retract tip of noce and introduce in line with nasal passage (perpendicular to face) - push cephalad
72
consequences of a nasal airway that's too short or too long
- too short = fails to relieve obstruction
- too long = obstruction via epiglottis displacement towards glottis
73
complications of oral and nasal airway placement
- laryngospasm if placed in lightly anesthetized pt
- vomiting (if gag reflex intact)
- dental injury
- oropharyngeal trauma
- ischemia
74
contraindications to nasal airway
- cribiform plate injury
- coagulopathy
- previous transphenoidal hypophysectomy
- previous Caldwell-Luc procedure
- nasal fracture
75
cribiform plate injures that make nasal instrumentation contraindicated
- Lefort 2 or 3 fracture
- basilar skull fracture
- CSF rhinorrhea
- raccoon eyes
- periorbital edema
76
what is the cribiform plate
bony structure that separates the nasal cavity from anterior cranial fossa
77
maximum ETT cuff pressure
25 cm H2O
78
what causes tracheal ischemia
ETT cuff pressure exceeds tracheal mucosal perfusion pressure
79
which ETTs use low-volume, high-pressure cuffs
- red rubber tube
- silicon tube for LMA-Fastrach
- bronchial balloon on DLT
80
cuff compliance in low-volume high-pressure cuff vs. high-volume low-pressure cuff
low volume = low compliance (takes a smaller volume to increase pressure in cuff)
high volume = high compliance (takes larger volume to increase pressure in cuff)
81
benefits of a high-volume, low-pressure cuff
cuff pressure closely resembles the pressure exerted on the trachea - this is why it can be measured with a manometer
82
benefits of low-volume, high-pressure cuffs
- better protection against aspiration
- lower incidence of sore throat
- easier visualization during intubation
83
risks of low-volume, high-pressure cuff
prolonged intubation = tracheal ischemia
84
benefits of a microthin cuff vs. standard high-volume, low-pressure cuff
- lower pressure on tracheal mucosa
- better protection against liquid aspiration
85
cuff type in nearly all modern ETTs
high-volume, low-pressure cuff
86
purpose of Murphy eye
provide alternate passage for air movement in case ETT tip becomes occluded or abuts tracheal wall
87
advantages of ETT without murphy eye
positioning the cuff closer to the tip and minimizes endobronchial intubation risk
88
formula for cuffed vs. cuffless ETT in pediatrics
- cuffless = (age/4) + 4
- cuffed = (age/4) + 3.5
89
how to calculate pediatric ETT depth
internal diameter * 3
90
predictors of difficult video assisted laryngoscopy
- neck pathology (radiation, tumor)
- short TMD
- limited cervical motion
- thin neck
- mandibular protrusion score of 3
91
examples of video assisted laryngoscopes with non-channeled design
- Glidescope
- C-MAC
- McGrath
92
acute angle video laryngoscope blades
- Glidescope LoPro
- CMac D-blade
- McGrath Xblade
93
what is a channeled video laryngoscope used for
integrates a channel for ETT into the device
channel automatically direct the tip of the ETT through vocal cords
94
examples of a channeled video laryngoscope
Airtraq Avant
Pentax AWS
95
greatest risk with video laryngoscopy
pharyngeal injury
96
what do the proximal, distal, and sides of an LMA touch?
proximal = base of tongue
distal = upper esophageal sphincter
sides = pyriform sinuses
97
max PPV pressure with an LMA
20 cm H2O
98
max cuff pressure of an LMA
60mcm H2O
(target = 40-60)
99
things to rule out if your LMA cuff pressure is > 60 and you still can't get a good seal
- improperly positioned LMA
- pt inadequately anesthetized
- laryngospasm
100
why should a manometer be used if using N2O with LMA
N2O diffuses into the cuff and increases cuff pressure
101
most common cause of nerve injury with LMA
cuff overinflation
102
what nerves are at risk for injury with LMA
- lingual n.
- hypoglossal n.
- RLN
103
risk factors for nerve injury with LMA
- cuff overinflation
- LMA too small
- lidocaine lubrication
- traumatic insertion
104
risks of cuff overinflation in LMA
- nerve injury
- sore throat
- pharyngeal necrosis
105
LMA size 1:
- patient size (kg)
- cuff inflation
- largest ETT that fits
- largest flexible endoscope
- < 5 kg
- cuff inflation: 4 mL
- largest ETT: 3.5
- largest endoscope: 2.7
106
LMA size 1.5:
- patient size (kg)
- cuff inflation
- largest ETT that fits
- largest flexible endoscope
- 5-10 kg pt
- 7 mL cuff inflation
- 4.0 largest ETT
- 3.0 largest endoscope
107
LMA size 2:
- patient size (kg)
- cuff inflation
- largest ETT that fits
- largest flexible endoscope
- 10-20 kg pt
- cuff: 10 mL
- largest ETT: 4.5
- largest endoscope: 3.5
108
LMA size 2.5:
- patient size (kg)
- cuff inflation
- largest ETT that fits
- largest flexible endoscope
- 20-30 kg pt
- cuff inflation 14 mL
- largest ETT: 5.0
- largest endoscope: 4.0
109
LMA size 3:
- patient size (kg)
- cuff inflation
- largest ETT that fits
- largest flexible endoscope
- pt 30-50 kg
- cuff 20 mL
- largest ETT 6.0
- largest endoscope 5.0
110
LMA size 4:
- patient size (kg)
- cuff inflation
- largest ETT that fits
- largest flexible endoscope
- 50-70 kg pt
- 30 mL cuff inflation
- largest ETT 6.0
- largest endoscope 5.0
111
LMA size 5:
- patient size (kg)
- cuff inflation
- largest ETT that fits
- largest flexible endoscope
- 70-100 kg pt
- cuff 40 mL
- largest ETT: 7.0
- largest endoscope: 5.5
112
what is the max PPV for a classic LMA before seeing an air leak?
20 cm H2O
113
purpose of LMA ProSeal
double lumen LMA with:
- gastric drain tube for decompression
- larger mask
- bite block
114
how can stomach be decompressed with a ProSeal LMA
place OGT through 2nd lumen
115
benefits of ProSeal vs. LMA classic
- better seal
- max pressure for PPV 30 cm H2O (vs. 20)
116
what is the LMA Supreme?
disposable version of LMA ProSeal
117
what is the LMA Fastrach
an intubating LMA
118
type of cuff used in ETTs for Fastrach LMA
high pressure
119
LMA useful for head and neck surgery
LMA Flexible
120
differences in LMA Flexible vs. LMA classic
- wire reinforced
- longer than classic
- narrower than classic (use smaller ETT/bronchoscope)
121
key features of an iGel
- no inflatable cuff
- has a gastric port
- can serve as conduit for endotracheal intubation (requires fiberoptic scope)
- no metal parts - safe for MRI
122
complications of iGel
- tongue trauma
- mucosal erosion of cricoid cartilage
- tracheal compression
- nerve injury
- airway obstruction
- regurgitation and aspiration
123
which type of LMA incorporates a low-volume, high-pressure cuff
LMA Fastrach
124
LMA contraindications
- full stomach/aspiration risk
- airway obstruction at or below glottis
- risk for tracheal collapse (ex. tracheomalacia)
- poor lung compliance
- high airway resistance
125
LMA tolerance requires a more or less anesthesia vs an ETT?
less
126
what to do if you see gastric contents behind the LMA cuff
- leave LMA in place
- place in Trendelenburg and deepen anesthetic
- 100% FiO2 via self-inflating resuscitation bag
- low FGF and Vt
- flexible suction catheter through LMA
- FOB to evaluate gastric contents in trachea
127
why is an LMA a better option vs ETT for asthmatics
- asthmatics most likely to experience wheezing during emergence
- since LMA sits over glottis, there's nothing inside the trachea to stimulate it during emergence
128
what is a Combitube
double lumen supraglottic device blindly placed in hypopharynx
129
contraindications to Combitube use
- intact gag reflex
- use > 2-3 hours
- esophageal diseaes (ex. Zenker's diverticulum)
- ingestion of caustic substances
- don't use 37 Fr in someone.< 4 ft
- don't use 41-F in someone < 6 ft
130
Combitube can't be used in patients under what height
4 ft
131
how does a Combitube work
- inflating oropharyngeal (proximal) cuff occludes hypopharynx
- inflating distal cuff occludes the esophagus
132
how much air should be put in oropharyngeal balloon of Combitube
size 37 = 40-85 mL
size 41 = 40-100 mL + option for additional 50mL
133
how much air should be put in distal cuff of Combitube
5-12 mL
134
where does the tip of the combitube typically enter?
esophagus
135
which lumen is typically used for ventilation with Combitube
blue (proxima/esophageal) lumen
136
which lumen is used for ventilation if the Combitube enters the trachea
clear (distal or tracheal) lumen
137
max cuff pressures for a combitube
60 cm H2O
138
similarities in King Laryngeal Tube and Combitube
- both inserted blindly
- both distal cuffs obstruct upper esophagus and proximal seals oral and nasal pharynxes
139
how many lumens does the King Airway have for ventilation
one
140
minimum weight for a King Airway
10 kg
141
what is a King LTS-D
disposable device that includes a 2nd lumen - gastric tube can be inserted
142
purpose of proximal cuff in King Airway
seals oral and nasal pharynxes
143
roles of dominant vs. nondominant hands in fiberoptic broncoscopy
dominant hand holds the cord
non-dominant controls the lever
144
lever movements in FOB
- pushing lever up points tip down
- pushing lever down points tip up
145
absolute contraindications for FOB
- uncooperative pt
- lack of provider skills
- near total upper airway obstruction
- massive trauma
146
moderate FOB contraindications
- obstruction that might prevent successful intubation
- lots of blood/fluid in airway
- hypoxia
147
relative FOB contraindications
- concern of vocal cord damage if ETT passed over FOB
- perilaryngeal mass
- infectious agent that complicates scope sterilization procedures
- allergy to LAs
148
best med choices for awake fiberoptic intubation
- precedex
- remifentani
- ketamine
- midazolam
149
use of Williams or Ovassapian airways in FOB
- help FOB stay midline
- may stimualte gag reflex in awake pt
150
what is the Bullard laryngoscope
a rigid fiberoptic device for indirect laryncoscopy
151
Bullard laryngoscope is useful for pts with:
- small mandible
- limited mouth opening (requires at least 7 mm)
- limited cervical mobility
- short, thick neck
152
positioning consideration for Bullard laryngoscope
pts head & neck must stay neutral or slightly flexed
153
how is glottic exposure obtained with Bullard laryngoscopt
handle is pulled straight up (90 degree angle to spine) - not up and caudally like DL
154
how to fix ETT hanging up on right arytenoid cartilage with Bullard laryngoscope
cricoid pressure
lift blade anteriorly
155
which causes less cervical displacement - direct video laryngoscopy or Bullard?
Bullard
156
absolute contraindication for Bullard
there are none
157
what is an Eschmann introducer?
a gum elastic bougie
158
best and worst times to use a bougie
- best = grade 3 view
- next best = 2b view
- worst = class 4
159
how to use a bougie
- hook angled tip under epiglottis
- advance tip into trachea (23-25 cm)
- placement confirmed with feeling clicks of tracheal rings
160
what should you do if you dont feel tracheal clicks with bougie placement but feel that it's in the trachea
look for "hold up sign" - resistance as it encouters the carina (35-40 cm)
161
troubleshooting ETT catching on soft tissue of larynx with bougie use
rotate ETT 90 degrees counter clockwise
162
indirect intubation method useful with severe oropharyngeal bleeding
lighted stylet
163
difficult intubation situations in which a lighted stylet is not useful
- super morbid obesity
- epiglottitis
- can't ventilate can't intubate scenario
164
how is a lighted stylet used
- blind intubation technique that transilluminates anterior neck to facilitate intubation
- stylet in trachea = well-defined glow below thyroid prominence
- stylet in esophagus = diffuse transillumination of neck without circumscribed glow
165
when does the light in a light stylet blink
after 30 seconds - minimizes heat production and reminds you of elapsed time
166
benefits of a lighted stylet technique
- useful for anterior airway
- useful for small mouth opening
- requires little neck manipulation
- less stimulating than DL
- less sore throat vs. DL
- useful for oral or nasal intubation
- useful for c spine abnormality, Pierre-Robin, severe burn contractures
167
disadvantages of lighted stylet
- difficult when pt has a short, thick neck
- should not be used in an emergent situation
- blind technique - don't use with tumor, FB, airway injury, or epiglottitis
- do not use with traumatic laryngeal injury
168
angle of Trachlight in adult vs. pediatric patients
- adult: bend tip to 90 degree angle
- children: angle 60-80 degrees (more acute) to accomadate a more cephalad glottic opening
169
why are false positive results more common in peds vs. adults with lighted stylet
children have thinner necks - glow more prominent
170
when is retrograde intubation indicated
- unstable c spine
- upper airway bleeding/difficult to visualize glottis
- failed awake intubation
171
7 contraindications to retrograde intubation
- tracheal stenosis under puncture site
- can't access/identify cricothyroid membrane
- pretracheal mass (goiter)
- tumor obstructing path of wire
- coagulopathy
- infection at puncture site
- neck flexion deformity
172
basic steps for retrograde intubation
1. puncture cricothyroid membrane with 14-18g needle
2. aspirate for air to confirm tracheal placement
3. pass wire through needle and advance cephalad
4. wire should travel through vocal cords and exit through mouth
5. load ETT over wire and advance into trachea
6. once ETT in trachea and can't be further advanced, withdraw wire and advance ETT to final position
173
6 complications of retrograde intubation
- bleeding
- pneumomediastinum
- PTX
- trigeminal nerve trauma
- breath holding
- wire travels wrong direction
174
most common use of retrograde intubation
unstable c spine
175
how long does retrograde intubation typically take for experienced practitioners
5-7 min
176
3 ways to create a surgical airway
- percutaneous cric with transtracheal jet ventilation
- surgical cric
- trach
177
pressure required for inspiration with jet ventilation via percutaneous cric
50psi or wall pressure
178
why is the pt at risk for hypercapnia with jet ventilation via percutaneous cric
ventilation can't be controlled
179
contraindications for percutaneous cricothyroidectomy
- upper airway obstruction
- laryngeal injury
180
complications of percutaneous cricothyroidectomy with airway obstruction above tip of jet ventilator
- barotrauma
- PTX
- subcutaneous emphysema
- mediastinal emphysema
(air can enter lungs but can't exit)
181
general complications of percutaneous cric
- hemorrhage
- aspiration
- tracheal injury
- esophageal injury
182
ventilation with a percutaneous vs. surgical cric
- percutaneous: jet ventilation
- surgical: cuffed ETT inserted through hole for mechanical ventilation
183
why is a surgical cric contraindicated in children
- children have more pliable and mobile laryngeal and cricoid cartilages
- thymoid isthmus commonly covers the mmebrane
184
emergency airway of choice in kids 6 yrs and younger
percutaneous transtracheal ventilation (needle cric)
185
contraindications to surgical cric
- children 6 and under (some books say 10)
- laryngeal fracture or neoplasm
186
complications of surgical cric
- tracheal stenosis
- tracheal or esophageal injury
- hemorrhage
- disordered swallowing
- subcutaneous or mediastinal emphysema
187
complications of transtracheal jet ventilation
- acute airway obstruction
- tracheal stenosis
- tracheomalacia
- tracheal necrosis
- trancheosophageal fistula (long term)
188
complications of cricothyroidotomy
- tracheal stenosis/injury
- esophageal injury
- hemorrhage
- dysphagia
- subcutaneous emphysema
189
complications of tracheostomy
- airway obstructin
- hypoventilation
- PTX
- acute bleeding
- tracheal stenosis/malacia/necrosis
- tracheoesophageal fistula
190
options to consider in a difficult airway in which face mask ventilation or SGA placement are adequate
alternative intubation approaches:
- VAL
- different DL blades
- SGA as conduit for intubation
- FOB
- lighted stylet
- blind approach
191
how does the DAA define difficult laryngoscopy
not possible to visualize any portion of the vocal cords after multiple attempts
the difficult or failed tracheal intubation requires multiple attempts to succeed or complete failure after multiple attempts
192
NMB recommended in new DAA difficult intubation guidelines
roc (if sugammadex available)
193
when is the emergency difficult airway pathway used
when the patient is anesthetized but you can't ventilate or intubate
194
first step of the emergency difficult airway pathway
call for help
195
options for emergency noninvasive ventilation
- SGA
- transtracheal jet ventilation
- combitube
- rigid bronch
196
newly updated difficult airway algorithm suggestion for maximizing oxygenation while trying to secure a tube
high flow NC/transnasal humidified rapid insufflation ventilatory exchange
197
The 4 plans in the difficult airway society difficult airway algorithm (DAS DAA)
A. facemask ventilation and tracheal intubation
B. maintain oxygenation with SGA insertion
C. facemask ventilation
D. emergency front of neck access
198
in DAS DAA guidelines, what are the options with failed DL/intubation but successful SGA placement
- wake pt
- intubate via SGA
- proceed without intubation
- trach or cric
199
first step of ASA DAA nonemergeny pathway
select an alternative approach to intubation (different blade, different airway device, etc)
200
preventing CV and SNS stimulation with awake extubation
- beta blockers
- calcium channel blockers
- vasodilators
201
meds to decrease coughing with awake extubation
- lidocaine
- opioids
202
4 techniques for extubating a difficult airway
1. extubate fully awake
2. extbuate over a flexible fiberoptic bronchoscope
3. extubate then place LMA
4. use airway exchange catheter
203
at what stage should deep extubation occur
Guedel stage 3
204
most common device used to manage extubation of difficult airway
airway exchange catheter
205
what is an airway exchange catheter
long, thin, flexible, hollow tube that maintains direct access to airway following tracheal extubation
206
when using an airway exchange catheter, what should you do if the ETT won't advance beyond the cords?
- use laryngoscope blade to displace supraglottic tissue
- rotate 90 degrees counterclockwise before readvancing
207
2 acceptable access points for wire-guided retrograde intubation
1. cricothyroid membrane
2. cricotracheal ligament
208
physiologic principle that underpins the mechanism of apneic oxygenation
diffusion
209
minimum pressure to power a hand-held jet ventialtor
15 psig
The hand-held jet ventilator is connected to a 50 pig oxygen source and the pressure is then set to 15 to 30 psig.
