question

Pneumonic that describes difficult bag-mask ventilation

answer

MOANS Mask seal Obese Aged Neck circumference Snores/stiff

question

Bushy beards, mustache, blood, saliva all affect

answer

Mask seal

question

Obesity describes a BMI>__?

answer

BMI > 26 Oropharynx tissue collapses, chest is heavy, may need to elevate HOB

question

Aged is anyone above age

answer

>55

question

No teeth. What's the problem ?

answer

Face tends to cave in- leave teeth in for induction and remove for intubation

question

Snoring is a reminder to check for what condition?

answer

Sleep apnea- BMV may be difficult or impossible due to increased airway resistance or decreased pulm compliance

question

First and vital step to securing airway

answer

PREOXYGENATION

question

T/f: u should apply mask ventilation before induction and during spontaneous breaths

answer

True

question

With mask ventilation u may want to avoid rigid parts of the mask to bridge of nose, contact with eyes, and excessive pressure on the ____.

answer

Mandible

question

LEMON for difficult laryngoscopy stands for

answer

Look externally Evaluate 3-3-2 Mallampati Obstruction/ Obesity Neck mobility

question

Looking externally involves looking at

answer

Dentition Short neck Lower facial disruption Upper airway disruption

question

Evaluate 3-3-2 looks at what 3 distances?

answer

First 3, extent of mouth opening Second 3, 3 fingers under chin. Mandibular space 2 shows distance of larynx to base of tongue

question

Thyromental distance (hypotenuse of patils triangle) is normally __cm

answer

Normally 6.5cm Less than 6 cm suggests difficult intubation

question

T/f: Mallampati classification relates the size of the tongue to the oropharynx structures identified

answer

True- do not have pt phonate- will get a false view

question

3 Cardinal signs of upper airway obstruction

answer

Muffled voice Strider Difficulty swallowing

question

Normal head extension

answer

35 degrees

question

Cormack-lehane categorizes the degree to which the ____ can be viewed during laryngoscopy

answer

Glottis Graded I-IV Document for next provider

question

6 components of "best attempt"

answer

1. Reasonably Experienced provider 2. No sig muscle tone 3. Use of external laryngeal manipulation 4. Length of blade 5. Type of blade 6. Neck mobility

question

Define Cormack-lehane views grade 1-4

answer

Grade 1- entire laryngeal aperture Grade 2- view posterior cords and arytenoids Grade 3- epiglottis only Grade 4- no glottis structures visible

question

What is the murphy's eye?

answer

An opening on the side of the distal end of ett to decrease the risk of occlusion if lodged against carina or trachea

question

First step of intubation

answer

Prepare equipment Suction ready Position head in sniffing position Preoxygenate

question

Step two

answer

Position head in sniffing position Put height of table so face is near xiphoid process

question

T/f: sniffing position improves line of sight to glottis

answer

True

question

Third step

answer

Open mouth by placing thumb on jaw teeth and second finger on upper teeth and push in opposing directions

question

Fourth step

answer

Slide blade on right side of mouth and move tongue to center while lifting blade up, displacing tongue to the left as u lift jaw with blade

question

Tip of curved blade (Macintosh) placed in the ___.

answer

Vallecula

question

Tip of straight blade (miller) placed _____.

answer

Under epiglottis

question

Fifth step

answer

Remove right hand and view pharyngeal structures

question

Sixth step

answer

If cords not visible look to see how deep the blade is reposition if needed. Lift up at 30 degree angle

question

Seventh step

answer

Once cords r visualized place tube with right hand Do not release upward pressure Watch tube/cuff pass through vocal cords

question

Eighth step

answer

Note length of tube at teeth/lips, check bilateral breath sounds, check etco2, sounds over abd, secure with tape

question

Use rapid sequence intubation if

answer

Non-fasting/full stomach Diabetic Pregnant Obese Trauma GERD Hx of intestinal obstruction

question

For intubation on burn pts, hyperkalemia, crush injuries, increased ICP or IOP avoid using this muscle relaxant

answer

Succinylcholine

question

The most frequent and serious type of damage during intubation

answer

Dental and oral soft tissue trauma

question

Most injuries from improper airway airway management occurred by (3 things)

answer

1. Inadequate ventilation ~45% 2. Esophageal intubation ~25% 3. Airway obstruction ~10%

question

How do u size and OPA?

answer

Center of mouth to earlobe or corner of jaw

question

How about NPA?

answer

Nose to earlobe

question

LMA indications

answer

When definitive airway (ETT) can't be place- LMA is not a sub ASA 1 or 2 General anesthesia Supine position Routine/shirt surgery ~2hrs Max PIP 20-25 cmH2O

question

Disadvantages of LMAs

answer

Pulmonary aspiration Laryngospasm Leaks Sore throat Tongue cyanosis Lower esophageal pressure lower in sport breathing pt

question

Contraindications of LMAs

answer

Nonfasted Morbid obesity - never get adequate PIP Need high PIP >20-25 cmH20 Acute abd/hiatal hernia/zenker's diverticulum Trauma- esp thoracic Airway prob at glottis/infraglottic Intoxication

question

How do we size LMAs?

answer

By weight <5kg= size 1 5-10kg= size 2 20-30kg= size 2.5 Small adult= size 3 Ave adult(FEMALE)= size 4 Large adult(MALE)= size 5

question

Inserting an LMA procedure

answer

Preoxygenate Check cuff Lubricate POSTERIOR cuff Head neutral or slightly flexed Insert following hard palate Stop when resistance met Inflate cuff (visualize pop) Confirm and secure

question

With LMAs air volume is dependable on ____ and ____.

answer

Cuff size and individual pt anatomy

question

Common provider problems with LMA

answer

Failure to seat properly Sizing difficulties Aspiration

question

Which airway device can u insert blindly?

answer

Combitube- dual lumen airway

question

Indications for Combitube

answer

Difficult anatomy Difficult circumstances Difficult illumination

question

Advantages of dual lumen airway/combitube

answer

Noninvasive Universal size Easy to learn No prep needed Insert blindly Can be used in paralyzed pts Neck extension unnecessary Works in trachea or esophagus Decrease risk of aspiration Can have up to 50 cmH2O suited for obese

question

Contraindications/limitations of combitube /dual lumen airway

answer

Intact gag Only 2 sizes 37/41 Fr Zenker's diverticulum Airway obstruction Toxic or caustic ingestions Impossible to sxn trachea when in esophagus position

question

Complications of combitube

answer

Discoloration of tongue Esophagus lacerations or rupture

question

Combitube insertion procedure

answer

Check equipment Preoxygenate Head neutral Insert to guide lines Inflate pharyngeal (blue) cuff with 85-100 ml air Inflate tracheal (white) cuff with 10-15 ml air Ventilate longer blue tube If no breath sounds ventilate shorter white tube

question

Nasotracheal intubation is indicated when

answer

Surgical procedure that requires access to oropharynx as in dental procedures and mandibular fixation

question

Insert nasotracheal tube during inspiration or expiration?

answer

Inspiration

question

Contraindicated when

answer

Apnea Resistance in nares Anticoagulation problems Basilar fx Facial le fort fx 2&3

question

Complications of nasal intubation

answer

Lacerations Hemorrhage Nose bleed Injure nasal septum Adenoidectomy Dislodge nasal polyps or turbinates Perforate Vallecula or peirform recess Nasal infections

question

Retrograde intubation is indicated when?

answer

Unable to to intubated using conventional methods (ett, LMA, dual lumen, bougie, fiber optic Trauma facial Limited ROM in neck Airway diseases

question

Contraindications to retrograde intubation

answer

Unfavorable anatomy -lack access to cricothyroid muscle -poor anatomic landmarks (obese) -pretracheal mass (goiter) -laryngotracheal disease -coagulopathy -infection /pretracheal abscess

question

Retrograde intubation technique

answer

Position supine in sniffing position or sitting Anesthetize airway Puncture above or below cricoid cartilage Feed epidural cath through and exits nasally or orally Thread catheter through Murphy eye and advance ett over catheter

question

Extubation criteria

answer

Wide awake Breathing spontaneously Follows commands Head lift x 5sec and good hand squeeze

question

Fiber optic intubation indications

answer

Routine intubation Difficult- known difficult airway or failed attempt Obstruction- upper or lower airway Awake patient Dental risk or damage Unstable or fixed C-spine Mass effect in upper or lower airway Previous tracheostomy or prolonged intubation

question

Advantages of fiber optic intubation include

answer

Being able to visualize structures below vocal cords Use as a diagnostic tool Tolerated well in awake pt Can be performed in any position Less trauma Able to apply topical anesthesia O2 can be given through the working channel

question

Fiberoptic intubation steps

answer

Benzos/fent Meds to dry secretions Aspiration prophylaxis Ready induction agent Anesthetize airway, mouth, oropharynx and vocal cords with lidocaine ( decrease aspiration risk) Pass through vocal cords until carina is seen

question

Proof of correct location with fiberoptic intubation

answer

Visualizing carina and tracheal rings View tip of ett above carina before removing FOB

question

What's an ovapassian incubator ?

answer

Similar to OPA except with wider opening

question

Fiberoptic intubation disadvantages

answer

Fiberoptic scope is fragile, expensive, separate light source may be required, time consuming to clean/disinfect, vision obscured easily by blood/secretions Passage of ett through cords is BLIND Resistance during ett advancement

question

Complications of fiberoptic intubation

answer

Sore throat Dysphasia Hoarseness Post obstructive pulm edema (peds)

question

Contraindications to fob

answer

Hypoxia Heavy airway secretions/blood unrelieved by antisialagogues or suction Local anesthetic allergy (awake pt) Unable to cooperate (awake pt)

question

Variations to normal anatomy, pathological conditions, small mouth, protruding upper teeth, large tongue, head/neck/jaw immobility all help predict a

answer

Difficult airway

question

Croup, bronchitis, and pneumonia all contribute to a more reactive airway that is more susceptible to

answer

Laryngospasms and bronchospasms

question

Masseter muscle spasms (hallmark for MH) is called

answer

Trismus

question

For which le fort fx would conventional intubation still be likely?

answer

Le fort 1- only maxilla is damaged (Le fort 2- involves nasal breakage & Le fort 3 involves zygomatic arch- consider FOB)

question

Decreased mobility of atlanto-occipital joint is present with this disease

answer

Diabetes mellitus

question

This condition is associated with: Lowered FRC Increase work or breathing Increased O2 consumption Distal airway collapse leading to v/q mismatch Increase risk of aspiration due to larger gastric residual volumes and more acid ph

answer

Obesity

question

With a foreign body In The airway this may advance foreign body deeper

answer

Positive pressure ventilation Instrumentation (Consider radiologic study)

question

Condition associated with fixed flexion deformity and decreased mobility

answer

Ankylosing spondylitis

question

Blockage of the nasal passages by bone or tissue from back f nose to throat

answer

Choanal atresia

question

What is tracheomalacia?

answer

Walls of the trachea collapse because of weak or soft tissue

question

Pierre robin syndrome is associated with what abnormalities?

answer

Cleft palate Micrognathia- jaw undersized Glossoptosis- big tongue

question

Turner syndrome associated with

answer

Short neck High palate Micrognathia

question

Hallermann-streiff characterized by

answer

Craniofacial malformations- fewer than 200 people worldwide

question

Treacher-Collins syndrome characterized by

answer

Micrognathia

question

Transtracheal jet ventilation inspiratory phase needs a driving pressure of ... To be succesful

answer

50 psi Or 15 L/min

question

Cricothyrotomy is contraindicated in

answer

Children Unable to feel cricoid Coagulopathy Peep grater than 20 cmH2O Unprotected airway High innominate artery

question

Cricothyrotomy is performed between what two structures

answer

Thyroid cartilage and cricothyroid cartilage

question

A difficult airway is most likely encountered during...

answer

Intubation and ventilation

question

Define difficult mask ventilation

answer

Unable to to keep sao2 >92 using 100% via anesthesia circuit Significant gas leak via face mask Using higher than 15 l/min and flush valve more than twice

question

The single most important factor leading to a failed airway is ...

answer

The failure to predict the difficult airway

Principles of Anesthesia – Airway assessment/intubation – Flashcards

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