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Advanced Principles- Fall 2018 > Difficult Airway > Flashcards

Flashcards in Difficult Airway Deck (22)
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What is the difficult airway algorithm?


How do you identify where you would do a cricothyroidotomy?

What can you do in advance if you anticipate a cricothyroidotomy being difficult on your patient?

  • If you anticipate difficulty, you can palpate the neck and identify and mark the cricothyroid membrane before any intervention


What 5 questions should you address before you even touch the patient?

  1. Does the airway have to be managed, or would regional be appropriate?
  2. Do you expect DVL to be difficult? Masking?
  3. Is a supraglottic (mask or LMA) possible?
  4. Is stomach empty?
  5. Can patient tolerate apnea?


What should you always give before you do a fiberoptic airway?



What is some of the equipment used for difficult airways?

  • Intubating LMA
  • bougie
  • light wand
  • optical stylet
  • Alternative laryngoscopes 
    • Upsher, airtraq, Bullard


When is the Upsher laryngoscope useful?

  • Helpful with visualization when you are unable to align the oral, pharangeal, and laryngeal axes
    • anterior larynx
    • unstable cervical spine fx
    • upper body burns
    • trauma
    • TMJ immobility
    • micrognathia
  • Must have mouth opening of 15 mm
  • Only for oral intubations
  • OK with RSI
  • No pediatric version


When is the Bullard Laryngoscope good to use?

  • All the same reasons as the Upsher
  • Can be used for oral AND nasal intubations
  • Can be used with a mouth opening of 6 mm
  • OK for RSI
  • Available in pediatric sizes


What is important to know about the Airtraq?

  • It is single use
  • allows view of glottic opening without aligning the axes
  • requires a minimal mouth opening of 16-18 mm
  • LED must be turned on 30 seconds prior to use


Who is the combitube used in?

  • Adults only; often in the ER
  • Can be inserted without visualization 
  • known esophageal disease is a contraindication


What are the different kinds of video laryngoscopes?

  • Glidescope
  • C-MAC
  • Mcgrath series 5
  • Mcgrath Mac
  • "channeled scopes"
  • Airtraq
  • The Airway Scope


What is Retrograde Endotracheal Intubation?

  • A wire or plastic stylet is passed through the cricothyroid membrane and is then coughed out of the larynx into the oropharynx
  • The ETT is then inserted into the larynx over the wire


How is a percutaneous cricothyrotomy done?

  • A 14 gauge angiocath is inserted through the cricothyroid membrane angled caudally
  • The correct position is confirmed by aspirating air
  • Attach a standard ETT connector to the syringe and then must use the jet ventilator


What I:E ratio do you use with a Jet ventilator through an angiocath?



How do you use the cricothyrotomy kits?


What are the benefits of awake intubation?

  • Maintain spontaneous respiration
  • patient can cooperate
  • maintain esophageal sphincter tone and decrease aspiration risk
  • can test neurological function post intubation


What praparation should be done for an awake intubation?

  • Patient education
  • sedatives
  • antisialogogue med
  • If nasal, vasoconstriction (cocaine/ neosynephrine)
  • Aspiration prophylaxis if high risk
  • supplemental O2


How is a glossopharyngeal nerve block done?

  • Use a tongue blade to move the patient's tong to the opposite side of the mouth
  • Inject LA using a 25g spinal needle inferiorly to pilars
    • 1-2 ml 2% lidocaine
  • OR Spray cetacaine or hurricaine spray to inferior border of pillars
  • OR use cetacaine, hurricaine, lidocaine soaked gause and place it at inferior border of pillars
  • Lidocaine gargle


How is a superior Laryngeal Nerve Block done?

  • Pts head extended with clinician standing on side to be blocked
  • Identify hyoid bone
  • displace hyoid bone toward clinician
  • Use 23g 1.75 cm needle inserted directly inferior to border of the cornu perpendicular to skin
    • insert 1/4 inch caudad and 1/4 inch medial until eld to pass through the thyrohyoid ligament (approx 1-2 cm)
    • Aspirate
    • inject 1-2 ml of LA above and 1-2 ml of LA below the thyrohyoid membrane


How is a transtracheal block done?

  • Use a 23 g butterfly needle attached to a syringe to inject 5 ml of 2% lidocaine through the cricothyroid membrane 
    • continuously aspirate while advancing needle through membrane in a posterior direction perpendicular to the floor
    • air bubbles verify placement in the tracheal lumen
  • Instruct pt to exhale fully prior to injection--inject on inspiration
    • pt will cough and will spread lidocaine
    • make sure to hold needle/syringe steady


What are the common reasons for failure of fiberoptic intubation? (7)

  • lack of provider experience
  • failure to adequately dry the airway
  • failure to adequately anesthetize the airway
  • nasal cavity bleeding
  • obstructing base of tongue
  • ETT/scope diameter ratio too large
  • flexible scope fogging


What should you take into consideration when trying to decide to extubate a pt with a difficult airway?

  • type and length of surgery
  • condition of pt
  • skills and preference of anesthetist
  • evaluation of clinical factors that may cause adverse impact on ventilation after extubation
  • back up plan if pt is unable to maintain adequate ventilation


What follow-up should you do for a patient with a difficult airway?

  • inform patient and family of difficult airway
  • meticulous documentation to help with future procedures
  • registration with an emergency notification service to decrease adverse airway related outcomes