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How must the OPA be inserted?
1.Use tongue blade; pt must be relaxed/asleep 2.Insert along the tongue; separating the posterior oropharynx and the base of the tongue
T/F: OPA; if properly inserted; can be kept in for up to 6 hrs.
FALSE: Do not keep in during long cases, causes paresthesias of tongue.
What must be used for every mask case?
OPA
Sizes of appropriate OPA for adults
90 female; 100 male
how to measure for appropriate size
From tragus to lips
What happens if the OPA is too small / large?
Too small: OPA will cause the tongue to fall back and obstruct airway Too large: cuts top of mouth and oropharynx
Disadvantages of OPA (3)
1.Pt must be deep for insertion 2.Potential injury to teeth; lips; gingival 3.Potential paresthesia of tongue
When should a nasal airway be used?
1. Pts who can't tolerate an OPA 2.Useful in pts who are unable / unwilling to open their mouths
What to do with nasal airway insertion & resistance
Remove and attempt in other nares
Procedure for inserting nasal airway
1.Prep with neosynephrine (prevents bleeding) 2. Insert w/bevel up and then down (pushing up puts airway into turbinates) 3. Use lube 4. Insert gently with 1 hand while the other deflects the tip of nose upward
Contraindications of nasal airway (3)
1. Leakage of CSF from nose 2. Coagulopathy 3. Nasal septal deformity
Disadvantage of nasal airway
Massive nose bleed
Soft Airway definition / use
DEF: dense roll of gauze with tape around it. NOT AN AIRWAY Use: w/ LMA (primarily) and ETT to prevent bite down on tube. Place between molars
LMA
Supraglottic airway designed to provide & maintain a seal around the laryngeal inlet to spontaneous ventilation & all controlled ventilation up to 14 cm H2O (modest)
Advantages of LMA (6)
1. More secure than face mask 2. Less invasive than ETT 3. Allows for hands free ventilation 4. Rapid; blind insertion 5. Can use with ventilator (not often) 6. Control of emergency airway can't mask/can't ventilate situation
disadvantages of LMA (4)
1. No protection against aspiration of gastric contents 2. Does not guard against laryngospasm 3. Placement alone can cause regurgitation pulm aspiration 4. Expensive
Contraindication of LMA
Any condition associated w/increased risk of aspiration
Types of LMA?s (5)
CLASSIC: reusable or disposable FLEXIBLE: outside extension is flexible; allows for any connection LMA-FASTRACH: for fascilitating ETT placement used for continuous ventilation during intubation PRO-SEAL: provides higher airway seal pressure w/bite block and OGT LMA CTRACH: LMA w/fiber optic hook up
Complications of LMA (3)
1. Pulmonary aspiration 2. Laryngospasm 3. Pulm diseases needed pressure for ventilation � cuff will break
position (head) for LMA insertion
Sniffing
3 parts of documentation for LMA insertion
Breath sounds; size of LMA; atraumatic vs traumatic insertion
Handle size for obese pts on laryngoscope
Short
Parts of blade and purpose
1. Spatula manages tongue and soft tissues 2. Flange- guides tube
MAC blade tip is in contact with ?
The vallecula and lifts the epiglottis
Theoretical advantages of MAC blade (3)
1. Conforms better to tongue anatomy 2. Leaves more room for tube insertion 3. chance of vagal stimulation because not touching the epiglottis
Disadvantages of MAC blade (2)
1. Doesn't move epiglottis away, therefore direct exposure is limited 2. Blade is larger, difficult with small mouthed patients
Miller blade is in contact with ?.
The epiglottis; goes directly UNDER the epiglottis and lifts it.
Range of sizes for Miller blades
00-4 (adult = 3)
Theoretical advantages of Miller blade (5)
1. Blade is longer / thinner 2. exposure with small mouth opening 3. Limited jaw mobility needed for insertion 4. OK with prominent teeth/buc teeth 5. visualization of cords
Disadvantage of Miller blade
incidence of vagal stimulation
Composition of ET tubes (4)
1. PVC conforms to anatomy when warm 2. Medical grade silicone for laser tubes 3. Red rubber 4. Radiopaque
Formula for ET tube size for kids > 2 yrs
Age + 16 / 4
Effects of ETT on airway resistance and anatomic deadspace
increase airway resistance, decrease anatomic deadspace
Resistance d/t ETT placement depends on:
Length; internal diameter; connectors (if curved; increases turbulent flow -> increase resistance); naso-tracheal tube
Advantages of high pressure cuff (low volume)
Tight seal; ? aspiration risk
Disadvantages of high pressure cuff (low volume)
? ischemia to tracheal mucosa (bad for long intubations)
Advantages of low pressure cuff (high volume)
? ischemia on mucosal lining � better for long intubations; facilitates positive pressure ventilation
Disadvantages of low pressure cuff (high volume)
1. inc surface area, increase risk of sore throat 2. increase risk of aspiration 3. increase risk of spontaneous extubation 4. difficult insertion d/t floppy cuff
������� ? risk of spontaneous extubation
Purpose of Murphy eye on ET tube
To decrease risk of occlusion by boogers or should distal tube abut the carina or trachea
Why are uncuffed tubes used for kids?
decrease risk of pressure injury decrease risk of post-intubation croup d/t airway irritation
What is used as an indication of ET tube integrity?
Pilot balloon
Uses of RAE ET tube
RAE = right angle endotracheal tube; rt angle bed at part outside of body
Use of ANODE tube
Oral / nasal / neck surgeries Tube is reinforced with wire and very flexible; wont kink/crush
Endotrol ET tube ? characteristics / use
Has plastic loop / thread that moves tip of tube lip when pulsed
Endobronchial tube characteristics / use
2 cuffs and lumens; can clamp off 1 lumen to ventilate other lung use: 1 lung ventilation
Metal ET tube ? characteristics / use
Very flexible; fill cuffs with saline d/t fire hazard
use: laser procedures, vocal cord procedures
Purpose of stylet
To alter configuration of ET tube
Complication of stylet
Tracheal perforation
Huge NO-NO with stylets
Tip of stylet should NOT come out of end of ETT or Murphy eye
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