Airway Management

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Author:
ariadne9
ID:
233017
Filename:
Airway Management
Updated:
2013-09-05 11:42:19
Tags:
BC NU 591
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Description:
airway management
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  1. What's the most important predictor of a difficult airway?
    A previously difficult laryngoscopy
  2. Mallampati 1
    uvula, tonsillar pillars, hard and soft palate visible
  3. Mallampati 2
    uvula not fully visible
  4. Mallampati 3
    uvula not visible, can still see hard and soft palate
  5. Mallampati 4
    only hard palate is visible
  6. sniff position
    • -neck flexion (35 degrees) and head extension (15 degrees) to align all 3 axes (oral, pharyngeal, and laryngeal)
    • -chin points towards the ceiling
    • -head on a pillow (adults)
    • -facilitates intubation
  7. Visually, what is a good indicator that sniff position has been obtained?
    external auditory meatus (ear) is lined up with the sternal notch
  8. How is sniff position obtained in a pedi pt?
    • -Chin up
    • -don't need a pillow as the head is so large
  9. Cormack and Lehane grade 1 laryngoscopy view
    entire VC in view
  10. Cormack and Lehane grade 2 laryngoscopy view
    Only posterior VC or arytenoid cartilage is seen
  11. Cormack and Lehane grade 3 laryngoscopy view
    only the epiglottis is seen
  12. Cormack and Lehane grade 4 laryngoscopy view
    no recognizable structures, epiglottis is not seen
  13. What Cormack and Lehane grading indicates easy intubation?  Difficult intubation?
    • Easy 1 and 2
    • Difficult 3 and 4
  14. LEMON
    • Look externally (face and neck shape, size, teeth)
    • Evaluate 3-3-2 (thyromental and interincisor >3, thyroid cartilage- mouth floor distance >2)
    • Mallapmati (1 or 2 desired)
    • Obstruction
    • Neck mobility
  15. What factors predict difficult face mask ventilation?
    • snoring
    • beard
    • mallampati 3 or 4
    • lack of teeth
    • limited mandibular protrusion
  16. What factors predict difficult intubation?
    • snoring
    • BMI > 30
    • thick neck
    • OSA
    • limited mandibular protrusion
  17. LMA uses
    • -routine cases where pt is NOT an aspiration risk
    • -often useful if unable to BMV a pt
    • -part of the difficult airway (CVCI) algorithm
  18. typical LMA size
    • 4
    • 5 for large adult
    • 3 for small adult

    pedi sizes also available
  19. The MAC blade tip should sit where for direct laryngoscopy?
    In the vallecula (the space just in front of the epiglottis)
  20. Usual ETT size used
    • women 7
    • men 8
  21. How do we verify tube placement?
    ETCO2 (continuous waveform) and auscultation of breath sounds
  22. The Miller blade tip should sit where for direct laryngoscopy?  Benefit of this blade?
    • -Tip goes past the vallecula and epiglottis
    • -Can provide a better view of the glottis when the larynx is anterior
  23. When performing laryngoscopy, the handle of the laryngoscope should point where?
    Towards the wall / ceiling junction
  24. BURP
    • -Backward Upwards Right Pressure
    • -difficult intubation technique
    • -assistant pushes cricoid down hard and to the right to help bring VC into view
  25. Where is the cricoid cartilage located?
    Below the thyroid cartilage (Adam's apple)
  26. Maximum number of intubation attempts
    3
  27. Where does the LMA sit when properly placed?
    • -sits in the pharynx
    • -at top of esophagus
    • -orifice points into trachea
  28. Recognized difficult airway options
    • -proper preparation!!
    • -awake intubation
    • -surgical airway
    • -cancel surgery and regroup
    • -regional anesthesia
  29. Unrecognized difficult airway options, able to BMV pt (non emergency pathway)
    • -attempt intubation
    • -anesthesia with mask ventilation
    • -surgical airway
    • -awaken pt
  30. Unrecognized difficult airway, unable to BMV pt (emergency pathway)
    • -LMA or transtracheal jet ventilation
    • -awaken pt
    • -surgical airway

    -don't keep trying to intubate

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