Exam Iii - Principles I - Bronchospasm And All

Front 1

Risks of intubation

Back 1

injury to soft tissue, lips, gums
dental trauma
nose bleeds
puncture/tearing trachea

Front 2

Who is typically responsible for soft tissue injuries

Back 2

SRNAs

Front 3

If fragments of teeth are not found, what has to happen

Back 3

chest x-ray

Front 4

Trick to prevent nosebleeds

Back 4

use phenylephrine and insert lubricated nasal airway

Front 5

Most common cause for airway obstruction

Back 5

tongue

Front 6

Common reasons for ETT obstruction

Back 6

kinked tube, foreign material - vomit, sputum, water, blood and tissue

Front 7

Most common postoperative complaint

Back 7

sore throat

Front 8

Sore throat is usually ____ and resolves over _____ with ____

Back 8

transient, 24 hours, fluid intake

Front 9

Factors that contribute to sore throat

Back 9

1. size of ETT
2. DVL attempts
3. NG tube
4. smoking hx
5. female gender

Front 10

Best way to avoid sore throat

Back 10

gentle DVL with minimal attempts

Front 11

Signs of esophageal intubation

Back 11

1. no breath sounds
2. gurgling sounds over epigastium with bagging
3. lack of sustained ETCO2

Front 12

It may take awhile to detect esophageal intubation (desaturation) if patient

Back 12

was well oxygenated

Front 13

Best two ways to know that patient was not intubated in the esophagus

Back 13

1. DVL
2. ETCO2

Front 14

Where are adults typically endobronchially intubated

Back 14

right side

Front 15

Why are adults typically endobronchially intubated on the right side

Back 15

R bronchus angle is 25 deg from vertical while the L bronchus angle is 45 degrees from vertical

Front 16

On which side do infants typically get endobronchially intubated

Back 16

either side

Front 17

Where can infants be endobronchially intubated on either side

Back 17

R and L bronchi branch at same angle - 55 degrees

Front 18

Signs of endobronchial intubation

Back 18

1. uneven chest rise
2. increased peak inspiratory pressure (maybe)
3. decreased breath sounds on unventilated side
4. drop in ETCO2
5. tachycardia
6. hypoxemia/desaturation - espec infants
7. bronchospasm

Front 19

Procedure to follow when realize pt has been endobronchially intubated

Back 19

1. deflate cuff
2. pull tube back

Front 20

Laryngospasm accounts for ___% of all critical postoperative respiratory events in adults

Back 20

23%

Front 21

Explain what a laryngospasm is

Back 21

forceful, involuntary spasm of the laryngeal musculature that occurs through the stimulation of the internal branch of the recurrent laryngeal nerve

Front 22

Causes of laryngospasm

Back 22

secretions
blood
vomitus
stimulation of supraglottic region during light plane of anesthesia
pain during light plane of anesthesia
pelvic or abdominal visceral stimulation

Front 23

You anticipate surgeon is going to perform some abdominal stimulation, what do you do

Back 23

deepen anesthesia plane

Front 24

Two phases of laryngospasm

Back 24

1. shutter phase
2. ball-valve phase where vocal cords are fully adducted

Front 25

Explain the shutter phase of laryngospasm

Back 25

vocal cords are spasming but not producing a total occlusion

Front 26

Explain the second phase of laryngospasm

Back 26

ball-valve phase where vocal cords are fully adducted producing complete occlusion

Front 27

Laryngospasms can be difficult to differentiate from

Back 27

airway occlusion due to the tongue or soft palate

Front 28

Partial airway occlusions can be identified by

Back 28

higher pitch sound as air changes

Front 29

Will placing an oral airway improve an laryngospasm

Back 29

no

Front 30

Indications of total occlusion - this is a tough one!

Back 30

no ETCO2
no chest rise
no breath sounds

Front 31

Treatment of laryngospasm

Back 31

1. gentle PPV with 100% oxygen
2. lidocaine 1-1.5mg/kg IV
3. succs 0.25-1mg/kg IV
4. succs 4mg/kg IM
5. inbutation

Front 32

Laryngospasms can occur

Back 32

1. on induction
2. during mask ventilation
3. LMA insertion and maintenance
4. emergency
5. post operatively

Front 33

Laryngospasms are least likely to occur when patient is

Back 33

fully awake

Front 34

Intraperative signs and symptoms of bronchospasm

Back 34

wheezing
increased peak airway pressures
decreased expired tidal volumes
slow rising waveform on capnograph

Front 35

Bronchospam can be seen with ___ patient

Back 35

any

Front 36

Bronchospasm is typically associated with

Back 36

asthmatics, pts with reactive airways (smokers, URI)

Front 37

Most critical time for bronchospasm in reactive airway patients is during

Back 37

instrumentation of airway during DVL

Front 38

Can regional techniques such as spinals and epidurals reduce the risk of bronchospasm

Back 38

yes

Front 39

Can regional anesthesia (spinal and epidural) prevent bronchospasm

Back 39

no

Front 40

Higher spinals above ___ knock out ____ to ____

Back 40

T1, sympathetic tone, lower airways

Front 41

If higher spinals above T1 knock out sympathetic tone in the lower airways, this allows _____ and ____

Back 41

parasympathetic takeover and bronchoconstriction

Front 42

Drugs with histamine release are also with

Back 42

bronchospasm

Front 43

Name a couple drugs associated with histamine release

Back 43

mivacurium (old drug) and morphine

Front 44

What can trigger bronchospasm

Back 44

volatile anesthetics (cold, dry air)
drugs with histamine release
surgical stimulation during light anesthesia plane

Front 45

The more ____ the volatile anesthetic, the more chance for bronchospasm

Back 45

irritating - desflurane more irritating

Front 46

Treatment of bronchospasm

Back 46

1. deepening anesthetic volatile agent (also has bronchodilation)
2. beta 2 agonist - albuterol
3. hydrocortisone - 1.5-2mg/kg
4. lidocaine - 1-1.5 mg/kg
5. atropine or glycopyrolate - 1mg may blunt parasympathetic outflow

Front 47

Bronchospasm - what is the key to

Back 47

prevention

Front 48

What better decreases bronchospasm - deep extubation or awake extubation

Back 48

deep extubation

Front 49

Post anesthetic croup is the result of

Back 49

subglottic edema

Front 50

Post extubation croup is most often seen in what pt population

Back 50

children

Front 51

How long after extubation does post croup occur

Back 51

immediately to 2-4 hours

Front 52

Post extubation croup is characterized by a

Back 52

barking cough

Front 53

Indications of severe subglottic edema

Back 53

tachypnea
labored respirations
retracting
arterial desaturation

Front 54

Mild cases of croup require little more than

Back 54

humidified oxygen

Front 55

#1 choice for post anesthetic croup after humidifed oxygen is

Back 55

racemic epinephrine - 0.5ml of 2% solution diluted in 2-4ml

Front 56

Another treatment for croup

Back 56

dexamethasone - 0.1-0.5mg/kg

Front 57

Problem with treating croup with dexamethasone - 0.1-0.5mg/kg

Back 57

very slow to respond - takes several hours

Front 58

Severe cases of croup with hypoxemia require

Back 58

intubation or advanced airway management (ENT surgery, T&A kids)

Front 59

READ AIRWAY MISHAPS ARTICLE

Back 59

READ AIRWAY MISHAPS ARTICLE