M & M Ch 5

Front 1

How do you know that the seal b/w pt and mask isn't established?

M & M Chap 5

Back 1

continued deflation of the anesthesia reservoir bag

Front 2

What does the LMA protect the larynx from? How long should it remain in place?

Back 2

*pharyngeal secretions but NOT gastric secretions
*Until the pt has regained airway reflexes

Front 3

Earliest manifestation of bronchial intubation? Other indicators

Back 3

increase in peak inspiratory pressure
*unilateral BS, inability to palpate cuff in suprasternal notch during cuff inflation, decreased breathing bag compliance

Front 4

Where should the ETT cuff be felt?

Back 4

In the suprasternal notch during cuff inflation

Front 5

The large negative intrathoracic pressures generated by a struggling pt in laryngospasm can lead to what?

Back 5

pulmonary edema

Front 6

Where is the epiglottis located? What is it's function?

Back 6

*at the base of the tongue, separating the oro from the laryngopharynx
*Prevents aspiration by covering the glottis (opening of the larynx) during swallowing

Front 7

Which muscles abduct & adduct the vocal cords?

Back 7

*Abduct: posterior cricoarytenoid muscles
*Adduct: lateral cricoarytenoid muscles

Front 8

Bilateral vagal denervation results in what?

Back 8

flaccid, midpositioned vocal cords similar to those seen after succ admin.

Front 9

What artery supplies blood to the larynx?

Back 9

throid arteries

Front 10

How should you measure to determine nasal airway size? How should they be inserted?

Back 10

*measure from nares to meatus of ear
*lubricated and slid along the floor of the nasal passage

Front 11

What 2 things does effective ventilation require?

Back 11

gas-tight mask fit and a patent airway

Front 12

How should the LMA be prepped prior to insertion? Major benefit?

Back 12

*cuff deflated and lubricate
*associated w/ less laryngospasms than ETT

Front 13

Contraindications to placing an LMA?

Back 13

*pharyngeal pathology (abscess)
*pharyngeal obstruction
*full stomachs (pregnancy, hiatal hernia)
*low pulmonary compliance requiring peak inspir. pressures >30

Front 14

What does a combitube look like? When is it useful?

Back 14

*2 tubes (longer blue tube and shorter clear tube)
*2 inflatable cuffs (100 ml proximal cuff & 15 ml distal cuff)--both fully inflated after placement
*95% of the time the tube will end up in the esophagus, so that ventilation through the longer blue tube will force gas out of side perforations
*Useful for blind intubations

Front 15

Purpose of Murphy ETT?

Back 15

Have a hole/Murphy eye to decrease the risk of occlusion in case the distal tube opening is lying against the carina or trachea

Front 16

What 2 things must be considered when choosing ETT size?

Back 16

*Diameter is a compromise b/w maximizing flow and minimzing tissue trauma

Front 17

Why are uncuffed ETTs used in children?

Back 17

minimize the risk of pressure injury and postintubation croup

Front 18

What are 2 major types of cuffs on ETT? Problems associated w/ each?

Back 18

*high pressure (low volume)~assoc. w/ more ischemic damage to the tracheal mucosa and are less suitable for long duration
*low pressure (high volume)~increase the liklihood of sore throat, aspiration, spont. extubation, and difficult insertion (floppy cuff)
****low pressure cuffs more commonly recommended

Front 19

Cuff pressure more rise during general anesthesia w/ the use of which gas?

Back 19

N20

Front 20

Appropriate size of ETT for full-term infant, adult male, & adult female pt?

Back 20

*infant: 3.5, 12 cm cut length
*F: 7-7.5, M: 7.5-9

Front 21

How can internal diameter and cut length for children be determined?

Back 21

*Internal diamter: age/4 + 4
*Cut length: age/2 + 14

Front 22

Aspiration channels allowing suctioning, insufflation of O2, or instillation of local anesthetic are possible w/ this type of airway visualization device?

Back 22

fiberoptic bronchoscopes

Front 23

When is intubation typically indicated?

Back 23

pt at risk of aspiration & for surgeries involving body cavities, or the head & neck

Front 24

How should ETT and room be prepped prior to intubation?

Back 24

*Test ETT cuff by inflating it, if stylet is used sculpt ETT into hockey stick shape
*Extra handle, blade, and ETT (size smaller) and stylet should be available
*Need functioning suction unit

Front 25

When may pre-oxygenation be eliminated (rare)?

Back 25

*pt who object face mask, are free of pulmonary disease, and who don't have a difficult airway

Front 26

Is feeling the pilot balloon a reliable method to determine adequacy of cuff pressure?

Back 26

NO

Front 27

what is the best confirmation of tracheal placement of the ETT

Back 27

persistent detection of CO2 by a capnoraph

Front 28

what is the earliest manisfestation of bronchial intubation

Back 28

increase in the peak inspiratory pressure

Front 29

how can palpation help determine tracheal intubation

Back 29

palpation of the cuff in the sternal notch
*THE CUFF SHOULD NOT BE FELT ABOVE THE LEVEL OF THE CRICOID CARTILAGE

Front 30

what changes could be made after a failed intubation

Back 30

*repositioning of the pt
*decrease tube size
*add stylet
*select different blade
*attempt nasal route

Front 31

what preparation should be made prior to nasal intubation

Back 31

select the nare through which the pt breathes more easily
apply vasocontrictor drops

Front 32

what could coughing during extubation be associated with

Back 32

increased
*HR
*CVP
*BP
*intracranial pressure
*intraocular pressure
*wound dehiscence
*bleeding

Front 33

complication of laryngoscopy and intubation

Back 33

*hypoxia
*hypercarbia
*dental and airway trauma
*tube malpositioning
*physiological responses to airway instrumentation
*tube malfunction

Front 34

what inflation of ETT cuff do to the tracheal blood flow

Back 34

reduces tracheal blood flow by 75% at the cuff site

Front 35

what does prevention of unintentional esophageal intubation depend on

Back 35

*direct visualization of the tip of the ETT passing through the vocal cords, careful *auscultation for the presence of bilateral breath sounds
absence of gstric gurgling
*persistent presence of exhaled CO2 (most reliable)
*chest radiography
*use of fiberoptic bronchoscope

Front 36

clues to the diagnosis of bronchial intubation

Back 36

*unilateral breath sounds
*unexpected hypoxia
*inability to palpate cuff at sternal notch
*decreased breathing bag compliance

Front 37

what can large negative intrathoracic pressures generate in pt with laryngospasm

Back 37

pulmonary edema

Front 38

what is a laryngospasm

Back 38

forceful involuntary spasm of laryngeal musculature caused by stimulation of the superior laryngeal nerve

Front 39

how can laryngospasm be prevented

Back 39

extubating pt deeply asleep or fully awake

Front 40

treament of laryngospasm

Back 40

positive pressure ventilation with anesthesia bag and mask with 100% O2 or administration of lidocaine
with persistence can give sux

Front 41

conditions associated with difficult intubation

Back 41

tumors
infections
congenital anomalies
foreign body
trauma
obesity
inadequate neck extension
anatomic variations