Trachea - Airway Management And Trachs

Front 1

inspiratory stridor points to....

Back 1

obstruction at the level of the larynx or above

Front 2

expiratory stridor points to...

Back 2

more distal obstruction
(Merz - intrathoracic trachea)

Front 3

biphasic stridor points to...

Back 3

subglottic obstruction

Front 4

what is the appropriate mix of helium to oxygen in heliox? how does this help?

Back 4

80% oxygen
20% helium

it decreases the density of the air allowing for greater flow under less pressure

Front 5

whats the main downside to racemic epi?

Back 5

short duration of effect.

can have a rebound effect if used repeatedly

Front 6

what has a more rapid onset than dexamethasone and should be used as a first dose of steroid in an airway emergency?

Back 6

methylprednisolone 125 mg IV

Front 7

when is it risky to place oropharyngeal or nasopharyngeal airways?

Back 7

when the patient is coming out of an anesthetic and is 'light.' there is an increased risk of laryngospasm

Front 8

what is a combitube? whats the down side?

Back 8

an intubating tube

if placed in the trachea - proceed normally.

if placed in the esophagus. You inflate a balloon in the esophagus and one in the pharynx proximally. Through this you force air into the larynx.

it's big, cannot be used in kids

Front 9

whats the difference between tracheotomy and tracheostomy?

Back 9

otomy - procedure that puts a hole in the trachea

ostomy - procedure the externalizes the trachea to the skin

Front 10

indications for urgent tracheotomy?

Back 10

(1) severe maxillofacial trauma in which injuries make the airway inaccessible for translaryngeal intubation,
(2) significant laryngeal trauma in which intubation may potentially cause more damage,
(3) excessive hemorrhage or emesis obscuring landmarks required for successful intubation,
(4) cervical spine injury with vocal cords that are difficult to visualize, and
(5) failed translaryngeal intubation

Front 11

why is a bjork flap contraindicated in children?

Back 11

higher risk of stenosis

higher rates of persistent TC fistula

Front 12

what needs to be done differently in a peds trach?

Back 12

non absorbable retraction sutures
vertical incision in the trachea
no bjork
should have ETT or bronch in place

Front 13

how do you treat subq emphysema after a trach?

Back 13

inflat the cuff and loosen any occlusive sutures

CXR

Front 14

what surgical error could have happened if pneumomediastinum or pneumothorax develop postoperatively?

Back 14

posterior tracheal wall injury - air gets into intervisceral spaces and tracts

Front 15

what is the most common time frame for TI fistula?

Back 15

2 weeks from tracheotomy. usually from pressure necrosis of the trachea,

73% mortality rate