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22 Cards in this Set

  • Front
  • Back
History [5]
Previous difficult intubation
Congenital abnormalities-small mouth, mallampati
Previous airway trauma
Previous airway surgery-laforte, genioplasy
Medical conditions, ankylosing spondylosis/RA
Airway Exam [9]
Nose: nares, use vasoconstrictors, topicals
Jaw: TMJ, overbite/underbite, mallampati
Chin: thyromental distance
Face: beard
Teeth: loose, missing, repaired, caps, crowns, braces, dentures (take out, hard to mask, watch trauma)
Tongue, #1 cause of AW obstruction
Uvula: major landmark in AW assessment
Pharynx: nasal and oral, secretions
Epiglottis: largest cartilage, Vallecula (where the tongue and epiglottis meet)
#1 cause of AW obstruction
Tongue
major landmark in AW assessment
Uvula
largest cartilage?
Vallecula (where the tongue and epiglottis meet)
Jaw exam [3]
TMJ,
overbite/underbite,
mallampati
Optimize the Situation [4]
Position carefully – “sniffing”

Ramp shoulders/head of obese patient

Locate cricoid cartilage prior to induction

PREOXYGENATE!!!!!
Eschmann (Bougie) stylet
If able to visualize posterior cords or arytenoids can pass stylet and intubate over it
Fastrach LMA effectiveness?
50%
Combitube [3]
Double lumen
Upper tube with larger balloon occludes mouth and nasal passage
Lower tube is in the esophagus, more protective than an LMA

don't use if esoph trauma
Fiberoptic Bronchoscope [5]
Difficult airway adjunct/rescue
Awake Fiber Optic Intubation
Confirm placement of double lumen tube
Ideally use before the mouth instrumented.
Use an Antisialogogue
Awake Fiber Optic Intubation (AFOI)
Thoroughly explain procedure to patient
Antisialogogue/aspiration prophylaxis
Sedation – not too much
Airway Blocks
Superior Laryngeal
Transtracheal
Glossopharyngeal [4]
Most important preventative measure in AFOI is?
aspiration propylaxis
_______ is what causes vomiting with AFOI.
Gagging
Lighted Stylets
Lighted end goes into trachea, with lights off, a glow will be seen on the anterior neck when properly positioned.
Retrograde intubation

what approach
Passage of a wire or a plastic stylet through the cricothyroid membrane which is then coughed out of the larynx and into the oropharynx by the patient.

Use cephlad approach
Transtracheal Jet Ventilation...

approach

Vt's?

s/a?
Cricothyroidotomy: faster than tracheostomy, safer, easier
Use 14 or 16 gauge for adults, 18 g. kids
Advance posteriorly and caudad
Aspirate as you go
1 second blast = 500cc
1 second on, 2 seconds off
Remember to allow for exhalation
One person holds hub of catheter, other ventilates
1600 vt with 14g
400 vt with 20g

S/A- barotrauma, pneumothorax, autopeep
Verification of Tube Placement [7]
Breath sounds: stomach, lungs
ETC02: doesn’t r/o right main stem
Blue bulb: reinflates = stomach
Chest: rise and fall
Compliance: easy if in trachea
Condensation: moisture from lungs
VS/SaO2: watch for changes
Do not give __________ unless absolutely necessary
paralytics
Never be caught without a ________
backup plan
Expect the ______ and hope for the best
worst
If a little voice is telling you to do something, what do you do?
listen!!