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22 Cards in this Set
- Front
- Back
History [5]
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Previous difficult intubation
Congenital abnormalities-small mouth, mallampati Previous airway trauma Previous airway surgery-laforte, genioplasy Medical conditions, ankylosing spondylosis/RA |
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Airway Exam [9]
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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) |
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#1 cause of AW obstruction
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Tongue
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major landmark in AW assessment
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Uvula
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largest cartilage?
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Vallecula (where the tongue and epiglottis meet)
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Jaw exam [3]
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TMJ,
overbite/underbite, mallampati |
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Optimize the Situation [4]
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Position carefully – “sniffing”
Ramp shoulders/head of obese patient Locate cricoid cartilage prior to induction PREOXYGENATE!!!!! |
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Eschmann (Bougie) stylet
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If able to visualize posterior cords or arytenoids can pass stylet and intubate over it
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Fastrach LMA effectiveness?
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50%
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Combitube [3]
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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 |
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Fiberoptic Bronchoscope [5]
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Difficult airway adjunct/rescue
Awake Fiber Optic Intubation Confirm placement of double lumen tube Ideally use before the mouth instrumented. Use an Antisialogogue |
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Awake Fiber Optic Intubation (AFOI)
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Thoroughly explain procedure to patient
Antisialogogue/aspiration prophylaxis Sedation – not too much Airway Blocks Superior Laryngeal Transtracheal Glossopharyngeal [4] |
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Most important preventative measure in AFOI is?
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aspiration propylaxis
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_______ is what causes vomiting with AFOI.
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Gagging
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Lighted Stylets
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Lighted end goes into trachea, with lights off, a glow will be seen on the anterior neck when properly positioned.
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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 |
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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 |
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Verification of Tube Placement [7]
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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 |
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Do not give __________ unless absolutely necessary
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paralytics
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Never be caught without a ________
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backup plan
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Expect the ______ and hope for the best
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worst
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If a little voice is telling you to do something, what do you do?
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listen!!
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