2) Basic Airway Equipment

List the components of a basic airway set up.

• ETT with 10cc syringe

• mac or miller blade & handle (check light)

• eye tape

• clear tape

• 2 sizes of oral airways with tongue depressor

• nasal airway with lube

• saline

• drugs: versed, lidocaine, fentanyl, propofol, sux/roc

before transporting a patient, what should you always check?

oxygen tank pressure

What is the pressure and volume of a full oxygen e-cylinder?

pressurized to 2200 psi and contains 660L of oxygen

how do you calculate tank life in minutes?

tank life (min) = tank volume (L) / flow rate (L/min)

benefit of rigid (Yankauer) suction

rapid and large volume suctioning from upper respiratory

drawbacks of Yankauer suction

dislodge ETT, damage teeth, mouth, etc.

soft (flexible) suction ________ suction down ETT

can

when is it useful to use soft (flexible) suction?

thoracic surgery (DLTT), to empty stomach

When do you use a nasal cannula?

awake (lightly sedated), spontaneously breathing but hypoventilating

max flow rate of a nasal cannula

6L/min

what gas is delivered when using simple mask?

mixture of pure O2 and air

minimum flow rate to avoid rebreathing in simple mask

5L/min

major difference between a simple mask and a venturi mask

simple: variable FiO2

venturi: predictable FiO2

what are venturi masks?

high air flow entrainment masks

what part of the venturi mask allows for better controlled F_iO₂?

fixed/adjustable orifice

if ports of a venturi mask are obstructed, what happens to F_iO₂?

becomes variable

partial rebreathing reservoir mask valve type

2 way

in a partial rebreathing reservoir bag, how much of the exhaled air goes back into the bag upon expiration?

first 1/3

partial rebreathing reservoir mask F_iO2

60%

non-rebreathing reservoir mask valve type

1 way

non-rebreathing reservoir mask F_iO2 and flow rate

95-100%, 6-15L/min

formula for F_iO2 you’re delivering to a patient

flow rate (L/min) x 3 + 21%

why would you use a face tent?

better patient cooperation

heated/cooled humidified O2

what equipment is used to support a patient who has lost control of their airway?

• oral or nasal airway

• resuscitation bag

• laryngoscope

• ETT

• stylet

typical oral airway sizes and colors

8mm = green

9mm = yellow

10mm = red

how to size an oral airway

hold against cheek and end should be at angle of jaw

Guedel oral airway shape

tubular channel

Berman oral airway shape

I-beam

nasal airways are measured in…

french diameters

how to size a nasal airway

tip of nose to angle of mandible/tip of earlobe

contraindications of nasal airways

hemorrhage disorders

anticoagulation therapy

history of epistaxis

basilar skull fractures

nasal packing in place

what causes gastric distention when using a breathing mask with the circuit in controlled ventilation?

using PPV > 20cmH2O

difficult airway techniques

oral/nasal airway

jaw thrust

2 person bag/mask technique

importance of self-inflating ambu bag

can be used with or without gas supply

how is a high F_iO2 achieved with an ambu bag?

high gas flow (15L/min), reservoir stays filled and no room air gets entrained in

tidal volume delivered with adult ambu bag

>600mL

is there rebreathing with an ambu bag?

no

type of ventilation ambu bags allow for

spontaneous or controlled

ambu bag ID and OD

15mm ID, 22mm OD

parts of the laryngoscope

tongue/spatula

web/vertical step

beak/tip

flange

hook-on base

handle/light source

tongue/spatula of laryngoscope function

compress/control the tongue

web/vertical step of laryngoscope function

displace tongue and soft tissues

beak/tip of laryngoscope structure & function

thickened to avoid tissue trauma

benefit of fiberoptic light source in laryngoscope blade

easy to sterilize, stays cool

benefit of lightbulb in laryngoscope blade

better illumination bc closer to blade tip

what is used for indirect laryngoscopy?

flexible fiberoptic bronchoscopy (FFOB)

channels of flexible fiberoptic bronchoscopy (FFOB)

light, image, aspiration

when to use flexible fiberoptic bronchoscopy (FFOB)

unstable C spine

h/o difficult intubation

awake

what do ETTs do to resistance and dead space of the airway?

increase resistance

decrease anatomical dead space (bc tube is smaller than throat)

what are ETTs made of?

PVC (polyvinyl chloride) (supports combustion)

importance of the murphy eye on a ETT

alternative passageway for air if there’s a mucous plug or it’s up against the trachea

where do you record the depth of oral ETT?

depth of the teeth (~3x size of tube)

procedures nasal rae used for

oropharyngeal, maxillofacial, dental

nasal rae: breathing circuit connector faces…

top of head

how to place nasal rae

inserted in nares, visualized in oropharynx with laryngoscope

nasal rae has ________ resistance than oral ETT

greater (bc greater length, smaller ID, preformed curve)

oral rae: breathing circuit connector faces…

down over chin

procedures oral rae is used for

tonsillectomies or facial

how is an oral rae secured?

taped to chin or stitched to gums

when and why would you need an anode ETT?

when you can’t see airway during case bc it resists kinking due to wire-reinforced wall

benefit of microlarygneal ETT

increases surgeon view for laryngeal surgery

microlarygneal ETT has a _______ diameter, so it ________ resistance

small, increases

laser-shield II is used with…

CO2 or KTP lasers

laser-shield II: material

aluminum inside, teflon outside

laser-shield II: cuff and contents

1 cuff with saline and methylene blue

laser flex: material

flexible stainless-steel tube

laser flex: cuff and contents

2 cuffs, proximal has saline and methylene blue, distal has saline

double lumen ETT function

lung isolation bc it has tracheal and bronchial lumen

is a left or right sided DLTT more common?

left to avoid dealing with right upper lobe

confirm placement of DLTT with…

fiberoptic scope

what tube can you not transport pt to ICU with?

DLTT

in a right sided DLTT, what allows for the right upper lobe to be ventilated?

murphy’s eye

how does a bronchial blocker work?

catheter with balloon tip to block single lung

how is a bronchial blocker placed and who does this benefit?

thru oral ETT, thus good for difficult airways or small mouths

can you transfer pt to ICU with a bronchial blocker?

yes

which is less traumatic: bronchial blocker or DLTT?

bronchial blocker

another name for gum-elastic bougie

eschmann tracheal introducer

how is a gum-elastic bougie used for a difficult airway?

inserted by video so tube can be passed over to achieve airway

how do you know you’ve reached the trachea with a gum-elastic bougie?

speed bump sensation from tracheal cartilage

when is a gum-elastic bougie useful?

tube exchange

laryngeal mask airway (LMA): invasiveness and insertion

minimally invasive, insert without visualizing vocal cords

LMA is designed for…

spontaneous ventilation in unconscious patients

is LMA a secure airway?

no