Bonus Question Study Guide Week 3
1. Study the Difficult Airway Algorithm in the Additional Resources folder. Know how to how to confirm ventilation, tracheal intubation and LMA placement.
2. Know what the alternatives for non-invasive approaches to difficult intubation are:
3. Know the definition of ventilation.
4. Know the definition of perfusion.
5. in the 18 Basics of Pediatric Airway, Anatomy, Physiology and Management (in the additional resources section): Know the reason for almost all of the pediatric codes.
6. Know the information below: The differences between pediatric and adult airway.
· The smaller airway in peds patients may lead to airway obstruction from the tongue and the anterior pharyngeal tissue lying against the posterior wall of the hypopharynx when the child is positioned flat on a stretcher.
· The narrowest point in a child’s airway is the subglottic region (whereas the level of the vocal cords is the narrowest in adults); this has been the reason for the traditional use of an uncuffed endotracheal tube in small children.
· All of these factors make a child more susceptible to airway obstruction, given the same degree of inflammation.
· A reduction in the diameter of the pediatric airway results in a significant increase in airflow resistance.
Other characteristics that are special to pediatric airways:
-smaller
-angled vocal cords
-funnel-shaped rostral (more anterior and superior/cephalad) larynx
-relatively larger tongue in proportion to mouth
-pharynx is smaller
-Epiglottis is larger and floppier and "U" shaped
-airway narrowest at the cricoid cartilage (subglottic airway region)
-trachea is narrower and less rigid
-smaller tracheal length (i.e. shorter); therefore right mainstem placement or displacement
is very common
-poor cervical spine support
-cartilage is less rigid (epiglottis, larynx and tracheal rings)
-larger occipital area of the skull
-infants are obligate nose breathers
7. Know why premature infants are prone to respiratory distress syndrome (RDS):
8. 14 Signs of respiratory failure in pediatric patient:
9) Why is an uncuffed ETT recommended in children <8 years old?
10) When should a cuffed ETT be used?
11) List 8 different difficult airway management techniques:
12) How many lobes does the right lung have?
13) How many lobes does the left lung have?
14) Know the following:
· The Trachea begins at the level of the cricoid and extends to the carina
· The carina (cough reflex in patients) is at the level of the angle of Louis or Thoracic Vertebrae #5 (T5)
· T7 is where the trachea bifurcates (splits into right and left main stem bronchi/lungs)
· The right main stem bronchus is angled at 25º (right lung) and is less angled than the left main stem bronchus (45º).
· The right main stem bronchus is more prone to accidental intubation if the endotracheal (ETT) tube is inserted too far. Therefore the anesthesiologist may pull the ETT back or out a by a couple of centimeters, so that both lungs have equal ability to be inflated during general surgery cases.
· However, in Thoracoscopy/Thoracotomy cases or Thoracic Surgery, the lung in which the surgeon is not going to be operating on is the one that gets inflated with a side specific double lumen endobronchial tube. Double-lumen endobronchial tubes allow for single-lung ventilation, while the other lung is collapsed to make surgery easier. The deflated lung is re-inflated as surgery finishes to check for fistulas (tears). Six sizes are available: 28, 32, 35, 37, 39, and 41 french sizes, in both left and right orientations. The extension tubes and pilot balloons are also imprinted with Tracheal (clear) or Bronchial (blue) to differentiate the appropriate lumen and cuff.
15) Another name for cricoid pressure is the Sellick maneuver.