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ANZCA Final Exam – Airway with verified detailed answers

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ANZCA Final Exam – Airway with verified detailed answers

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ANZCA Final Exam – Airway with verified detailed ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




answers

Terms in this set (197) ||\\//|| ||\\//|| ||\\//|| ||\\//||




Original

What are the predictors of difficult face mask ventilation?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




as per RcOA analysis are:
||\\//|| ||\\//|| ||\\//|| ||\\//||




Age > 55 ||\\//|| ||\\//||




BMI > 26 ||\\//|| ||\\//||




Edentulus
Facial hair ||\\//||




Hx of snoring
||\\//|| ||\\//||




Limited jaw protrusion ||\\//|| ||\\//||




Mallampati 3 - 4 ||\\//|| ||\\//|| ||\\//||




Previous notes / history of difficult airway ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




What can you do to improve face mask ventilation?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Keep dentures in ||\\//|| ||\\//||




Shave beard ||\\//||




Use tegaderm on beard
||\\//|| ||\\//|| ||\\//||




Airway adjuncts ||\\//||




SGA as an alternative to BMV post induction prior to intubation
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




What are the predictors of difficult LMA placement?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




RODS
MO < 2.5cm ||\\//|| ||\\//||




Abnormal anatomy - won't sit well ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Laryngeal obstruction ||\\//||




Stiff lungs ||\\//||




Stiff neck ||\\//||




What are the predictors of difficult ETT placement?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




The strongest independent predictors of difficult intubation
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||

,Mallampati

Thyromental distance ||\\//||




(note sensitivity only 36%!) ||\\//|| ||\\//|| ||\\//||




TMD < 6 0 suggests intubation using conventional laryngoscopy may be difficult
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Upper lip bite test (mandible jaw protrusion) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




JP = C -> diagnostic of difficult intubation
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Other tests include ||\\//|| ||\\//||




Inter-incisor distance ||\\//||




> 5cm = easy insertion of laryngoscope, but does not predict intubation difficulty
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




relatively high predictive value ||\\//|| ||\\//|| ||\\//||




In morbid obesity what are the predictors of difficult intubation?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Airway assessment ||\\//||




Neck circumference ||\\//||




Pre-tracheal soft tissue >2.5cm predictor of difficult airway ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




What equipment might we commonly place down an LMA?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Cook AEC, Aintree catheter ||\\//|| ||\\//|| ||\\//||




Predictors of difficult FONA ||\\//|| ||\\//|| ||\\//||




Flexed neck / prominent thoracic kyphosis ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




AS

Neck stuff: ||\\//||




FAT
Tumour
Radiation
Blood
Surgery
Infection
beard

Describe an Aintree catheter ||\\//|| ||\\//|| ||\\//||

,56 cm long ||\\//|| ||\\//||




19Fr
6.5mm external diameter ||\\//|| ||\\//||




hollow and stiff enough to facilitate railroading of ETT ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




>= 7 ||\\//||




4.7 inner diameter ||\\//|| ||\\//||




Easily preloaded over ≤ 4.2 mm diameter fibrescope ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Comes with 2 rapifit adaptors - allows oxygen administration but be cautious of
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




barotrauma/perforation
Max. depth 26cm ||\\//|| ||\\//||




Max O2 flow rate = 2L/min ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




(Louise airway notes) ||\\//|| ||\\//||




Describe the process of using an Aintree to intubate through an LMA ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




How to use to intubate through an LMA (EXCEPT THE SUPREME LMA)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




2 person technique
||\\//|| ||\\//||




prepare fibrescope and camera system ||\\//|| ||\\//|| ||\\//|| ||\\//||




lubricate outer surfaces of both AIC and fibrescope (FS) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Preload AIC onto FS and secure with tape ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Attach a Bodie-Y connector (aka a 15mm bronchoscopic swivel connector (with port)) to the
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




LMA and anaesthetic circuit ||\\//|| ||\\//|| ||\\//||




this enables ventilation while you are using the FS
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Confirm adequate anaesthesia, mm relaxation and assisted ventilation ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Get assistant to hold LMA still
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Introduce FS loaded with AIC thoguth the top port of the Bodie-Y connector ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Advance until you are ~ 3cm above the carina ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Note depth of AIC (MAXIMUM DEPTH 26cm) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Remove tape attaching AIC to FS ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Withdraw FS while keeping AIC in situ at the same depth ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Withdraw LMA while keeping AIC in situ at same depth ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Railroad ETT (conventional size for F or M size 7 - 8) over AIC ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||

, Use laryngoscope to ensure position of ETT ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Remove AIC and reconnect circuit -> confirm ventilation + anaesthesia ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Consider FS to confirm ETT position ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




https://www.youtube.com/watch?v=Pn8CRYZz4Q4

Describe the Cook Airway Exchange Catheter (AEC). Describe the process of using the Cook ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




AEC

Compare and contrast a Cook AEC and Aintree? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Both are: long hollow tubes, able to ventilate, both have maximum depth of 26cm and max
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




O2 flow rate of 2L/min, both have risk of barotrauma and perforation.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




Difference: Cook AEC - various sizes, long 100cm soft tip or shorter 83cm; Aintree can thread ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




a bronchoscope through and bronchoscopically guide
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




What equipment do we commonly place down an ETT? ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




EQUIPMENT THROUGH ETT ||\\//|| ||\\//||




· Bronchoscope:
||\\//||




o 3.2 mm ||\\//|| ||\\//||




o 4 mm → Use for placing DLT & intubating via LMA
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




o 5.2 mm → 7.5 ETT
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




· Cook Frova Bougie (Blue):
||\\//|| ||\\//|| ||\\//|| ||\\//||




o 14 Fr (4.7 mm)
||\\//|| ||\\//|| ||\\//|| ||\\//||




o Compatible with ≥ 6 ETT
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




o Not compatible with DLT (shearing end of bougie)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




· Cook exchange catheter (green/purple):
||\\//|| ||\\//|| ||\\//|| ||\\//||




o 11 Fr (3.7 mm) → Compatible 4 ETT or 35 Fr DLT
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




o 14 Fr (4.7 mm) → Compatible 5 ETT or 39 Fr DLT
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




· Aintree intubating catheter:
||\\//|| ||\\//|| ||\\//||




o 19 Fr (6.3 mm) → Compatible 7 ETT
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||




o Internal diameter 4.7 → Compatible 4 mm scope
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||

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