Exam (elaborations)
CCU EXAM 4 - CRNA.
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Exam of 6 pages for the course SRU ELEC340 F at SRU ELEC340 F (CCU EXAM 4 - CRNA.)
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CCU EXAM 4 - CRNACormack & Lehane grades. List least difficult to most difficult. - ANS-Grade 1: Most of
the glottis is seen, no difficulty
Grade 2: Posterior glottis seen, laryngeal pressure may improve view, slightly difficult
Grade 3: Only epiglottis visible, stylet may be helpful, may be severe difficulty
Grade 4: Not even epiglottis visible, usually obvious pathology, intubation may be
impossible w/o special techniques
Define difficult intubation - ANS-3 or more attempts
Eventually place ETT
*can be presence or absence of tracheal pathology
Define failed intubation - ANS-The inability to place a tube after multiple attempts
- 1:2100 surgical cases
Describe steps for oral intubation in order. - ANS-1. Position pt supine, sniffing position
(unless suspect spinal injury - then leave in neutral position)
2. Open mouth with R hand using scissor technique
3. Hold laryngoscope in L hand, insert into mouth - blade directed to R tonsil
4. Once tonsil is reached, sweep the blade to midline - keeping tongue to the left
5. Epiglottis in view. Do not lose sight. Advance blade into vallecula
6. Lift the laryngoscope up and forward. DO NOT BREAK YOUR WRIST/ROCK BACK.
Vocal cords in view. Applied laryngeal pressure may improve vision.
7. Place ETT in R hand. Keep curve of tube facing forward.
8. Insert tube through the cords, ensuring cuff has passed. HOLD ETT IN PLACE.
Remove blade with L hand. Remove stylet.
9. Inflate cuff.
10. Begin to bag-ventilate. Use CO2 monitor and listen to breath sounds to confirm
placement.
11. Secure tube with tape/tube holder.
12. Ventilate.
Describe the sniffing position. - ANS-Pt should be supine (bed flat) with neck slightly
flexed towards chest
Extend head at atlanto-occipital joint
Elevation of head ~4" w/ pads under occiput
Shoulders remain down on table
, Sniffing is both flexing c-spine (with pillow/wedge) and extending the head over the neck
In this position - the oral/pharyngeal/laryngeal axes line up, tongue obstructs less,
shortens distance from teeth to laryngeal inlet
For LMA and ETT intubations, which patient populations are considered to have a full
stomach? - ANS-1. Pregnant women (post 10 wks GA - baby pushing gastric contents)
2. Pt with no history/unable to obtain anesthesia consult/emergency-unconscious/etc
How do you break a laryngospasm? (First-line treatment) - ANS-Positive pressure (20
cm H2O or more)
How is a Macintosh blade shaped?
What are the benefits of a Mac blade? - ANS-Curved
Better recognition of anatomical structures
How is a Miller blade shaped?
What are the benefits of a Miller blade? - ANS-Straight/flat
For anterior larynx, small mandibular space, large incisors, long and floppy epiglottis
How would you situate your patient to determine a Mallampati class? - ANS-Have
patient seated, hold head in neutral position, mouth open wide, tongue fully extended
List (11) complications and hazards of intubations - ANS-1. Trauma to teeth, cords,
laryngeal structures
2. NT tubes can damage turbinates, cause epistaxis, perforate mucosa
3. HTN and tachycardia from intense stimulation
4. Transient arrhythmias from vagal/sympathetic stimulation
5. Right mainstem intubation
6. Hypoxemia during intubation
7. Damage to cuff (later cuff leak/poor seal - reintubate)
8. Intubation to esophagus - gastric distention, regurgitation, hypoxemia
9. Barotrauma from too high volumes while bagging
10. Laryngospasm from overstimulation of larynx
11. ETT obstruction (foreign material, dried secretions/blood)
List [9] ways to assess an airway prior to oral intubation: - ANS-1. Interincisor distance
3cm
2. Thyromental distance 6cm
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