Difficult Airway Flashcards Preview

Maternal Advanced Principles > Difficult Airway > Flashcards

Flashcards in Difficult Airway Deck (77)
Loading flashcards...
1
Q

5 Ind. Risk Factors for diff Face mask Ventilation

A
Age > 55
Beard
Teeth
BMI> 26 kg/m2
Hx of Snoring
2
Q

What 4 things can define Diff Tracheal Intubation

A

Time taken to intubate
Number of attempts
View at laryngoscopy
Requirement for special equipment

3
Q

Failed intubation rate is ____ times higher in _______ surgical patients

A

8; obstetrical

4
Q

Physiologic and anatomical Changes of pregnancy affect:

A

Airway
Oxygenation
Metabolism

5
Q

2 examples of causes of worsened glottic view in parturients

A

1) Excessive cricoid pressure

2) Left Lateral Tilt positioning

6
Q

What are the risk factors for airway complications during pregnancy

A
Airway edema
Dec FRC
Inc O2 consumption 
Weight gain 
Breast enlargement 
Full dentition 
Dec LES tone 
In labor: delayed gastric emptying.
7
Q

Oral component of the airway

A

Incisors to oropharyngeal junction

8
Q

Pharyngeal component of airway

A

Oropharyngeal junction to Glottis

9
Q

Airway narrowing more significant in with Pregnant women with …

A

Preeclampsia

10
Q

In pregnant women at the end of pregnancy and start of labor they have changes in…

A

Their oral mucosa, usually due to swelling

11
Q

Always reevaluate the airway before induction of GA rather than prelabor assessment

A

May labor for 12 hrs or so and changed in airway from prelabor assessment on admission happens

12
Q

Patient is not able to Intubate:

A

Wake them up and discuss fiberoptic intubation.

13
Q

Pregnancy weight gain

A

10 to 15 kg ( 22 to 33lbs )

14
Q

3 things that contribute to pregnancy weight gain

A

Fat
Blood and Instertitial fluid volume inc
Uterine and Fetal mass

15
Q

High BMI means

A

Diff mask and tracheal ventilation
Inc risk for req. emergency c-section
Rapid O2 desaturation during apnea

16
Q

Full dentition, Protuding Maxillary Incisors and smal TMD

A

Interfere on DL

17
Q

When does LES tone return to normal postpartum ?

A

1 - 4 weeks postpartum

18
Q

Two types aspiration Pneumonitis :

A

Solids: asphyxiation

Liquids : more severe when highly acidic

19
Q

Morbidity and mortality of aspiration depends on 2 things :

A

Chemical nature of aspirate
Physical nature of aspirate
Volume of aspirate

20
Q

Pts who aspirate while breathing spontaneously will..

A

Breath holding then …tachypnea, tachycardia , slight Resp acidosis ,

21
Q

Aspiration Pneumonitis aka Mendelson’s syndrome

A

Chemical Injury to the tracheobonchial tree and alveoli by sterile acidic gastric content

22
Q

Aspiration Pneumonia

A

Infectious , Inhaled colonized oropharyngeal secretions

23
Q

What causes the slight PO2 dec and inc in shunt seen in Aspiration

A

Bronchospasm ; disruption of surfactant

24
Q

Large particle aspiration lead to

A

Atelectasis

25
Q

Smaller particulate matter aspiration lead to ——and resembles ——

A

Exudative neutrophilic response at bronchioles and alveolar ducts; resembles acidic liquid aspiration

26
Q

3 Management of aspiration

A

1) Tracheal suction
2) Rigid bronch if large aspiration or solid
3) manage Hypoxemia with C-pap in those not intubated and PEEP in those ventilated= restores FRC, reduce shunting, reverses Hypoxemia

27
Q

Post aspiration : Why C-pap in spont and PEEP in ventilates pts?

A

Restores FRC
Decreases Pulmonary shunt
Reverses Hypoxemia

28
Q

For aspiration prophylaxis : Before surgical procedures consider timely admin of

A

Non-particulate antacid
H2 Blockers
And/or Reglan

29
Q

Efficacy of non-particulates depend on

A

Baseline gastric volume

Acidity of gastric fluid.

30
Q

30 ml bicitra will neutralize

A

225ml of HCl acid with a pH of 1.0

Duration of bicitra depends on rate of gastric emptying

31
Q

H2 blockers reduce both ___and _____but ______minutes required for max effect when given IV

A

Acidity And Volume ; 60-90 minutes

* onset 30 mins

32
Q

Advantages of PPI are_____;_______;______.

A

Long DOA; Low toxicity ; low maternal/fetal blood concentration

33
Q

Metoclopramide great because_____but effect antagonized by ______potential s/e is _____

A

10 mg can inc LES tone & Inc peristalsis= Dec volume in 15 mins
Opioids and atropine
Extrapyramidal Effects

34
Q

Elective C-section for prevention of aspiration give : 3 options

A

P.O. or IV H2B/ Pepcid 20mg 60-120 mins b4 induction
And Bicitra 30 ml with 30 mins of surgery

Some may give
Reglan 10mg PO at the same time as H2B or IV 15mins b4 induction

35
Q

Emergency C-section Under GA

A

30 ml of Bicitral just after transfer to OR
Plus
Raniditine 50 or Pepcid 20 or Omeprazole 40 + Reglan 10mg IV when time allows

36
Q

Bicitra short DOA unless given to

A

Mothers with delayed gastric emptying because of opioids

37
Q

H2 receptor antagonists block____ receptors on the ______ and thus diminishes____

A

Histamine; Oxyntic cell; gastric production

38
Q

What is Postpartum headache ?

A

C/O cephalic, neck, and/or shoulder pain during 1st 6 weeks after delivery .

39
Q

Most common postpartum complications of neuraxial anesthesia

A

PDPH

40
Q

Tension Headache

A

1) Mild to moderate Headache
2) lasting 30 mins to 7 days
3) Bilateral;Non-Pulsating; not aggravated by physical activity

41
Q

Migraine

A

1) Recurrent Mod or Severe
2) Lasting 4 to 72 hrs
3) Unilateral ;Pulsating; agg. By physical activity
4) Nausea/Photo and Phonophobia

42
Q

Musculoskeletal Headache

A

1) Mild to Mod

2) Neck and Shoulder pain

43
Q

Preeclampsia/Eclampsia headache S/S & Diag.

A

1) HTN and/or HELLP
2) Bilateral; pulsating; aggravated by physical activity
* H&P + labs

44
Q

What labs for pre & eclampsia ? (5)

A

1) Alanine aminotransferase ( ALT)
2) Aspartate Transminase ( AST)
3) Uric Acid
4) Platelet Count
5) Urine Protein

45
Q

What is HELLP syndrome

A

Hemolysis, Elevated Liver enzymes, Low Platelet count syndrome

46
Q

PRES syndrome headache S/S and Dx

A

1) Severe to Diffuse
2) acute or gradual onset
3) Focal neuro deficit and seizures
Dx: MRI + H&P

47
Q

What is PRES syndrome

A

Posterior , Reversible (leuko) Encephalopathy Syndrome

48
Q

Stroke Headache S/S and Dx; 2 types headache

A

Cerebral ischemia:
1) New headache overshadowed by focal signs and/or disorders of consciousness.
Subarachnoid Hemorrhage :
1)Unilateral, abrupt and Intense& Incapacitating
2)Nausea, nuchal rigidity , altered consciousness

49
Q

Dx of Stroke headaches

A

H&P + CT w/o contrast or MRI ( FLAIR sequence )

50
Q

Subdural Hematoma Headache S/S and Dx

A

1) without typical features
2) Overshadowed by focal neuro S/S and/or alt. Consciousness
Dx: H&P + CT/MRI

51
Q

Carotid Artery Dissection Headache

A

1) late developing & constant
2) Bilateral or Unilateral
Dx: H&P + Carotid US or MRA

52
Q

Cerebral venous and Sinus thrombosis headache S/S and Dx:

A

1) Non-Specific + may have post Dural component
2) Focal neuro signs & seizures
H&P + MRV+ Angiography

53
Q

Brain tumor headache S/S and Dx

A

1) Progressive Localized
2) Worse in Morning
3) aggravated by cough/straining
Dx: H&P + CT or MRI

54
Q

Idiopathic Intracranial HTN headache (pseudotumor cerebri or benign )

A

1) Progressive non pulsating
2) Aggravated by cough/straining
3) Ass. With Inc CSF pressure ;normal CSF chem

55
Q

Dx of Idiopathic Intracranial HTN

A

H&P + Lumbar Puncture

56
Q

Spontaneous intracranial Hypotension S/S only (5)

A

1) No hx of Dural trauma
2) Diffuse, Dull Headache
3) worsen w/n 15 mins of sitting out standing
4) Neck stiffness , nausea, tinnitus, photophobia
5) CSF opening pressure <60 mm H2O in the Sitting position

57
Q

Spontaneous Intracranial Hypotention

A

H&P + Lumbar Puncture + Radioisoptope cisternography + CT Myelography

58
Q

Pneumocephalus Headache

A

1) Frontal Headache
2) Abrupt onset immediately after Dural puncture
3) Symptoms worsen w/ upright position

59
Q

Meningitis Headache

A

1) headache itself most frequent symptom
2) Diffuse
3)Intensity diffuses with time
4) nausea, photo and phonophobia
5) general malaise
6) fever
Dx: H& P + Lumbar puncture

60
Q

Sinusitis Headache

A

1) Frontal Headache w/ facial pain
2) Dev of headache w/ nasal obstruction
3) Purulent nasal discharge , anosmia and fever

61
Q

lactation headache

A

1) Mild to Mod

2) Temporarilly with onset of breast feeding or breast engorgement

62
Q

Zofran Headache

A

Mild to Mod associated w/ zofran intake

63
Q

PDPH headache s/s

A

1) Headache within 5 days of Dural puncture
2) Worsens w/in 15 minutes sitting or standing
3) Neck stiffness, tinnitus, photophobia , nausea

64
Q

Primary headaches

A

Recurring activities: coughing, sex etc..
20 times more common than secondary headaches in women in 1st week postpartum.
Tension, Migraine, Trigeminal, cluster , other primary.

65
Q

Secondary Headaches

A

Underlying pathological process

66
Q

Most common postpartum headaches are :

A

Tension

Migraine

67
Q

Pregnant with sever Migraine

A

C-section < Adverse labor and delivery : i.e.preterm, *preeclampsia, LBW

68
Q

Eclampsia

A

Hypertensive encephalopathy : Headache, Visual dist., N/V, seizures, stupor, coma
* Headache serious pre-monitoring sign .

69
Q

Why are Pregos at risk for strokes ?

A

Venous stasis, hypercoag , edema . Headache common sign of stroke too. 50% strokes within 1st6 weeks postpartum

70
Q

6 risk factors for Gestational Diabetes

A
Age> 30
Prior Hx
Large Fetus
Prior abortions
Still births
Obesity
71
Q

What H&P & lab seen in Gestational Diabetes ?

A

1) Fetus LGA and mom asymptomatic in H&P

Lab: Glycosuria, Abnormal hyperglycemia, Abnormal glucose tolerance test

72
Q

Treatment for Gestational DM

A

Diet
Insulin
NO ORAL agents= fetal hypoglycemia

73
Q

Preterm labor - Mother

A

Macrosomia - Fetus

74
Q

Polyhydramnios- Mother

A

Shoulder dystocia - Fetus

75
Q

C/S for macrosomia- Mother

A

Perinatal Mortality 2-5%- Fetus

76
Q

Preeclampsia/eclampsia - Mother

A

Congenital defects - Fetus

77
Q

DM type II- Mother

A

Hypoglycemia- Fetus