Respiratory 4: Airway Management Flashcards

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Questions and Answers

Describe the Mallampati score.

The Mallampati exam assesses the oropharyngeal space and quantifies the size of the tongue relative to the volume in the mouth.

Describe the inter-incisor gap. What is normal?

The inter-incisor gap assesses mouth opening. Normal is 2-3 fingerbreadths or 4 cm.

What is the thyromental distance and what values suggest an increased risk of difficult intubation?

The thyromental distance measures the space from the tip of the thyroid cartilage to the tip of the mentum. Increased risk of intubation difficulty is suggested if TMD is less than 6 cm or greater than 9 cm.

What is the mandibular protrusion test, and what values suggest an increased risk of difficult intubation?

The mandibular protrusion test assesses temporomandibular joint function, classified into three classes based on the position of the lower incisors relative to the upper incisors. Signup and view all the answers

What conditions impair atlanto-occipital joint mobility? (Select all that apply)

Rheumatic arthritis Signup and view all the answers

Describe the Cormack and Lehane score.

The Cormack and Lehane grading system measures the view obtained during direct vision laryngoscopy. Signup and view all the answers

List 5 risk factors for difficult mask ventilation.

Beard, Obese (BMI > 26 kg/m²), No teeth, Elderly (age > 55 years), Snoring. Signup and view all the answers

List 10 risk factors for difficult tracheal intubation.

Small mouth opening, narrow palate, long upper incisors, interincisor distance < 3 cm, Mallampati class 3 or 4, mandibular protrusion test class 3, poor compliance of the submandibular space, thyromental distance < 6 cm or > 9 cm, thick and short neck, poor atlanto-occipital joint mobility. Signup and view all the answers

List 6 risk factors for difficult supraglottic device placement.

Limited mouth opening, upper airway obstruction, altered pharyngeal anatomy, poor airway compliance, increased airway resistance, lower airway obstruction. Signup and view all the answers

List 5 risk factors for difficult invasive airway placement.

Abnormal neck anatomy, obesity, short neck, limited access to cricothyroid membrane, laryngeal trauma. Signup and view all the answers

What is angioedema?

Angioedema is increased vascular permeability leading to swelling of the face, tongue, and airway, posing a risk for airway obstruction. Signup and view all the answers

What are two common causes of angioedema? What is the treatment for each?

<ol> <li>Angiotensin converting inhibitors - Treatment: Epinephrine, antihistamines, steroids. 2. Hereditary angioedema (C1 esterase deficiency) - Treatment: C1 esterase concentrate or FFP.</li> </ol> Signup and view all the answers

What is Ludwig's angina?

Ludwig's angina is a bacterial infection characterized by rapidly progressing cellulitis in the floor of the mouth, leading to significant airway concerns. Signup and view all the answers

What is the best way to secure the airway in the patient with Ludwig's angina?

The best way is with the patient awake through awake nasal intubation or awake tracheostomy. Signup and view all the answers

Study Notes

Mallampati Score

Assesses oropharyngeal space and size of the tongue relative to the mouth volume, mnemonic: PUSH.
Class I: Pillars, Uvula, Soft palate, Hard palate visible.
Class II: Uvula visible, Soft palate, Hard palate visible.
Class III: Soft palate and hard palate visible.
Class IV: Hard palate only visible.

Inter-Incisor Gap

Indicates mouth opening; crucial for aligning airway axes.
Small gap leads to difficult intubation; normal range is 2-3 finger breaths (4 cm).

Thyromental Distance (TMD)

Measures submandibular space size from thyroid cartilage to mentum with neck extended and mouth closed.
TMD < 6 cm (3 fingerbreadths) or > 9 cm suggests difficult intubation.

Mandibular Protrusion Test (MPT)

Evaluates temporomandibular joint function by checking jaw subluxation.
Class I: Lower incisors can extend past upper incisors.
Class II: Lower incisors align with upper incisors.
Class III: Lower incisors cannot pass upper incisors, indicating increased intubation risk.

Impaired Atlanto-Occipital Joint Mobility

Conditions include degenerative joint disease, rheumatic arthritis, ankylosing spondylitis, trauma, surgical fixation, Klippel-Feil syndrome, and Down syndrome.

Cormack and Lehane Score

Grades the view during direct vision laryngoscopy; assessment occurs post-laryngoscopy.

Difficult Mask Ventilation Risk Factors

Mnemonic: BONES.
Beard, Obesity (BMI > 26 kg/m²), No teeth, Elderly (> 55 years), Snoring.

Difficult Tracheal Intubation Risk Factors

Small mouth opening, narrow high-arched palate, long upper incisors.
Interincisor distance < 3 cm, Mallampati class 3 or 4, Mandibular protrusion test class 3.
Thyromental distance < 6 cm or > 9 cm, thick short neck, poor atlanto-occipital joint mobility.

Difficult Supraglottic Device Placement Risk Factors

Limited mouth opening, upper airway obstruction, altered pharyngeal anatomy.
Poor airway compliance and increased airway resistance lead to excessive pressure required.

Difficult Invasive Airway Placement Risk Factors

Abnormal neck anatomy (tumor, hematoma, radiation history), obesity, short neck, limited access to cricothyroid membrane, laryngeal trauma.

Angioedema

Increased vascular permeability causing facial, tongue, and airway swelling. Airway obstruction poses a severe risk.

Common Causes and Treatments for Angioedema

Angiotensin converting inhibitors: treated with epinephrine, antihistamines, and steroids.
Hereditary angioedema (C1 esterase deficiency): treated with C1 esterase concentrate or FFP; avoid standard allergy treatments.

Ludwig's Angina

A bacterial infection with rapid cellulitis progression in the floor of the mouth, risking complete airway obstruction due to posterior tongue displacement.

Securing Airway in Ludwig's Angina

Best secured awake via awake nasal intubation or awake tracheostomy.

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Description

This quiz focuses on key concepts in airway management, particularly the Mallampati score and the inter-incisor gap. Understanding these concepts is crucial for medical professionals involved in anesthesia and airway assessment. Use these flashcards to test your knowledge and improve your clinical skills.