7/29/2013

7/29/2013

Answers:

All of the following are classic signs of tracheoesophageal fistulas except?

A) Hemoptysis 

B) increased tracheal secretions 

C) presence of gastric secretions in airway 

D) recurrent pneumonia 

E) gastric dilation

 

Hemoptysis is a sign of tracheoinnominate fistula, increased tracheal secretions, especially those resembling gastric secretions are a sign of tracheoesophagela fistula. Additionally, this type of fistula may lead to massive gastric dilation as well as recurrent pneumonia secondary to aspiration.

 

Name several ways to prevent tracheoinnominate fistula formation.

Prevention
-limited intubation times (>2wks)
-place trach tube btwn 2-3rd tracheal rings.
-avoid sharp angled tubes.
-proper tracheostomy technique

 

MC Question:
Airway obstructions above the larynx are associated with --- stridor, whereas biphasic stridor is associated with --- obstructions.
A) Inspiratory, supraglottic
B) Expiratory, Tracheal
C)Inspiratory, Tracheal
D)Expiratory, subglottic
E) Inspiratory, subglottic
 

 
 
Free Response Questions:
Name two advantages and one disadvantage to using a Laryngeal Mask Airway (LMA) in securing an airway.




Quick Facts:

-Laryngeal Mask airway (LMA): can be inserted blindly, and quickly, no neck movement required, 95-99% success rate, easy to learn and less postop sore throat, cough and laryngeal injury. Fiberoptic scope can be placed through LMA and tube passed over that for later definitive airway management. Risk of LMA is pulm aspiration of vomit. Contraindications include full stomachs, hiatal hernia, obesity and emergency abdominal surgery.
  -Combitube: double lumen tube w/ tracheal cannula and blocked esophageal end w/ ventilated side holes. Blindly inserted, can ventilate if in trachea or esophagus. Device is large so contraindicated in kids or small people. Be careful if upper airway/esophageal pathology. Also laryngospasm or foreign bodies can impair devices ventilation.