CCU EXAM 4 - CRNA
List general airway problems and associated findings that may be found on global
examination - ANS-1. Difficulties in airway management
- Micrognathia (small jaw)
- Macroglossia (big tongue)
- Acromegaly (excessive growth hormone -> deformities)
2. Potential airway obstructions
- Inability to articulate clearly
- Dysphagia (difficulty swallowing)
- Stridor
3. Inability to swallow or manage secretions
- Drooling
- Sitting up to breath (indication of potential obstruction)
What is the M of MOAN[S] of a difficult bag-valve-mask ventilation technique - ANS-M -
Mask seal (inadequate w/ beard, facial deformity)
What is the O of MOANS (bag-valve-mask technique) - ANS-O - Obesity - difficult to
ventilate -> 3rd trimester pregnancy, or UA obstruction (neck swelling, bruising,
angioedema, cancer)
What is the A of MOANS (bag-valve-mask technique) - ANS-A - Age - elderly, loss of
muscle tone to support the upper airway
What is the N of MOANS (bag-valve-mask technique) - ANS-N - No teeth - loss of
alveolar ridge support
What is the S of MOANS (bag-valve-mask ventilation technique) - ANS-S - Stiff lungs -
upper airway obstruction, exacerbation of asthma, fibrosis, etc
List [9] ways to assess an airway prior to oral intubation: - ANS-1. Interincisor distance
3cm
2. Thyromental distance 6cm
3. maxillary dentition interfering with jaw thrust
4. Mallampati Classes (1-4)
5. Neck in fixed flexion
6. Neck radiation, scarring/ neck or UA masses
7. High BMI
, 8. OSA
9. Term pregnancy
What areas do you apply the 3-3-2 rule to - ANS-3 fingers of the mouth opening
(vertically between dentition)
3 fingers between the chin and the hyoid
2 fingers between the hyoid and thyroid
**Significantly more or less of these values suggests more difficult airway management
What is the Mallampati classification? - ANS-A scale to measure the difficulty of a
patient's mouth during intubation. The easiest (1) and the most difficult (4).
Mallampati Class I - ANS-Can visualize: soft palate, tonsillar fauces, tonsillar pillars,
uvula = easy intubation
Mallampati Class II - ANS-Can visualize: soft palate, tonsillar fauces, uvula = relatively
easy intubation
Mallampati Class III - ANS-Can visualize: soft palate, base of uvula = more difficult
intubation
Mallampati Class IV - ANS-Soft palate not visible = near impossible intubation
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
What is a Cormack & Lehane grade? - ANS-- Cormack and Lehane is a method used to
asses a difficult direct laryngoscopy and placement of ETT
- Cannot determine this grading from view of oral cavity alone
What must first be performed to assign a Cormack & Lehane grade? - ANS-An initial
direct laryngoscopy
Cormack & 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
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