Fiber Optic Ventilation (Exam 4)

Question 1

Fiberoptics Scope Parts

Answer 1

1. Control Section: flexes tip up and down
2. Channel port: suctioning, medications, oxygen
3. Eyepiece
4. Light Source

Question 2

Fiberoptic Scope Indications

Answer 2

Anticipated difficult tracheal intubation
Anticipated difficult mask ventilation
Small mouth opening
C-Spine
Upper airway trauma
Tube placement verification

Question 3

Fiberoptic Scope Contraindications

Answer 3

Absolute
–Lack of time
Relative
–active bleeding
–active vomiting
–uncooperative patient

Question 4

Fiberoptic Scope Methods

Answer 4

Oral
–Facial/Skull Injury
–May cause gagging
Nasal
–Small Mouth
–More of a conduit for FO scope
Asleep
–Deep Sedation (not breathing)
–For uncooperative patients
Awake
–Preferred method
–Maintains ventilation and secured airway

Question 5

Fiberoptic Scope Process

Answer 5

1. Create plan with the ACT
2. Patient education is vital
3. Equipment
   –Sedation medication
   –Airway adjunct
   –Localization
   –Bronchoscope
   –CMAC/Glidescope as backup
   –Route for supp O2
4. Premedicate with antisialagogue (glycopyrrolate)
5. In OR, begin sedation and O2 admin (nasal canula, blowby, or facemask)
   –Propofol, Precedex, and Remi can be used
   –Verify spontaneous ventilation
6. Nebulize Lidocaine in airway
7. Nasal Route:
   –Vasoconstrict and localize nares
   –Phenylephrine and atomized lidocaine
8. Nasal Route:
   –Advance scope through preferred nare down to oropharynx
9. Oral Route:
   –Incrementally spray Lido onto tongue and oropharynx
10. Oral Route:
    –Insert FO airway (Ovassapain, Williams, or Bermann II)
11. Tape ETT onto FO scope
12. Both Routes:
    –Advance scope to pharynx
13. Pass through vocal cords
    –Identify landmarks (Trachealis posteriorly)
14. Advance near carina (do not touch, very sensitive)
15. Railroad ETT to appropriate depth
16. Connect to circuit, confirm EtCO2 then secure