Bonus Question Study Guide Week 3
1. Study the Difficult Airway Algorithm in the Additional Resources folder. Know how
to how to confirm ventilation, tracheal intubation and LMA placement.
2. Know what the alternatives for non-invasive approaches to difficult intubation are:
3. Know the definition of ventilation.
4. Know the definition of perfusion.
5. in the 18 Basics of Pediatric Airway, Anatomy, Physiology and Management (in the
additional resources section): Know the reason for almost all of the pediatric codes.
6. Know the information below: The differences between pediatric and adult airway.

The smaller airway in peds patients may lead to airway obstruction from the
tongue and the anterior pharyngeal tissue lying against the posterior wall of the
hypopharynx when the child is positioned flat on a stretcher.
 The narrowest point in a child’s airway is the subglottic region (whereas the level
of the vocal cords is the narrowest in adults); this has been the reason for the
traditional use of an uncuffed endotracheal tube in small children.
 All of these factors make a child more susceptible to airway obstruction, given the
same degree of inflammation.
 A reduction in the diameter of the pediatric airway results in a significant increase
in airflow resistance.
Other characteristics that are special to pediatric airways:
-smaller
-angled vocal cords
-funnel-shaped rostral (more anterior and superior/cephalad) larynx
-relatively larger tongue in proportion to mouth
-pharynx is smaller
-Epiglottis is larger and floppier and "U" shaped
-airway narrowest at the cricoid cartilage (subglottic airway region)
-trachea is narrower and less rigid
-smaller tracheal length (i.e. shorter); therefore right mainstem placement or displacement
is very common
-poor cervical spine support
-cartilage is less rigid (epiglottis, larynx and tracheal rings)
-larger occipital area of the skull
-infants are obligate nose breathers
7. Know why premature infants are prone to respiratory distress syndrome (RDS):
8. 14 Signs of respiratory failure in pediatric patient:
9) Why is an uncuffed ETT recommended in children <8 years old?
10) When should a cuffed ETT be used?
11) List 8 different difficult airway management techniques:
12) How many lobes does the right lung have?
13) How many lobes does the left lung have?
14) Know the following:
 The Trachea begins at the level of the cricoid and extends to the carina
 The carina (cough reflex in patients) is at the level of the angle of Louis or
Thoracic Vertebrae #5 (T5)
 T7 is where the trachea bifurcates (splits into right and left main stem
bronchi/lungs)
 The right main stem bronchus is angled at 25º (right lung) and is less angled than
the left main stem bronchus (45º).
 The right main stem bronchus is more prone to accidental intubation if the
endotracheal (ETT) tube is inserted too far. Therefore the anesthesiologist may
pull the ETT back or out a by a couple of centimeters, so that both lungs have
equal ability to be inflated during general surgery cases.
 However, in Thoracoscopy/Thoracotomy cases or Thoracic Surgery, the lung in
which the surgeon is not going to be operating on is the one that gets inflated with
a side specific double lumen endobronchial tube. Double-lumen endobronchial
tubes allow for single-lung ventilation, while the other lung is collapsed to make
surgery easier. The deflated lung is re-inflated as surgery finishes to check for
fistulas (tears). Six sizes are available: 28, 32, 35, 37, 39, and 41 french sizes, in
both left and right orientations. The extension tubes and pilot balloons are also
imprinted with Tracheal (clear) or Bronchial (blue) to differentiate the appropriate
lumen and cuff.
15) Another name for cricoid pressure is the Sellick maneuver.