1 Airway Anatomy Flashcards
Airway anatomy innervation
All RLN except cricothyroid= external SLN
Action: aryepiglottic, interarytenoid
Closes laryngeal vestibule. Closes posterior commissure of glottis
Function of extrinsic larynx muscles
Breathing, swallowing, phonation
Muscles that elevate larynx 6
Stylo/genio/mylo/thyrohyoid, digastric, stylopharyngeus
Muscles that depress larynx
Omo/sternohyoid, sternothyroid
Airway anatomy innervated by SLN, internal and external branch
Internal: sensory, epiglottis to top of VC. External: motor, cricothyroid
What is innervated by V1, V2, V3
1: Nares, ant 1/3 septum. 2: turbinates and septum. 3: ant 2/3 tongue
What does CN IX provide sensory info for
Soft palate, oropharynx, tonsils, post 1/3 tongue, vallecula, ant epiglottis, afferrent limb of gag
SLN: what does it provide sensory innerv to, which branch
Posterior epiglottis to level of VC, internal branch
True vocal cords are ___ and not ___
Ligaments, innervated
What area does RLN provide sensory info to
Below VC to trachea
Which side of vagus does the recurrent laryngeal loop around the aorta
Left
SLN: internal branch goes to ___, external branch goes to ____
Internal: thyrohyoid, external: cricothyroid
Nerve damage to what leads to hoarseness
Damage to external branch of SLN
What does the right RLN loop under
Subclavian A
RLN injury to either side can occur from what: 6
ETT pressure, LMA pressure, thyroid or parathyroid sx, neck stretching, tumor
Which 4 things lead to RLN injury only on the left side
PDA ligation, LA enlargement (mitral stenosis), aortic arch anuerysm, thoracic tumor
How to do SLN block
Anes at inf border of greater Cornu of hyoid: 1 ml above thyrohyoid, 2 ml beneath thyrohyoid. If asp air too deep
How to do transtracheal block
Needle in caudal direc in cricothyroid membrane. Pt takes deep breath and inject 3-5 ml LA, pt coughs
How to do glossopharyngeal block
Needle in base of palatoglossal arch 0.25-0.5 cm deep, if asp air= too deep. If blood redirect (could be carotid). 1-2 ml LA both sides
Cuneiform are ____ to corniculates. Both provide structure to ___ ___
Lateral. Aryepiglottic folds
Adult vs peds: shape and narrowest region of larynx
Adult: cylinder, VC. Peds: funnel, cricoid (fixed)VC (dynamic)
Laryngospasm is most common in which age
<1 year old, children
Laryngospasm reflex pathway
Afferrent: internal branch SLN. Efferent: external branch SLN and RLN
CO2: too high or too low leads to inc risk laryngospasm
Too low —> risk. Too high: preventative
IM dose of sux for laryngospasm in peds and adults, atropine dose to give at which age
Peds: 5 mg/kg if neonate/infant, 4 if child or adult. <5 y/o needs atropine 0.02 mg/kg
Which maneuver leads to neg p pulm edema
Mullers maneuver
3 muscles that can lead to a/w obstruction/where
Tensor palatine (nasopharynx), genioglossus (oro), hyoid muscles (hypo)
Tracheobronchial tree: ____ divisions of smaller airways. Airflow velocity ___ as you move down the tree
23, slows
Lower airway beginning/end
Tracheo/alveoli
Trachea begins/ends C__-T__ Sensory innerv, epithelium type, blood supply
6-4. Vagus. Ciliated columnar. Inferior thyroid, superior thyroid, bronchial, and internal thoracic arteries
Alveoli: how many we have, epithelium type, what allows air movement between them
300 million at 9 years old. Squamous. Pores of kohn
Carina: what level, corresponds w what, epithelium
T4-5, angle of louis, ciliated columnar
Mainstem bronchi: length and take off of each side, epithelium type
Right: 2.5 cm long, 25 degree take off. Left: 5 cm, 45 degree. Cuboidal
Pneumocytes: type 1 function, junctions, cell type
Surface for gas exchange, 80% of surface, squamous, tight junctions
Type II pneymovyte functions
Provide surfactant,t resistant to 02 toxicity, can do cell division and make type I cells
Type III pneumocyte: what they are and function
Macrophages, fight infection and produce inflammation
____ are in alveolus of smokers and ppl w acute lung injury
Neutrophils
Neck ___ makes distance from incisors to carina ___ while extension makes it ___
Flexion- shorter. Longer
More likely to mainstem and aspirate on which side of bronchus
Right
<3 year old anatomical diff of bronchi
Both take off at 55 degrees
3 aspects that increase as airway bifurcates
Number of airways, area, and muscular layer
4 things that decrease as airway bifurcates
Airflow velocity, amt of cartilage, goblet cells (make mucus), ciliated cells (clear mucus)
Order of the cartilages superior to inferior
Epiglottis, corniculate, arytenoid, cricoid
Where is the infant larynx located
C2-4
