Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1: Intro to Anesthesia > Airway > Flashcards

Airway Flashcards

1
Q

<p>The nasal pages (nasopharanx) includes</p>

A

<p>septum, turbinates, adenoids</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

<p>The functions of the nasopharanyx (4)</p>

A

<p>2/3 upper aw resistance, humidify, filter, warm air</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

<p>Nasopharanyx innervated by</p>

A

<p>trigeminal nerve</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

<p>Oropharnyx includes (4)</p>

A

<p>teeth, tongue, hard and soft palate</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

<p>Predominate cause of aw resistance in oropharynx</p>

A

<p>tongue</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

<p>Oropharynx innervated by (2)</p>

A

<p>Trigeminal Nerve (hard and soft palate, ant. 2/3 tongue)

Glossopharyngeal (post. 1/3 tongue, soft palate, oropharynx)</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

<p>Border of nasopharynx</p>

A

<p>soft palate</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

<p>Border of oropharynx</p>

A

<p>epiglottis, tonsils, uvula</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

<p>Primary cause of upper aw obstruction during anesthesia</p>

A

<p>loss of pharyngeal muscle tone</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

<p>Pharynx innervated by</p>

A

<p>glossopharyngeal and vagus nerves</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

<p>Larynx is located at</p>

A

<p>C4-C6</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

<p>Functions of the larynx (3)</p>

A

<p>phonation, respiration, aw protection</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

<p>The function of the epiglottis</p>

A

<p>cartilaginous anterior border of laryngeal inlet, blocks food from entering larynx when swallowing</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

<p>Larynx has 9 cartilages, name them.</p>

A

<p>3 paired (Corniculate, Cuneiform, Arytenoid)

3 unpaired (epiglottis, thyroid, cricoid)</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

<p>Anterior attachment for vocal cords</p>

A

<p>Thyroid cartilage, large/most prominent</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

<p>Cricoid cartilage is the only</p>

A

<p>complete cartilaginous ring</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

<p>Narrowest part of pediatric aw</p>

A

<p>cricoid cartilage</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

<p>Narrowest part of adult aiw</p>

A

<p>glottic opening between cords</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

<p>Posterior attachment for vocal cords</p>

A

<p>arytenoid cartilage</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

<p>Often cartilage that is falsely identified in DL</p>

A

<p>arytenoid</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

<p>Corniculate cartilages are located</p>

A

<p>on posterior portion of aryepiglottic fold</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

<p>Cuneiform cartilages are located</p>

A

<p>lateral to corniculate cartilages on aryepiglottic fold, sometimes missing*</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

<p>vocal cords are formed by</p>

A

<p>thyroartenoid ligaments, are pearly white in color</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

<p>the portion of the laryngeal cavity above the glottis is the 1

and the portion inferior to vocal cords is 2</p>

A

<p>1 vestibule

| 2 subglottis</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

<p>Name intrinsic laryngeal muscles</p>

A

<p>cricothyroid, vocalis, thyroarytenoid, lateral cricoarytenoid, arytenoid, posterior cricoarytenoid</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

<p>Lateral cricoarytenoid muscle functions by 1 and is innervated by 2</p>

A

<p>1 adduct (lets close aw)

| 2 recurrent laryngeal nerve (branch of vagus)</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

<p>arytenoid muscles function 1 and innervated by 2</p>

A

<p>1 adducts vocal cords (oblique and transverse)

| 2 recurrent laryngeal nerve (branch of vagus)</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

<p>posterior cricoarytenoid muscle function 1 and innervated 2</p>

A

<p>1 abduct (pull cord apart)

| 2 recurrent laryngeal nerve (branch of vagus)</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

<p>cricothyroid muscle function 1 and innervated 2</p>

A

<p>1 elongates/tenses vocal cords

| 2 superior laryngeal nerve, external branch of vagus</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

<p>thyroarytenoid muscle functions 1, innervated by 2</p>

A

<p>1 shortens/relaxes

| 2 recurrent laryngeal nerve (branch of vagus)</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

<p>Vocalis muscle functions 1, innervated by 2</p>

A

<p>1 relaxes/shortens

| 2 recurrent laryngeal nerve (branch of vagus)</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

<p>Function of intrinsic laryngeal muscles</p>

A

<p>Control length and tension of vocal cords/size of glottic opening</p>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

From superior to inferior name parts of vagus nerve

A

superior laryngeal, internal laryngeal, external laryngeal, recurrent laryngeal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

extrinsic laryngeal muscles function (2)

A

suprahyoid - move larynx cephalad

infrahyoid - move larynx caudad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Suprahyoid group of muscles

A

digastric, geniohyoid, mylohyoid, stylohyoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Infrahyoid group of muscles

A

thyrohyoid, omohyoid, sternohyoid, sternothyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

List parts of lower airway from largest to smallest (7)

A

tranchea > carina > bronchi > bronchioles > term. bronchioles > resp. bronchioles > alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Describe traits of trachea

A

fibromuscular tube, 10-20 cm long, 22 mm diameter in adult, 16-20 u shaped cartilages, no cart on post side, bifurcates at T4 (carina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Describe traits of carina

A

divides intro R and L main stem bronchi, at T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Right bronchi length and angle and special fact

A

2.5cm, 25 degrees, more common intubate and ge t foreign body due to angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Left bronchi length and angle

A

5cm, 45 degrees

42
Q

AW assessment is done when?

A

preoperatively

43
Q

Goal of AW assessment

A

identify potential aw problems, identify diff. aw

44
Q

What ?’s to ask during AW assessment (9)

A

radiation or burn to head/neck, cspine pain ROM, TMJ pain, RA, ankylosing spondylitis, abscess/tumor, prior intubation or trach, snoring/sleep apnea, dysphagia/stridor

45
Q

What to assess in aw assessment? (12)

A 
1 general appearance (head neck size >43cm/17in and fullness)
2 ROM
3 dentition
4 mouth - tongue lips gums
5 mouth opening - 2-3 fingers, > 3cm/30-40mm
6 body habitus
7 mallampati
8 thyromental distance
9 mandibular protrusion (overbite)
10 hx diff aw
11 diagnosis
12 planned surgery
46
Q

Mallampati Classification - what is it, how is it done, describe structures

A

Correlation of oropharyngeal space w/ ease of DL and intubation

Pt sits upright, sticks tongue out (no ah) as far as possible and mouth open as wide as possible, head neutral

Class 0: tip of epiglottis + class 1

Class 1: pillars, uvula, soft palate, hard palate

Class 2: uvula, soft palate, hard palate

Class 3: soft and hard palate

Class 4: hard palate

47
Q

Cormack-Lehane score what is it, how is it done, describe structures.

A

DL view of glottis, correlated to Mallampati.

Grade 1: most of glottis
Grade 2: post. portion of glottis (most common)
Grade 3: only epiglottis visible
Grade 4: no aw structures seen

48
Q

Normal thyromental distance and anatomical landmarks to measure it

A

Lower border of mandible to thyroid notch w/ neck fully extended. Normal is 6cm, 4 fingers. Difficult intubation is < 3 fingers

49
Q

Mandibular protrusion test describe it

A

Class A: lower incisor protrudes anterior to upper
Class B: lower incisor brought to edge w/ upper
Class C: lower incisor cant be brought to edge w/ upper

50
Q

How to prepare for induction?

A 
MSMAIDS
Monitors on and settings appropriate
Suction on and at head of bed
Machine checked w/ means of positive pressure vent
aw
IV
drugs
special equipment
51
Q

An airway set up includes 12

A 
1 appropriate sized mask
2 PPV - ambu, machine circuit
3 suction on and accessible
4 tongue depressor
5 appropriate oral and nasal aws
6 laryngoscope handle
7 2 different blades (Mac, Miller)
8 2 ETT sizes
9 stylet
10 syringe
11 LMA
12 tape
52
Q

Sizing for ETT is as follows:

A

F 6.5-7mm M 7.5-8mm

53
Q

Describe mask ventilation

A

Mask in Left Hand and reservoir bag in Right Hand, C grip on mask and 4th/5th fingers under chin and lift/jaw thrust

54
Q

Goal of preoxygenation is

A

to increase O2 concentration of FRC by washing out N2 (79% RA)

55
Q

FRC is

A

volume of air left in lung at end of passive expiration

56
Q

3-5 min tight mask fit during normal tidal breathing w/ 100% FiO2 > 6L is _____minutes of safe apnea time

A

10

57
Q

4 vital capacity breaths over 30 sec at 100 FiO2 >6L/min is _____ minutes of safe apnea time

A

5

58
Q

Preoxygenation is less effective for what types of pts

A

obese, pregnant pts bc they have decreased FRC

59
Q

What things to look for effective mask ventilation (4)

A

chest rise and fall, exhaled Tv, pulse oximetry, capnography

60
Q

Adequate Tv should be achieved w/ peak inspiratory pressures (PIP) < than

A

20 cm H2O

61
Q

Higher PIPs should be avoided bc of

A

gastric insufflation and therefore aspiration risk

62
Q

If PIPs are inadequate at 20 cmH2O what should you assess

A

aw patency, pulm compliance

63
Q

Predictors of difficult mask ventilation (7):

A 
obstructive sleep apnea/hx of snoring, 
age > 55, 
male gender, 
BMI >30, 
Mallampati > III, 
beard, 
edentulousness
64
Q

Relaxation of the genioglossus muscle during anesthesia can cause

A

aw obstruction d/t tongue and epiglottis

65
Q

What are two types of oral airways?

A

Berman/BOA and Guedel

66
Q

How do you size oral airways?

A

Center of mouth to angle of jaw OR from corner of mouth to earlobe

67
Q

Complications of oral airways (3)

A

laryngospasm, bleeding, soft tissue damage

68
Q

What are oral airway sizes for both BOA and Guedel?

A

small BOA 80mm = Guedel 3
medium BOA 90mm = Guedel 4
large BOA 100mm = Guedel 5

69
Q

What happens if oral aw is improperly sized?

A

too big - obstructs

too small - tongue obstructs

70
Q

How are nasal trumpets sized?

A

24 Fr, 26, ….36

Measure from nares to meatus of ear.

71
Q

If a pt is lightly sedated which type of aw do they tolerate better- nasal or oral aw?

A

Nasal

72
Q

Complications of nasal airway? (4)

A

epistaxis, nasal/basal skull fx, adenoid hypertrophy, anticoagulants

73
Q

What should be checked on laryngoscope handle?

A

battery

74
Q

What should be checked on laryngoscope blade?

A

light

75
Q

Macintosh blade is (shape)

A

curved

76
Q

Miller blade is (shape)

A

straight

77
Q

Macintosh blades come in sizes _____

Miller blades come in sizes _____

A

1-4, Adults 3

0-4, Adult 3

78
Q

When DL’ing pt what technique is used to open mouth?

A

scissor technique

79
Q

Describe scissor technique

A

RIGHT Thumb on upper molars moving them cephalad, pointer finger on lower molars moving moving them caudad

80
Q

Ideal position for ETT

A

4 cm above carina, 2 cm below cords

81
Q

How do you estimate ideal ETT depth?

A

ETT size x 3

82
Q

How to confirm good placement of ETT? (3)

A

etCO2*, bilateral breath sounds, chest rise/fall

83
Q

Absolute indications of ETT placement (12)

A

1 full stomach (pt didnt fast),
2 high asp. risk dt gastric or bloody secretions
3 critically ill
4 sig. lung abnorm. (poor compliance, aw resistance, impaired O2)
5 lung isolation surgery
6 ENT/otorhinolaryngologic surgery where SGA not possible
7 post op vent support needed
8 failed SGA
9 NMBD
10 positioning w/out quick access to aw (prone)
11 predicted diff. aw
12 prolonged procedure

84
Q

Features of an ETT (5)

A

15 mm adapter,

high volume/low pressure cuff - prevents gastric asp., ensures Tv goes to lungs, helps prevent mucosal injury d/t increased surface area, inflate w/ 4-5cc (or min. air to achieve leak of 20-25 cmH2O)

beveled tip - makes it easier for tube to pass thru vocal cords,

murphy eye - side wall opening, back up hole for ventilation in case of obstruction of distal lumen

pilot balloon w/ one way valve

85
Q

Describe the difference between high pressure/low volume and high volume/low pressure ETT cuffs?

A

High pressure/low volume - good at preventing aspiration, but exerts high pressure on tracheal wall, if left for long periods, causes injury

High volume, low pressure not as good at preventing aspiration but exerts minimal pressure on tracheal wall

86
Q

What position needed for intubation and WHY?

A

Sniffing position, optimally visualized vocal cords

87
Q

What 3 axis need to be aligned for intubation?

A

oral, pharyngeal, and laryngeal (OPL)

88
Q

When should the stylet be removed from ETT during intubation and WHY?

A

At the level of the cords, just before passing thru glottis, prevents trauma to tracheal mucosa.

89
Q

Describe the features of a stylet (2)

A

malleable, form 60 degree angle 4-5cm distal end - hockey stick shape

90
Q

What is the ideal position for mask ventilation and WHY?

A

Sniffing position, aligns OPL axis

91
Q

How is sniffing position achieved w/ obese pts?

A

ramp shoulders w/ pillows and blankets

92
Q

Predictors of a difficult airway? (8)

A 
1 long upper incisors,
2 prominent overbite
3 inability to protrude mandible
4 small mouth opening (2-3 fingers, > 3cm/30-40mm)
5 mallampati > III
6 high arched palate
7 short thyromental distance
8 short thick neck
limited cervical mobility
93
Q

What are the sizes of LMAs?

A

30-50 kg - LMA 3
50-70kg - LMA 4
70-100kg LMA 5
>100 kg LMA 6

94
Q

What to inflate LMA cuff to?

A

Normal: 40 to 60 cm H2O, w/ a 18-20 cm H2O audible air leak

Proseal/Supreme: 40-60 cm H20, w/ 20 cm H2O air leak

95
Q

Complications of improperly sized LMA (2)?

A

too small - cuff inflated too large to achieve seal, r/o nerve damage

too large - sore throat

96
Q

Features of a supreme LMA that differ from LMA classic?

A

integrated bite block, drain tube for stomach, can achieve PIP of up to 30 cm H2O (vs 20 cm H2O on classic)

97
Q

Advantages (5) and disadvantages of LMA?

A

A: 1 increase speed and ease of placement, 2 improved hemodynamics at inductions/emergence d/t less anesthesia required, 3 lower freq. coughing, 4 lower freq. sore throats, 5 avoids foreign body in trachea (ex. asthmatics have rxtive aws and do better w/ less invasive aws)

D: 1 not a definitive aw, 2 lower seal pressure, 3 higher freq. of gastric insufflation, 4 esophageal reflux, 5 mech ventilation limited - pressure support

98
Q

Hazards of AW management (8)

A 
1 dental damage
2 soft tissue/mech injury
3 laryngospasm
4 bronchospasm
5 vomitting/aspiration
6hypoxemia/hypercarbia
7 SNS stimulation (tachy adults, brady kids)
8 esophageal/endobronchial intubation
99
Q

Describe MAC case

A

complete aw set up, nasal cannula - everyone gets O2, spont. breathing pt, nasal aw if snoring

100
Q

Describe GA mask case

A

no diff aw, no need to access head/neck for surg, no aw bleeding/secretions, short surg., no position changes, pt spont. breathing

101
Q

Describe GA LMA case

A

no difficult aw, access head/neck for surg, no aw bleeding/secretions, short surg., more reliable than mask, want free hands

102
Q

Describe GA tracheal intubation case

A

used for aw compromised, aw inaccessible, long surg, changing surgical positions, surgery of head/neck,abdomen, need for controlled vent./PEEP, inability to maintain aw w/ mask/LMA, aspiration risk, aw/lung disease, NMBD

1: Intro to Anesthesia (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions