Brainscape's Knowledge GenomeTM

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


See full index

Gen Exam 1 > Airway > Flashcards

Airway Flashcards

1
Q

T/F
breathing can be performed exclusively by the diaphragm

A

True
in normal lungs this is possible

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

In the adult, the tip of an orotracheal tube moves an average of __ cm with flexion/extension of the neck, but can travel as much as ___ cm. In infants and children, displacement of even __ cm can move the tube above the vocal cords or below the carina

A

In the adult, the tip of an orotracheal tube moves an average of 3.8 cm with flexion/extension of the neck, but can travel as much as 6.4 cm. In infants and children, displacement of even 1 cm can move the tube above the vocal cords or below the carina

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

When ____ is reduced, larger changes in pleural pressure are needed to create the same tidal volume (Vt).

A

lung compliance

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

Patients with low lung compliance breathe with (smaller/larger) Vt and more rapidly, making spontaneous ____ the most sensitive clinical index of lung compliance.

A

smaller Vt
respiratory rate

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

Carotid and aortic bodies are stimulated by ____ values less than ____.
Thus, patients who depend on hypoxic ventilatory drive must have PaO2 values below ____.

A

PaO2
60 to 65 mmHg
65 mmHg

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

The three etiologies of hyperventilation

A

arterial hypoxemia
metabolic acidemia
central etiologies (e.g., intracranial hypertension, hepatic cirrhosis, anxiety, pharmacologic agents).

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

Increases in dead space ventilation primarily affect ____ elimination (with minimal influence on arterial oxygenation)
Increases in physiologic shunt primarily affect ____ (with minimal influence on CO2 elimination).

A

Increased dead space ventilation affects CO2 elimination
Increased shunt affects arterial oxygenation

*dead space: volume of ventilated air that does not participate in gas exchange; fills the conducting zone of respiration made up by the nose, trachea, and bronchi

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

alveolar ventilation : dead space ventilation ratio
What is it during spontaneous breathing?
What is it during during positive-pressure ventilation?

A

2:1

1:1

*When on vent, need higher minute ventilation than during spontaneous ventilation to achieve the same PaCO2.

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

PaCO2 ≥ PETCO2 unless the patient inspires/receives…

A

exogenous CO2

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

The difference between PaCO2 and PETCO2 is due to…

A

dead space ventilation

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

The most common reason for an acute increase in dead space ventilation is…

A

decreased cardiac output

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

What happens with reduced functional residual capacity (FRC)?

A

-tachypnea (reduced lung compliance )
-arterial hypoxemia (venous admixture increases)

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

The thoracic cage is shaped like…

A

a truncated cone

small superior aperture
larger inferior opening (attaches to diaphragm)

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

Thorax
horizontal plane that passes through the vertebral column at…

A

T4 or T5

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

Thorax
The horizontal plane separates which two structures?

A

the superior from the inferior mediastinum

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

During ventilation, the upper thoracic diameter mostly changes in the ____ direction & the lower thorax changes in the ____ direction.

A

thoracic diameter changes:
upper thorax: anteroposteriorly
lower thorax: lateral/transverse

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

Work of breathing is the energy expenditure of ___.

A

ventilatory muscles

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

Ventilatory muscles are ____ muscles. They are susceptible to ____.

A

endurance
fatigue

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

Some causes of respiratory fatigue

A

inadequate oxygen delivery
poor nutrition
increased work secondary to COPD with gas trapping or increased airway resistance

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

ventilatory muscles (7)

A
  • diaphragm
  • intercostal muscles
  • abdominal muscles
  • cervical strap muscles
  • sternocleidomastoid muscles
  • back muscles
  • intervertebral muscles of the shoulder girdle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The diaphragm performs most of the muscle work during….

A

nonstrenuous breathing

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

Exhalation is usually (active/passive).

A

passive

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

Patients with c-spine injurty rely on which muscles to breathe?

A

rely on abd & back muscle
the cervical strap muscles are not working

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

(Increased work of breathing)
Initial increase will require help from ____ muscles. Further increase in WOB recruits ____ muscles. Maximal work incorporates ____ muscles.

A

Initial: abdominal muscles rib depression, forced exhalation (felt as rib pain when atheletes forcibily exhale)

Further: cervical strap muscles(elevate sternum & upper chest = optimize thoracic dimensions)

Maximal work: back & paravertebral muscles of the shoulder girdle

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

Most powerful muscles of expiration

A

muscles of the abdominal wall
ie: coughing

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

____ twitch muscles are most susceptible to fatigue.

A

fast

(“the fast and fatigued”)

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

What creates negative pressure in the intrapleural space?

A

diaphragm descends
ribcage expands

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

Functional residual capacity (FRC)
Definition

A

The volume of gas remaining in the lungs at PASSIVE end-expiration
created by equal and opposing forces at end-inspiration

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

At FRC, the intrapleural space has a slightly subambient pressure of…

A

-2 to -3 mmHg

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

The 3 divisions of lung parenchyma

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

Which airway division is responsible for bulk gas movement?

A

conductive

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

T/F
Gas exchange occurs in the transitional airways.

A

True
Transitional airways: gas movement, limited gas diffusion and exchange.

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

T/F
Gas exchange occurs in the smallest respiratory airway.

A

True
the primary function of the smallest respiratory airways is gas exchange

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

The trachea is part of the ____ airway division.

A

conductive

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

(T/F)
The transitional airway division contains the alveolar sacs.

A

False.
The respiratory airway contains the alveolar sacs.

The transitional airway division contains the alveolar ducts.

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

Which airway are the alveoli located in?

A

Respiratory
Alveoli and their sacs are in the respiratory airway.

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

R & L Mainstem bronchi
Which bronchus has the greater diameter?
Angles of each?
Which has longer length before the branching point?

A

right bronchus has larger diameter

right bronchus leaves the trachea at 25 degrees (less acute)
left bronchus is about 45 degrees.

right main bronchus ~2.5 cm long
left main bronchus ~5 cm

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

T/F
In all populations, endobronchial intubation and aspiration are more likely in the right bronchus.

A

False
<3 Y/O: bronchi angles are about equal (55 degrees)

Dr H: “it’s a crapchute where it goes”

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

The last airway component incapable of gas exchange

A

bronchioles

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

First site in the tracheobronchial tree where gas exchange occurs?

A

respiratory bronchiole

note how it follows the terminal bronchiole
(you’d think terminal means last but w/e)

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

Alveolar sacs open into what structure?

A

alveolar clusters

terminal bronchiole > respiratory brionchiole (gas exch starts) > alveolar ducts > alveolar sacs > alveolar clusters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Alveolar-capillary membrane has two primary functions. What are they?

A
  1. transport of respiratory gases (oxygen and carbon dioxide)
  2. production of a wide variety of local and humoral substances

“I’m good at 2 things: breathing and being hormonal”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Surfactant

A

keeps alv. membrane open
needed for gas exch.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Pulmonary Vascular System Flow

A

mixed-venous blood RV –> pulmonary capillary bed via two pulmonary arteries

gas exchange occurs in the pulmonary capillary bed

blood is returned to the left atrium via four pulmonary veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How many pulmonary arteries do we have? how many veins?

A

2 arteries
4 veins

looks like we prioritize transport of O2 rich blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What provides oxygen to the conductive airways and pulmonary vessels?

A

The bronchial arterial system

similar to how the heart has coronary arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What determines the lung’s response to external forces?

A

two main characteristics:
1. ease of elastic recoil of the chest wall
2. resistance to gas flow within airways

Response = recoil & resistance
“R & R”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

The natural tendency of the lungs is to…

A

collapse due to elastic recoil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Older people have (more/less) recoil.

A

Less recoil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Asthma (increases/decreases) airway resistance.

A

increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Physiologic work of breathing includes which types of work? What are they for?

A

elastic work (inspiratory work; overcome the elastic recoil of the pulmonary system)

resistive work (work to overcome resistance to gas flow in the airway)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is shown from the pressure-volume relationship of the thorax and lungs?

A

how normal breathing relates pressure (Vt) to curves when illness affects breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Pressure-volume relationship of thorax and lung results in a ___ curve

A

sigmoidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How do we find FRC on a pressure-volume relationship?

A

vertical line drawn at end-expiration coincides with FRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

(Pressure-volume relationship)
Humans breathe on which part of the sigmoid curve? What does this tell us?

A

The steepest part
shows total lung capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

(Pressure-volume relationship)
What causes right shift of the compliance curve?

A

restrictive Dz (less FRC and Vt)

Restrictive = Right shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

T/F
Decreased lung compliance = larger FRC.

A

False
Decreased lung compliance results in lower FRCs.

Compliance inversely r/t elastic recoil
High compliance = pliable
ie: grocery bag; easy inflation, no elastic recoil
Low compliance = stiff
ie: thick balloon; hard to inflate, high elastic recoil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Increase lung compliance requires (less/more) elastic work to inspire & have (increased/decreased) elastic recoil. This ultimately leads to….

A

higher compliance:
-less elastic work to inspire
-decreased elastic recoil

result: larger than normal FRC (gas trapping)

High compliance lung = plastic bag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What can cause active exhalation?

A

high FRC & compliance; gas trapping
COPD & asthma

active exhalation: must use ventilatory muscles to exhale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Diseases characterized by high compliance

A

COPD
acute asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Gas trapping is seen in elevated ____.

A

FRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

⭐️
What do we need to measure to determine compliance and inspiratory elastic work per breath

A

airway pressure (Paw)
intrapleural (Ppl) pressure
tidal volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Laminar Flow Characteristics

A

-zero velocity at container wall
-maximum velocity at the center of the advancing “cone”.

-conical front: some fresh gas reaches the end of the tube before its completely filled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Laminar flow in the airways allows…

A

alveolar ventilation even when the tidal volume (Vt) is less than anatomic dead space

(conical front: some fresh gas reaches the end of the tube before its completely filled)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Which type of flow is audible? Which is inaudible?

A

Audible: turbulent
Inaudible: laminar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Four conditions that will change laminar flow to turbulent flow

A
  1. high gas flows
  2. sharp angles within the tube
  3. branching/irreg shape in the tube
  4. decrease in tube diameter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Relationship between resistance and gas flow rate in laminar and turbulent flow

A

laminar flow
⬆️ resistance = ⬇️ flow rate. (inversely proportional)

turbulent flow
⬆️ flow rate = ⬆️ resistance significantly in proportion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

The conscious subject can detect small increases in…

A

inspiratory resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

The normal response to increased inspiratory resistance is…

A

increased inspiratory muscle effort
little change in FRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

An asthmatic pt is showing increased PaCO2 in the setting of increased airway resistance. What does this tell us?

A

the patient’s compensatory mechanisms are nearly exhausted

acute ventilatory failure!

asthmatic pts can usually compensate for increased airway resistance and keep their paCO2 in the lower normal range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Can asthmatic pts compensate for increased airway resistance? What happens to their PaCO2?

A

Yes
PaCO2 stays in the low normal range

***PaCO2 = measured the partial pressure of carbon dioxide in arterial blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Increased airway resistance may indicate/result from…

A

BRONCHOSPASM
musocal edema/plug
epitheal desquamination
tumors
foreign bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

How does recoil affect FRC?

A

less recoil = high FRC (and residual volume)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

How does compliance affect WOB?

A

diminished compliance of the chest wall = increased WOB

“Noncompliant pts are more work”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Age related changes in respiratory fxn

A

decreased recoil (elastance)
increased residual vol
increased FRC
decreased chest wall compliance (higher WOB)

usually normal gas exch at rest & exertion

modest decrease in PaO2
no change in PaCO2

decreased sensitivity to hypoxemia and hypercapnia; blunted ventilatory response when challenged by heart failure, airway obstruction, or pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

⭐️
Breathing

A

act of inspiring and exhaling
requires energy for muscle work
limited by energy reserves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

⭐️
Inhalation induction would be (ventilation/respiration).

A

ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

⭐️
Ventilation

A

movement of gas in and out of the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

⭐️
Respiration

A
  • energy is released from organic molecules
  • dependent on the movement of gas molecules (CO2 & O2) across membranes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

⭐️
humans breathe to _____ and ventilate to ______.

A

we breathe to ventilate
we ventilate to respire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

⭐️
Eupnea

A

good breathing!

continuous inspiratory and expiratory movement without interruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

⭐️
Apnea

A

“No breathing”: cessation of ventilatory effort at passive end-expiration (lung volume = FRC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

⭐️
When is lung volume equal to FRC?

A

during apnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

⭐️
Apneusis

A

TB definition: Cessation of ventilatory effort with lungs filled at TLC

Google: prolonged, gasping inhalations followed by extremely short and inadequate exhalations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

⭐️
Apneustic ventilation

A

Apneusis with periodic expiratory spasms

Dr. H: full lungs w/ periodic exp. spasms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

⭐️
Biot

A

Ventilatory gasps interposed between periods of ventilation apnea; also “agonal ventilation”

biot = ‘bouta meet Jesus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Where are the most basic ventilatory control centers?

A

medulla oblongata

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Dorsal Respiratory Group (DRG)

A

pacemaker for respiratory system

source of elementary ventilatory rhythmicity

“PACE the DRG so you don’t kill the pt”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

ventral respiratory group (VRG)

A

ventral medullary reticular formation
serves as the expiratory coordinating center

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

How do DRG and VRG control breathing?

A

-DRG= impulse to inspire
-inspiration occurs
-DRG impulse quenched by a reciprocating VRG impulse
-VRG prohibits further use of the inspiratory muscles
-passive expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

pneumotaxic respiratory center

A

limits the depth of inspiration

“the PNEUMOTAXI will take us this DEEP into the city”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

peripheral chemoreceptors are composed of…

A

the carotid and aortic bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Where are the carotid bodies? What do they do?

A

located at the bifurcation of the common carotid artery
predominantly ventilatory effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

How do the carotid bodies control ventilation?

A
  • reaches the central respiratory centers via the afferent glossopharyngeal nerves
  • stimulated by decreased PaO2

-PaO2 must reach 60 to 65 mmHg to increase neural activity to substantially augment minute ventilation

“C.I.M.V. (Candy in my van)
Carotid Bodies Increase Minute Ventilation”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

During withdrawal of mechanical ventilatory support in a patient who depends on hypoxic ventilatory drive, the PaO2 must fall to less than __ mmHg for spontaneous ventilation to resume.

A

65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

When do the carotid bodies increase minute ventilation?

A

PaO2 must decrease to 60-65 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

80% of the ventilatory response to inhaled carbon dioxide originates in the…

A

central medullary centers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Acid–base regulation involving carbon dioxide, H+, and bicarbonate is related primarily to…

A

chemosensitive receptors located in the medulla
(central chemoreceptors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Central Chemoreceptors characteristics

A

-ventilatory response to inhaled anesthetics
-acid-base regulation
-sensitive to ECF H+ [ ]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

(Acid-base regulation)
Carbon dioxide has a potent but indirect effect by reacting with water to form ____, which dissociates into ___ & _____ ions.

A

CO2 + H2O = carbonic acid

carbonic acid dissociates –> H & bicarb ions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Which passes readily through the blood–brain and blood–CSF barriers?

CO2
H+

A

Carbon dioxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Which is a more potent ventilatory stimulus?
-acute increase in PaCO2
-acute increase in arterial H+ [ ] from a metabolic source

A

An acute increase in PaCO2

Carbon dioxide, but not H+, passes readily through the blood–brain and blood–CSF barriers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What are the ventilatory responses to changes in PaCO2?
Onset?
Duration?

A

increased Vt
increased respiratory rate

rapid; peaks within 1 to 2 minutes after an acute change in PaCO2

increase in ventilation declines over a period of several hours (if CO2 stimulant persists)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Desaturation in a healthy patient takes how long? De-nitrogenating buys us how much time?

A

3-4 mins

wash out nitro can buy us 10 mins of apnea (in healthy pts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Breathing 100% oxygen prior to breath-holding
-how long can pt be apneic?

A

2 to 3 minutes
or
until PaCO2 rises to 60 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

⭐️
Innervation of the Larynx

A

2 Branches of the Vagus Nerve innervate the Larynx

Superior Laryngeal Nerve

Recurrent Laryngeal Nerve- supply all of the Intrinsic Muscles of the larynx (except the cricothyroid)

SCAR
Super laryngeal
Cricothyroid muscle
All other muscles
Recurrent Laryngeal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Hyperventilation with 100% FiO2 extends the apenic period from ___ minutes to ___ minutes.

A

3-4

6-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

The rate of PaCO2 rise in awake, preoxygenated adults with normal lungs who hold their breath without previous hyperventilation is ___ mmHg/min in the first 10 seconds, ___ mmHg/min in the next 10 seconds, and ___ mmHg/min thereafter.

A

7
2
6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

⭐️
What causes the CO2 rise in apneic patients under general anesthesia?

A

“breath-hold” at FRC rather than at vital capacity, which tends to accelerate the rate of PaCO2 rise

However, CO2 rise is still slower than awake state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

⭐️
PaCO2 rises in apneic anesthetized patients is __ mmHg during the first minute and __ mmHg/min thereafter

A

12
3.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

⭐️
Which pt would have a faster rise in CO2? Why?
-apneic under general anesthesia
-pre-oxygenated, awake

A

Rate of rise of PaCO2 in apneic anesthetized pt is slower than awake state

metabolic rate and carbon dioxide production are significantly less when under anesthesia

lower rate of PaCO2 rise under anesthesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

T/F
If pt is refusing supplemental O2, hyperventilation with room air can be performed.

A

False
hyperventilation before prolonged breath-holding can cause loss of consciousness due to arterial hypoxemia

blow off all CO2 = no stimulus to breathe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Is it okay to give aggressive intermittent positive-pressure breathing treatments for patients with COPD?

A

Nah (if they have a carbon dioxide–based ventilatory drive)

it can depress minute ventilation sufficiently to create arterial hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

T/F
Lung capacities are based on weight.

A

False
height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Capacities are composed of….

A

2+ lung volumes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Tidal Volume (Vt)

A

volume of gas that moves in and out of the lungs during quiet breathing

~ 6 to 8 mL/kg

“tidal volume; think of tides moving in AND out”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What would decrease tidal volume (Vt)?

A

decreased lung compliance
reduced ventilatory muscle strength

less flexibility and strength = less Vt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Vital capacity (VC)
Definition
Normal value

A

Google: the volume of exhaled air after maximal inspiration

60 ml/kg

can vary ~20% in healthy ppl

deep breathing and effective coughing. It is decreased by restrictive pulmonary disease such as pulmonary edema or atelectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What would decrease vital capacity (VC)?

A

restrictive pulmonary disease
-pulmonary edema
-atelectasis

mechanically induced, extrapulmonary restriction:
-pleural effusion
-pneumothorax
-pregnancy
-large ascites
-ventilatory muscle weakness

Things that would press against you exhaling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Inspiratory capacity

A

largest volume of gas that can be inspired from the resting expiratory level

decreased: significant extrathoracic airway obstruction; obesity

“relax. now take the deepest breath you can”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Residual volume

A

gas remaining within the lungs at the end of forced maximal expiration; cannot get any more air out

(Residual=what’s left over)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

The 2 fxns of FRC on curve

A

1.resting ventilation on the pulmonary volume–pressure curve

2.elastic pressure–volume relationships in the lung

greatly influences ventilation–perfusion relationships within the lung!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

primary determinant of oxygen reserve in humans when apnea occurs

A

FRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

resting expiratory volume of the lung

A

FRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What can FRC tell us (not regarding the curve)

A

-quantify the degree of pulmonary restriction

-primary determinant of oxygen reserve in humans when apnea occurs

-resting expiratory volume of the lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Reduces FRC

A

acute lung injury
pulmonary edema
pulmonary fibrotic processes
atelectasis
(these also reduce compliance)

pregnancy
obesity
pleural effusion
posture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

The ____ decreases 10% when a healthy subject lies supine.

A

FRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

T/F
COPD increases compliance.

A

True
due to gas trapping
lungs recoil less forcibly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Gas Trapping

A

retain an abnormally large volume at the end of passive expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Forced vital capacity (FVC)

A

volume of gas that can be expired as forcefully and rapidly as possible after maximal inspiration.

Normally, FVC is equal to vital capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

FVC may be reduced in…

A

-chronic obstructive diseases (even if vital capacity is ~normal).

-restrictive diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

FVC values lower than __ mL/kg are associated with an increased incidence of post-op pulmonary complications (PPCs).

A

15

and its your fault ;)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Forced expiratory volume (FEVT)
Definition
what does it tell us?

A

forced expiratory volume of gas over a given time interval during the FVC maneuver

Dr. H: the most gas you can exhale over a time period

-measures flow and severity of airway obstruction!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

The most important application of FEVT is…

The most common FEVT?

A

its comparison with the patient’s FVC

normal: expire 75%+ of FVC in one second

most common: FEVT1 (1 second)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Normal results for FEVT

A

0.5 sec: expire 50% to 60% of FVC
1 sec: 75% to 85%
2 sec: 94%
3 sec: 97%

tldr: normally, we can forcibly expire nearly all FVC in ~3 secs

reduced= obstructive Dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

FEF25%–75%

A

“maximum mid-expiratory flow rate”

average forced expiratory flow during the middle half of the FEV maneuver

length of time required for a subject to expire the middle half of the FVC is divided into 50% of the FVC.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Airway management always begins with…

A

A thorough airway-relevant history and physical examination.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Preoxygenation is also known as…

A

denitrogenation

should be practiced in all cases when time allows

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What is the goal of direct laryngoscopy?

A

direct line of sight to the larynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Videolaryngoscopy

A

mimics direct laryngoscopy, but places an imaging device toward the distal end of the laryngoscope blade

moves the provider’s point of view past the tongue, avoiding the need for a direct line of sight to the glottis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Steps for favorable airway outcome

A

(1) thorough airway history and physical examination
(2) direct or indirect laryngoscopy
(3) preinduction plan that includes supraglottic ventilation (e.g., facemask supraglottic airway [SGA])
(4) aspiration risk
(5) risk of failed airway maneuvers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Airway

A

refers to the upper airway
-nasal cavity
-oral cavities
-pharynx
-larynx
-trachea
-principal bronchi

Say pharnyx/larnyx so we can see Dr. H throw the shoe!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

The airway in humans is primarily a ___ pathway.

A

conducting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

We want our thyromental distance to be…

A

3+ finger breadths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

The laryngeal skeleton consists of ___ cartilages. It houses the ___.

A

nine (3 paired; 3 unpaired)

vocal folds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

⭐️
Movement of the laryngeal structures are controlled by…

A

two groups of muscles:

extrinsic muscles- move the larynx as a whole

intrinsic muscles- move the cartilages in relation to one another

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

⭐️⭐️⭐️
The larynx is innervated by the…

A

superior and recurrent laryngeal nerves (branches of the vagus nerve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

⭐️
Supplies all of the intrinsic muscles of the larynx (with the exception of cricothyroid muscle)

A

Recurrent

SCAR
Superior laryngeal nerve
Cricothyroid

All other muscles
Recurrent laryngeal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Unilateral recurrent laryngeal nerve injury

A

hoarseness

aspiration risk!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Bilateral laryngeal nerve injury

A

risk complete airway obstruction due to fixed cord adduction (surgical emergency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Cricothyroid membrane (CTM)
where it at
what it do

A

1 to 1.5 fingerbreadths below the laryngeal prominence (thyroid notch)

below thyroid cartilage & above cricoid cartilage

coverage for cricothyroid space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Any incisions or needle punctures to the CTM be made in…

A

its inferior third
directed posteriorly (a posterior probing needle will strike the back side of the ring-shaped cricoid cartilage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

How long is the adult trachea?
where does it end?

A

15 cm
ends @ t5; carina
bifurcates into R & L principal bronchi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Which bronchi deviates from the sagittal plane at a less acute angle?

A

right principle bronchus

part of why accidental intubation and aspiration are more common here

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Edentulous patients pose what challenge to airway management?

A

(no teeth)
difficult mask ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Thyromental distance reflects…

A

neck mobility
degree of retrognathia (bull-dog look)

remember, we want 3 finger breadths!

Thyromtental distance: tip of mentum to thyroid notch in neck-extended position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Mallampati grade

A

Describes the relationship between mouth opening, tongue size, and pharyngeal space
predicts ease of laryngoscopy

158
Q

Vocal folds

A

extends from the thyroid cartilage to arytenoid cartilage

159
Q

Thyroid cartilage

A

Shield shaped; protects vocal mechanism from the anterior aspect

160
Q

Increases aspiration risk

A

GERD not responsive to medication
pregnancy >12 wks
post partum <2 days
frequent pneumonia(could be from frequent aspiration!)
voice changes
hiatal hernia
diabetic (gastroparesis)
vocal cord polyp
acute narcotic therapy

161
Q

What airway should be used for pts with increased aspiration risk?

A

ETT
the truly secure airway bc of the balloon blocking passage

162
Q

How do we measure thyromental distance

A

distance measured from tip of mentum to thyroid notch in neck-extended position

163
Q

Mallampati I

A

Can see:
tonsillar pillars
uvula
full view soft palate

164
Q

Mallampati II

A

Can see:
upper uvula
soft palate

165
Q

Mallampati III

A

Can see:
soft palate

166
Q

Mallampati IV

A

Can see:
hard palate only

167
Q

Mallampati score?

A

II

168
Q

Mallampati score?

A

IV
can see hard palate only

169
Q

Mallampati score?

A

III
can see soft palate
Cannot see uvula or its upper portion

170
Q

Common assessments of airway

A

thyromental distance
mouth opening
mallampati
head & neck mobility
ability to prognath- bring lower teeth in front of top teeth; jaw mobility

171
Q

Airway concerns for Down Syndrome

A

Poorly developed or absent bridge of nose
Macroglossia
Microcephaly
C-spine abnormalities

172
Q

Ariway concerns for Pierre Robin Syndrome

A

Micrognathia (lower jaw (mandible) is smaller than normal)
Macroglossia
Cleft Soft Palate

173
Q

Is the LMA a secure airway?

A

No; only ETT is

174
Q

Barriers to proper mask ventilation

A

beard
sleep apnea
neck radiation
>55 Y/o
no teeth
obese

BONES (beard, obese, no teeth, elderly, sleep apnea)

175
Q

De-nitrogenating can replace up to 95% of the ____ with ___ to provide an apneic reservoir.

A

FRC
oxygen

176
Q

Does nitrogen pass thru alveoli?

A

No

177
Q

Before induction, etO2 should be at least

A

90

etO2 NOT etCO2

178
Q

Several minutes of preoxygenation with 100% O2 via a tight-fitting facemask may support at least __ minutes of apnea before desaturation occurs.

A

8

179
Q

What happens if mask straps are too tight?

A

facial nerve (CN VII) ischemia

compresses buccal branch of CN VII

180
Q

⭐️
A patient with normal lung compliance should require no more than ___ pressure for lung inflation, as measured on the anesthesia circle manometer.

A

20-25 cm H2O

higher can cause belly expansion –> regurg

181
Q

Nasal airways
Pros and Cons

A

less likely to stimulate coughing, gagging, or vomiting in the lightly anesthetized patient

may cause epistaxis

182
Q

Inability to mask ventilate could mean that your patient is experiencing…

A

laryngospasm, a local reflex closure of the vocal folds

-foreign body (e.g., oral or nasal airway)
-saliva
-blood
-vomitus
…..touching the glottis.

183
Q

Laryngospasm
definition
causes

A

reflex closes the vocal folds

may be triggered by a foreign body (e.g., oral or nasal airway), saliva, blood, or vomitus touching the glottis

184
Q

Laryngospasm
consequences
treatment

A

Hypoxia

noncardiogenic (negative pressure) pulmonary edema (if pt ventilates against closed vocal cords/ other obstruction)

Treatmeant:
-remove offending stimulus
-oxygen with continuous positive airway pressure (CPAP),
-deepen the anesthesia (IV)
-if unsuccessful, use rapid-acting muscle relaxant

185
Q

Early extubation may cause…

A

noncardiogenic (negative pressure) pulmonary edema

186
Q

Laryngeal Mask Airway (LMA)
positioning
inflation
fit

A

-in hypopharynx with the opening overlying the laryngeal inlet
-distal tip in the esophageal inlet, it does not reliably seal it

-cuff fills hypopharyngeal space = seal allows positive pressure ventilation up to 20cm of H2O pressure

-Adequacy of the seal is dependent upon correct placement and appropriate size

187
Q

Supraglottic Airway (SGA)

A

ABOVE the vocal cords

188
Q

T/F
LMAs protect against aspiration.

A

False

189
Q

Advantages of using LMA

A

-can give oxygen until complete restoration of airway reflexes

-reduced risk laryngospasm

-less aspiration risk than mask ventilation

-reduced cardiovascular responses

-reduced coughing on emergence

-Reduced intraoperative bronchospasm

190
Q

SGA removal
when to remove?
when not to remove?

A

-deeply anesthetized or
-after protective airway reflexes have returned and the patient is able to open the mouth on command

DONT REMOVE:
during excitation stages of emergence –> coughing, laryngospasm

191
Q

Confirming airway placement

A

-chest rise
-ausc
-etCO2
-condensation

“piece of C.A.E.C.”

and watch it go into vocal cords ofc

192
Q

SGA contraindications

A

-high aspiration risk
-full stomach/hiatus hernia
- significant GERD
-bowel obstruction
-delayed gastric emptying
-unclear history
-muscle relaxant
-laparoscopic surgery

CORDS (C-spine injury, obstruction, restricted mouth opening, distorted airway, stiff lungs)

193
Q

Tracheal Intubation

A
194
Q

Before any case, what do we need?

A

Oxygen (ambu)
Suction

195
Q

Stimulation of _____ will cause vagal reactions. These include…

A

The Internal Branch of the Superior Laryngeal Nerve

laryngospasm
bradycardia
hypertension

196
Q

Mac blade

A

-curved
-displace epiglottis out of the line of sight
-placed anterior to epiglottis into the vallecula
-should not contact the epiglottis while lifting!
-tenses of the glossoepiglottic ligament

Mac blades are curved like the “c” in “Mac”

A= mac
B = miller

197
Q

Miller blade

A

-straight
-reveals the glottis by compressing the epiglottis against the base of the tongue
-blade is placed over (posterior to) the epiglottis
-DOES contact epiglottis while lifting

A= mac
B = miller

198
Q

We sweep the tongue to the (right/left).

A

left

199
Q

Which blade is better to use if there is little room to pass a tube (small mouth)?

A

Mac

“a small macintosh apple”

A= mac
B = miller

200
Q

Better blade for anterior airways

A

Miller

A= mac
B = miller

201
Q

The tracheal tube cuff should be placed…

A

advance it 2 cm past the glottic opening for midtracheal placement

202
Q

ETT sizing for men and women?
When is larger sizing appropriate?

A

Men 8-9
Woman 7-8

“why was 6 afraid of 7?”
“Cause 7, 8, 9!”

use larger sizing for bronchoscopy

203
Q

T/F
Gastric intubation will not show CO2 values.

A

False
CO2 can come from the stomach; ie: pt had a soda; if we’ve ventilated the belly

204
Q

Use your ____ hand to hold the laryngoscope.

A

left

205
Q

Just a gentle reminder to NEVER TAKE YOUR EYES OFF THE CHORDS

A
206
Q

⭐️
Extubation criteria

A

-Return of Consciousness

-Spontaneous Respiration

-Resolution of Neuromuscular Blockade (sustained tetany – 5 sec)

-follow commands

-Sustained Head lift for 5 seconds

-Sustained hand grasp

-Spontaneous Tidal Volume >6cc/kg

-Negative Inspiratory Pressure > 20cm H2O

207
Q

Which practice of anesthesia is considered benign?

A

none lol

208
Q

Which nare do we attempt to intubate first?

A

right

209
Q

ASA definition of difficult airway

A

situation in which the conventionally trained anesthesiologist experiences difficulty with mask ventilation of the upper airway, endotracheal intubation, or both

210
Q

Considerations of difficult airway management

A

difficulty of the patient’s airway in terms of:

-Laryngoscopy and Intubation
-Supraglottic Ventilation Techniques
-Aspiration Risk
-Apnea Tolerance

211
Q

Start ASA difficult airway algorithm at which 2 root points?

A

-awake intubation

-Intubation attempts after Induction of General Anesthesia

212
Q

T/F
The difficult airway algorithm can only be applied to difficult airways.

A

False
relevant in ALL instances where the airway is managed!

213
Q

Awake intubation would be good for which situations?

A

airways we only get one shot at

Ludwig’s angina
angioedema
epiglottitis

214
Q

Can you give sedation for an awake intubation?

A

Yes! but very little

transtracheal block (local anes)

215
Q

If awake intubation doesnt work, what do we do?

A

must use judgement: cancel case vs. consider other options vs. invasive airway.

Use invasive airway if surgery is vital to survival

216
Q

⭐️
Regional Anesthesia with a Difficult Airway:
When to use and when not to?

A

can use regional with difficult airway depending on situation

consider toxicity if large dose is needed (extensive neuraxial local anesthetic)

217
Q

Awake airway management

A

Sedation can be used to decrease patient anxiety (small doses of benzos maintain spont Respirations)

Anti-sialagogues administered (dry up secretions)

Vasoconstriction of nasal passages

Supplemental Oxygen during the procedure

218
Q

My drug-addicted patient when I tell him he’s getting cocaine for his nasal intubation

A

-highly effective local anesthetic & a potent vasoconstrictor

-4% solution applied to mucosa

-max dose 200mg in adults

219
Q

Lidocaine
onset
preparations
administration

A

Applied topically- 15min peak onset

Injectable/Topical solution- 1%,2%, 4%

Viscous solution- 1%, 2%

Ointment- 1%, 5%

Aerosol- 10%

Adminstration:
inject into trachea (air aspiration to confirm location)

push hard to induce coughing, which distributes the medication

220
Q

____ are a cornerstone of awake airway management.

A

local anesthetics

221
Q

Benzocaine
onset /duration
preparations
toxic dose

A

Rapid Onset & Short Duration

Available in 10%, 15% & 20% solutions

Hurricane spray- Benzocaine + Tetracaine

half-second spray delivers 30mg of benzocaine

toxic dose is 100mg

222
Q

Cetacaine spray

A

Benzocaine + tetracaine, butyl aminobenzoate, benzalkonium chloride and cetydimethyl ammonium bromide

May produce methemoglobinemia(treat with methylene blue)

*methemoglobinemia: diminution of the oxygen-carrying capacity of circulating hemoglobin; conversion of iron species

223
Q

Nasopharynx is innervated by…

A

greater and lesser Palatine Nerves (nasal turbinate & most of the septum)

(Palatine nasal nerves–>Palpatine and his big nose)

224
Q

How long should cotton-tipped applicators stay in place for nasal anesthetics?

A

5-10 mins

225
Q

The Pharynx/ Base of the Tongue is
Innervated by…

A

branches of the Vagus, Facial & Glossopharyngeal

226
Q

How to administer local anesthetics to pharynx/base of tongue

A

aerosolization or “swish & swallow”

227
Q

What kind of nerve block is done for the Hypopharynx/ Larynx/ Trachea?

A

Superior Laryngeal Nerve Block

228
Q

Contraindications to Fiberoptic Bronchoscopy

A

Hypoxia

Heavy Airway Secretions- not relieved with suction or anti-sialagogues

Bleeding from the Upper or Lower Airway- not relieved with suction

Local Anesthetic Allergy (for awake attempts)

Inability to Cooperate (for awake attempts)

229
Q

Which route is “easiest” for fiberoptic bronchoscope?

A

nasal

230
Q

The glidescope is a brand name. It performs…

A

video laryngoscopy

Their Laryngoscope blade 60 degree angle. Its good bc:
-Similar technique as conventional DL
-Video display team can see
-Less stress on the airway (Dr. H calling BS on this)

231
Q

Retrograde Wire-Aided Tracheal Intubation procedure

A

“last ditch effort”

Inject local anesthetic over mid-cricothyroid membrane (18 guage)

45 degree angle to the chest

aspirate air

guidewire sheath is advanced into the trachea

advance wire until the wire emerges from the mouth

7.0 OET placed over the guidewire into the trachea

Check tube placement

Remove guidewire

232
Q

Airway Bougie

A

-semimalleable
-stylets
may be blindly manipulated through the glottis when a poor laryngeal view is obtained

-“clicks” as it touches tracheal rings; you’re in!

233
Q

⭐️
Percutaneous Transtracheal Jet Ventilation (PTJV)
“Jet Ventilator”

A

“CANNOT INTUBATE/ CANNOT VENTILATE” situation

An IV catheter (12,14 or 16 gauge)- attached to a 5ml syringe (empty or filled with local)

Once in the airway remove the sharp

Attach the luer-lock of the jet ventilator to the Angio Cath

“twinkle twinkle little star” (each syllable) = tempo for delivering breaths

234
Q

⭐️
NPO guidelines

A

-clears 2H
-breast milk 4H
-nonhuman milk 6H
-light meal 6H
-fatty meal/meats 8H+

235
Q

Intubating LMAs
when to use
how to use

A

-if RSI fails
-ETT is inserted through the LMA
-use #5 classic LMA for 7.0 ETT (like male to female shoe sizing!)

236
Q

⭐️
Complications of Retrograde wire-aided intubation (RWI)

A

bleeding
subcutaneous emphysema
pneumomediastinum
pneumothorax
breath-holding
caudal migration of wire
trigeminal nerve trauma

237
Q

Complication of Jet ventilation

A

barotrauma!

238
Q

Preoxygentation:
Most common reason for not achieving max alveolar FiO2?

A

loose fitting mask

239
Q

Preoxygenation:
if pt refuses mask, what else can we do?

A

Can work around the need for 5 min pre-oxygenation!

Have pt take four vital capacity breaths

240
Q

Hold LMA in which hand

A

dominant

(left for laryngoscope and mask)

241
Q

What are the single and paired cartilages of the larynx?

A

3 unpaired (single) cartilages: epiglottis, thyroid, cricoid

3 paired catilages: arytenoid, corniculate, cuneiform

242
Q

Surgical airways

A

Cricothyrotomy (emergent/temporary)

Tracheostomy

243
Q

⭐️
Which branches of the vagus nerve innervate the hypopharynx?

A

Superior laryngeal nerve
Recurrent laryngeal nerve: supplies all of intrinsic muscles of the larynx (except the cricothyroid)

244
Q

⭐️
The Superior laryngeal nerve provides sensory information from the level of ____ to the ____.

A

level of the vocal cords to the underside of the epiglottis

245
Q

What does the recurrent laryngeal nerve innervate in the larynx?

A

Recurrent laryngeal nerve innervates the supply of all the intrinsic muscles of the larynx except the cricothyroid

246
Q

Trauma to which laryngeal structure can cause vocal cord dysfxn?

A

recurrent laryngeal nerve

247
Q

Cranial nerve ____ is responsible for the gag reflex.

A

CN IX Glossopharyngeal

248
Q

Characteristics associated with difficult intubation
Think features of the
Mouth
Teeth
Jaw
Neck
Other common anesthesia assessments

A

high arched palate
Small mouth opening

long incisors

prominent overbite
retrognathic jaw
inability to sublux jaw

short-thick neck
reduced cervical mobility

Mallampati 3 or 4
short thyro-mental distance

**sublux: partial dislocation of a joint or organ

249
Q

The sniffing position

A

cervical flexion, atlanto-occipital extension

oral, pharyngeal, and laryngeal axes into alignment during laryngoscopy

250
Q

T/F
The mallampati score is a comprehensive airway exam.

A

False
used alone, it is a poor predictor of a difficult airway
use in addition to other assessments

251
Q

Laryngeal View grading

A

*Grade I: Visualization of Entire Glottic Aperture
*Grade II: Visualization of Only Posterior Aspects of Glottic Aperture *Grade III: Visualization of the Tip of the Epiglottis
*Grade IV: Visualization of No More Than the Soft Palate

252
Q

External anesthesia assessments

A

Evaluate 3-3-2
-fit 3 fingers between incisors?
-Is the mandible 3 fingers from the mentum to the hyoid bone?
-Is the distance from the hyoid bone to the thyroid 2 fingers?]

253
Q

sellicks maneuver (cricoid pressure)
How and why do you perform this maneuver?

A

● The patient is not ventilated
● esophagus is compressed by applying pressure to the cricoid ring against the C5 vertebra.
● apply pressure before LOC & until intubation confirmed

● Pressure before LOC = 20 Newtons or about 2 kg
● Pressure after LOC = 40 Newtons or about 4 kg

crush that cricoid after they’re out cold lol

goal: compress esophagus to prevent regurgitation

254
Q

Facemask
-use
-flow rate
-how to properly ventilate
-max pressure

A

● equipment used to preoxygenate patients with 100 oxygen at flow of 10 to 12 L/min

● Successful Mask Ventilation:
-positioning: supine; head and neck in “Sniffing” position
-proper oral/nasal airway size prevents coughing, vomiting and laryngospasm
-hold with left hand
-right hand squeezing bag
-thumb over the mask/bridge of nose
-index over wide edge of the mask near the patient’s chin
-middle, ring and pinky on the bony prominence of patient’s jaw.

NO more than 20-25 cm H20 of pressure to inflate the lungs

255
Q

Which blade has higher risk of vagal stimulation?

A

miller blade
bradycardia

256
Q

Intubation setup

A

Oxygen source
Ambu bag
oropharyngeal and nasopharyngeal airways
tracheal tubes
stylet
suction
laryngoscope handle (tested before)
laryngoscope blades (MacIntosh and Miller)
Pillow
Towel
Blanket or Foam for head positioning
Stethoscope

257
Q

How do size an LMA?

A

pick largest size that will sit comfortably in mouth

258
Q

Mallampati exam assesses the _____ space.

A

oropharyngeal

259
Q

Inter-incisor gap assessment
what does it assess?
why is it important?

A

assesses ability to open mouth
directly affects ability to align the oral, pharyngeal & laryngeal axes

260
Q

What does a smaller inter-incisor gap mean?
Whats normal?

A

smaller gap = more acute angle between oral & glottic openings
normal: 2-3 finger breadths/4 cm

261
Q

What increases chance of tooth damage?

A

buck teeth

262
Q

Laryngoscopy
Displace the tongue into the _____ to expose the glottic opening. What conditions make this more difficult?

A

submandibular space

tumor, radiation, submandib. abscess

263
Q

T/F
The transitional airways can perform limited gas exchange.

A

True
the respiratory airways are not the only airways that can perform gas exchange

264
Q

A thyromental distance (TMD) of less than ____ or above ___ indicates difficult intubation.

A

TMD
6< or >9 cm = difficult intubation

265
Q

Mandibular protrusion test (MPT)

A

assess TMJ fxn

have pt sublux jaw
compare position of lower incisors to upper

stage 3 = more difficult intubation
(pt cannot extend lower past upper)

266
Q

Atlanto-occipital joint mobility
importance to intubation
conditions that impair

A

affects our ability to place pt in sniffing position

impair AO mobility:
-degen. joint Dz
-rheumatoid arthritis
-ankylosing spondylitis
-trauma
-surgical fixation
-klippel-feil
-down syndrome
-DM

267
Q

The grading system that helps us measure the laryngoscopic view we obtain during direct vision laryngoscopy

A

Cormack & Lehane score

268
Q

LEMON

A

For intubation:

Look externally
Evaluate 3-3-2
Mallampati
Obstruction
Neck mobility

269
Q

Which traits would demand higher PiP?

A

poor lung compliance
higher airway resistance

270
Q
A
271
Q

Mendelson Syndrome
risk factors
how to reduce risk

A

chemical injury caused by the inhalation of sterile gastric contents

risk factors: gastric pH <2.5; gastric volume >25 ml (0.4ml/kg)

clears 2H before surgery: reduces gastric volume; increases gastric pH

272
Q

Cricoid pressure
complications

A
  • airway obstruction (difficult laryngoscopy, poor glottic view)
  • esoph. rupture if pt is vomiting
273
Q

Angioedema
whats our chief concern?
etiologies?

A

primary concern: airway obstruction

causes:
-anaphylaxis
-ACE inhibitors
-hereditary
-C-1 esterase deficiency

274
Q

Anaphylactic angioedema treatment

A

epi
antihistamine
steroids

-Icatibant (bradykinin receptor antag)
-FFP (enzymes to brkdwn bradykinin)
-C-1 esterase concentrate
-ecallantide (kalikrein inhibitor; stops kininogen–> bradykinin)

275
Q

ACE inhibitor/C-1 esterase deficiency angioedema treatment

A

C-1 inhibitor concentrate
FFP
Icatibant
Ecallantide

276
Q

Ludwig’s Angina

A

aggressive cellulitis on floor of the mouth

inflammation & edema compress the submandibular, submaxillary and sublingual spaces

primary concern: pushes tongue posteriorly –> complete supraglottic airway obstruction

277
Q

What happens if the tongue is displaced more posteriorly?

A

supraglottic airway obstruction

278
Q

How do we intubate with Ludwig’s angina?

A

awake nasal intubation
awake trach

279
Q

Conditions that cause enlarged tongues

A

Beckwith Syndrome
Trisomy 21 (Downs)

B. T. = big tongue

280
Q

Conditions that cause small/underdeveloped mandible

A

Pierre Robin
Goldenhar
Treacher Collins
Cri du chat

P-lease
G-et
T-hat
C-hin

281
Q

Conditions that cause cervical spine anomaly

A

Klippel-fiel
Trisomy 21
Goldenhar

“Try Klipping Gold”

282
Q

The sniffing position aligns which axes?

A

oral
pharyngeal
laryngeal

283
Q

Sniffing position includes ___ flexion and ___ extension.

A

cervical flex
atlanto-occipital extension

284
Q

Intubation positioning for morbidly obese patients

A

their body anatomy places chest above the level of the head

HELP position
Head Elevated Laryngoscopy Position

285
Q

Benefits of the HELP position

A

unloads diaphragm
may prolong time until desat when apneic

286
Q

How can head position shift the ETT? (3 positions)

A

nose to chest = toward carina 2 cm
nose away from chest = away from carina 2 cm
lateral head rotation = away from carina 0.7 cm

287
Q

Aggressive jaw thrust can damage the _____ nerve. This will show as…

A

facial nerve

facial sagging, drooling, may affect chewing

288
Q

Why shouldn’t we leave the ETT connector on the patient’s face?

A

supraorbital nerve compression
eye pain, forehead numbness, photophobia

289
Q

An oro/nasopharyngeal airway relieves ____ obstruction by…

A

upper airway obstruction

moves tongue & epiglottis away from posterior wall of pharynx

290
Q

How to size an OPA

A

measure corner of mouth to earlobe OR angle of mandible

flange should protrude outside lips

pharyngeal end should rest at base of tongue

291
Q

What happens if we use an OPA that is too short? Or one that’s too long?

A

too short = airway obstruction

too long = displaces epiglottis (obstructs)
airway trauma

292
Q

How to size a NPA

A

measure nare to earlobe OR angle of mandible

293
Q

What happens if we use an NPA that is too short? Or one that’s too long?

A

too short = won’t relieve obstruction

too long = displaces epiglottis towards glottis; risk trauma

294
Q

Inserting an NPA in a pt with a cribiform plate injury may cause…

A

brain injury

295
Q

Contraindications to NPA

A

Cribiform plate injury
coagulopathy
h/o transsphenoidal hypophysectomy
h/o Caldwell Luc surgery
nasal fracture

296
Q

What are these fractures called? What significance do they have to nasal intubation?

A

Lefort fractures

Nasaltracheal intubation contraindicated in Le Fort II or III fractures (possible cribriform plate involvement)

297
Q

Cricoid pressure vs. BURP

A

“BURP” (Backwards Upwards Rightwards Pressure) improve the view of the glottis during laryngoscopy/intubation, rather than to prevent regurgitation (cricoid pressure)

298
Q

BURP maneuver

A

larynx is displaced backward (B) against the cervical vertebrae, upward (U, superiorly) and to the patient’s right (R), using pressure (P) over the thyroid cartilage

improves glottic visualization

https://www.google.com/search?q=burp+maneuver&source=lmns&tbm=vid&bih=747&biw=1470&hl=en&sa=X&ved=2ahUKEwiIoqKr1JCEAxVpobAFHTTXDS8Q0pQJKAJ6BAgBEAY#fpstate=ive&vld=cid:aa4834b5,vid:oqwXX_mk5YA,st:0

299
Q

ETT cuff can cause ischemia if its pressure is….

A

25+ cm H2O

300
Q

Tracheal ischemia can occur if the ETT cuff pressure exceeds the ____ pressure.

A

tracheal mucosal perfusion

301
Q

Whats the best way to reduce risk of tracheal ischemia?

A

measure pressure using nanometer
without out, measurement is not accurate

302
Q

Murphy Eye

A

small hole opposite of the bevel
provide alternate path of air if ETT tip occludes or is blocked by touching tracheal wall

303
Q

Low vol, high pressure cuff
vs.
high vol, low pressure cuff

A

low vol, high prssr:
-better aspiration protection
-less sore throat
-better view when intubating
-prolonged intubation = tracheal ischemia

high vol, lo prssr:
-cuff pressure close to pressure exerted on trachea
-can underestimate pressure
-N2O increases cuff prsr
-OGT/NGT can pass

304
Q

Pediatric ETT formulas

A

ETT w/o cuff = (age/4) +4
ETT + cuff = (age/4) + 3.5
depth = Internal diameter x 3

305
Q

LMA
max PP ventilation
max cuff pressure

A

max PPV = 20 cm H2O

max cuff = 60 cm H2O (target 40-60)

306
Q

Video Laryngoscopy
Non-channeled vs channeled

A

Channeled integrates ETT onto the device

Non-channeled: ETT separate from device

307
Q

If video laryngoscopy fails, consider…..

A

awake fiberoptic

308
Q

Apertures on the LMA

A

prevents epiglottis from obstructing tube

309
Q

LMA ___ is the most common cause of nerve damages. The nerves at risk are….

A

cuff overinflation

lingual hypoglossal
RLN (recurrent laryngeal nerve)

310
Q

If LMA does not have a good seal…

A

add air to cuff

311
Q

LMA sizing

A
312
Q

Airway obstruction at or below the ___ is a contraindication for LMA.

A

glottis

313
Q

Those at risk for tracheal ___ should not use an LMA.

A

collapse (tracheomalacia, external tracheal compression)

314
Q

gastric regurgitation with LMA

A

leave LMA in place (avoid displace contents already behind it)

Trendelenburg

deep anesthetic

100% O2 ambu unless contents in circuit

low flow & Vt

suction catheter thru LMA

fiberoptic to assess if contents in trachea (if so, consider ETT + aspiration protocol)

315
Q

LMA with asthmatic pt

A

less risk of bronchospasm vs. ETT
volatiles can cause aggressive return of resp reflexes on emergence, worsened with ETT b/c it sits in trachea

316
Q

Volatile anesthetics initially ___ respiratory reflexes, but can cause _____ on emergence.

A

blunt

coughing/bronchospasm

ETT can intensify response on emergence

317
Q

Which airway device is least stimulating?

A

LMA

318
Q

Direct laryngoscopy can cause _____ stimulation.

A

SNS
increase catecholamines
HTN
tachycardia
arrhythmia
Bspasm

319
Q

Combitube

A

supraglottic
double lumen
difficult airway
blindly placed in hypopharynx

Size 37 (4-6ft) 40-85 ml
size 41 (>6ft) 40-100 ml
distal cuff always 5-12 ml

not for under 4 ft

inflate orophar. first
if in esoph vent thru blue lumen
if in trachea vent thru tracheal lumen

320
Q

King Tube

A

blindly inserted
distal cuff obstructs upper esoph.
proximal cuff seals oral and nasal pharynxes

321
Q

Combi vs King tube

A

King:
only one ventilation lumen
inflates both balloons at once
child sizes 10 kg +

both have same considerations
both blindly inserted

322
Q

Gold standard for maintaining difficult airway in awake spont. breathing pt

A

flexible fiberoptic bronch

323
Q

How to maneuver fiberoptic scope

A
324
Q

Fiberoptic Bronch indications

A

Gold standard for maintaining difficult airway in awake spont. breathing pt

C-spine limitations: cerv. stenosis/fixation, chiari malformation, vertebral art. insuff

limited mouth opening: TMJ, facial burn, mandib-maxillary fixation

325
Q

Fiberoptic Bronch contraindications

A

Absolute: too uncooperative, near total upper arwy obstrutn, massive trauma (unless using retrograde intubation)

Moderate: mildly uncoopertv, obstruction enough to prevent intubation, copious blood/sectrns, hypoxia (not enough time)

Relative: concern for vocal crd damage if ETT is passed over bronchoscope, infxn that may impair sterility, coagpathy, allergy to local anes.

***picture is retrograde intubation

326
Q

Bullard Laryngoscope
when to use

A

rigid, fiberoptic
indirect laryngoscopy

Use for:
small mouth opening (minimum 7mm)
impaired C-spine mobility
short/thick neck
treacher collins syndrome
Pierre Robin syndrome

adult + peds sizes

327
Q

Compared to DVL, the Bullard causes less ___.

A

cervical spine displacement

328
Q

Examples of Rigid Fiberoptic devices

A

Bullard
Wuscope
Upsher

329
Q

Intubating stylet is also known as ___ & ___.

A

Eschmann
bougie

330
Q

A Cormack & Lehane score of __ warrants use of the angled tip (coude) intubating stylet.

A

3

331
Q

⭐️
If you don’t feel clicks, but believe you’re in the trachea, assess for the ___ sign. If you dont feel this, then you are in the ____.

A

Hold up sign
advance bougie to 45 cm max
stop when increase in resistance
bougie becomes lodged in the smaller airways
bougie stops at carina

no sign = esophagus

332
Q

If ETT catches on larynx soft tissue, rotate it ___ degrees (clockwise/counterclockwise). This will orient the bevel ____.

A

90 degrees
counterclockwise
posteriorly

333
Q

T/F
Lighted stylets can be used for blind intubation.

A

True
transilluminate anterior neck to facilitate intubation

334
Q

How do we know if the lighted stylet is in the trachea?

A

well-defined circumscribed glow

A= trachea
B = esophagus (diffuse; no circum. glow)

335
Q

Lighted Stylet
Pros
Cons

A

Pros:
-anterior airways
-small mouth opening
-minimal neck manipul8n (C-spine issues, pierre-robin)
-less stimulating/sore throat than direct laryn.
-oral/nasal intubation

Cons:
-short/thick neck difficult
-not for emergent/cant intubate/cant ventilate (use jet vent for this)
-blind technique! (no tumors, foreign body, airway injury, epiglottitis)
-not for traumatic laryngeal airway

336
Q

Retrograde intubation is a ____ procedure. ETT is passed….

A

BLIND
over a wire

337
Q

⭐️
Steps for Retrograde intubation

A
  • Puncture Cricothyroid membrane (14 - 18g needle)
  • Aspirate air = inside tracheal lumen
  • Pass a wire through the needle and advance it in a cephalad direction.
  • The wire should travel in-between the vocal cords exit thru the mouth
  • Load the endotracheal tube over the wire
  • Once the ETT is in the trachea and cannot be advanced any further, withdraw the wire
  • advance the ETT to final position
338
Q

Needle gauge for retrograde intubation

A

14-18 G

339
Q

indications for retrograde intubation

A

-unstable C spine (most common)
-upper airway bleeding (can’t see glottis)
-failed intubation but ventilation possible (allows for time needed)

340
Q

Can retrograde intubation be performed on awake patient?

A

yes!

that’s gotta be a horrible day

341
Q

contraindications for retrograde intubation

A

Anatomy:
-neck flexion deformity (can’t access CTM)
-severe obesity (unable to identify landmarks)
-Pretracheal abscess/mass (goiter)

Laryngotracheal Dz:
-trach. stenosis under punctr site
-tumor in wire path

-coagulopathy

342
Q

⭐️
complications for retrograde intubation

A

-bleeding
-pneumomediastinum
-pneumothorax
-trigeminal nerve trauma
-breath holding
-wire goes in wrong direction

**Pneumothorax = air leaks between lung & chest wall or visceral & parietal pleura

**Pneumomediastinum = air in the mediastinum

343
Q

The surgical airways include….(3)

A

EMERGENCY:
1. Percutaneous cricothyroidotomy with transtracheal jet ventilation
2. Surgical cricothyroidotomy

controlled situation:
3. Tracheostomy

344
Q

Percutaneous cricothyroidotomy with transtracheal jet ventilation

A

inserting a large-bore needle through CTM
ventilate with high-pressure oxygen source (ie: jet ventilator)

CTM =cricothyroid membrane

345
Q

Jet ventilation requires a high-pressure oxygen source, about ___ psi during ___.

A

50 psi
inhalation

346
Q

Airway obstruction in jet ventilation

A

can prevent exhalation
contraindication!

347
Q

Surgical Cricothyroidotomy

A

small, horizontal incision in cricothyroid membrane (percutan uses large bore needle)
insert cuffed ETT

348
Q

Contraindications for tracheostomy

A

nun

349
Q

Surg. Cricothyroidotomy contraindications

A

-challenging prediatric cricothyroidotomy (more pliable/mobile larynx)

-Percutan. Cric is best in emergency <6yrs

350
Q

Surg. Cricothyroidotomy complications

A

-tracheal stenosis
-trach/esoph injury
-hemorrhage
-disordered swallowing
-SubQ/mediastinal emphysema

351
Q

The ____ commonly covers the CTM in children.

A

thryoid isthmus

352
Q

Percutaneous Cricothyroidotomy contraindications

A

upper airway obstruction
laryngeal injury

353
Q

Percutaneous Cricothyroidotomy complications

A

any obstruction above jet vent tip will prevent exhaling

barotrauma
pnemothor
subQ/mediastinal emphysema

354
Q

Tracheostomy complications

A

Acute:
airway obstruction
hypoventilation
pneumo
bleeding

Longterm:
tracheal stenosis
tracheomalacia
tracheoesophageal fistula
tracheal necrosis

355
Q

Can we extubate patients in a state of consciousness between deep or awake?

A

no
ExTT when deep or awake, no inbetween

356
Q

Guedel stage 1

A

awake, disoriented, airway reflexes intact

357
Q

Guedel stage 2

A

light anesthetic plane
hyperactive airway reflex
risk laryngospasm

358
Q

Guedel stage 3

A

Deep anesth. plane
airway reflexes weak

359
Q

Which Guedel stage is associated with risk of laryngospasm

A

2

360
Q

Awake ExTT
pros
cons

A

P
airway intact
maintain their airway patency
lower risk aspiration

C
higher:
CV & SNS stimulation
coughing
ICP
IOP (intra oc prsr)
intra-abd prsr

361
Q

Deep ExTT
pros
cons

A

P
less CV, SNS stimulation & coughing

C
ineffective airway reflexes
higher risk obstruction, aspiration

362
Q

Know the difficult airway algorithm

A

2022 version

363
Q

prevent complications of awake extubation

A

CV & SNS stimulation:
Betablockers
Ca channel blockers
vasodilators

Coughing:
Lidocaine (IV or thru ETT cuff)
opioids

364
Q

techniques for extubating the difficult airway

A
  • ExTT while fully awake
    -extubate over a flexible fiberoptic bronchoscope
    -extubate then placeLMA
    -airway exchange catheter
365
Q

Reintubating a difficult airway (post extubation)

A

AEC is used as a stylet
Seldinger technique (similar to retrograde wire)

https://www.youtube.com/watch?v=27V7puDyMAY

**AEC= airway exchange catheter

366
Q

The airway exchange catheter (AEC) lumen can be used to…

A

End-tidal CO2 measurement
Jet ventilation (via Luer lock adapter)
Oxygenation insufflation (via 15mm adapter)

367
Q

(Re-intubating a difficult airway)
Complications of exchange catheter (AEC)

A

barotrauma
pnemothorax
inability to replace ETT

368
Q

Endotracheal tube

A

PVC
placed between the vocal cords through the trachea
provide oxygen and inhaled gases to the lungs

369
Q

muscles elevate the sternum

A

cervical trap muscles

370
Q

Left shift on the P-V curve signifies…

A

obstructive Dz
(increased FRC)

371
Q

____ airflow swirls when going from ___ to ___ area.

A

Turbulent
large
small

372
Q

Carotid bodies are part of the (central/peripheral) chemoreceptors.

A

peripheral

central = medulla

373
Q

The (central/peripheral) chemoreceptors account for 80% of respiratory response.

A

central

374
Q

⭐️
In apneic patients, PaCO2, increases of ___ mmHg in the first minute and ___ mmHg per minute afterwards.

A

12
3.5

375
Q

V:P ratio is determined by

A

FRC

376
Q

anatomic location of the 1st tracheal ring

A

anterior to C6
ends at the carina ~T5

377
Q

T/F
The carina bifurcates into R & L bronchi

A

False
trachea

378
Q

Do we bag patients?

A

Not unless they’re dying

If they’re not dying, we are ventilating them

379
Q

Its not preoxygenating, its _____.

A

denitrogenizing

380
Q

Non-cardiogenic pulmonary edema is the result of…

A

a spontaneous breath against a
closed glottis

381
Q

Direct Laryngoscopy
Black lines on ETT should be …

A

on either side of the vocal cords

382
Q

Procedures when its best to nasally intubate

A

facial trauma, jaw wiring, maxillofacial surgery

383
Q

Awake intubation is best when the patient has which conditions/diagnoses?

A

Ludwig’s angina
Epiglottitis
angioedema

384
Q

Onset of topical Lidocaine

A

15 mins

385
Q

Easiest route for fiberoptic bronch

A

nasal

386
Q

How far in advance of surgery should the pt stop smoking?

A

2 months
reduces PPC risk

387
Q

What surgery has highest risk of PPC?

A

nonlaparoscopic upper abdominal surgery

388
Q

most important aspect of postoperative pulmonary care and prevention of PPC is…

A

early ambulation

389
Q

Reduced FRC ultimately results in…

A

arterial hypoxemia
low FRC –> venous admixture increases –> arterial hypoxemia

390
Q

rapid-sequence induction

A

gain control of the airway in the shortest period of time after the ablation of protective airway reflexes with the induction of anesthesia

391
Q

Airway access via the extrathoracic trachea may be warranted when…

A

intubation and mask and SGA ventilation fail

392
Q

Know the airway approach algorithm

A

Gen Exam 1 (4 decks)

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