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6900 > Airway > Flashcards

Airway Flashcards

1
Q

Nine cartilages of larynx

A

Unpaired: Epiglottis, Thyroid, Cricoid
Paired: Arytenoid, Corniculate, Cuneiform

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2
Q

Cranial Nerves that innervate muscles of pharynx, larynx, soft palate

A

IX: Glossopharyngeal
X: Vagus
XI: Spinal accessory

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3
Q

Superior Laryngeal Nerve Sensory/Motor innervation

A

Internal: Sensory to all larynx above TVCs
External: Motor to cricothyroid muscle

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4
Q

Recurrent Laryngeal Nerve Sensory/Motor innervation

A

Motor to all larynx muscles except cricothyroid

Sensory to TVCs, trachea

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5
Q

Triangular intubation axes

A

Align oral axis, pharyngeal axis, and laryngeal axis

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6
Q

Lemon law airway assessment

A 
L=Look externally (0-4pts)
E=Evaluate 3-3-2 (0-3pts)
M=Mallampati
O=Obstruction (0-1pt)
N=Neck mobility (0-1pt)
Score 0-9 points, higher score means possibly more difficult airway
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7
Q

Formula to size pediatric ETT

A

Age/4 + 4
-1/2 size for cuffed tube
Age=most reliable indicator of appropriate tube size for children

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8
Q

____ separates the upper and lower airway

A

Cricoid cartilage

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9
Q

Upper airway components (5 parts)

A 
Nose
Mouth
Pharynx
Hypopharynx
Larynx
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10
Q

Lower airway components (5 parts)

A 
Trachea
Bronchi
Bronchioles
Respiratory bronchioles
Alveoli
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11
Q

Hard vs soft palate

A

Hard
-Stationary
Soft
-Posterior 1/2 of oral cavity
-Rises during eating to prevent aspiration
-Sleep/paralytic can cause it to obstruct the nasal passage

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12
Q

Pharynx (overall structure and 2 compartments)

A
  • Extends from the base of the skull to the cricoid cartilage
  • Nasopharynx, oropharynx, and hypopharynx
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13
Q

Cricothyroid membrane

A

Only complete cartilaginous ring in the airway

-Connects cricoid cartilage at C6 to the thyroid cartilage

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14
Q

Vocal folds (name, anatomy)

A

True vocal cords

-Attach anteriorly to the thyroid cartilage and posteriorly to the arytenoids

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15
Q

Space between vocal folds

A

Rima glottidis, goes to the trachea

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16
Q

Vestibular folds

A

False vocal cords, around the vocal folds/true vocal cords

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17
Q

Superior valeculla

A

Space between base of tongue and epiglottis

-Applying force here pulls the epiglottis away from the glottis opening

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18
Q

Inferior valeculla

A

Between the inferior ridge of the epiglottis and true vocal cords

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19
Q

Epiglottis

A

Single leaf like cartilage, sits above the glottic opening (to the larynx)

  • Closes during swallowing
  • Attached to the upper border of the hyoid bone
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20
Q

Direct laryngoscopy anatomy

A
  • Larynx starts at epiglottis
  • Internal to larynx=articulating cartilages, arytenoids, epiglottis
  • Epiglottis, superior, and interior valeculla
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21
Q

Larynx (C space and number of cartilages)

A
  • Starts at C4-5 in adults, ends at C6
  • 3 single cartilages
  • 3 paired cartilages
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22
Q

Branches of Recurrent laryngeal nerve

A

Right-subclavian

Left-aortic arch

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23
Q

Vagus nerve supply and branches

A

Sensation below the epiglottis

-2 branches innervate the hypopharynx: Superior laryngeal nerve, Recurrent laryngeal nerve

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24
Q

RLN injury

A
  • Acute bilateral injury=risk for stridor and respiratory distress
  • Unilateral or chronic injury isn’t as dangerous
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25
Larynx muscles
Intrinsic -Moves individual components of the larynx -Provides functional movement of cartilages and the vocal cords Extrinsic -Moves larynx as a whole in the neck superiorly and inferiorly
26
Cricothyroid muscle
"Cords tense" | -Tense vocal cords
27
Thyroarytenoid muscle
"They relax" - Relax vocal cords - Adductor
28
Posterior Cricoarytenoid muscle
"Please come apart" | -Abductor to vocal cords
29
Lateral cricoarytenoid muscles
"Lets close away" | -Adductor for vocal cords
30
Interior arytenoid muscle
- Closes glottis | - Adductor
31
Larynx blood supply
- From branches of the thyroid arteries - Superior laryngeal artery: Top 1/2 of larynx, branch of the superior thyroid artery off the external carotid - Inferior laryngeal artery: Branch of the inferior thyroid artery off the subclavian artery
32
Trigeminal nerve (#, sensory, motor)
``` CN V V1: Opthalmic V2: Maxillary V3: Mandibular Sensory: Nares, anterior 1/3 of septum, turbinates, anterior 2/3 of tongue Motor: 0 ```
33
Glossopharyngeal nerve (#, sensory, motor)
CN IX Sensory: -Posterior 1/3 of tongue, anterior epiglottis, oropharynx, pharynx, soft palate, tonsils, valeculla Motor: 0
34
Superior laryngeal nerve (#, sensory, motor)
``` CN X External -Sensory: 0 -Motor: Cricothyroid (tense VCs) Internal -Sensory: Larynx above TVCs, post of epiglottis -Motor: 0 ```
35
Recurrent laryngeal nerve (#, sensory, motor)
CN X Sensory: Below VCs: larynx and trachea Motor: Larynx, all intrinsic muscles except cricothyroid
36
Carina
Lower part of trachea, richly innervated | -Sensitive to sensory stimulation
37
Mallampati classification
-Indirect method of relating the size of the base of the tongue to the oral cavity
38
Mallampati 2 = ____ hidden
Tonsillary pillars are hidden by tongue
39
Mallampati 3
Only the base of the uvula is seen
40
3-3-2 rule
- Mouth should open at least 3 fingerbreadths - Thyromental distance (chin to hyoid) <3 fingerbreadths is difficult - 2 fingerbreadths between the hyoid bone and thyroid notch
41
Too short of an oral airway = ____
Pushes posterior tongue against the post pharyngeal wall = obstruction/trauma
42
Too long of an oral airway = ____
Causes airway obstruction to laryngeal inlet by compressing the epiglottis = trauma/laryngospasm
43
Nasal airway contraindication
- Anticoagulated - Sepsis - Children with prominent adenoids - Caution in patients with basilar skull fractures
44
Inadequate mask ventilation (cause, steps to take)
- Due to decreased compliance and increased resistance - Place an OA/NA - 2 handed BMV - Intubate or place SGA
45
ETT size - what does it mean
Inner diameter size - Most important in resistance to fresh gas flow - Effects resistance much more than the length of the tube
46
Murphy eye
Additional distal opening in the side of the ETT - Ventilation port if the distal end is obstructed - Decreased trauma during nasal intubation
47
ETT size range and pressure to check cuff leak for pediatric tubes
2. 5 - 8.5 | - Cuff leak at 20-30 cmH2O
48
ETT size and depth for adults
Male: 7.0-8.0mm, 23cm Female: 6.5-7.0mm, 21cm
49
Normal tracheal wall pressure
15-30 mmHg
50
Type of cuff recommended for ETT
High volume low pressure | -Decreases risk of mucosal damage
51
Reinforced ETT
Used when a standard tube would be likely to kink
52
Oral RAE ETT
Used in ENT surgery to provide full access to the face, taped to lower lip
53
Nasal RAE ETT
Used in oral surgery
54
Laser ETT
Covered with nonflammable material, some made of metal
55
Macintosh blade inserted ____
In vallecular fold | -Lifting motion elevates the epiglottis and uncovers the vocal cords
56
Miller blade used to ____
Lift the epiglottis and compress it against the base of the tongue
57
Phillips blade
Used for peds age 2-6 Provides great visibility directly to the trachea -Strait Jackson blade design with curved distal tip
58
Wisconsin blade
Increases the visual field and decreases the possibility of trauma -Strait spatula, flange expands slightly toward the distal blade
59
BURP maneuver
- Backward, Upward, Rightward Pressure on thyroid cartilage | - Displaces larynx, may improve visualization of the glottis
60
Verify ETT placement
Bilateral chest rise Bilateral breath sounds Auscultate stomach ETCO2
61
Preoxygenation before RSI
Healthy patient: Four maximal breaths | Patient with lung disease: 3-5 minutes
62
RSI ETT size
1/2 size smaller than normal | -Use ETT with stylet to maximize chance of easy intubation
63
Modified RSI
Allows for gentle ventilation with cricoid pressure maintained
64
LMA intracuff pressure
<60 cmH2O
65
LMA maximum airway seal pressures
- Classic LMA: <30cmH2O - ProSeal, Supreme LMA: 40cmH2O - Limit TV to 8mL/kg
66
Double lumen ETT indications
- Thoracic procedures - Control of contamination or hemorrhage - Unilateral pathology (bronchopleural or bronchocutaneous fistula, large cyst/bullae, different compliance)
67
McGrath MAC video laryngoscope
Has a video display mounted on the handle | -Sizes 2, 3, 4 correspond to Mac blades
68
Patients at risk of aspiration
- Full stomach - GERD - Hiatal hernia - NG - Morbid obesity - DM - Pregnancy - Use of narcotics
69
Preventing aspiration
- Antacid preop (bicitra) - Reglan - Cricoid pressure - Mild reverse trendelenberg - Working suction
70
Laryngospasm
Spasm of laryngeal musculature | -Caused by sensory stimulation by vagus nerve (external branch of SLN or RLN)

6900 (12 decks)

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