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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
Q

Larynx muscles

A

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

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26
Q

Cricothyroid muscle

A

“Cords tense”

-Tense vocal cords

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27
Q

Thyroarytenoid muscle

A

“They relax”

  • Relax vocal cords
  • Adductor
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28
Q

Posterior Cricoarytenoid muscle

A

“Please come apart”

-Abductor to vocal cords

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29
Q

Lateral cricoarytenoid muscles

A

“Lets close away”

-Adductor for vocal cords

30
Q

Interior arytenoid muscle

A
  • Closes glottis

- Adductor

31
Q

Larynx blood supply

A
  • 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
Q

Trigeminal nerve (#, sensory, motor)

A 
CN V
V1: Opthalmic
V2: Maxillary
V3: Mandibular
Sensory: Nares, anterior 1/3 of septum, turbinates, anterior 2/3 of tongue
Motor: 0
33
Q

Glossopharyngeal nerve (#, sensory, motor)

A

CN IX
Sensory:
-Posterior 1/3 of tongue, anterior epiglottis, oropharynx, pharynx, soft palate, tonsils, valeculla
Motor: 0

34
Q

Superior laryngeal nerve (#, sensory, motor)

A 
CN X
External
-Sensory: 0
-Motor: Cricothyroid (tense VCs)
Internal
-Sensory: Larynx above TVCs, post of epiglottis
-Motor: 0
35
Q

Recurrent laryngeal nerve (#, sensory, motor)

A

CN X
Sensory: Below VCs: larynx and trachea
Motor: Larynx, all intrinsic muscles except cricothyroid

36
Q

Carina

A

Lower part of trachea, richly innervated

-Sensitive to sensory stimulation

37
Q

Mallampati classification

A

-Indirect method of relating the size of the base of the tongue to the oral cavity

38
Q

Mallampati 2 = ____ hidden

A

Tonsillary pillars are hidden by tongue

39
Q

Mallampati 3

A

Only the base of the uvula is seen

40
Q

3-3-2 rule

A
  • 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
Q

Too short of an oral airway = ____

A

Pushes posterior tongue against the post pharyngeal wall = obstruction/trauma

42
Q

Too long of an oral airway = ____

A

Causes airway obstruction to laryngeal inlet by compressing the epiglottis = trauma/laryngospasm

43
Q

Nasal airway contraindication

A
  • Anticoagulated
  • Sepsis
  • Children with prominent adenoids
  • Caution in patients with basilar skull fractures
44
Q

Inadequate mask ventilation (cause, steps to take)

A
  • Due to decreased compliance and increased resistance
  • Place an OA/NA
  • 2 handed BMV
  • Intubate or place SGA
45
Q

ETT size - what does it mean

A

Inner diameter size

  • Most important in resistance to fresh gas flow
  • Effects resistance much more than the length of the tube
46
Q

Murphy eye

A

Additional distal opening in the side of the ETT

  • Ventilation port if the distal end is obstructed
  • Decreased trauma during nasal intubation
47
Q

ETT size range and pressure to check cuff leak for pediatric tubes

A
  1. 5 - 8.5

- Cuff leak at 20-30 cmH2O

48
Q

ETT size and depth for adults

A

Male: 7.0-8.0mm, 23cm
Female: 6.5-7.0mm, 21cm

49
Q

Normal tracheal wall pressure

A

15-30 mmHg

50
Q

Type of cuff recommended for ETT

A

High volume low pressure

-Decreases risk of mucosal damage

51
Q

Reinforced ETT

A

Used when a standard tube would be likely to kink

52
Q

Oral RAE ETT

A

Used in ENT surgery to provide full access to the face, taped to lower lip

53
Q

Nasal RAE ETT

A

Used in oral surgery

54
Q

Laser ETT

A

Covered with nonflammable material, some made of metal

55
Q

Macintosh blade inserted ____

A

In vallecular fold

-Lifting motion elevates the epiglottis and uncovers the vocal cords

56
Q

Miller blade used to ____

A

Lift the epiglottis and compress it against the base of the tongue

57
Q

Phillips blade

A

Used for peds age 2-6
Provides great visibility directly to the trachea
-Strait Jackson blade design with curved distal tip

58
Q

Wisconsin blade

A

Increases the visual field and decreases the possibility of trauma
-Strait spatula, flange expands slightly toward the distal blade

59
Q

BURP maneuver

A
  • Backward, Upward, Rightward Pressure on thyroid cartilage

- Displaces larynx, may improve visualization of the glottis

60
Q

Verify ETT placement

A

Bilateral chest rise
Bilateral breath sounds
Auscultate stomach
ETCO2

61
Q

Preoxygenation before RSI

A

Healthy patient: Four maximal breaths

Patient with lung disease: 3-5 minutes

62
Q

RSI ETT size

A

1/2 size smaller than normal

-Use ETT with stylet to maximize chance of easy intubation

63
Q

Modified RSI

A

Allows for gentle ventilation with cricoid pressure maintained

64
Q

LMA intracuff pressure

A

<60 cmH2O

65
Q

LMA maximum airway seal pressures

A
  • Classic LMA: <30cmH2O
  • ProSeal, Supreme LMA: 40cmH2O
  • Limit TV to 8mL/kg
66
Q

Double lumen ETT indications

A
  • Thoracic procedures
  • Control of contamination or hemorrhage
  • Unilateral pathology (bronchopleural or bronchocutaneous fistula, large cyst/bullae, different compliance)
67
Q

McGrath MAC video laryngoscope

A

Has a video display mounted on the handle

-Sizes 2, 3, 4 correspond to Mac blades

68
Q

Patients at risk of aspiration

A
  • Full stomach
  • GERD
  • Hiatal hernia
  • NG
  • Morbid obesity
  • DM
  • Pregnancy
  • Use of narcotics
69
Q

Preventing aspiration

A
  • Antacid preop (bicitra)
  • Reglan
  • Cricoid pressure
  • Mild reverse trendelenberg
  • Working suction
70
Q

Laryngospasm

A

Spasm of laryngeal musculature

-Caused by sensory stimulation by vagus nerve (external branch of SLN or RLN)

6900 (12 decks)

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