Airway A&P Flashcards
Most common airway management claims?
vocal chord paralysis
what landmark separates the upper and lower airway?
cricoid cartilage
Upper airway (above cricoid) parts?
nose, mouth, pharynx, hypopharynx (laryngopharynx), larynx and vocal cords
Lower airway (below cricoid) parts
Trachea, bronchi, bronchioles, terminal bronchioles, respiratory bronchioles, alveoli
part of pharynx at C1 level, skull to soft palate
Nasopharynx
part of pharynx at C2-C3 level, soft palate to epiglottis
Oropharynx
part of pharynx at C5-C6 level, epiglottis to cricoid
Hypopharynx
key airway landmark?
vallecula
4 functions of Upper Respiratory Tract
Provides for gas exchange
Filters inspired air
Contains olfactory receptors
Contributes to phonation
part of upper airway at Level: C4, C5, C6
higher in females than in males
larynx
how many cartilages make up larynx?
9
3 single cartilages of larynx
thyroid cartilage
cricoid cartilage
epiglottis
what structure protects airway from aspiration?
epiglottis
3 paired cartilages of larynx
corniculate
cuneiform
arytenoid
3 Major Function of the Larynx
Protection of the lower airway
Facilitate respiration
Facilitate phonation
borders of upper airway?
Anterior and lateral border: thyroid cartilage
Posterior border: posterior cricoid cartilage
action: vocal cord tension, open,close
Intrinsic muscles upper airway
action: position, phonation,swallowing
Extrinsic muscles
Anchors and suspends larynx
U shaped
Does not articulate with any other bone
hyoid bone
elastic cartilage, attached to hyoid bone and thyroid cartilage
epiglottis
‘shield’, articulates with cricoid, provides attachment for vocal fold
thyroid cartilage
articulates with thyroid cartilage, attached to 1st tracheal ring
cricoid cartilage
pyramidal, vocal and muscular processes, pivot on cricoid lamina to abduct and adduct vocal folds, vocal cord attached to vocal process
arytenoids
2 laryngeal joints?
cricothyroid joint
cricoarytenoid joint
lengthens and tenses cords- controls pitch
Cricothyroid joint
something to consider with older patients?
cartilage continues to grow, chronic diseases (think rheumatoid) destroys joints - including airway
opening/inlet to trachea
Triangle in shape
glottis
vestibular folds which are narrow bands of fibrous tissue on each side.
False vocal cords
: pale, white ligament bands
Attachment: thyroid anterior, arytenoids posterior
True vocal cords
C6, lower border of cricoid to T5 carina
10-15 cm in length.
trachea
describe posterior trachea
flattened
what are the angles of the right and left bronchus?
Left bronchus is a greater angle (45°) than right bronchus (25°)
[easier to intubate right because least resistance with lesser angle]
– smooth muscle, alters diameter of trachea, changing trachea’s resistance to flow e.g. constricts when cough to expel air more forceably
trachealis
Upper Airway Innervation: 4 sensory
3 branches of trigeminal nerve (V1,V2,V3)
Glossopharyngeal nerve
Facial nerve
Internal branch of superior laryngeal nerve
Upper Airway Innervation: motor
Vagus has 2 branches SLN, RLN
Recurrent laryngeal nerve (RLN) innervates ALL muscles of larynx except
cricothyroid muscle
what innervates cricothyroid muscle?
external branch of the superior laryngeal nerve (SLN)
Innervation of Trachea and Bronchial Tree
vagus
protect the lower airway from entry of secretions and foreign bodies
Pharynx, epiglottis & vocal cords
what is the Pharyngeal Reflex?
posterior wall of pharynx is touched causing the gag reflex. Suppression in stage 3 plane 1.
what is the Laryngeal reflex
touching or irritating mucosa results in a cough reflex. Suppression in stage 3 plane 2
what is Glottic closure reflex
: laryngeal closure, exaggeration of this is laryngospasm. Most common during stage 2 when reflexes are hyperirritable.
what is Carinal reflex
gagging and coughing when carina is touched. Suppressed in stage 3, plane 3
Posterior Cricoarytenoid action and nerve?
Opens glottis (abducts) RLN
Lateral cricoarytenoids action and nerve?
Closes glottis (adducts) RLN
Arytenoids (interarytenoids) action and nerve
Closes glottis mainly posterior (adducts)
RLN
Cricothyroid action and nerve?
Tension and elongation of cords (adducts)
SLN
Thyroarytenoids action and nerve
Relaxes/shortens vocal cords
RLN
adjusts length (tension) of the vocal ligaments?
cricothyroid
vocalis
thyroarytenoid
AB or AD ducts vocal folds (glottic opening)
thyroaretynoid
lateral cricoarytenoid
posterior cricoarytenoid
sphincter function?
aryepiglottic
interarytenoid
muscles increase tension on vocal ligaments by rotating the thyroid cartilage inferiorly –raises pitch
Cricothyroid (CT
relaxes vocal ligaments by pulling arytenoid cartilage anteriorly- lowers pitch
Thyroarytenoid (TA)
SLN injury
unilateral - minimal
bilateral - hoarseness, tired voice
RLN injury?
unilateral - hoarse
bilateral
acute: stridor, resp distress
chronic: aphonia
vagus injury?
unilateral - hoarseness
bilateral - aphonia
