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october exam > airway anatomy > Flashcards

airway anatomy Flashcards

1
Q

what cranial nerve is trigeminal

A

CN 5

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2
Q

what are the 3 branches of trigeminal

A

V1- opthalmic
V2- maxillary
V3- mandibular

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3
Q

V1 branch of trigeminal

A

opthalmic

sensory to nares and anterior 1/3 of nasal septum

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4
Q

v2 branch of trigeminal

A

maxillary

sensory to turbinates and nasal septum

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5
Q

v3 branch of trigeminal

A

mandibular

sensory to anterior 2/3 of tongue

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6
Q

what nerve is glossopharngeal

A

CN9

-sensory for soft palate, oropharynx-> anterior side of epiglottis (valecula)
-afferent limb of gag reflex
-motor for swallowing and phonation

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7
Q

what nerve is vagus

A

cn 10

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8
Q

what does vagus divide into

A

SLN (internal and external)
RLN

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9
Q

where does SLN divide into branches

A

at level of hyoid bone

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10
Q

SLN internal branch

A

SENSORY to posterior side of epiglottis-> vocal cords

penetrates thyrohyoid membrane

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11
Q

SLN external branch

A

motor to cricothyroid membrane (tenses vocal cords)

bilateral injury-> hoarseness but no resp distress

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12
Q

RLN

A

sensation and motor

sensory from below VC-> trachea

motor: all intrinsic muscles of larynx (thryoarytenoid, lat cricoarytenoid, post cricoarytenoid)

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13
Q

what happens with unilateral injury to RLN

A

no respiratory distress

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14
Q

what happens with acute bilateral injury to RLN

A

respiratory distress from unopposed action of cricothyroid m

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15
Q

what happens with bilateral chronic injury of RLN

A

no respiratory distress

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16
Q

risk factors for bilateral RLN injury

A

-overinflation of ETT/LMA
-excessive neck stretching
-neck surgery (thyroidectomy most common)

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17
Q

risk factors for specific L sided RLN injury

A

-PDA ligation
-L atrial enlargement (mitral stenosis
-aortic arch aneurysm
-thoracic tumor

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18
Q

what side of RLN is more susceptible to injury

A

Left! loops around aortic arch

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19
Q

how to do a glossopharyngeal block

A

inject at base of palatoglossal arch (anterior tonsillar pillar) to depth of 0.25-0.5 cm

inject 1-2 cc local

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20
Q

risks with glossopharyngeal block

A

seizure from accidental intracarotid injection

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21
Q

how to do sueprior laryngeal injection

A

inject at inferior border of greater cornu of hyoid bone (1 mL outside of thyrohyoid membrane) and 2 mL deep to this structure

22
Q

how to block RLN

A

transtracheal block- insert needle through cricothyroid membrane in CAUDAL direction

pt takes deep breath- inject 3-5 cc of local into tracheal lumen

23
Q

landmarks for larynx

A

anterior to c3-c6

24
Q

tensor palantine role

A

opens nasopharynx

obstruction at level of soft palate

25
Q

genioglossus role

A

opens oropharynx

obstruction at level of tongue

26
Q

hyoid muscle role

A

opens hypopharynx

27
Q

what are the unpaired cartilages

A

thyroid, cricoid, epiglottis

28
Q

what are the paired cartilages

A

arytenoid, corniculate, cuneiform

29
Q

what is the narrowest region in the airway for adults

A

glottic opening

30
Q

trachea begins and ends at

A

cricoid cartilage (c6)- carina (t4/5)

31
Q

trachea rings open posterior or anterior

A

posterior

32
Q

what cells produce mucus in the trachea

A

goblet

33
Q

where is carina located

A

t4/5
angle of louis

34
Q

R vs L bronchus

A

L bronchus 5 cm 45 degrees
R bronchus 2.5 cm 25 degrees

35
Q

how are bronchi different in children

A

children up to 3 - both bronchi take off at 55 degrees

36
Q

whats different in airway bifurcations

A

decreased airflow velocity, cartilage, cilia, and goblet cells

37
Q

type 1 pneumocytes

A

provide surface for gas exchange

38
Q

type 2 pneymocytes

A

produce surfactant- can also produce type 1

39
Q

type 3 pneumocytes

A

macrophages, fight infection

40
Q

laryngospasm reflex arc

A

afferent limb: internal branch of SLN

efferent limb: external branch of SLN (cricothyroid m.) and RLN (lateral cricoarytenoid and thyroarytenoid m.)

41
Q

complications from laryngospasm

A

airway obstruction, neg pressure pulm edema, pulm aspiration of gastric contents, cardiac dysrhythmias, cardiac arrest, death

42
Q

s/s of laryngospasm

A

inspiratory stridor, suprasternal/ supraclavicular retractions, “rocking horse”, apperance of chest wall, increased diaphragmatic excursion, lower rib flailing, absent/ altered etco2 waveform

43
Q
A
44
Q

causes of laryngospasm

A

airway manipulation (light anesthesia), secretions, airway surgery, active or recent resp infeciton (<2 weeks), age < 1 yr

45
Q

tx of laryngospasm

A

fio2 100% remove stimuli, deepen anesthesia, larsons, chin lift, cpap 15-20, succ

46
Q

succ dose adult/child

A

IV 0.1-1 mg/kg
IM=4 mg/kg

47
Q

succ neonate/ infant dosing

A

IV = 2 mg/kg
IM = 5 mg/kg

48
Q

succ give with atropine ___ mg/kg in children < _ yrs

A

0.02 mg/kg in children < 5 yrs old

49
Q

larsons maneuver is also called

A

laryngospasm notch

pressure applied backward bilateral toward skull base for 3-5 seconds than released 5-10 sec

50
Q

borders for larsons

A

superior= skull base
anterior= ramus of mandible
posterior= mastoid process

51
Q
A

october exam (12 decks)

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