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Principles of the Airway & Taxonomy > Airway Anatomy > Flashcards

Airway Anatomy Flashcards

1
Q

What structures are considered the upper airway?

A 
Nose
Mouth
Pharynx
Hypopharynx
Larynx
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2
Q

What are the two openings to the human airway?

A

The nose and the mouth

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3
Q

What structures are considered the lower airway?

A

Trachea
Bronchi
Bronchioles (terminal and respiratory)
Alveoli

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4
Q

What is the primary function of the nose?

A

Warms and humidifies gases

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5
Q

What structure is the primary pathway for normal breathing?

A

The nose, unless there is obstructions, polyps, or upper respiratory infection

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6
Q

What opening to the airway has more resistance?

A

The Nose, almost two times that of mouth breathing

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7
Q

What structure does the nose and mouth form?

A

They are separated anteriorly and joined posteriorly to form the pharynx

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8
Q

When does mouth breathing occur?

A

When high flow rates are required

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9
Q

What are the three compartments of the pharynx?

A

Nasopharynx
Oropharynx
Hypopharynx

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10
Q

Where is the pharynx located?

A

Extends from posterior aspect of nose to the level of the cricoid cartilage

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11
Q

What structures are present in the nasopharynx?

A

Nasal Septum
Turbinates/Concha
Adenoids

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12
Q

Where is the nasopharynx located?

A

Anterior to C1, bound superiorly by base of skull and inferiorly by soft palate

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13
Q

Where is the oropharynx located?

A

Lies at C2-C3, bound superiorly by soft palate and inferiorly by epiglottis

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14
Q

What is the major source of oropharyngeal obstructions?

A

The tongue due to decreased genioglossus muscle tone

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15
Q

Where is the hypopharynx located?

A

C5-C6, bound by superior border of the epiglottis and inferior border of the cricoid cartilage

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16
Q

What is the purpose of the upper esophageal sphincter?

A

Acts as a barrier to regurgitation in the conscious patient, closed when swallowing and open when breathing

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17
Q

What is the only complete ring of cartilage in the adult trachea?

A

Cricoid Cartilage

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18
Q

Lymphoid tissue ring in the pharynx that is at high risk for bleeding, especially with nasal intubation?

A

Waldeyer’s Tonsillar Ring

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19
Q

What makes up Waldeyer’s tonsillar ring?

A

Pharyngeal tonsils (adenoids)
Palatine tonsils
Lingual tonsils

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20
Q

Where does the larynx typically lie in infants and children?

A

C2-C4 and descends to C4-C5 by the age of 5

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21
Q

What is the purpose of the larynx?

A

It serves as an organ of phonation and as a valve to protect the lower airways

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22
Q

Where is the larynx located?

A

Extends from epiglottis to lower level of cricoid cartilage and sits at the junction of the airway and the esophagus

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23
Q

How is the trachea protected from aspiration?

A

The epiglottis will fold over when swallowing and the vocal cords will spasm close if irritated

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24
Q

How are the tracheal rings typically structured?

A

Incomplete posteriorly and complete anteriorly, with the exception of the cricoid cartilage

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25
Q

What are the components of the cartilaginous skeleton of the larynx?

A

Ligaments, muscles, cartilages and one bone

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26
Q

What is the name of the one bone included in the cartilaginous skeleton of the larynx?

A

Hyoid bone

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27
Q

Name the nine cartilages that make up the larynx?

A 
Thyroid (one)
Cricoid (one) 
Epiglottic (one)
Corniculate (pair)
Arytenoid (pair)
Cuneiform (pair)
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28
Q

Where is the epiglottis located?

A

Sits at base of tongue and separates hypopharynx from the larynx and hangs over the laryngeal opening

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29
Q

What is important to remember about the epiglottis prior to performing DVL?

A

Very vascular and can be traumatized, swelling incredibly

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30
Q

What are the most commonly seen cartilages on laryngoscopy?

A

Arytenoids, pyramidal and posterior to the cords

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31
Q

What are the false vocal cords?

A

Also known as vestibular folds, narrow bands of fibrous tissue on each side of the larynx that are found first inside the laryngeal cavity opening

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32
Q

What do the true vocal cords looks like?

A

Pale, white, ligamentous structures that attach to the thyroid anteriorly and the arytenoids posteriorly

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33
Q

What is the narrowest portion of the adult airway?

A

Glottic opening

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34
Q

What is the average width of the glottic opening in an adults?

A

6-9mm but can be stretched to 12mm

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35
Q

What is the narrowest portion of the pediatric airway?

A

Just below the cords at the cricoid ring

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36
Q

Where should the Macintosh blade be inserted in the airway?

A

Valecula

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37
Q

What is the largest cartilage of the larynx?

A

Thyroid cartilage

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38
Q

Where is the site for Sellicks Maneuver?

A

Cricoid cartilage, 6.6-8.8 pounds BURP (backward, upward, rightward pressure)

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39
Q

Where should an emergency airway be attempted?

A

Cricothyroid membrane

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40
Q

Where is the trachea located?

A

Begins at C6 at the inferior border of the cricoid cartilage and extends to the carina

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41
Q

About how long is the trachea?

A

10-15cm in length

42
Q

About how many cartilaginous rings compose the trachea?

A

16-20 rings anteriorly

43
Q

When does bifurcation to right and left mainstem bronchus occur?

A

T5

44
Q

At what angles does the right and left bronchus occur?

A

Right bifurcates at 25-30 degrees

Left bifurcates at 45 degrees

45
Q

What mainstem is more likely to occur?

A

Right mainstem, fairly shallow favors intubation

46
Q

What are some important considerations for the pediatric airway?

A 
Larynx is higher
Tongue large compared to size of mouth
Epiglottis larger, stiffer more posterior
Head large compared to body
Short neck
Narrow nares
47
Q

What is the responsibility of the intrinsic muscles of the larynx?

A

Responsible for opening, closing and controlling tension of the vocal cords

48
Q

What is the responsibility of the extrinsic muscles of the larynx?

A

Connect the larynx with the hyoid bone and other structures

Serves to move the larynx as a whole during phonation, swallowing and breathing

49
Q

What is the action of the Posterior Cricoarytenoid muscle?

A

Abducts (opens) the vocal cords and opens the glottis

50
Q

What is the action of the Lateral Cricoarytenoid muscle?

A

Adducts the vocal cords

51
Q

What does the term Ab mean in Latin?

A

To move away, muscles that abduct move away and an opening can occur

52
Q

What does the term Ad mean in Latin?

A

To move towards, muscles that adduct move together thus closing an opening

53
Q

What is the action of the Arytenoid muscle?

A

Adducts the vocal cords

54
Q

What is the action of the Cricothyroid muscle?

A

Produces cord tension, closure and elongates the vocal cords. Can result in total and profound glottic closure called laryngospasm

55
Q

What is the action of the Thyroarytenoid muscle?

A

Shortens and relaxes the vocal cords

56
Q

What is the action of the Sternohyoid muscle?

A

Draws hyoid bone inferiorly

57
Q

What is the action of the Sternothyroid muscle?

A

Draws thyroid cartilage caudad (toward posterior end)

58
Q

What is the action of the Thyrohyoid muscle?

A

Draws hyoid bone inferiorly

59
Q

What is the action of the Omohyoid muscle?

A

Draws hyoid bone caudad

60
Q

What is the action of the Stylohyoid muscle?

A

Elevated larynx

61
Q

What is the action of the Mylohyoid muscle?

A

Elevates larynx

62
Q

What nerves innervate the anterior septum and lateral walls of the nose?

A

Ophthalmic division of trigeminal nerve (V), specifically anterior ethmoidal nerve

63
Q

What nerves innervate the posterior septum of the nose?

A

Maxillary division of the trigeminal nerve (V), specifically nasopalatine nerves and sphenopalatine ganglion

64
Q

Why is a nose bleed more likely to occur after placing a nasal airway during general anesthesia?

A

SNS results in vasoconstriction, anesthesia knocks out SNS causing PSNS engorgement of blood vessels easy to damage

65
Q

What cranial nerve innervates the tonsils, roof of pharynx and underside of soft palate?

A

Glossopharyngeal nerve (IX)

66
Q

What nerves innervate the tongue?

A

Anterior 2/3: Lingual nerve (mandibular division f the Trigeminal nerve (V)
Posterior 1/3: Glossopharyngeal nerve (IX)

67
Q

What are the functions of the facial nerve?

A 
Muscles of facial expressions
Taste
Motor control of stylohyoid laryngeal muscle
Salivary glands
Small afferent conduction to oropharynx
68
Q

Damage to which nerve may cause the tongue to relax causing it to fall back resulting in airway obstruction

A

Hypoglossal Nerve(XII)

69
Q

Where does the vagus nerve innervate the airway?

A

Below the epiglottis

70
Q

What are the two branches of the Superior laryngeal nerve?

A

Internal branch and External branch

71
Q

What is the function of the internal branch of the Superior laryngeal nerve?

A

Provides sensation to larynx from epiglottis to vocal cords (ABOVE vocal cords)

72
Q

What is the function of the external branch of the Superior laryngeal nerve?

A

The external branch is a motor nerve

73
Q

What is the function of the Recurrent Laryngeal Nerve?

A

Provides sensation to larynx BELOW vocal cords

74
Q

What are the names of the two branches of the Vagus nerve that innervate all muscles of the larynx?

A

Superior Laryngeal Nerve

Recurrent Laryngeal nerve

75
Q

What is the only muscle the Recurrent Laryngeal nerve does not innervate?

A

Cricothyroid muscle, external branch of Superior laryngeal nerve provides motor innervation

76
Q

What is the function of the Internal superior laryngeal nerve?

A

Sensory (SIS)

77
Q

What is the function of the External superior laryngeal nerve?

A

Motor (SEM)

78
Q

Where does the Internal superior laryngeal nerve provide sensory information?

A

Lower pharynx
Underside of epiglottis
Larynx above the cords

79
Q

What sensory information does the recurrent laryngeal nerve provide?

A

Below the cords and Upper esophagus

80
Q

Where does the right side of the recurrent laryngeal nerve go?

A

Leave vagus at the level of the subclavian and loops up

81
Q

Where does the left side of the recurrent laryngeal nerve go?

A

Leaves vagus at the level of the aortic arch and loops up

82
Q

What can occur with damage to the superior laryngeal nerve?

A

Unilateral: minimal effects
Bilateral: Hoarseness, vocal tiring

83
Q

What can occur with damage to the recurrent laryngeal nerve?

A

Unilateral: Hoarseness
Bilateral:
Acute- stridor, resp distress, unopposed tension of the cricothyroid muscle
Chronic- aphonia

84
Q

What is the end result if bilateral vagal denervations occurs?

A

Flaccid, mid-positioned cords, resulting in aphonia

85
Q

What does the superior laryngeal artery supply?

A

Supraglottic laryngeal structures

86
Q

Where does the superior laryngeal artery originate?

A

carotid –> superior thyroid artery –> SLA

87
Q

What does the inferior laryngeal artery supply?

A

Infraglottic laryngeal structures

88
Q

Where does the inferior laryngeal artery originate?

A

Subclavian –> inferior thyroid artery –> ILA

89
Q

What is the venous drainage of the airway?

A

Superior/inferior thyroid veins to SVC

90
Q

What are the five branches of the facial nerve?

A 
Temporal
Zygomatic
Buccal
Mandibular
Cervical
91
Q

What structure does the nasal airway follow?

A

The hard palate

92
Q

What structure does the oral airway follow?

A

The base of the tongue

93
Q

What structures does the larynx attach to?

A

Anteriorly by the epiglottis, posteriorly by the mucous membrane which extends between the arytenoid cartilage and laterally by the a folds

94
Q

Where does the superior laryngeal nerve penetrate the throhyoid membrane?

A

At the level of the cornu (horn) of the hyoid

95
Q

What attaches the thyroid cartilage to the cricoid cartilage?

A

Cricothyroid membrane (avascular)

96
Q

What muscle can cause a laryngospasm?

A

Cricothyroid muscle (intrinsic muscle)

97
Q

What structures does the Glossopharyngeal nerve innervate?

A

Tonsils, roof of pharynx, underside of soft palate and posterior 1/3 of tongue

98
Q

What four cranial nerves innervate the tongue?

A

Glossopharyngeal (IX)-sensory
Trigeminal (V)-sensory
Facial (VII)-sensory
Hypoglossal (XII)-motor

99
Q

What is the most important mechanism of protecting the lower airways?

A

Glottic closure reflex

100
Q

Define the characteristics of a laryngospasm?

A

A prolonged, intense glottic closure and an exaggeration of glottic closure reflex

101
Q

What three structures protect the lower airways from aspiration and secretions?

A

Pharynx
Epiglottis
Vocal cords

102
Q

At what cervical structure is the carina located?

A

T5 (also where bronchus branches to right and left)

Principles of the Airway & Taxonomy (5 decks)

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