Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

AFN Assessment > Airway Assessment 1 > Flashcards

Airway Assessment 1 Flashcards

1
Q

Single most important factor in safe and satisfactory anesthesia & resuscitation

A

Airway management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 High Risk Themes

A

Communication failure: CRNA, surgeon, nurses, pt, etc. tx of care
Failure to comply w/ AANA standards: read through the list
Errors in judgment: fatigue/stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Improvement in airway risk

A

implementation of systems for prevention/detection of errors, quality improvement, airway assessment tools, difficult airway algorithm, better equipment, drug safety, improvements in operating systems (time outs, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

People do not die from lack of intubation, they die from a lack of ventilation!!!

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Examples of anesthesia complications

A

aspiration
obstruction
resp failure
high spinal
local anesthetic toxicity
anaphylaxis
sedative overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How many breaths of Positive CO2 is needed on monitor to confirm ETT placement?

A

6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Minor morbidity

A

Moderate distress w/o prolonging hospital stay
No permanent complications (PONV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Intermediate morbidity

A

Serious distress prolonging hospital stay.
No permanent complications (dental injury, aspiration, spasm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Major Morbidity

A

permanent disability or complication (anoxic brain injury, spinal injury)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Airway types

A

Routine, anticipated difficult, unanticipated difficult, failed

Most difficult airways are unanticipated - usually due to inflamed or swollen lingual tonsils undetected on assessment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Considerations for airway mgmt

A

Thorough airway history/exam
Consideration of ease of intubation
Form mgmt plan for mask ventilation or supraglottic airway
Estimate relative risk of periods of apnea
Aspiration risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Review the Difficult Airway Algorithm

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Induction Mgmt Plan

A

provide oxygen the entire time!! (new).
Patient can tolerate a longer apneic period if you’re oxygenating the whole time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Consideration in induction Mgmt Plan

A

Aspiration risk
Likeliness to obstruct
Difficulty in masking
Difficulty with SGA/intubation
Toleration of apneic period
Comorbidities
Anesthesia history

Make extubation part of your plan. Unless you decide to leave ETT in.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nose & Nasopharynx (Turbinates)

A

Large surface area, very vascular
Relevant for placement of nasal trumpet
Risk for bleeding increases if enlarged.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nose Bleeds

A

Inc vascularity with pregnancy, allergies, and prolonged prone positioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

_________ stimulation usually constricts blood vessels, but we block that with anesthesia

A

Sympathethic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where do 90% of nose bleeds occur?

A

Anterior (littles area): ICA/ECA branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How should you stop nose bleeds

A

hold pressure on cartilaginous part of nose, not on nasal bone! (many branches of anterior ethmoid artery here)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx of Posterior Nose bleed

A

hard bleed to treat (may require embolization, surgery, silver nitrate, ballooning, packing), further back, profuse, sphenopalatine artery, greater risk of airway compromise, blood in both nostrils & posterior pharynx.

Apply pressure, gauze, neo on gauze. If doesn’t stop → CALL ENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What causes a person to be more susceptible to nose bleeds?

A

allergies, dryness, chemical exposure, prone position, blood thinners, broken nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Location of the Oropharynx

A

Starts at the mouth and meets the nasopharynx posteriorly. Soft palate → epiglottis, contains the palatine & lingual tonsils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tongue

A

Large muscle, relaxes when it falls back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Soft Palate

A

Raises during swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Uvula
protects passageway from oral cavity to nasopharynx
26
What happens to the oropharynx with increasing age?
With increased age (>50), muscle tissues stretch/relax → increases obstruction
27
Enlargement of the pharyngeal adenoids tonsils can cause obstruction of what structure in the nasopharynx?
Eustachian tubes
28
T/F: Palatine tonsils which are located in the oropharynx can cause enlargement w or w/o infection?
True
29
What are the most common cause of enlargement and are compensatory mechanisms after tonsillectomy or with auto-immune disorders. These are also located on posterior ⅓ of tongue.
Lingual Tonsils
30
Lingual Tonsil enlargement
CANNOT see with airway assessment; unanticipated difficult airway!!!
31
Laryngeal skeleton
3 unpaired cartilage (thyroid, cricoid, epiglottis) 3 paired cartilages (arytenoid, corniculate, cuneiform)
32
Hyoid bone
chief support for the larynx
33
Fxn of the Larynx
Protect patency between hypopharynx (part of throat that lies behind the larynx; entrance to the esophagus) & trachea Phonation Gag/cough reflexes
34
Location of Larynx in adults
C4-C6
35
Location of Larynx in infants
C3-C4 & more anterior
36
Differences b/w Male and Female Vocal Cords
Male vocal folds are longer (17mm-25mm) - deeper voice Female vocal folds are shorter (12.5-17.5) - higher pitch voice.
37
Review Netter’s plates 54, 60, 70-74 for airway anatomy
38
Thyroid cartilage
Largest of the 9 cartilages Superior cornu attaches to lateral thyrohyoid ligament Inferior cornu attaches to cricoid cartilage
39
Cricoid Cartilage
Anatomical lower limit of the larynx Wraps completely around larynx (only complete ring in upper airway!) Narrowest part of larynx in a child Attaches to the thyroid cartilage by the cricothyroid membrane (1-1.5 cm past laryngeal prominence)
40
Cricoid Pressure
Used in RSI, controversial. Apply light pressure until they fall asleep, then firmer. If vomiting, let go
41
Epiglottis anatomy
Unpaired leaf-shaped projects obliquely upward (free extremity is broad & rounded with a stem connected to the thyroid cartilage),
42
Epiglottis fxn
protect the glottis from aspiration (when swallow, it folds backward)
43
Vallecula
pouch-like area found between the median & lateral folds of epiglottis
44
Epiglottis attachments
INFERIORLY to posterior aspect of thyroid cartilage SUPERIORLY into the hypopharynx POSTERIORLY is free & visualized with laryngoscopy ANTERIOR attached the hyoid bone
45
What are the paired cartilages of larynx?
Artyenoids Cuneiform Corniculate
46
Arytenoids
pyramidal shaped, attached to posterior portion of vocal cords, articulates with the cricoid cartilage forming a synovial joint (problem w rheumatoid arthritis- vocal cord fatigue)
47
Cuneiform & Corniculate
connected to the arytenoids by laterally placed aryepiglottic ligaments & folds, embedded in the aryepiglottic folds, reinforce & support the aryepiglottic folds & may help the arytenoids move
48
Vocal Cords & Glottis
Fibromembranous folds attached anteriorly to the thyroid cartilage and posteriorly to the arytenoids, alteration in tension on the vocal cords determines the pitch of the voice
49
Intrinsic muscles
TENSION of vocal cords control the glottic opening, moves the cartilages in relation to each other
50
Extrinsic muscles
move the larynx as a whole, connects larynx, hyoid, & neighboring structures, adjusts the POSITIONING of the larynx
51
Pharyngeal Muscles
Posterior Cricoarytenoids- abduction Lateral Cricoarytenoids - adduction
52
In an awake patient muscle tension is maintained by...
Tensor palatini m (nasopharynx) Genioglossus m (oropharynx) Hyoid m (laryngopharynx)
53
Importance with correction of sleep apnea
Many surgeries to correct: hyoid suspension, genioglossal advancement, upper airway stimulators)
54
Motor innervation of the tongue
CN XII Hypoglossal N CN IX Glossopharyngeal N
55
Complications of CN XII Hypoglossal N
Risk of injury during vigorous manipulation of airway Risk of nerve palsy with LMA/use of nitrous oxide. Complications can lead to Dysphagia
56
CN IX Glossopharyngeal
Sensory innervation to: vallecula, base of the tongue, roof of the pharynx, tonsils, undersurface of soft palate)
57
Stimulation of CN IX Glossopharyngeal N will result in what?
Gag reflex and increased coughing
58
Glossopharyngeal Nerve Block
Anesthetize the tongue with topical anesthesia Inject in the gutter where tongue meets palatoglossal arch using a 23 or 25g needle → Inject 1-2 cc lido on both side MUST ASPIRATE! Risk of intracarotid injection!
59
Which nerves share nuclei in the medulla?
Glossopharyngeal, vagus, & spinal accessory nerves
60
Gag reflex MOA
stimulation such as suctioning back of oropharynx sends afferent impulse via CN IX to medulla → vagus nerve sends efferent impulse for all muscles to contract → GAG
61
Innervation of the Larynx
CN X Vagus nerve Supplies sensory & motor innervation, 2 main branches
62
What nerve supplies sensory innervation above the VC (supraglottic)?
Superior Laryngeal N (2 Branches)
63
What are the 2 branches of the SLN?
Internal Branch External Branch
64
What does the External branch of the SLN do?
Motor innervation to cricothyroid muscles Tenses the VC
65
T/F: Unilateral injury to the larynx indicates an immediate need for repair.
False: usually no treatment, over time the VC will move medial, changes in voice or voice tiring
66
Bilateral injury to the larynx
(rare) aspiration risk Possible need for tracheostomy Loss of sensation above cords (inability to adduct-close) Floppy cords
67
Route of the Recurrent Laryngeal N
Right RLN loops around Brachiocephalic innominate artery; Left RLN wraps around Aorta
68
Sensory innervation for the Recurrent Laryngeal N
Sensory below VC (Subglottic)
69
Motor innervation for the Recurrent Laryngeal N
Motor innervation to all intrinsic muscles EXCEPT cricothyroid Motor innervation to the cricoarytenoids (ONLY ABDUCTORS of VC)
70
Unilateral damage to the RLN will cause what?
Hoarseness
71
Bilateral injury to the RLN will cause what?
*** worst scenario** Unopposed adduction by the cricothyroid via the SLN → inability of the cords to abduct Aphonia Stridor can lead to death IMMEDIATE REINTUBATION & laryngoscopy to evaluate cord function
72
Damage to either the SLN or the RLN may cause the larynx to become incompetent with a potential for _________ or _____________!!
Aspiration or Airway obstruction
73
Superior Laryngeal Nerve Block
→sensory above vocal cords, supraglottic region Find the hyoid bone & greater cornu of hyoid bone at angle of mandible Walk off hyoid bone to thyrohyoid membrane Inject a small amount of local Go 2-3mm deep & inject 2 mL lido Repeat on the other side
74
What risk is associated with a Transtracheal Block?
Risk of tearing mucosa with needle This block is contraindicated if aspiration risk
75
Transtracheal Block Procedure
Find cricothyroid membrane & find middle Do a skin wheel of local 22g angiocath w 5mL syringe attached Add about 3-5 mL of lidocaine Aspirate constantly (want air bubbles) When get bubbles, remove needle while advancing catheter & inject lido Tell patient to take a deep breath while injecting → cough spreads local
76
What are the laryngeal muscles?
Vocal cords Glottis
77
Vocal cords movement
Lengthened by cricothyroid muscles (tension) Shortened by thyroarytenoid muscles (relaxation)
78
Glottis movement
Abducted by posterior cricoarytenoid (opens) - “Pulls Cords Apart” Adducted by lateral cricoarytenoids (closes )
79
How many cartilaginous rings are located in the trachea?
15-20 rings
80
The last ring produces the bronchial bifurcation also known as what?
Carina Lies at the angle of louis formed by the articulation of the manubrium with the body of the sternum
81
Why are the tracheal rings incomplete?
Allow for esophageal expansion
82
The length from the VC to carina is about________
10-15cm
83
Right mainstem bronchi
Diverges from trachea at 20 degree angle, 2 cm long
84
Left mainstem bronchi
Diverges from trachea at 45 degree angle, 5 cm long

AFN Assessment (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions