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Adv. Phys & Health Assessment > Airway assessment > Flashcards

Airway assessment Flashcards

1
Q

Nasal passages are also called ______

A

fossae

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2
Q

The nasal passages include 3 _______ that divide the nasal passage into 3 scroll-shaped meatuses

A

turbinates

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3
Q

The preferred pathway for nasal airway devices

A

Inferior meatus - between inferior turbinate and floor of nasal cavity

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4
Q

Nasal vasoconstrictors include

A
  • Cocaine
  • Oxymetazoline (Afrin)
  • phenylephrine
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5
Q

The cribriform plate is

A

roof of nasal passage/floor of cranial fossa

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6
Q

The hard palate is formed by parts of the _______ and _______, makes up which part of the roof of the mouth?

A

maxilla and palatine bone

makes up anterior 2/3rds roof of mouth

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7
Q

Pharyngeal musculature in the awake patient helps maintain

A

airway patency

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8
Q

One of the primary causes of upper airway obstruction during anesthesia

A

loss of pharyngeal muscle tone

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9
Q

What is a method of counteracting the tendency of the pharyngeal airway to collapse

A

Chin lift with mouth closure, increases longitudinal tension in the pharyngeal muscles

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10
Q

Where does the nasopharynx end?

A

at the soft palate; this region is termed velopharynx

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11
Q

What is the common site of airway obstruction in both awake and anesthetized patients?

A

velopharynx

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12
Q

What are the 3 regions of the pharynx

A

Nasopharynx, oropharynx, hypopharynx

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13
Q

The pharynx extends from

A

base of the skull to lower border of cricoid cartilage

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14
Q

The oropharynx includes

A

soft palate to epiglottis

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15
Q

The hypopharynx includes

A

epiglottis to cricoid cartilage

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16
Q

The larynx extends from

A

epiglottis to lower end of cricoid cartilage; 6th cervical vertebrae

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17
Q

The larynx includes which structures

A
  • epiglottis
  • supraglottis
  • vocal cords
  • glottis
  • subglottis
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18
Q

Functions of the larynx includes

A
  • inlet to trachea
  • phonation
  • airway protection
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19
Q

The larynx is suspended from the ___________ by the __________

A

hyoid bone, thyrohyoid membrane

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20
Q

Which laryngeal cartilages are paired

A
  • arytenoids
  • corniculate
  • cuneiform
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21
Q

Which laryngeal cartilages are unpaired

A
  • thyroid
  • cricoid
  • epiglottis
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22
Q

Which is the only complete ring cartilage

A

cricoid cartilage

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23
Q

The true vocal cords attach to

A

arytenoids and the thyroid notch on thyroid cartilage

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24
Q

Which is the largest of the laryngeal cartilages

A

thyroid cartilage

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25
Q

The trachea extends from

A

inferior cricoid membrane to carina

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26
Q

Normal trachea length in adults

A

10-15cm

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27
Q

The trachea is anteriorly bound by _________, and posteriorly by the ___________

A

anterior = C-shaped tracheal rings
posterior= longitudinal trachealis muscle

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28
Q

What should be conducted before initiation in all patients thoroughly

A

basic airway assessment

can i ventilate/intubate?

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29
Q

What airway assessment is the most valuable, more than any testing

A

Reviewing history
- Asking the patient if they have had history of difficulty with anesthesia. (complaints of jaw soreness or hoarseness may indicate difficulty masking or intubating)

  • review of past medical records
  • report of cut lip/broken tooth
  • history of OSA
  • intraoral lesions present
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30
Q

Most predictive factor of difficult intubation

A

past difficult intubation

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31
Q

OSA screening tool

A

STOP BANG

snoring, tired, obese, pressure (htn), BMI >35, age >50, neck circum >40cm, gender=male

32
Q

Airway evaluation includes

A
  • visual inspection of face and neck
  • Assessment of mouth opening
  • Evaluation of oropharyngeal anatomy and dentition
  • assessment of neck ROM (sniffing position)
  • assessment of submandibular space
  • mandible movement (bulldog face, upper teeth behind lower)
33
Q

Visual inspection findings that would indicate potentially difficult airway

A
  • facial deformities
  • head/neck cancers
  • burns (singed facial hair)
  • Goiter
  • short or thick neck >43cm, more predictive than bmi
  • Receding mandible/recessed jaw
  • beard
  • c-collar
34
Q

Ideal mouth opening (interincisor distance) should be

A

> 6cm or (3 patient finger-widths)

35
Q

Treatment of angioedema from ACE-i include

A

FFP and transexamic acid (TXA)

36
Q

Lack of teeth may make what more difficult?

A

masking, teeth provide structure

edentulous= teethless

37
Q

25% of insurance claims against anesthesia are because of

A

dental injuries

38
Q

Which teeth are most common to damage during intubation

A

frontal and left side (due to where we insert blade)

anterior maxillary central and lateral incisors

39
Q

The sniffing position incorporates

A

cervical flexion and atlanto-occipital extension

aligns oral, pharyngeal and laryngeal axis

40
Q

Proper sniffing position should align the ____ and _____

A

ears to sternum

41
Q

Ideal sternomental distance

A

> 12.5cm

distance between sternal notch and chin

42
Q

Ideal thyromental distance

A

> 6.5cm (3 finger)

tip of chin to thyroid notch

43
Q

Mallampati test includes

A

Visibility of oropharyngeal structures

class 1-4

patient seated upright, head neutral, mouth open, tongue protruded, no phonation

44
Q

Mallampati class 1 can visualize

A

fauces, pillars, entire uvula, soft palate

45
Q

mallampati class 2 can visualize

A

fauces, portion of uvula, soft palate

46
Q

Mallampati class 3 can visualize

A

Base of uvula and soft palate only

47
Q

Mallampati class 4 can visualize

A

only hard palate

48
Q

Proper cricoid manipulation

A

BURP

backward, upward, rightward pressure

49
Q

Classification of laryngeal view is called

A

Cormack-Lehane classification, grades 1-4

50
Q

Cormack-Lehane grade 1 can visualize

A

entire glottis

51
Q

Cormack-Lehane grade 2 can visualize

A

Only posterior portion of the glottis

sometimes classified as 2a or 2b

2a= partial view of glottis
2b= only posterior extremity of glottis or only arytenoid cartilages seen

52
Q

Cormack-Lehane grade 3 can visualize

A

No part of the glottis and only epiglottis

53
Q

Cormack-Lehane grade 4 can visualize

A

No visualization of epiglottis

54
Q

Criteria for difficult mask ventilation include

A

OBESE

  • O -Obesity, BMI >30
  • B - beard
  • E - Edentulous (no teeth)
  • S - Snorer, OSA
  • E - Elderly (>55), male

Mallampati 3 or 4

55
Q

An awake intubation may be appropriate when

A

difficult airway, allows patient to maintain their own airway during intubation. Should be thoroughly planned

56
Q

If your attempt to intubate fails, what should be done next

A
  • Limit attempts, call for help
  • mask ventilate if possible
  • if masking not adequate, consider supraglottic airway (LMA)
  • consider waking the patient up and canceling case
57
Q

Emergency invasive airway should be performed

A

if still cant ventilate with mask or supraglottic airway

58
Q

Intubating early is best in which conditions

A

dynamic airways: only going to get worse over time
- bullets, neck trauma
- bites, anaphylaxis/angioedema
- burns, thermal and caustic airway injuries

59
Q

Which conditions would RSI be favorable compared to awake intubation

A
  • Urgency: peri-arrest, airway deteriorating
  • Airway features: known easy airway, normal anatomy
  • Vomiting risk: upper GI bleed, bowel obstruction, vomiting in ED
  • Sympatholysis risk
  • Apnea risk

paralyzed patients easy to intubate but cannot easily un-paralyze

60
Q

Medications to give with awake intubation

A
  • Glycopyrolate 0.2mg or Atropine 0.01mg/kg, 15min prior
  • Nebulized lidocane (WITHOUT EPI), 4mL 4% lido, or 8mL 2% lido
  • Atomized lidocaine
  • Viscous lidocaine
  • light sedation, Versed 2-4mg or Ketamine 20mg, precedex 20mcg
61
Q

The black stripe on a bougie is marked at _____ cm

A

25cm, should be at lips, mid trachea in adult male

62
Q

A risk of giving lots of opioids quickly is

A

stiff, rigid chest. difficulty ventilating

63
Q

When should succinylcholine be avoided

A
  • rhabdo/trauma patients
  • hyperkalemia
  • MS
  • muscular dystrophies
  • denervating injuries > 72hrs old (stroke, spinal cord inj)
  • burns >72hrs
  • Tetanus, botulism, and exotoxins
  • severe infections (esp. intra-abdominal)
  • predisposition to MH
  • bradycardia
  • increased ICP
64
Q

Contraindications for rocuronium

A

true allergy only

65
Q

Succinylcholine vs Rocuronium DOA

A

Sux= 5-10min
Rocuronium= 30-90min

66
Q

The 3 physiologic killers are

A

hypoxemia, hypotension, metabolic acidosis

67
Q

Succinylcholine onset

68
Q

What dose of rocuronium gives the same onset of succinylcholine

69
Q

What is appropriate dose of succinylcholine

70
Q

In emergent situations, which vasopressor should be the agent of choice

A

epinephrine, vasopressin good alternative if patient not responding to epi

71
Q

Why is phenylephrine less ideal to be used in emergent situations

A

increases vascular resistance and BP, but decreases cardiac output and venous return. Can cause reflex bradycardia

72
Q

Intervention 1 in emergency ventilating

A

Apneic CPAP recruitment
NC 15LPM+ BVM 15PM + PEEP Valve 5-15cmH20

If they’re breathing, just keep good seal

73
Q

In critically ill patients in which you cannot get O2 sats >95%, you should consider what?

A

shunt pathology, use Apneic CPAP recruitment

74
Q

Intervention 2 in emergency ventilating

A

Delayed sequence intubation (DSI)
Used for uncooperative or combative patient

  • Ketamine 1mg/kg IV -> preoxygenate -> paralyze -> Apneic oxygenation -> intubate
75
Q

Treatment of acidosis

A

Tenuous at best= bicarb (lowers H+ but increases CO2)
already tachypnic= increasing CO2 would worsen

VAPOX= ventilator assisted pre-oxygenation

76
Q

Ventilator Assisted Pre-oxygenation (VAPOX) includes:

A
  • Nasal cannula 15LPM
  • SIMV+PSV
  • RR 0
  • Vt 8mL/kg predicted body weight
  • PS 5-10cmH20
  • PEEP 5
  • inspiratory flow rate= 30LPM (normal vent set 60LPM; we want slower breaths to avoid insufflation of stomach)
  • decrease flow rate to avoid stomach insufflation
  • increase flow to compensate for mask leak
77
Q

If patient is high aspiration risk, what should be done prior to intubation

A

NGT to suction

Adv. Phys & Health Assessment (12 decks)

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