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733 > Airway Assessment And Anatomy > Flashcards

Airway Assessment And Anatomy Flashcards

1
Q

List types of preanesthetic airway assessment

A

Mouth opening- incisor distance >3cm

Mallampati- PUSH

Thyromental distance- 332

Neck circumference <17cm

Upper lip bite test

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2
Q

What is the earliest indication of bronchial intubation?

A

High peak inspiratory pressures

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3
Q
A

Know IT

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4
Q

What is the larynx?

A

Part of respiratory tract between pharynx and trachea

Voice box

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5
Q

Cervical vertebrae location of larynx

A

C4-c6

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6
Q

3 single and 3 paired cartilages

A

Epiglottis
Thyroid
Cricoid

Arytenoid
Corniculate
Cuneiform

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7
Q

Types of cartilage in the airway

A

All major cartilages are hyaline cartilage

Exception: epiglottis is elastic cartilage

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8
Q

Describe surface anatomy of arytenoid cartilages

A

Apex
Anterolateral surface
Medial surface

Muscular process
Vocal process

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9
Q

Purpose of corniculate/ cuneiform cartilages

A

Support ary-epiglottic folds (swelling under mucosa are called tubercles)

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10
Q

Attachment points for epiglottis

A

Hyo-epiglottic ligament

Thyro-epiglottic ligament

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11
Q

Extrinsic ligaments

A

Thyrohyoid ligament (elevation of larynx during swallowing)

Cricothyroid ligament

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12
Q

Other name for laryngeal inlet

A

Aditus

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13
Q

How many vocal folds in the laryngeal cavity?

A

Vestibular folds

Vocal folds…

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14
Q

Term for the space between the vocal folds

A

Rima glottidis

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15
Q

2 parts of the fibro elastic membrane of the larynx

A

Quardangular membrane- supports vestibule between vestibular and vocal folds

Conus elasticus- superior, internal continuation of the cricothyroid ligament

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16
Q

Movement of arytenoids

A

Rotating
Gliding

Adduction- together
Abduction- apart

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17
Q

What are the four basic action of the “muscles of phonation”

A

Adduct
Abduct
Tense/relax
Close laryngeal inlet

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18
Q

Muscles that ABduct vocal cords and innervation

A

Posterior Crico-arytenoid muscles

Recurrent Laryngeal Nerve

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19
Q

Muscles that ADduct the vocal cords

A

Lateral crico-arytenoid muscles and transverse arytenoid muscles

Recurrent Laryngeal Nerve

Close rima glottidis

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20
Q

Muscles that tense the vocal cords and motor innervation

A

Cricothyroid muscles

External branch of the superior laryngeal nerve

Pull down and tilting forward of thyroid c

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21
Q

Fine, regional adjustments of tension on vocal cords

A

Vocalis muscles

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22
Q

Muscles that close the laryngeal inlet

A

Transverse arytenoid, ary-epiglottic, and thyro-epiglottic muscles

Recurrent LN

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23
Q

Blood supply to the larynx

A

Superior and inferior laryngeal arteries

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24
Q

All the nerves of the larynx

A

Vagus!! CN X

Superior laryngeal nerve (internal and external)

Recurrent laryngeal nerve

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25
Q

Explain motor innervation of larynx

A

RLN supplies all muscles EXCEPT

cricothyroid-external branch of superior laryngeal nerve

26
Q

Sensory innervation inferior to the vocal cords

A

Recurrent laryngeal nerve

27
Q

Sensory innervation superior to vocal cords

A

Internal branch of superior laryngeal nerve

INCLUDES vocal cords

28
Q

Lymph drainage pathways above and below vocal folds

A

Above: superior group of deep cervical nodes

Below: paratracheal and inferior group of deep cervical nodes

29
Q

5 steps of airway assessment

A

H&P

Assess intubation difficulty preop

Formulate multiple plans

Aspiration risk

Approximate risk of airway failure

30
Q

H&P of airway?

A

Previous issues

Congenital or anatomical issues

Visual inspection

Active pathologies

Weight changes

OSA

31
Q

Pierre robin

A

Micrognathia- small jaw
(Mandibular hypoplasia)
(Choanal atresia-narrowing of nasal passages)

Large tongue

32
Q

Treacher Collins

A

Cleft palate

Micrognathia

Recessed mandible

33
Q

Down syndrome-trisomy 21

A

Extreme variation

Redundant skin (neck)

Large tongue- acute angle

34
Q

Klippel-feil

A

Vertebral fusion

Can’t place spirals

35
Q

Cretinism

A

Caused by iodine deficiency during pregnancy

Goiters common

36
Q

Beckwith syndrome

A

VERY large tongue

37
Q

Cherubism

A

Cyst filled sacs in facial structures

38
Q

Neurofibromatosis type 1

A

Fairly common

Accompanies scoliosis commonly

39
Q

Croup

A

Barking cough

Inflammation/narrowing of upper airways

40
Q

Ludwig angina

A

Submandibular space infection (fluid sacs)

Push tongue up

41
Q

Acromegaly considerations

A

Instability in c1/c2

Longer tube

42
Q

Rheumatoid arthritis

A

Always elevate head, you can decapitate them

43
Q

Ankylosing spondylitis

A

Very painful inflammation of vertebrae resulting in fusion

44
Q

Aspiration risk chart

A
45
Q

Five airway measurements

A

Thyromental distance

Mouth opening

Mallampati score

Head and neck mobility

Ability to prognath

46
Q

Thyromental distance

A

3 fingers (6 cm)

47
Q

Cormack lehane

A

Grade 1: full view of glottic opening

Grade 2a- posterior portion of glottic opening

Grade 2b- epiglottis and arytenoids

Grade 3- epiglottis

Grade 4- nothing/palates

48
Q

Mallampati

A

1- uvula, pillars, hard and soft

2- pillars, hard and soft

3- hard and soft

4- hard only

49
Q

Which joint are we assessing in neck mobility

A

Atlantoaxial?

50
Q

ULBT

A

1- full bite

2- doesn’t cross vermillion border

3- can’t bite upper lip

51
Q

Best airway screening test?

A

ULBT

52
Q

Mask ventilation difficulty mneumonic

A

BONES

Beard

Obese BMI>26

No teeth

Elderly >55

Snoring

53
Q

Rapid airway assessment LEMON

A

LEMON

Look- malformations

Evaluate 332

Mallampati

Obstruction?

Neck mobility

Saturation

54
Q

Notes on preoxygenation

A

Tight fitting mask 5 minutes

10-12L flows

Gives you 8 min of apnea in healthy adult

55
Q

ASA minimum monitoring standards

A
56
Q

Four indications for awake intubation

A

Difficult mask ventilation

Significant risk of aspiration

Increased risk of rapid desaturation

Suspected difficult emergent airway

57
Q

Pharynx cranial nerves

A

Nasopharynx-trigeminal
Oropharynx- glossopharyngeal

Larynx- vagus nerve
-superior laryngeal nerve
External branch
Internal branch
Recurrent laryngeal nerve

58
Q

Also called the cricovocal ligament

A

Conus elasticus

Superior, internal continuation of cricothyroid ligament

59
Q

Differentiate between conus elasticus and quadrangular membranes in relation to vocal cords

A

Conus- inferior

Quad- superior

60
Q

Risk factors for airway assessment to get percentages

A

Mallampati >1 or =4

Mouth opening <4cm

Do they have teeth or history of difficult intubation

61
Q

Least to most sensitive muscle mnemonic

A

Very -vocal cords
Daring -diaphram
Octopuses -orbicularis oculi
Also - abdominal rectus
Admire- adductor pollicis
Mighty- masseter
Pearls - pharyngeal
Everyday- extraocular

733 (10 decks)

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