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TxWes Spring '25: Health assessment > Airway Assessment Exam 2 > Flashcards

Airway Assessment Exam 2 Flashcards

1
Q

How many turbinates are there? What are they called?

A

Three: Inferior, Middle, Superior

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2
Q

What is the preferred pathway for nasal airway devices?

A

the inferior meatus
Between Inferior turbinate + nasal cavity floor

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3
Q

What is necessary for bleeding reduction during nasal intubation?

A

Vasoconstrictors (ex. oxymetazoline (Afrin))

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4
Q

What makes up the anterior 2/3 of the roof of the mouth?

A
  • Hard palate (Maxilla + Palatine bone)
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5
Q

The pharynx extends from which structures?

A

Base of skull to lower border of cricoid cartilage.

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6
Q

What is the pharynx subdivided into?

A
  • Nasopharynx
  • Oropharynx
  • Hypopharynx
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7
Q

What is the primary cause of upper airway obstruction?
How do we treat it?

A

Loss of pharyngeal tone
Chin lift
increase tension in pharyngeal muscles

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8
Q

Where does upper airway obstruction occur most?

A

level of soft palate (velopharynx)
epiglottis, tongue

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9
Q

Nasopharynx begins and ends where?

A

Base of skull - soft palate

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10
Q

Oropharynx begins and ends where?

A

Soft palate - epiglottis

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11
Q

Hypopharynx begins and ends where?

A

epiglottis - cricoid cartilage

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12
Q

The larynx extends from which vertebrae?
What does the larynx do?

A
  • C4-C6
  • Inlet to trachea
  • Phonation
  • Airway protection
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13
Q

What is the larynx comprised of? (5)

A
  1. epiglottis
  2. supraglottis
  3. vocal cord
  4. glottis
  5. subglottis
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14
Q

What structure is indicated by 1 on the figure below?

A

Median glossoepiglottic fold

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15
Q

What structure is indicated by 2 on the figure below?

A

Lateral glossoepiglottic fold

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16
Q

What structure is indicated by 3 on the figure below?

A

Aryepiglottic fold

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17
Q

What structure is indicated by 4 on the figure below?

A

Ventricular fold

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18
Q

What structure is indicated by 5 on the figure below?

A

Vocal fold

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19
Q

What structure is indicated by 6 on the figure below?

A

Trachea

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20
Q

What structure is indicated by 7 on the figure below?

A

Corniculate Cartilage

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21
Q

What structure is indicated by 8 on the figure below?

A

Cuneiform Cartilage

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22
Q

What structure is indicated by 9 on the figure below?

A

Piriform Recess

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23
Q

What structure is indicated by 10 on the figure below?

A

Tubercle of Epiglottis

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24
Q

What structure is indicated by 11 on the figure below?

A

Epiglottis

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25
Q

What structure is indicated by 12 on the figure below?

A

Vallecula

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26
Q

Which laryngeal cartilages are unpaired? (3)

A
  • Thyroid cartilage (largest, supports soft tissue)
  • Cricoid cartilage
  • Epiglottis cartilage
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27
Q

Which laryngeal cartilages are paired? (3)

A
  • Arytenoid cartilage
  • Corniculate cartilage
  • Cuneiform cartilage
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28
Q

what is the only complete cartilaginous ring in the airway?

A

Cricoid cartilage

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29
Q

What is the role of the epiglottis?

A

Diverts food away from the larynx during swallowing

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30
Q

What do the true vocal cords attach to?

A

Arytenoids & thyroid notch on thyroid cartilage

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31
Q

Where is the false vocal cord?

A

Vestibular fold
sits superior to the true vocal cord

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32
Q

How far does the trachea span?
What supports it anteriorly and posteriorly?

A
  • inferior cricoid membrane - carina
  • 10 - 15 cm (adult)
  • Posterior: longitudinal trachealis muscle
  • Anterior: Tracheal rings
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33
Q

Is airway history or assessment more valuable?

A

Airway history

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34
Q

What portions of patient history can be a cause for airway concern? Which is most important?

A
  • Past difficult airway
  • Report of sore throat
  • Report of cut lip or broken tooth
  • Recent hoarseness
  • Hx of OSA (STOP-BANG)
  • Oral lesions
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35
Q

What is more important: ventilate or intubate?

36
Q

What is apneic oxygenation? What happens to CO2/O2?

A

Passive oxygenation in an apneic patient
Delays desaturation (O2)
May result in hypercarbia (CO2)

37
Q

What is a better indication of airway difficulty than BMI?

A

Short/thick neck >43 cm = difficult intubation

38
Q

What findings on visual inspection would indicate a potentially difficult airway?

A
  • Facial deformities
  • Head & neck cancers
  • Burns
  • Goiter
  • Short/Thick neck
  • Receding mandible
  • Large beard
  • C-collar
39
Q

What inter-incisor distance is best?

A

>6cm (3 finger breadths)

40
Q

Which oropharyngeal disformity will cause difficult intubation?

A

Macroglossia (big tongue)

41
Q

What deformity will cause difficult mask ventilation?

A

Edentulousness

42
Q

What tooth is the most likely to be injured during intubation?

A

Left incisors 47%

43
Q

What percent of insurance claims are due to dental injuries?

A

25%
75% of these occur during intubation

44
Q

What is the sniffing position? Why does it make intubation easier?

A

Cervical flexion and antlanto-occipital extension
Aligns oral, pharyngeal, and laryngeal axes.

45
Q

What technique is depicted below? Why is it used?

A

Ramping: used for positioning larger patients.

46
Q

What is the sternomental distance? What is an indicator of a potentially difficult airway?

A

Distance between sternal notch and chin with head fully extended and mouth closed.
> 12.5cm preferred

47
Q

What is thyromental distance measuring? What would be preferred?

A

Submandibular compliance (tip of chin to thyroid notch)
> 6.5cm preferred (3 finger breadths)

48
Q

How is prognathic ability measured? (2)

A
  • Upper lip bite test
  • extension of lower incisors beyond upper incisors
49
Q

What structures should be visible in a Mallampati class I?

A
  • Fauces
  • Tonsillar pillars
  • Entire uvula
  • Soft palate
50
Q

What should be visible in a Mallampati class II?

A
  • Fauces
  • portion of uvula
  • soft palate
51
Q

What should be visible in a Mallampati class III?

A
  • Base of uvula
  • soft palate
52
Q

What should be visible in a Mallampati class IV?

A

Only the hard palate

53
Q

What is BURP?

A
  • External laryngeal manipulation to facilitate intubation.
  • Backward
  • Upward
  • Rightward Pressure
54
Q

What is Optimal External Laryngeal Manipulation (OELM)?

A

Moving assistant hand over external neck until a proper view is seen.

55
Q

What Cormack-Lehane view is depicted below? What is visible with this view?

A

CL - 1
* Entire glottis is visible
* 68-74% frequency
* < 1% chance difficult intubation

56
Q

What Cormack-Lehane view is depicted below? What is visible with this view?

A

CL - 2
* Posterior of glottis is visible
* 3.3-24% frequency
* 4.3-67.4% chand difficult intubation

57
Q

What Cormack-Lehane view is depicted below? What is visible with this view?

A

CL - 3
* Only the epiglottis is visible
* 1.2-1.6% frequency
* 80-87.5% chance of difficult intubation

58
Q

What Cormack-Lehane view is depicted below? What is visible with this view?

A

CL - 4
* Epiglottis can’t be visualized
* very rare
* very likely difficult intubation

59
Q

What criteria can suggest difficulty with mask ventilation? (6)

A
  • Obesity (BMI>30)
  • Beard
  • Edentulous (no teeth)
  • Snorer (OSA)
  • Elderly male (>55)
  • Mallampati 3-4
60
Q

What is the BOOTS acronym?

A

Predictr of difficult intubation
Beard
Obesity
Older
Toothless
Sounds (OSA)

61
Q

What does LEMON evaluate in terms of difficult intubation?

A

Look (unusual anatomy)
Evaluate (3-3-2 rule)
Mallampati score
Obstruction/obesity
Neck mobility

62
Q

Overview of criteria for difficult airway (11)

A
  1. Large incisors
  2. strong overbite/inability to protrude mandible
  3. interincisor distance < 6cm
  4. mallampati 3-4
  5. large tongue
  6. narrow/high arch palate
  7. thyromental distance < 6.5cm
  8. sternomental distance < 12.5cm
  9. excess mandibular tissue
  10. short/thick neck
  11. limited neck ROM
63
Q

What to do: failed GA intubation but able to mask ventilate adequate as confirmed by CO2?

A

Non-emergent pathway
* limit attempts
* consider awakening patient
* Consider alternative approaches.

64
Q

What to do: failed GA intubation and unable to mask ventilate adequate?

A

Consider/attempt supraglottic airway (LMA)

65
Q

What to do: failed supraglottic airway (cannot intubate, cannot ventilate)?

A

Emergency pathway: call for help
attempt alternatives while preparing for emergency invasive airway
cricothyrotomy

66
Q

What criteria would suggest considering an awake intubation?

A
  • Suspected difficulty with mask ventilation or supraglottic
  • suspected difficult laryngoscopy
  • high risk of aspiration
  • high risk rapid desaturation
  • suspect difficult emergency invasive airway
67
Q

What factors would express a dynamic changing airway?

A
  • Bullets Neck trauma
  • Bites anaphylaxis/angioedema
  • Burns thermal/caustic injury
68
Q

When considering awake intubation, what options could you use to manage secretions?

A

Glycopyrolate 0.2mg (takes 15 min onset)
Suctions and pad dry with gauze.

69
Q

When is RSI indicated?

A
  • High risk for aspiration
  • GERD
  • NGT
  • Obese
  • Difficult BMV
  • Edentulous
  • Bearded
  • IV anesthetic + succinylcholine/rocuronium
70
Q

If you fail laryngoscopy what options should you consider?

A
  • Help
  • Indirect laryngoscopy (glidescope)
  • Introducer bougie
  • positioning
  • LMA
71
Q

Why might you avoid using etomidate for intubation?

A
  • Adrenal suppression
  • lowers seizure threshold.
72
Q

What might ketamine be a drug of choice for?

A
  • Hypotensive
  • asthmatics (bronchodilation effects).
73
Q

What are some key contraindications for succinylcholine? (5)

A
  • Rhabdo
  • hyperkalemia
  • neuromuscular disorders (MS, ALS)
  • malignant hyperthermia hx
  • burns
74
Q

What is the duration of action of succinylcholine?

A

5-10 min
very short acting
(weigh pros and cons)

75
Q

What is the duration of action of rocuronium?

A

30-90 min
lasts longer than sux

76
Q

What are the 3 main physiologic killers (as discussed in lecture)?

A
  • Hypotension
  • hypoxemia
  • metabolic acidosis
77
Q

What are the main purposes of sedation when intubating?

A
  • Blunt sympathetic surge
  • amnesia
78
Q

What is the best induction agent and paralytic for shock? Why?

A
  • Ketamine
  • Gives simultaneous sympathetic surge
  • pain control
  • avoid in tachycardic/HTN
  • rocuronium
79
Q

Why is rocuronium the preferred paralytic for the critically ill?

A
  • Rocuronium dosed at 1.6mg/kg IV
  • same onset of muscle relaxation as succinylcholine
  • gives a longer safe apnea time
80
Q

What are your two main amnestic agents?

A
  • Ketamine
  • versed
81
Q

How would you make push-dose Epi from a code stick?

A
  • Code stick: 1mg/10mL (0.1mg/mL or 100mcg/mL)
  • Dilute 1mL Epi (100 mcg/ml) with 9mL NS = 10mcg/mL
  • 10mcg pushes
82
Q

What options would you have with intubating a trauma pt with possible cervical injury?

A
  • Fiberoptic
  • glidescope to avoid movement
  • helper holding C-spine
  • awake intubation?
83
Q

What options would you have for intubating a high risk aspiration pt?

A
  • Sit up (gravity)
  • NGT - suction
  • RSI
84
Q

Conversion from french to mm?

A

Usually 4:1
28fr = 7.0mm.

85
Q

What does Ventilator Assisted Pre-Oxygenation (Vapox) treatment for acidosis entail?

A
  • NC 15 LPM, SIMV+PSV,
  • VT 8mL/kg, FiO2 80%
  • Pressure support 5-10cmH2O
  • PEEP- 5

TxWes Spring '25: Health assessment (10 decks)

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