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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
What structure is indicated by 12 on the figure below?
Vallecula
26
Which laryngeal cartilages are **unpaired**? (3)
* **Thyroid** cartilage (largest, supports soft tissue) * **Cricoid** cartilage * **Epiglottis** cartilage
27
Which laryngeal cartilages are **paired**? (3)
* **Arytenoid** cartilage * **Corniculate** cartilage * **Cuneiform** cartilage
28
what is the only complete cartilaginous ring in the airway?
Cricoid cartilage
29
What is the role of the epiglottis?
Diverts food away from the larynx during swallowing
30
What do the true vocal cords attach to?
**Arytenoids** & **thyroid notch** on thyroid cartilage
31
Where is the false vocal cord?
Vestibular fold sits **superior** to the true vocal cord
32
How far does the **trachea** span? What **supports** it anteriorly and posteriorly?
* **inferior cricoid membrane** - **carina** * **10 - 15 cm (adult)** * Posterior: **longitudinal trachealis muscle** * Anterior: **Tracheal rings**
33
Is airway history or assessment more valuable?
Airway history
34
What portions of patient history can be a cause for airway concern? Which is most important?
* Past difficult airway * Report of sore throat * Report of cut lip or broken tooth * Recent hoarseness * Hx of OSA (STOP-BANG) * Oral lesions
35
What is more important: ventilate or intubate?
Ventilate
36
What is apneic oxygenation? What happens to CO2/O2?
**Passive** oxygenation in an **apneic** patient **Delays** desaturation (O2) May result in **hypercarbia** (CO2)
37
What is a better indication of airway difficulty than BMI?
**Short/thick neck >43 cm** = difficult intubation
38
What findings on **visual inspection** would indicate a potentially difficult airway?
* Facial deformities * Head & neck cancers * Burns * Goiter * **Short/Thick neck** * Receding mandible * Large beard * C-collar
39
What inter-incisor distance is best?
**>6cm** (3 finger breadths)
40
Which oropharyngeal disformity will cause difficult intubation?
Macroglossia (big tongue)
41
What deformity will cause difficult **mask ventilation**?
Edentulousness
42
What tooth is the most likely to be injured during intubation?
Left incisors 47% anterior maxillary central and lateral incisors
43
What percent of insurance claims are due to **dental injuries**?
**25%** 75% of these occur during intubation
44
What is the sniffing position? Why does it make intubation easier?
**Cervical flexion** and antlanto-occipital **extension** Aligns **oral**, **pharyngeal**, and **laryngeal** axes.
45
What technique is depicted below? Why is it used?
**Ramping**: used for positioning larger patients.
46
What is the **sternomental distance**? What is an indicator of a potentially difficult airway?
Distance between **sternal notch** and **chin** with head fully extended and mouth closed. **> 12.5cm** preferred
47
What is **thyromental distance** measuring? What would be preferred?
**Submandibular compliance** (tip of chin to thyroid notch) **> 6.5cm preferred (3 finger breadths)**
48
How is **prognathic ability** measured? (2)
* Upper lip bite test * extension of lower incisors beyond upper incisors
49
What structures should be visible in a **Mallampati class I**?
* Fauces * Tonsillar pillars * Entire uvula * Soft palate
50
What should be visible in a **Mallampati class II**?
* Fauces * portion of uvula * soft palate
51
What should be visible in a **Mallampati class III**?
* Base of uvula * soft palate
52
What should be visible in a **Mallampati class IV**?
Only the hard palate
53
What is BURP?
* External laryngeal manipulation to facilitate intubation. * **Backward** * **Upward** * **Rightward Pressure**
54
What is Optimal External Laryngeal Manipulation (OELM)?
Moving **assistant hand** over external neck until a proper view is seen.
55
What Cormack-Lehane view is depicted below? What is visible with this view?
**CL - 1** * Entire **glottis** is visible * **68-74%** frequency * **< 1%** chance difficult intubation
56
What Cormack-Lehane view is depicted below? What is visible with this view?
**CL - 2** * **Posterior of glottis** is visible * **3.3-24%** frequency * **4.3-67.4%** chand difficult intubation
57
What Cormack-Lehane view is depicted below? What is visible with this view?
**CL - 3** * Only the **epiglottis** is visible * **1.2-1.6%** frequency * **80-87.5%** chance of difficult intubation
58
What Cormack-Lehane view is depicted below? What is visible with this view?
**CL - 4** * **Epiglottis** can’t be visualized * **very rare** * **very likely** difficult intubation
59
What criteria can suggest difficulty with **mask ventilation**? (6)
* **O**besity (BMI>30) * **B**eard * **E**dentulous (no teeth) * **S**norer (OSA) * **E**lderly male (>55) * **M**allampati 3-4
60
What is the BOOTS acronym?
Predictr of difficult intubation **B**eard **O**besity **O**lder **T**oothless **S**ounds (OSA)
61
What does **LEMON** evaluate in terms of difficult intubation?
**L**ook (unusual anatomy) **E**valuate (3-3-2 rule) **M**allampati score **O**bstruction/obesity **N**eck mobility
62
Overview of criteria for difficult airway (11)
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 8. excess mandibular tissue 9. short/thick neck 10. limited neck ROM
63
What to do: failed GA intubation but **able to mask ventilate** adequate as confirmed by CO2?
**Non-emergent pathway** * limit attempts * consider awakening patient * Consider alternative approaches.
64
What to do: failed GA intubation and **unable to mask ventilate** adequate?
Consider/attempt **supraglottic airway** (LMA)
65
What to do: **failed supraglottic airway** (cannot intubate, cannot ventilate)?
**Emergency pathway: call for help** attempt alternatives while preparing for **emergency invasive airway** **cricothyrotomy**
66
What criteria would suggest considering an **awake intubation**?
* Suspected difficulty with mask ventilation or supraglottic * suspected difficult laryngoscopy * high risk of aspiration * high risk rapid desaturation * suspect difficult emergency invasive airway
67
What factors would express a **dynamic changing airway**?
* **Bullets** Neck trauma * **Bites** anaphylaxis/angioedema * **Burns** thermal/caustic injury
68
What is the best treatment for a dynamic changing airway?
**Intubate early (RSI)** Inflammation will get worse with time
69
RSI is inappropriate in what conditions?
* Known difficult airway * cannot open mouth * fixed neck ROM * NMS disease
70
When is RSI appropriate?
* peri-arrest * dynamic airway * easy/normal anatomy * GI bleed * SBO/aspiration
71
What does the awake technique incorporate?
* Glycopyrolate 0.2mg (takes 15 min onset) * lidocaine with epi 4%/4ml (neb/atomized/viscous) * versed 2-4mg or ketamine 20 mg
72
When is RSI indicated?
* High risk for aspiration * GERD * NGT * Obese * Difficult BMV * Edentulous * Bearded * IV anesthetic + succinylcholine/rocuronium
73
If you **fail laryngoscopy** what options should you consider?
* Help * Indirect laryngoscopy (glidescope) * Introducer bougie * positioning * LMA
74
Why might you avoid using **etomidate** for intubation?
* Adrenal suppression * lowers seizure threshold.
75
What might **ketamine** be a drug of choice for?
* Hypotensive * asthmatics (bronchodilation effects).
76
What are some key contraindications for succinylcholine? (5)
* Rhabdo * hyperkalemia * neuromuscular disorders (MS, ALS) * malignant hyperthermia hx * burns
77
What is the duration of action of succinylcholine?
5-10 min very short acting (weigh pros and cons)
78
What is the duration of action of rocuronium?
30-90 min lasts longer than sux
79
What are the 3 main physiologic killers (as discussed in lecture)?
* Hypotension * hypoxemia * metabolic acidosis
80
What are the main purposes of sedation when intubating?
* Blunt sympathetic surge * amnesia
81
What is the best **induction** agent and **paralytic** for **shock**? Why?
* **Ketamine** * Gives simultaneous sympathetic surge * pain control * avoid in tachycardic/HTN * **rocuronium**
82
Why is **rocuronium** the preferred paralytic for the critically ill?
* Rocuronium dosed at **1.6mg/kg IV** * same onset of muscle relaxation as succinylcholine * gives a longer safe apnea time
83
What are your two main amnestic agents?
* Ketamine * versed
84
How would you make push-dose Epi from a code stick?
* Code stick: **1mg/10mL** (0.1mg/mL or 100mcg/mL) * Dilute **1mL Epi (100 mcg/ml)** with **9mL NS** = **10mcg/mL** * **10mcg pushes**
85
What options would you have with intubating a trauma pt with possible **cervical injury**?
* Fiberoptic * glidescope to avoid movement * helper holding C-spine * awake intubation?
86
What options would you have for intubating a high risk aspiration pt?
* Sit up (gravity) * NGT - suction * RSI
87
Conversion from french to mm?
Usually 4:1 28fr = 7.0mm.
88
What does Ventilator Assisted Pre-Oxygenation (Vapox) treatment for acidosis entail?
* NC 15 LPM, SIMV+PSV, * VT 8mL/kg, FiO2 80% * Pressure support 5-10cmH2O * PEEP- 5

TxWes Spring '25: Health assessment (19 decks)

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