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Basics EXAm 1 > Airway assessment & Management > Flashcards

Airway assessment & Management Flashcards

1
Q

What is the primary passage for air into lungs

A

Nose

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2
Q

What allows for humidification & filtration of air?

A

Large surface area of the turbinates

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3
Q

Blood supply to the nose includes

A

Maxillary artery

Ophthalmic artery

Facial artery

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4
Q

What nerves innervate the nose

A

Maxillary & Ophthalmic branches of the Trigeminal nerve

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5
Q

Characteristics of the hard palate

A

Anterior 1/2-2/3 of the top of the mouth

Fixed

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6
Q

Characteristics of the Soft palate

A

Posterior 1/2-1/3 of the top of the mouth

Contributes to airway obstruction

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7
Q

What structures are apart of the oropharynx

A

Hard & soft palate

Tonsils

Tonsillar pillars

Uvula

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8
Q

The opening into the oropharynx is knows as the

A

Fauces, which is located behind the oral cavity

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9
Q

Identifying the _____ is important when using Mallampati

A

Fauces

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10
Q

What are the subdivisions of the pharynx?

A

TOP to BOTTOM

Nasopharynx

Oropharynx

Hypopharynx

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11
Q

The pharynx extends from the

A

Base of the skull to the cricoid cartilage

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12
Q

The Nasopharynx is at level

A

C1

Skull base superior

Soft palate inferior

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13
Q

The Oropharynx is at level

A

C2-3

Soft palate superior

Epiglottis is inferior

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14
Q

The Hypopharynx is at level

A

C5-6

Epiglottis superior

Cricoid cartilage inferior

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15
Q

The pharynx is innervated by

A

Superior Laryngeal Nerve (SLN)

Recurrent Laryngeal nerve (RLN)

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16
Q

The Internal Branch of the Superior Laryngeal Nerve provides

A

Sensory input to the hypopharynx above vocal cords

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17
Q

The External Branch of the Superior Laryngeal Nerve provides

A

Motor input to cricothyroid muscle

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18
Q

The recurrent laryngeal Nerve provides

A

Sensory innervation to subglottic area & trachea

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19
Q

The RIGHT Recurrent Laryngeal nerve loops around the

A

Subclavian Artery

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20
Q

The LEFT Recurrent Laryngeal nerve loops around

A

Aortic Arch

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21
Q

Unilateral injury to the Recurrent Laryngeal Nerve will cause

A

Vocal Cord paralysis on one side

Not problematic

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22
Q

Bilateral injury to the Recurrent Laryngeal nerve can casue

A

Unopposed adduction of the vocal cords, causing stridor & severe respiratory distress

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23
Q

Is injury to the Superior Laryngeal nerve a concern?

A

No

Not associated with respiratory distress

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24
Q

The larynx begins with the

A

Epiglottis & extends to the cricoid cartilage

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25
Q

What is the purpose of the larynx?

A

Phonation

Protects lower airway from aspiration

Provides gag & cough reflex

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26
Q

Blood supply to the larynx is provided by the

A

External carotid, which branches into the superior thyroid, then superior laryngeal artery (supraglottic) & inferior laryngeal artery (infraglottic)

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27
Q

The Larynx is composed of what 3 single cartilages?

A

Thyroid
Cricoid
Epiglottis

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28
Q

The larynx is composed of what 3 paired cartilages?

A

Arytenoid
Corniculate
Cuneiform

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29
Q

What comprises the larynx is all joined by

A

Ligaments, membranes & synovial joints that are suspended by the hyoid bone via the thyrohyoid ligaments & membrane

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30
Q

The cricoid cartilage is at the level of the

A

C6; anteriorly connected to the thyroid cartilage by the cricothyroid membrane

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31
Q

The cricoid cartilage is the only

A

Complete cartilaginous ring in the airway

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32
Q

The trachea begins at the level of the

A

Cricoid cartilage & extends to the carina; level T5

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33
Q

How many C-shaped rings?

A

16-20 rings, with trachealis muscle at the posterior side

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34
Q

In the adult, the RIGHT mainstem bronchus

A

Branches off at a more vertical angle than the left

Creates a likelihood of an ETT tube entering the right side

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35
Q

The diaphragm lies between the

A

Pleural & ABD cavities

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36
Q

Diaphragm is innverated by the

A

Phrenic nerve

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37
Q

Relaxation of the diaphragm causes

A

Exhalation

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38
Q

What assessment tools are used for the airway Exam?

A

Mallampati (assesses size of tongue relative to the oropharyngeal opening; airway visualization; class 1-4; PUSH; OSA)

TMD (from chin & thyroid cartilage; assess mandibular space)

ULBT

Dental

Neck ROM

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39
Q

The interincisor gap measurement refers to the

A

Distance between the upper & lower incisors when the mouth is open

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40
Q

An interincisor gap less than 3cm means

A

Difficult intubation

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41
Q

An interincisor gap greater than or equal to 6cm (3 finger-breadths) indicates

A

Good visualization

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42
Q

What is the 3-3-2 rule?

A

3 fingers between teeth
3 fingers from mandible to neck
2 fingers from hyoid to thyroid

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43
Q

The thyroidmental distance is measured from the

A

Thyroid notch to the lower border of the mentum at the tip of chin; identifies potential submandibular space

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44
Q

What is the Mandibular-Hyoid Distance (MHD)?

A

Used to evaluate the position of the larynx in relation to the base of the tongue

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45
Q

The MHD is measured from the

A

Junction of the mandible & neck to the tip of the thyroid notch

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46
Q

A MHD that is more than 2 finger breadths may indicate

A

A larynx that is too far down the neck

Difficult intubation

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47
Q

A MHD that is less than 2 finger breadths can indicate

A

A larynx that is tucked under the base of the tongue

Anterior position of the larynx

Challenging intubation

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48
Q

The Atlantooccipital joint mobility tests

A

Neck ROM

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49
Q

Pre-oxygenation is

A

Denitrogenation; filling lungs up with air

Allows for safe apneic time (up to 8 min)

take in good tidal volume for 3-5 min

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50
Q

What is the goal of fraction of expired O2?

A

Above 70%

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51
Q

What is the gold standard that ensures a good bag/mask ventilation?

A

Chest Rise
Fog
ETCO2

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52
Q

Where is the placement of a straight blade, like the MILLER?

A

Placed behind the epiglottis & gentle force is applied to lift it DIRECTLY

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53
Q

What is the placement when using a Miller blade?

A

Tip is placed in the VALLECULA & lifts the epiglottis indirectly

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54
Q

What is BURP glottic Manipulation?

A

Applying backward, upward, rightward pressure on the larynx to enhance vocal cord visualization

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55
Q

Most ETT are high_____ & low_____

A

High Volume
Low Pressure

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56
Q

When are cuffless ETTs often used?

A

Neonates & infants

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57
Q

Cuff pressure should be no more than

A

25cm H20

Should be monitored, especially when nitrous oxide (N2O) is used

58
Q

ETT is sized based on

A

Internal diameter

59
Q

The size of an ETT will affect

A

Airway resistance

WOB

Potential for Mucosal trauma

60
Q

What is the typical ETT size for a male? Female?

A

Male: 7.0-7.5

Female: 6.5-7

61
Q

The use of a smaller ETT will increase

A

Resistance

62
Q

Larger ETT will risk

A

Trauma & sore throat

63
Q

Armored tubes are used to

A

Prevent kinking (reinforced)

64
Q

Sniffing helps align

A

LA, OA & PA

65
Q

Cormack & Lehane grading system Grade 1?

A

Full view of glottic opening, including anterior commissure & posterior laryngeal cartilages

66
Q

Cormack & Lehane grading system Grade 2a?

A

Partial view of the vocal cords (anterior commissure not seen) & full view of posterior laryngeal cartilages

67
Q

Cormack & Lehane grading system Grade 2b?

A

Only posterior portion of the glottic opening can be seen (posterior laryngeal cartilages)

68
Q

Cormack & Lehane grading system Grade 3?

A

Only epiglottis can be seen; No portion of the glottic opening can be seen

69
Q

Cormack & Lehane grading system Grade 4?

A

Epiglottis cannot be seen; can only see soft palate

70
Q

What can minimize bleeding during nasotracheal intubation?

A

Applying a vasoconstrictor like phenylephrine or oxymetazoline

71
Q

Which way should the bevel of a nasal tube point?

A

facing away from the midline

72
Q

When inserting a nasotracheal tube, traction should be applied

A

Cephalad (upper)

73
Q

A difficult airway is one where a trained anesthetist struggles with

A

Facemask ventilation
Laryngoscopy
Intubation

74
Q

For an awake intubation, you need

A

Sedation
Block
Topicalization

75
Q

Benzocaine & Cetacaine are

A

Rapid & have a short duration

76
Q

What is a serious complication associated with Benzocaine?

A

Methemoglobinemia

77
Q

With a Glossopharyngeal block, where should the needle be placed?

A

0.25 to 0.5 cm where gutter meets the base of the palatoglossal arch

78
Q

In a Glossopharyngeal block, what should happen before injection?

A

Aspirate!

Air?-needle is too deep

Blood?- reposition needle more medially to avoid carotid artery

79
Q

How much anesthetic should be injected during a Glossopharyngeal block?

A

1-2mL of 2% lidocaine & repeat on opposite side

80
Q

The placement of a Glossopharyngeal block targets

A

Lingual branches of the glossopharyngeal nerve, providing sensory anesthesia to the posterior third of the tongue, upper larynx & inner surface of the tympanic membrane

81
Q

When placing a Superior Laryngeal block, what should be located & displaced?

A

Locate Hyoid bone & displace it toward injection side

82
Q

With a Superior Laryngeal block, where should the needle be inserted & advanced?

A

Insert perpendicular of skin & advance to the inferior border of the greater cornu

Walk needle off the caudal edge of hyoid bone until it contacts thyrohyoid membrane (will feel a bounce)

83
Q

When placing a Superior Laryngeal block, aspiration of blood may indicate

A

Intravascular placement

84
Q

How much & where should the anesthetic be placed when placing a Superior Laryngeal block?

A

1mL of 2% lidocaine above the thyrohyoid membrane, then advance needle 2-3 mm through membrane & inject additional 2mL of lidocaine

85
Q

The Superior Laryngeal block provides a

A

Dense block of the Supraglottic region by targeting the superior laryngeal nerve

86
Q

When placing a transtracheal block, what should be located?

A

The cricoid membrane by palpating the cricothyroid membrane with index & middle to identify

87
Q

How much anesthetic is needed with a transtracheal block?

A

3-5mL of 2% lidocaine

88
Q

Where should the needle be placed with a Transtracheal block?

A

Midline through the cricothyroid membrane in a caudal direction with continuously aspirating

When you see bubbles, the tip is in the tracheal lumen

Patient may cough

89
Q

What should happen with injection when performing a transtracheal block?

A

Ask patient to take a deep breath

Inspiration-inject into tracheal lumen (will cough & distribute anesthetic to VC)

90
Q

The transtracheal block provides local anesthetic directly to the

A

Trachea & VC

91
Q

Cricoid pressure is also known as

A

The Sellick maneuver

92
Q

The cricoid pressure involves applying pressure

A

To cricoid cartilage to prevent aspiration during the induction of general anesthesia

Occludes esophagus the prevent aspiration (RSI)

93
Q

How much force is applied with Cricoid Pressure?

A

10-20 Newtons before loss of consciousness & increase to 30-40 after loss of consciousness

94
Q

What position should the patient be in when performing Cricoid pressure?

A

20 degree angle

95
Q

What are the complications of Cricoid pressure?

A

Excessive force can cause discomfort & laryngeal injury

Vomiting

Cervical spine injury

Hinder visualization or intubation

96
Q

What is the primary use of an LMA

A

Can replace bag-mask ventilation during general anesthesia & is used in many surgical procedures

97
Q

An LMA can serve as a _________ for endotracheal intubation

A

Conduit

98
Q

Second generation LMAs provide

A

Aspiration prevention

Reinforced tips

Improved Cuff design (allows for more pressures)

Increased rigidity

99
Q

LMA cuff pressure should not exceed

A

60cm H2O

100
Q

What are the complications of placing an LMA

A

Overinflation (opens esophageal sphincter or cricoarytenoid muscle fatigue)

No seal

Laryngospasm

Aspiration

101
Q

The LMA ProSeal is the only LMA that can

A

Exceed 20mm water pressure for effective ventilation

102
Q

When can a Bougie be used?

A

When The glottic opening is hard to see

103
Q

How far should the Bougie be advanced?

A

Until the 25cm marking at the lip

104
Q

What should happen is you meet resistance when placing ETT?

A

Rotate 90 degrees to the left

105
Q

How is a person ventilated when using an airway exchange catheter

A

Jet ventilation; using jet insufflation with an airway exchange catheter may require muscle relaxation to prevent glottic closure

Oral airway can keep airway open

106
Q

Flexible intubating scopes (FIS0 use a

A

camera at the distal end to transmit images to an external screen

107
Q

How should a Glidescope be inserted?

A

Midline & into the vallecula

108
Q

The anesthesia machine uses what system?

A

Semi-closed circle system

Recycles a portion of the patient’s exhaled gas, presenting unique engineering challenges

109
Q

The Maquet Volume Reflector uses a system that

A

Uses a pneumatic pressure system to deliver ventilation

110
Q

What is the purpose & function of the Adjustable Pressure Limiting (APL) valve (pop off)

A

An adjustable relief valve used to manage the pressure within the anesthesia breathing circuit

vents Excess gas to the scavenging system & controls circuit pressure during spontaneous & manual ventilation modes

111
Q

What are advantages of deep extubation?

A

Reduced risk of gagging, coughing, & discomfort

112
Q

What are the disadvantages of deep exubation?

A

Respiratory depression

Delayed awakening

Difficult assessing airway reflexes

113
Q

What are the advantages of an awake extubation?

A

Patient can protect airway & breathe spontaneously

Useful when there is a history of difficult intubation or high aspiration risks

114
Q

What are the disadvantages of an awake extubation?

A

Increased CV stimulation & discomfort

Coughing & straining

115
Q

What are complication of Extubation?

A

Airway Obstruction (swelling, bleeding)

Respiratory depression/failure

Laryngospasm

Aspiration

CV instability

116
Q

What is a good extubation position for a patient at high risk for pulmonary aspiration?

A

Lateral Decubitus Position

117
Q

What is the purpose of applying positive pressure immediately before cuff deflation

A

Expels secretions collected above the cuff

118
Q

Upper airway obstruction after extubation can be due to

A

A weakened pharyngeal muscle, which can increase the risk of obstruction

119
Q

Response to hypoxia

A

Can be diminished

120
Q

What is a laryngospasm?

A

An involuntary reflex resulting in the contraction of laryngeal muscle, which can significantly affect airway management & patient safety

121
Q

Laryngospasm can cause

A

Bradycardia

Pulmonary edema

Pulmonary Aspiration

Desaturation/Hypoxemia

122
Q

What causes a laryngospasm?

A

Sensory stimulation of the vagus nerve (SLN is stimulated)

Muscle contraction (cricothyroid muscle tenses the VC- SLN while the thyroarytenoid & lateral cricothyroid muscle-RLN causes ADDUCTION of cords)

123
Q

What can overcome a laryngospasm?

A

Avoid stimualtion

Provide Positive Pressure

Jaw Thrust/Chin left

Give Lidocaine or Muscle relaxant

124
Q

What processes are involved with breathing

A

Neuropathways

Pressure Gradient

Chemoreceptors

Phrenic nerve

Need a pH balance

Kreb cycle

125
Q

Activation of the sympathetic system is due to

A

Superior Cervical Ganglion

Will cause vasoconstriction

125
Q

Activation of the parasympathetic system is caused by

A

CN 7 (facial) & pterygopalatine ganglion

Will cause vasodilation

126
Q

Mallampati acronym is

A

PUSH

127
Q

Roughly, how long does it take to wake up from propofol?

A

8 min

127
Q

The larynx is also called the

A

Adams Apple

128
Q

Which assessment tool gathers the most information?

A

The 3:3:2 interincisor Gap

129
Q

What makes bag mask ventilation difficult?

A

Beard

Obstruction/Obese/Old/OSA

No teeth

130
Q

Sequence of Induction?

A

Pre-oxygenate

Induction medication

Bag mask

NMB

DL/VL

131
Q

What is FRC?

A

Functional Residual Capacity

132
Q

What are the 3 distinct laryngoscopy procedures?

A

DL

VL

Tracheal intubation

133
Q

The BURP technique helps enchance

A

Vocal cord visualization

134
Q

Standard ETT are usually ______volume & _______pressure

A

High volume

Low Pressure

135
Q

What size is the universal adapter?

A

15mm

136
Q

Cuff pressure should be less than

A

25cmH2O

137
Q

Roughly, how many cc of air can go in the ETT cuff?

A

8-12cc

138
Q

What are the 3 benefits to an awake intubation?

A

Preserves Spontaneous Breathing

Improves Pharyngeal Anatomy

Increases Safety

139
Q

What are the 4 advances when using a Second Generation LMA?

A

Aspiration Prevention

Reinforced Tip

Improved Cuff design

increased Rigidity

Basics EXAm 1 (4 decks)

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