Airway Assessment, Views, Facts

Question 1

normal atlanto-occipital joint mobility

Answer 1

normal extension 35 degrees

Question 2

greater than 2/3 decrease of atlanto-occipital joint extension from normal is associated with ____

Answer 2

is associated with a Grade III or Grade IV view

Question 3

three axes of the larynx

Answer 3

oral
pharyngeal
laryngeal

Question 4

Airway “tests” (9)

Answer 4

Mallampati Class (I, II, III, IV & the oh so rare 0)
- 3 & 4 greater chance of difficult airway; dependent upon patient cooperation
Inter-incisor (3 finger breadths)
Thyromental distance; BAD <6cm, GOOD 3 fingers >7cm
Sternomental Distance; BAD <13cm, GOOD >14cm
Neck circumference; GOOD <45cm & BMI <40
Upper lip bite; Class 1, 2, 3 (whole lip, half lip, no lip bite)
Prayer Sign/Table top test; ↓ joint/cartilage mobility (atlanto-occipital joint involvement = ↓ ROM
Dentition; malnourished, drug abuse
Cervical mobility/ROM - atlanto-occipital joint mobility

Question 5

TMJ

Answer 5

ball and socket joint; mandible & maxilla
muscles, tendons, bones
Disorders: teeth grinding, nail biting, gum chewing, malocclusion, stress-clenched teeth, jaw trauma

Question 6

Patil’s test

Answer 6

Thyromental distance, head fully extended.
upper edge of thyroid to mentum;

BAD <6cm, GOOD 3 fingers >7cm

Question 7

cervical spine mobility / sniffing position

Answer 7

oral - pharyngeal - laryngeal axis alignment.

allows view of glottic opening

Question 8

dentition

Answer 8

loose, chipped, cracked, broken, removable
DOCUMENT
any crowns, implants, devices, removable objects?

Question 9

neck circumference suggestive of difficult intubation

Answer 9

> 45cm

BMI >40

Question 10

difficult mask prediction pneumonic (3)

Answer 10

Mask seal
Obesity
Age >55yr
No teeth
Stiff lungs

Beard
Obesity
No teeth
Elderly (>55 yr)
Snores

Facial hair
ROM 
Over 55 yr
Zzz (OSA / snore)
Edentulous
Neck surgery / trauma / radiation

Question 11

difficult intubation pneumonic (2)

Answer 11

Look for pathology
Evaluate 3-3-2 rule
Mallampati classification
Obstruction
Neck mobility (pain or tight?)

Look @ face/neck (mass, injury, bleed)
Evaluate (ROM, thickness, circumf, surgical Hx)
Thyromental distance
Incisors; opening; 3 fingers
Teeth (chips, cracks, loose, missing, dentures, braces)
Grade, Mallampati
Overbite (oral space, TMJ, tonsillar hypertrophy, abscess, mandibular compliance)

Question 12

beard will do 2 things

Answer 12

1. difficult to get mask seal

2. disguise potential difficult airway

Question 13

airway visual assessment

Answer 13

Identification of structures (hard & soft p, tonsils, faucial pillars, uvula, dentition, upper lip bite test, thyromental distance, sternomental? distance, neck circumference, mobility/ROM, interincisor distance)

Question 14

distance between incisors should be (adult)

Answer 14

mouth fully open, 30-40mm (2 large fingerbreaths)

Question 15

Mallampati sensitivity

Answer 15

60-80%

Question 16

Mallampati specificity

Answer 16

50-80%

Question 17

Mallampati positive predictive value

Answer 17

20% when used alone

Question 18

Mallampati Class I

Answer 18

hard palate, soft palate, fauces, tonsillar pillars, uvula visible

Question 19

Mallampati Class II

Answer 19

hard palate, soft palate, fauces, attachment of uvula

*tonsillar pillars and bottom of uvula hidden by base of the tongue

Question 20

Mallampati Class III

Answer 20

hard palate & soft palate, base of uvula

Question 21

Mallampati Class IV

Answer 21

hard palate visible only, NO soft palate

Question 22

Grade I view

Answer 22

full view of glottic opening

Question 23

Grade II view

Answer 23

posterior portion of glottic opening and arytenoid cartilage is visible

Question 24

Grade III view

Answer 24

only tip of epiglottis is visible

Question 25

Grade IV view

Answer 25

soft palate visible; no recognizable laryngeal structures

Question 26

most important mechanism of airway protection

Answer 26

glottic closure reflex

Question 27

laryngospasm

Answer 27

prolonged, intense glottic closure and an exaggeration of glottic closure reflex

Question 28

causes of laryngospasm (5)

Answer 28

• direct [glottic or supraglottic] stimulation
• secretions
• foreign bodies
• inhalation agents
• other noxious stimuli

Question 29

treatment of laryngospasm (4)

Answer 29

• remove the stimulus
• CPAP for mild, incomplete glottic closure
• deepen anesthetic
• muscle relaxants and intubation necessary for more severe cases

Question 30

upper airway obstruction can be treated by (4)

Answer 30

• head-tilt, chin-lift maneuver
• jaw thrust
• placement of oropharyngeal airway
• placement of nasopharyngeal airway

Question 31

difficult mask ventilation BMI

Answer 31

> 26kg/m^2

Question 32

Predicting difficult mask ventilation

MOANS

Answer 32

Mask seal
Obesity
Aged
No teeth
Snores

Question 33

predicting difficult intubation

LEMON

Answer 33

Look externally
Evaluate the mandibular space
Mallampati classification
Obstructions
Neck mobility

Question 34

stage 1 of anesthesia

Answer 34

LOC

Question 35

stage 2 of anesthesia

Answer 35

“hyper-excitable”

Question 36

stage 3 of anesthesia

Answer 36

Surgical anesthesia

Question 37

stage 4 of anesthesia

Answer 37

CV collapse

Question 38

difficult supraglottic device placement risk factors

Answer 38

R estricted mouth opening
O bstruction of the upper airway
D istorted airway preventing seal
S tiff lungs

Question 39

difficult invasive airway placement risk factors (CRICOTHYRODOTOMY)

Answer 39

D istortion of neck anatomy
O bestity or short neck
T rauma in or around the cricothyroid area
I mpediments causing limited access to the neck
S urgery causing limited access to anatomic landmarks

Question 40

short distance of Patil’s test implies visualization during intubation may be difficult d/t (3):

Answer 40

• more anterior larynx
• more acute angle
• less space to displace/ compress tongue