Airway Evaluation

Question 1

What are two major risk factors for a difficult airway?

Answer 1

Morbid obesity

Obstructive sleep apnea

Question 2

What type of position should we place the patient in prior to intubation?

Answer 2

Sniffing position

Question 3

Describe the importance of the Atlanta-occipital joint mobility?

Answer 3

Successful exposure of glottis during direct laryngoscopy requires aligning the oral, pharyngeal and laryngeal axis

Question 4

Elevating the patient’s head with a pillow aligns what two axes?

Answer 4

Pharyngeal and laryngeal

Question 5

What is the purpose of extending the head prior to intubation?

Answer 5

To create the shortest distance and most nearly straight line from the incisor teeth to the glottic opening

Question 6

What are the three axes of the larynx?

Answer 6

Oral
Pharyngeal
Laryngeal

Question 7

What is the normal amount of head extension required for optimal view?

Answer 7

normal extension is 35 degrees

Question 8

What Atlanto-occipital joint extension is associated with a grade III or IV view?

Answer 8

a greater than two-thrds decrease from normal

Question 9

What does temporo-mandibular mobility measure?

Answer 9

How widely can the patient open his/her mouth

Question 10

How is temper-mandibular mobility measured?

Answer 10

Distance between incisors in adults with mouth fully opened

Question 11

What is the typical distance of a fully opened mouth of an adult?

Answer 11

30-40mm (3 large finger-breaths)

Question 12

What is another method of assessing the temper-mandibular mobility other than mouth opening?

Answer 12

The ability to protrude the mandible

Question 13

What is the positive predictive value of Mallampati classification when used alone?

Answer 13

Positive predictive value 20% when used alone

Question 14

What is the premise of the Mallampati classification system?

Answer 14

Based on the assumption that when the base of the tongue is disproportionately large, the tongue overshadows the larynx, resulting in difficult exposure of the larynx during DVL

Question 15

What is a disadvantage to the Mallampati classification system?

Answer 15

Subject to inter-observer variability

Question 16

How should the Mallampati test be performed?

Answer 16

The patient is sitting up in a neutral position, open mouth as wide as they can, extrude tongue with no phonation

Question 17

What can nullify a Mallampati test?

Answer 17

Phonation gives false data

Question 18

How are Mallampati tests classified?

Answer 18

Class I: P-pillars, uvula, soft palate, hard palate
Class II: U- uvula, soft palate, hard palate
Class III: S- soft palate, hard palate
Class IV:H-hard palate only

Question 19

What can mandibular movement determine?

Answer 19

Indicates the available space for the tongue to be displaced anteriorly during DVL

Question 20

How do we measure the Thyromental distance?

Answer 20

Distance from the notch of the thyroid cartilage to the tip of the mentum

Question 21

What thyromental distance may indicate difficulty achieving cord visualization?

Answer 21

Distance less than 6cm (3 finger breaths)

Question 22

How does the provider check the thyromental distance?

Answer 22

Ask the patient to fully extend their head and close their mouth

Question 23

What problem does a short thyromental distance create?

Answer 23

Creates difficulty in aligning pharyngeal and laryngeal axes

Question 24

Where is the sternomental distance measured?

Answer 24

Distance between the sternal notch and mentum

Question 25

What sternomental distance is associated with difficult intubation?

Answer 25

Distance less than 13.5cm

Question 26

What dental issues may interfere with achieving optimal laryngoscopes view?

Answer 26

Prominent maxillary incisors or overbite

Question 27

What grading system is used to classify what is seen on a DVL?

Answer 27

Cormac Lagane grading scale

Question 28

What is seen on a Grade I view on the Cormac Lagane grading scale?

Answer 28

Full view of glottic opening

Question 29

What is seen on a Grade II view on the Cormac Lagane grading scale?

Answer 29

Posterior portion of glottic opening and arytenoid cartilage is visible

Question 30

What is seen on a Grade III view on the Cormac Lagane grading scale?

Answer 30

Only tip of epiglottis is visible

Question 31

What is seen on a Grade IV view on the Cormac Lagane grading scale?

Answer 31

Soft palate visible, no recognizable laryngeal structures

Question 32

What causes a laryngospasm?

Answer 32

Direct glottic or supraglottic stimulation including secretions, foreign bodies, inhaled agents and other noxious stimuli

Question 33

What steps should be taken to treat a laryngospasm?

Answer 33

Remove the stimulus
CPAP for mild, incomplete glottic closure
Deepen anesthetic
Muscle relaxants (intubation if serious)

Question 34

How much Sucs is required to break a laryngospasm?

Answer 34

10-20mg

Question 35

What is the purpose of coughing?

Answer 35

Expels secretions and foreign bodies from lower respiratory tract

Question 36

What are characteristics of a partial obstruction?

Answer 36

Diminished tidal volume
Retraction of upper chest
Snoring sound heard
Inspiratory stridor

Question 37

What are characteristics of a complete obstruction?

Answer 37

Lack of air movement or breath sounds

Diaphragmatic tugging, paradoxical movements

Question 38

How can soft tissue obstructions be treated?

Answer 38

Head-tilt, chin-lift maneuver or by jaw thrust (moves hyoid bone anteriorly and lifts epiglottis)

Question 39

How do oropharyngeal and nasopharyngeal function?

Answer 39

Provides an artificial passage behind the tongue