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Spr24 Assess Ex1&2 - Cornelius > Airway (Exam II) > Flashcards

Airway (Exam II) Flashcards

1
Q

How many turbinates are there?
What are their names?

A

Three
- Inferior
- Middle
- Superior

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2
Q

Which turbinate does the endotracheal tube pass through during a nasal intubation?

A
  • Inferior turbinate
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3
Q

What is necessary for bleeding reduction during nasal intubation?

A
  • Vasoconstrictors (ex. oxymetazoline)
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4
Q

What area is considered the pharynx?

A
  • Base of skull to lower border of cricoid cartilage.
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5
Q

What area is indicated by 1 on the figure below?

A

Nasopharynx

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6
Q

What area is indicated by 2 on the figure below?

A

Oropharynx

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7
Q

What area is indicated by 3 on the figure below?

A

Hypopharynx

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8
Q

What structure divides the oropharynx and the hypopharynx?

A
  • Epiglottis
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9
Q

Loss of pharyngeal muscle tone results in _________ _________.

A

Airway obstruction

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10
Q

Fill in the structures that compose the picture of the larynx below.

A
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11
Q

What structure is indicated by 1 on the figure below?

A
  • Median glossoepiglottic fold
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12
Q

What structure is indicated by 2 on the figure below?

A
  • Lateral glossoepiglottic fold
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13
Q

What structure is indicated by 3 on the figure below?

A
  • Aryepiglottic fold
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14
Q

What structure is indicated by 4 on the figure below?

A
  • Ventricular fold
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15
Q

What structure is indicated by 5 on the figure below?

A
  • Vocal fold
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16
Q

What structure is indicated by 6 on the figure below?

A
  • Trachea
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17
Q

What structure is indicated by 7 on the figure below?

A
  • Corniculate Cartilage
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18
Q

What structure is indicated by 8 on the figure below?

A
  • Cuneiform Cartilage
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19
Q

What structure is indicated by 9 on the figure below?

A
  • Piriform Recess
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20
Q

What structure is indicated by 10 on the figure below?

A
  • Tubercle of Epiglottis
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21
Q

What structure is indicated by 11 on the figure below?

A
  • Epiglottis
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22
Q

What structure is indicated by 12 on the figure below?

A
  • Vallecula
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23
Q

What is the purpose of the larynx?

A
  • Inlet to trachea
  • Phonation
  • Airway protection
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24
Q

Which laryngeal cartilages are unpaired?

A
  • Thyroid cartilage (largest, supports soft tissue)
  • Cricoid cartilage
  • Epiglottis cartilage
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25
Q

Which laryngeal cartilages are paired?

A
  • Arytenoid cartilage
  • Corniculate cartilage
  • Cuneiform cartilage
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26
Q

What do the vocal cords attach to?

A
  • Arytenoid muscles & cartilage
  • Thyroid at thyroid notch
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27
Q

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

A
  • From the inferior cricoid membrane to the carina (10 - 15 cm).
  • Posterior: longitudinal trachealis muscle
  • Anterior: Tracheal rings
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28
Q

Is airway history or assessment more valuable?

A
  • Airway history
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29
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
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30
Q

What is a better indication of airway difficulty than BMI?

A
  • Thick neck greater than 43cm
31
Q

What factors that are assessed visually would give one concern for a potentially difficult airway?

A
  • Facial deformities
  • Head & neck cancers
  • Burns
  • Goiter
  • Short/Thick neck
  • Receding mandible
  • Large beard
  • C-collar
32
Q

What inter-incisor distance is best?

A
  • > 6cm (3 finger breadths)
33
Q

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

A
  • Cervical flexion and antlanto-occipital extension, ear to sternal notch
  • Aligns oral, pharyngeal, and laryngeal axes.
34
Q

What technique is depicted below?
Why is it used?

A
  • Ramping: used for positioning larger patients.
35
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.
  • Less than 12.5 cm = potentially difficult
36
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)
37
Q

How is prognathic ability measured?

A
  • Upper lip bite test (assesses how much lower incisors can extend beyond upper incisors)
38
Q

What structures should be visible in a Mallampati class I?

A
  • Fauces
  • Tonsillar pillars
  • Entire uvula
  • Soft palate
39
Q

What should be visible in a Mallampati class II?

A
  • Fauces, portion of uvula, and soft palate
40
Q

What should be visible in a Mallampati class III?

A
  • Base of uvula and soft palate
41
Q

What should be visible in a Mallampati class IV?

A
  • Only the hard palate
42
Q

What is BURP?

A

External laryngeal manipulation- Backward, Upward, and Rightward pressure to facilitate intubation.

43
Q

What is Optimal External Laryngeal Manipulation (OELM) ?

A
  • Moving someone else’s hand over external neck until a proper view is seen.
44
Q

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

A
  • CL - 1
  • Entire glottis is visible
45
Q

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

A
  • CL - 2
  • Posterior of glottis is visible
46
Q

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

A
  • CL - 3
  • Only the epiglottis is visible
47
Q

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

A
  • CL - 4
  • Epiglottis can’t be visualized.
48
Q

What criteria can suggest difficulty with mask ventilation?

A

Obesity (BMI>30)
Beard
Edentulous (no teeth)
Snorer (OSA)
Elderly (>55)

49
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

50
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.

51
Q

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

A

consider/attempt supraglottic airway

52
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.

53
Q

What criteria would suggest considering an awake intubation?

A
  • Suspected difficulty with mask ventilation or supraglottic
  • high risk of aspiration
  • high risk rapid desaturation
  • suspect difficult emergency invasive airway
54
Q

What factors would express a dynamic changing airway?

A
  • neck trauma (bullet)
  • anaphylaxis/angioedema
  • thermal/caustic injury (burns)
55
Q

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

A

*glycopyrolate 0.2mg (takes 15 min onset)
*suction and pad dry with gauze

56
Q

If you fail laryngoscopy what options should you consider?

A
  • help
  • glidescope
  • bougie
  • positioning
  • LMA
57
Q

Why might you avoid using etomidate for intubation?

A
  • adrenal suppression
  • lowers seizure threshold
58
Q

What might ketamine be a drug of choice for?

A
  • hypotensive
  • asthmatics (bronchodilation effects)
59
Q

What are some key contraindications for succinylcholine? (5)

A
  • rhabdo
  • hyperkalemia
  • Neuromuscular disorders (MS, ALS)
  • Malignant Hyperthermia hx
  • Burns
60
Q

What is the duration of action of succinycholine?

A

5-10 min

61
Q

What is the duration of action of rocuronium?

A

30-90 min

62
Q

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

A
  • Hypotension
  • Hypoxemia
  • Metabolic Acidosis
63
Q

What are the main purposes of sedation when intubating?

A

blunt sympathetic surge and provide amnesia

64
Q

What might be a good drug of choice for shock? Why?

A

Ketamine
-gives simultaneous sympathetic surge

65
Q

What are your two main amnestic agents?

A

ketamine and versed

66
Q

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

A

Code stick: 1mg/10mL (0.1mg/mL) = 100mcg/mL => dilute 1mL Epi with 9mL = 10mcg/mL
10mcg pushes

67
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
68
Q

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

A
  • sit up (gravity)
  • NGT - suction
  • RSI
69
Q

Conversion from french to mm?

A

usually 4:1
28fr = 7.0mm

70
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
71
Q

What makes up the anterior 2/3 of the roof of the mouth? What bones does this consist of?

A
  • Hard palate
  • maxilla & palatine bone
72
Q

Where does the nasopharynx end? What is another term for nasopharynx?

A
  • soft palate
  • velopharynx
73
Q

What area does the hypopharynx span?

A

epiglottis to the cricoid cartilage

Spr24 Assess Ex1&2 - Cornelius (26 decks)

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