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Physical & Health Assessment COPY - Grayson > Airway (Exam II) > Flashcards

Airway (Exam II) Flashcards

1
Q

How many turbinates are there?
What is another name for turbinates?

A

Three (also known as meatus)
- 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-afrin, neosynephrine)

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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 vertebrae corresponds with the very bottom of the larynx?

A

6th vertebrae

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24
Q

What is the purpose of the larynx?

A
  • Inlet to trachea
  • Phonation
  • Airway protection
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25
Q

Which laryngeal cartilages are unpaired?

A
  • Thyroid (largest, supports soft tissue)
  • Cricoid
  • Epiglottis
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26
Q

Which laryngeal cartilages are paired?

A
  • Arytenoid
  • Corniculate
  • Cuneiform
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27
Q

What do the vocal cords attach to?

A
  • Arytenoid muscles & cartilage
  • Thyroid at thyroid notch
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28
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 (c-shaped, bougie intubation)
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29
Q

Is airway history or assessment more valuable?

A

Airway history

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30
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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31
Q

What is a better indication of airway difficulty than BMI?

A

Thick neck greater than 43cm

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32
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
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33
Q

What inter-incisor distance is best?

A

> 6cm (3 finger breadths)

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34
Q

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

A
  • Cervical flexion and antlanto-occipital extension
  • Aligns oral, pharyngeal, and laryngeal axes.
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35
Q

What technique is depicted below?
Why is it used?

A

Ramping: used for positioning larger patients.

Ear to sternal notch

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36
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
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37
Q

What is thyromental distance measuring?
What would be preferred?

A
  • Submandibular compliance (tip of chin to thyroid notch)
  • > 6.5cm preferred
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38
Q

How is prognathic ability measured?

A

Upper lip bite test (assesses how much lower incisors can extend beyond upper incisors)

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39
Q

What structures should be visible in a Mallampati class I?

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

comparing tongue to oropharyngeal space

40
Q

What should be visible in a Mallampati class II?

A
  • Fauces
  • Portion of uvula
  • Soft palate
41
Q

What should be visible in a Mallampati class III?

A
  • Base of uvula
  • Soft palate
42
Q

What should be visible in a Mallampati class IV?

A

Only the hard palate

43
Q

What is BURP?

A

Backward, Upward, and Rightward Pressure on larynx to facilitate intubation

44
Q

What is Optimal External Laryngeal Manipulation (OELM) ?

A

Moving someone else’s hand over external neck until a proper view is seen

45
Q

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

A
  • CL - 1
  • Entire glottis is visible
46
Q

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

A
  • CL - 2
  • Posterior of glottis is visible
47
Q

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

A
  • CL - 3
  • Only the epiglottis is visible
48
Q

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

A
  • CL - 4
  • Epiglottis can’t be visualized.
49
Q

What forms the medial wall of each nasal passage (fossae)?

A

Nasal Septum

50
Q

What forms the hard palate of the mouth?

A

Part of maxilla and palantine bone

2/3 of anterior roof of mouth

51
Q

What’s one manuevar you can do to prevent pharyngeal muscle airway collapse?

A

Chin lift with mouth closure

52
Q

What area is considered the larynx?

A

Epiglottis to lower end of cricoid cartilage

inlet to trachea

53
Q

How do you assess mandibular prognathism?

A

Have pt slide mandible anteriorly

54
Q

What is edentulousness?

A

Having no teeth

Difficult mask ventilation

55
Q

What teeth are most likely to get injured?

A

Anterior maxillary center and lateral incisors

56
Q

Why are teeth more frequently knocked out on the left?

A

The blade

57
Q

Position for laryngoscopy

A

ear to sternal notch

suction ready

58
Q
A

Class I

59
Q
A

Class II

60
Q
A

Class III

61
Q
A

Class IV

62
Q

What is Cromack-Lehane classification?

A

Classification of laryngeal view

63
Q

Criterial associated w/difficult mask ventilation

A

O: Obesity
B: Beard
E: Edentulous
S: Snorer, OSA
E: Elderly, male
& Mallampati 3/4

64
Q

What does BOOTS stand for?

A

B: Beard
O: Obesity
O: Older
T: Toothless
S: Sounds - snoring, stridor
Indicators of difficult airway

65
Q

What does LEMONS stand for?

A

L: Look (abnormal face, trauma, unusual anatomy)
E: Evaluate 3-3-2 rule
M: Mallampati score
O: Obstruction/Obesity
N: Neck mobility

66
Q

All criteria associated with difficult airway

A

Large upper incisiors
Strong overbite
Inability to protrude mandible
Small inter-incisor distance (<6 cm)
Mallampati 3/4
Large tongue
Narrow or high-arched palate
Short thyromental distance (<6.5 cm)
Excessive mandibular soft tissue
Short, thick neck
Decreased cervical range of motionap

67
Q

How is adequate mask ventilation assessed?

A

CO2

68
Q

What are 5 things you will consider when deciding on awake intubation or intubation after induction?

A
  • Suspected difficult laryngoscopy
  • Suspected difficult ventilation
  • Significant increased risk of aspiration
  • Increased risk of desaturation
  • Suspected difficult emergency invasive airway

If yes to any of the above = awake intubation

69
Q

If you fail at an attempted awake intubation what do you do?

A

Consider other options

70
Q

If you fail an attempted awake intubation and fail at “other options” what do you do?

A

Postpone case

71
Q

What is your first step after failed intubation attempt following induction?

A

Consider calling for help
Limit attempts

72
Q

After failed intubation following induction you are not able to adequately mask ventilate, what do you do now?

A

Consider supraglottic airway

73
Q

What is one thing you do with both awake and induced intubation?

A

Optomize oxygenation throughout

74
Q

You have induced, failed to intubate, failed to bag, but successfully placed a supraglottic airway. Now what do you do?

A

Limit attempts, consider waking patient and consider other options

Non-emergent pathway

75
Q

You induced, failed to intubate, failed to bag, failed to place a supraglottic airway… now what do you do?

A
  • Call for help
  • Limit attempts & beware of time
  • Consider invasive access

Emergency pathway because you suck at anesthesia

76
Q

3 B’s of dynamic airways

A

Bullets
Bites
Burns

77
Q

RSI or Awake

Known easy airway
Normal anatomy

A

RSI

78
Q

RSI or Awake

Upper GI bleed

A

RSI

79
Q

RSI or Awake

Bowel obstruction

A

RSI

aspiration

80
Q

RSI or Awake

Stable GI bleed requiring endo and slow progressive neuromuscular weakness requiring transfer

A

Awake

81
Q

RSI or Awake

Flixed flexion deformity of the neck, cannot open mouth

A

Awake

82
Q

If you fail to intubate what should you do?

A

Change something, don’t try again without adjusting

83
Q

Where is the black line on the bougie?

A

25 cm

84
Q

Which patients can’t you use SUX on?

A

Rhabdo
Hyperkalemia
ALS, MS
Stroke/spinal injury > 72hrs old
Burns > 72hrs old
Tetanus, botulism, severe infection
Immobilization
MH
Bradycardia
Fasciculation
Masseter spasm

85
Q

Contraindications to ROC

A
  • Allergy
  • Longer DOA
  • Suggamadex not avalible
86
Q

DOA SUX

A

5-10 min

87
Q

DOA ROC

A

30-90 min

88
Q

Intubation is not a cause of death but what physiologic killers surounding intubation are?

A

Hypotension
Hypoxia
Metabolic acidosis

Resuscitate before you intubate!

89
Q

Induction agent of choice in shock patients & dose

A

Ketamine
1-2 mg/kg
reduce to 0.5 mg/kg in shock pts

90
Q

Paralytic agent of choice in shock patients & dose

A

ROC
1.6 mg/kg

longer safe apnea time

91
Q

Push dose pressor of choice

A

Epinephrine

Alpha & Beta

92
Q

Intervention 1 (hypoxia)

A

NC 15 LPM
BVM 15 LPM
PEEP 5-15 cmH2O

93
Q

Intervention 2 (hypoxia)

A
  • DSI (delayed sequence intubation)
  • procedural sedation for preoxygenation
    ketamine 1mg/kg -> preoxygenate -> paralyze -> apneic oxygenation -> intubate
94
Q

Intervention 3 (hypoxia)

A

BUHE (back up head elevated) intubation

95
Q

Intervention 1 (acidosis)

A

Bicarb

make sure you’re ventilating well

96
Q

Intervention 2 (acidosis)

A

VAPOX - ventilator assisted pre-oxygenation

Physical & Health Assessment COPY - Grayson (24 decks)

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