Airway (Exam II) Flashcards
How many turbinates are there?
What is another name for turbinates?
Three (also known as meatus)
- Inferior
- Middle
- Superior
Which turbinate does the endotracheal tube pass through during a nasal intubation?
- Inferior turbinate
What is necessary for bleeding reduction during nasal intubation?
- Vasoconstrictors (ex. oxymetazoline)
What area is considered the pharynx?
- Base of skull to lower border of cricoid cartilage.
What area is indicated by 1 on the figure below?
Nasopharynx
What area is indicated by 2 on the figure below?
Oropharynx
What area is indicated by 3 on the figure below?
Hypopharynx
What structure divides the oropharynx and the hypopharynx?
- Epiglottis
Loss of pharyngeal muscle tone results in _________ _________.
Airway obstruction
Fill in the structures that compose the picture of the larynx below.
What structure is indicated by 1 on the figure below?
- Median glossoepiglottic fold
What structure is indicated by 2 on the figure below?
- Lateral glossoepiglottic fold
What structure is indicated by 3 on the figure below?
- Aryepiglottic fold
What structure is indicated by 4 on the figure below?
- Ventricular fold
What structure is indicated by 5 on the figure below?
- Vocal fold
What structure is indicated by 6 on the figure below?
- Trachea
What structure is indicated by 7 on the figure below?
- Corniculate Cartilage
What structure is indicated by 8 on the figure below?
- Cuneiform Cartilage
What structure is indicated by 9 on the figure below?
- Piriform Recess
What structure is indicated by 10 on the figure below?
- Tubercle of Epiglottis
What structure is indicated by 11 on the figure below?
- Epiglottis
What structure is indicated by 12 on the figure below?
- Vallecula
What vertebrae corresponds with the very bottom of the larynx?
- 6th vertebrae
What is the purpose of the larynx?
- Inlet to trachea
- Phonation
- Airway protection
Which laryngeal cartilages are unpaired?
- Thyroid (largest, supports soft tissue)
- Cricoid
- Epiglottis
Which laryngeal cartilages are paired?
- Arytenoid
- Corniculate
- Cuneiform
What do the vocal cords attach to?
- Arytenoid muscles & cartilage
- Thyroid at thyroid notch
How far does the trachea span?
What supports it anteriorly and posteriorly?
- From the inferior cricoid membrane to the carina (10 - 15 cm).
- Posterior: longitudinal trachealis muscle
- Anterior: Tracheal rings (bougie intubation)
Is airway history or assessment more valuable?
- Airway history
What portions of patient history can be a cause for airway concern? Which is most important?
- Past difficult airway
- Report of sore throat
- Report of cut lip or broken tooth
- Recent hoarseness
- Hx of OSA
What is a better indication of airway difficulty than BMI?
- Thick neck greater than 43cm
What factors that are assessed visually would give one concern for a potentially difficult airway?
- Facial deformities
- Head & neck cancers
- Burns
- Goiter
- Short/Thick neck
- Receding mandible
- Large beard
- C-collar
What inter-incisor distance is best?
- > 6cm (3 finger breadths)
What is the sniffing position?
Why does it make intubation easier?
- Cervical flexion and antlanto-occipital extension
- Aligns oral, pharyngeal, and laryngeal axes.
What technique is depicted below?
Why is it used?
- Ramping: used for positioning larger patients.
What is the sternomental distance?
What is an indicator of a potentially difficult airway?
- Distance between sternal notch and chin with head fully extended and mouth closed.
- Less than <12.5 cm
What is thyromental distance measuring?
What would be preferred?
- Submandibular compliance (tip of chin to thyroid notch)
- > 6.5cm preferred
How is prognathic ability measured?
- Upper lip bite test (assesses how much lower incisors can extend beyond upper incisors)
What structures should be visible in a Mallampati class I?
- Fauces
- Tonsillar pillars
- Entire uvula
- Soft palate
What should be visible in a Mallampati class II?
- Fauces, portion of uvula, and soft palate
What should be visible in a Mallampati class III?
- Base of uvula and soft palate
What should be visible in a Mallampati class IV?
- Only the hard palate
What is BURP?
- Backward, Upward, and Rightward pressure to facilitate intubation.
What is Optimal External Laryngeal Manipulation (OELM) ?
- Moving someone else’s hand over external neck until a proper view is seen.
What Cormack-Lehane view is depicted below? What is visible with this view?
- CL - 1
- Entire glottis is visible
What Cormack-Lehane view is depicted below? What is visible with this view?
- CL - 2
- Posterior of glottis is visible
What Cormack-Lehane view is depicted below? What is visible with this view?
- CL - 3
- Only the epiglottis is visible
What Cormack-Lehane view is depicted below? What is visible with this view?
- CL - 4
- Epiglottis can’t be visualized.
