AIRWAY INFECTIONS, BURNS, RELATED BONE AND JOINT DISEASES Flashcards
name 4 upper airway infections common in children
acute epiglottitis
croup
laryngotracheobronchitis
tonsilitis
what tool would be used for surgery on a peritonsillar abscess?
mcivor mouth gag
what would be the airway management plan for a pt with pertonsillar abscess?
general/anode oett
definition: spasm of the jaw muscles, causing the mouth to remain tightly closed
trismus
what are two complications related to peritonsillar abscess?
partial airway obstruction
trismus
what tools should be available for intubation for peritonsillar abscess surgery?
anode ett
+/- FFOB
definition: connective tissue infection that occurs on the floor of the mouth under the tongue
ludwig’s angina
what is the best course of airway management for Ludwig’s angina?
FFOB NETT sedation
what is the appropriate induction plan for Ludwig’s angina?
IV after intubation complete & confirmed
what is the most appropriate post-op airway management for ludwig’s angina?
patient will remain intubated
what is the appropriate emergence plan for ludwig’s angina?
sedation with propofol infustion
definition: (greek - ankhon) strangling
angina
what is the appropriate induction plan for a case of pediatric acute epiglottitis?
single-breath sevoflurane induction
appropriate postop airway management for pediatric epiglottitis?
patient will remain intubated
appropriate emergence plan for pediatric acute epiglottitis?
complete sedation with possible nmb
what are the symptoms that present with pediatric acute epiglottitis?
fever, drooling, difficulty swallowing
sitting upright, leaning forward, drooling
how does resolution of acute epiglottitis appear?
decreased WBC, fever abates, air leak develops
what airway complications present with retropharyngeal abscess?
partial airway obstruction
limited nasopharyngeal access
infection limits topical pharyngeal anesthesia
what is the major airway management periop risk associated with surgery for chronoic recurrent tonsillitis?
postop hemorrhage
what is the male:female ratio of thermal injury?
69:31
what is the survival rate of thermal injuries?
96.6%
how many burn centers are there in the US?
62 (in 29 states)
what are the two major types of burns?
fire/flame
scalds
where do most thermal injuries occur?
72% – home
what is the percentage of burn patients that have inhalational injury?
33% of burn pts have inhalational injuries
name four types of inhalational injuries
hot, dry gases
steam
toxic/ chemical/ irritating gases
smoke
how should the assessment of airway injury be approached?
current vs projected status
how should the assessment of the cardiovascular effects be conducted?
current vs. projected cardiovascular effects
what is the primary goal of airway management of thermal/chemical injuries?
maintain airway patency and oxygenate
what are the related pathophysiologies related to fire-thermal injuries?
CO poisoning
CN poisoning
aspiration
what would be included in current status airway assessment of thermal injury if airway directly involved?
facial, oral, nasal burns
singed nasal hairs
what would be included in projected status of airway assessment of thermal injuries if airway directly involved?
laryngeal edema – rapid loss of airway patency
why is tracheostomy contraindicated in thermal injury pts?
risk of wound and mediastinal infection
at what pressure at which air leak is audible is discontinuation of airway support acceptable/unacceptable?
5-10cmH2O – acceptable
> 20cmH2O – unacceptable
definition: released by cellulosic conflagration: denatures protein; produces pulmonary edema (10ppm)
acrolein
released by polyurethane conflagration
CN
released by fires and incomplete combustion
CO
released by PVC conflagration; severe mucosal burns in airway
HCl
what is the goal of initial burn treatment?
debridement and burn dressing changes
what is the goal of long-term burn treatment?
plastic/ other surgeries
definition: immobility
ankylosis
definition: inflammation of joint
arthritis
definition: pertaining to vertebra(e) or spine
spondyl(o)-
definition: vertebral inflammation
spondylitis
definition: partial displacement of a joint
subluxation
definition: cervical vertebral fusion + short neck + low hairline; C-spine: 2-7 vertebrae
kippel-feil syndrome
definition: small posterior fossa, caudal displacement, hydrocephalus
arnold-chiari malformation
definition: inflammatory, multiple organ disease; C-spine, TMJ, cricoarytenoid joint; progressive and devastating
juevenile rheumatoid arthritis
definition: an extremely short individual with disproportionate body parts
dwarfism
what type of dwarfism is autosomal dominant; development disorder with decreased proliferation of growth plate cartilage
achonddroplastic dwarfism
what is the airway complication most often observed in pts with achondroplastic dwarfism?
cervical instability – due to premature fusion of bones at base of skull
definition: synovial inflammation and granulation with insidious onset progressing to cartilaginous destruction; presents with morning stiffness
polyarthropy
how does rheumatic arthritis affect lower c-spine?
decreased flexion
how does rheumatic arthritis affect atlanto-occipital joint?
decrease extension
how does rheumatic arthritis affect TMJ movement?
decreased rotation/gliding – decreased mouth opening
how does rheumatic arthritis affect cricoarytenoid joints?
decreased rotation/gliding – hoarseness/ stridor/ dyspnea
also known as marie-strumpell disease, a progressive arthritis of spine and pelvis; a flexion deformity of the spine with fixed cervical spine
ankylosing spondylitis – spondyloarthropathy
degenerative joint disease of TMJ presents how?
degeneration of articular cartilage – limited inflammation and pain with use
degenerative joint disease of the cervical spine presents how?
limited movement, pain, paresthesias, motor involvement
definition: grating, crackling or popping sounds between bone and cartilage or fractured parts of bone
crepitus
