Airway management

Question 1

Larynx

Answer 1

Consists of 9 cartilages, protects entrance to respiratory tract and allows phonation

Question 2

Thyroid cartilage

Answer 2

largest and most prominent for lateral and anterior walls

Question 3

Crick thyroid membrane

Answer 3

Connects thyroid and cricoid cartilage

Question 4

Cricoid cartilage

Answer 4

Shaped like signet ring, inferior to thyroid cartilage only complete ring along trachea

Question 5

Arytenoids

Answer 5

Originate in posterior aspect of larynx and posterior attachments of vocal cords, may be only visible structure if patient has anterior airway

Question 6

Laryngeal muscles

Answer 6

Lateral cricoarytenoid (adduction)
Posterior cricoarytenoid (abduction)
Transverse arytenoids (open/close glottis)

Question 7

Glossopharyngeal nerve (IX)

Answer 7

Posterior 1/3 tongue (gag), oropharynx to junction of pharynx and epiglottis (vallecula)
No motor function

Question 8

Superior laryngeal nerve (internal)

Answer 8

Mucosa from epiglottis to vocal cords

No motor function

Question 9

Superior laryngeal nerve (external)

Answer 9

Anterior subglottic mucosa - sensory
Cricothyroid muscles (vocal cords) - motor

Question 10

Recurrent laryngeal nerve

Answer 10

Subglottic mucosa and muscle spindles - sensory

All intrinsic muscles of larynx - motor

Question 11

Hoarseness

Answer 11

Injury to SLN, RLN (ipsilateral vocal cord paralysis)

Question 12

Airway History

Answer 12

Adverse events in past.
Past surgical history?
Edema?
OSA?
C-spine disease?

Question 13

PE of airway

Answer 13

Mallampati score
Symmetry?
Teeth?
Macroglossia?
Palate arch?
Mandible size
Neck exam

Question 14

Signs of difficult airway

Answer 14

Abnormal face shape
Narrow mouth
Obesity
Buck teeth or edentulous
Mallampati 3-4
Neck pathology
Sunken cheeks

Question 15

Airway Devices

Answer 15

Oral and nasal airways -> during induction
Mask -> 1-hand or 2-hand technique (jaw thrust)
LMA - insert blindly along roof of mouth, inflate and confirm

Question 16

ETT

Answer 16

Used to deliver anesthesia and ventilate (Mac or Miller blades)
Infants - 3.5 diameter, 12 length
Child - 4+age/4 diameter, 14+age/2 length
Female - 7.0-7.5 diameter, 20 length
Male - 7.5-8.5 diameter, 22 length

Question 17

Epiglottis

Answer 17

Divides into nasopharynx, oropharynx, laryngopharynx

Question 18

Intubation Equipment

Answer 18

O2 w/ vent
Mask and oral/nasal airway
ETT w/ styles
Syringe
Suction
Scope w/ handle
Stethoscope
Capnographer

Question 19

RSI

Answer 19

For people at risk of aspiration
Use Suc (1-1.5 mg/jog) or Roc (.6-1.2 mg/kg)
Apply cricoid pressure (BURP)
Don’t ventilate during paralysis –> aspiration risk

Question 20

Contraindications to nasal airway

Answer 20

Nasal fractures, basilar skull fracture, coagulopathies

Question 21

Nerve blocking airway for awake intubation

Answer 21

Topical gel or spray
Block hyoid with local
Penetrate cricothyroid and squirt

Question 22

Transtracheal procedures

Answer 22

Per cutaneous transtracheal ventilation

• place catheter thru cricothyroid membrane and attach O2
• don’t do cric in

Question 23

Extension

Answer 23

Stage 3 or 1 --> stage 2 has risk of laryngospasm
Criteria
1. Regular RR
2. Stable SpO2
3. Paralysis reversed (hold head >4 sec)
4. TV >4 mL/kg
5. Follow commands
6. Stable end-tidal CO2

Question 24

Continue intubation?

Answer 24

Epiglottitis 
Airway edema
Injury to RLN
Bleeding
Unstable hemodynamics
Neuro compromise