Airways A Final Flashcards
Name of sinus located behind the conchae
Sphenoidal sinus
What vertebral level is the hyoid bone
C3
What vertebral level is the thyroid cartilage
C4-C5
What vertebral level is the cricoid cartilage
C6
Which bones suspend the larynx
Skull and mandible
Which bones stabilize the larynx
Sternum and scapulae
What are the tubercles directly lateral to the interarytenoid incisure
Corniculate
What are the tubercles lateral to the corniculate tubercles
Cuneiform
What position are the vocal cords in during phonation and effort closure
Midline
What position are the vocal cords in when a patient is anesthesized
Paramedian
What position are the vocal cords in during maximum inspiration
Lateral
Whats the most common reason for airway obstruction in an anesthesized patient
Tongue falling against the posterior pharyngeal wall
Which vertebral level is the major carina located
T6
What is the inner diameter of a face mask
22mm
What is the outer diameter of the ETT connector
15mm
What is the outer diameter of the elbow
22mm
What is the inner diameter of the elbow
15mm
What is the definition of risk
The probability of injury or loss; the likelihood of doing harm
What happens to the lower C spine during DL alignment
Flexes
What happens to the atlanto-occipital joint during DL aligmnment
Extends
What is the appropriate inter-incisor distance for managing the airway
Equal to or greater than 4cm
What can you see in a MAL1 view
Tonsils, uvula, both palates
What can you see in a MAL2 view
Uvula, both palates
What can you see in a MAL3 view
Both palates
What can you see in a MAL4 view
Hard palate
What are the motions of the TMJ
Rotate and glide
What is the appropriate thyromental distance for managing the airway
6.5cm
What is the appropriate mandibular length for managing the airway
Greater than or equal to 9cm
What is the medical term for nose bleed
Epistaxis
What muscle do you test to assess motor function of CN VII
Orbicularis oculi
What is the fulcrum point for the larynx
Hyoid bone
What are the suspenders and stabilizers of the larynx
Extrinsic laryngeal muscles
What are the 2 suspension points of the larynx
Mastoid and styloid processes
What are the 2 stabilization points of the larynx
Sternum and scalpula
What is the large muscle that makes up the floor of the mouth
Mylohyoid
What is macrogenia
Large chin
What is micrognathia
Small jaw
What is macrognathia
Large jaw
What is mandibular prognathism
Jaw jets out in front of upper teeth
Where do I place my fingers during jaw thrust maneuver
Behind the angle of the mandible
Where do I not place my fingers during jaw thrust maneuver
Submental space
How many phases of swallowing are there
3
What is the purpose of swallowing
To move solids and liquids to the stomach
What are the 3 phases of swallowing (deglutition)
Oral, pharyngeal, esophageal
Which arches relax during the oral phase of swalling
Palatoglossal
Whats the last step of the oral phase of deglutition
Food bolus moves into the oropharynx
What occludes during the pharyngeal phase of swallowing
Nasopharynx
What closes during the pharyngeal phase of swallowing to prevent aspiration
Larynx
What is the vocal cord action to prevent aspiration
Adduct
What is the aryepiglottic fold action to prevent aspiration
Adduct
What does the epiglottis do to prevent aspiration
Fold over the glottis
What aerodigestive activities are inhibited during the pharyngeal phase of swallowing
Breathing, coughing, sneezing, vomiting
What elevates during pharyngeal phase of swallowing to receive food bolus
Hypopharynx
What action moves the food bolus toward the esophagus during the pharyngeal phase of swallowing
Pharyngeal peristalsis
What 3 structures constrict during the pharyngeal phase of swallowing to produce pharyngeal peristalsis
Superior, middle, and inferior pharyngeal constrictor
What moves food bolus into the stomach during the esophageal phase of deglutition
Esophageal peristalsis
What positions are pharynx and larynx in during esophageal phase of deglutition
Rest
During what phase of breathing does deglutition occur
Expiration
What vertebral levels does the esophagus extend to
C6-T11
What are the 4 layers of the esophagus
Muscosa, submucosa, muscular layer, fibrous layer
What is achalasia
Increased tone at LES, incomplete relaxation of LES
What are the 3 signs and symptoms of achalsia
1) Progressive dysphagia
2) Noctural regurgitation
3) Aspiration
What can a diverticulum impede the placement of
NG/OG tube
What’s another name of Zenker’s Diverticulum
Pharyngoesophageal diverticulum
What is Zenker’s Diverticulum
Outpouching of esophageal mucosa between the cricopharyngeus muscle and inferior pharyngeal constrictor
What is the ratio of M:F for Zenker’s Diverticulum
1.5 Males:1 Female
Does Zenker’s Diverticulum occur more in older or younger patients?
Older
What side does Zenker’s Diverticulum occur in most often
Left side, 90%
What is the most common hiatal hernia
Axial (sliding) - 95%
What are the two types of hiatal hernias
Axial (sliding) and nonaxial (paraesophageal)
Patients with hiatal hernias are at high risk for what?
Aspiration
What are the 4 main risk factors for aspiration
Full stomach, GERD, hiatal hernia, upper GI diverticula
What is the bony protrusion from bones in the oral cavity
Torus
What is the posterior process on the axis
Dens
What is the large hole in the bottom of the skull
Foramen magnum
Which vertebrae have vertebral foramen
Cervical
What facets are on the atlas and axis
Superior and inferior facets
What is the condyle on the base of the skull
Occipital condyle
At what vertebral level are the vocal cords located
C4/C5
What vertebral level should the tip of the ET tube end
T2
What are the orders of axial alignment for a DL
Laryngeal, pharyngeal, oral
How do you bring the laryngeal axis into alignment for a DL
Folded sheets
How do you bring the pharyngeal axis into alignment for a DL
Atlanto-occipital extension
Where do the gas exchange airways begin
Respiratory bronchioles
Where to the upper conducting airways begin and end
Nose—>glottis
Where do the lower conducting airways end
Terminal bronchioles
What cranial nerve innervates the trachea
Vagus
What nerve innervates the sensory portion of the RLN
Vagus
What landmark do you use to assess the major carina ventrally in a physical exam
Sternal angle
What is the landmark for the dorsal portion of the major carina
T5-T7 in Xray of upright adult
What procedure requires anesthesia of the major carina
FFOB
At what angle does the right mainstem bronchus branch at in adults and infants
20 degrees in adults
30 degrees in infants
RUL takes off within how many centimeters of mainstem origin
2cm
At what angle does the left mainstem bronchus at in adults and infants
40 degrees in adults
47 degrees in infants
How long is the left mainstem bronchus
5cm
What is physiologic deadspace
Total deadspace in the patient
What is anatomic deadspace
Volume of the conducting airways
What is alveolar deadspace
Exchange airways that are not being perfused
What is normal per kilo amount of dead space
2.2ml/kg or 1ml/pound
Anatomical dead space is decreased by what
ETT tube, tracheostomy, laryngectomy
Which dead space is increased by the volume of the tube
Physical dead space
How much does intubation decrease anatomical dead space
By half
How do you calculate physical deadspace of an ETT
pir^2h
How do you calculate net change in deadspace with an ETT
Anatomical deadspace/2 + physical deadspace of ETT
What are the 4 functions of the larynx
1) Air passage into and out of the lungs
2) Protect lungs from solids and liquids
3) Phonation
4) Effort closure
What 4 actions cause effort closure of the larynx
1) Coughing
2) Lifting
3) Defecation
4) Parturition
From a lateral view of oral muscles, what muscle under the tongue appears to fan out
Genioglossus
From a lateral view of oral muscles, what 2 muscles are inferior to the genioglossus muscle
Geniohyoid and mylohyoid
From a lateral view of oral muscles, what large muscle extends vertically from the tongue to the hyoid
Hyoglossus muscle
From a side view of oral muscles, what muscle branches off the hyoglossus muscle posteriorly and connects to the styloid process of the skull
Styloglossus muscle
What muscle attaches to the hyoid bone and styloid process and appears diagonal in a lateral view of oral muscles
Stylohyoid muscle
From a lateral view of the muscles of the neck region, what is the order from posterior to anterior of the muscles that stabilize the larynx (TOS)
Thyrohyoid, omohyoid, sternohyoid
What 4 muscles suspend the larynx
Digastric, mylohyoid, stylohyoid, geniohyoid
Which 3 extrinsic laryngeal muscles, all connected to the hyoid, form the floor of the mouth
Mylohyoid, digastric, stylohoid
What is the name for the horns of the hyoid bone
Cornua (greater and lesser)
Why are the greater cornua important anatomic landmarks for an airway exam
You can use them to palpate and move the hyoid
What membrane attaches to the hyoid bone
Thyrohyoid membrane
What ligament attaches to the hyoid bone
Hyoepiglottic ligament
What are 3 examples of hyaline cartilage in the larynx (CAT)
Cricoid, arytenoid, thyroid
What are 3 examples of elastic cartilage in the larynx
Epiglottis, corniculate tubercles, cuneiform tubercles
What is the general shape of the thyroid cartilage
Shield
What are the wings of the thyroid cartilage called
Alae
What is the midline fusion of alae called (2 names)
Prominentia laryngis/Adam’s apple
What is the cephalad attachment of the thyroid cartilage
Thyrohyoid membrane
What is the caudad attachment on the thyroid cartilage
Cricothyroid membrane
Where are the vocal cords located in relation to the thyroid cartilage
Midline, interior
What are the 2 functions of the thyroid cartilage
1) Protect larynx
2) Suspends 7 of the 8 laryngeal folds
What suspends the thyroid cartilage from the hyoid bone
Superior cornu
What suspends the cricoid cartilage from the thyroid cartilage
Inferior cornu
What type of cartilage is cricoid cartilage
Hyaline
What is the general shape of the cricoid cartilage
Signet ring
What are the 2 functions of the cricoid cartilage
1) Supports arytenoid cartilages
2) Tilts for tensing VCs
How do you locate the cricoid cartilage on a physical ecam
It is the midline, rounded prominence below the prominentia laryngis
What is the cephalad attachment of the cricoid cartilage
Cricothyroid membrane
What is the caudad attachment of the cricoid cartilage
Trachea
What type of cartilage is arytenoid cartilage
Hyaline
What is the general shape of arytenoid cartilage
Pyramid
What is a unique aspect of arytenoid cartilages
They are the action center of the larynx
What is the attachment of the muscular process of the arytenoid cartilage
Cricoarytenoid muscles
What is the attachment of the vocal process of the arytenoid cartilage
Vocal cords
What are the 4 functions of the arytenoid cartilages
1) Movement of vocal cords
2) Rotates on vertical axis
3) Glides or slides on base
4) Intermediary for vocal cord tensing
What type of cartilage is the epiglottis
Elastic
What is the function of the epiglottis
Folds to help protect laryngeal adieus
What type of cartilage is corniculate cartilage
Elastic
What is a unique aspect of the corniculate cartilages
Cartilages of Santorini
What is the function of the corniculate cartilages
Spring-like action produces recoil assistance with seperation of arytenoids and reopening of the glottis
What type of cartilage is cuneiform cartilage
Elastic
What is a unique aspect of the cuneiform cartilages
Cartilages of Wrisberg
What are the 2 functions of the cuneiform cartilages
1) Stiffens aryepiglottic folds
2) Spring-like action facilitates reopening of the glottis
What type of joints are in the larynx
Synovial
What are the 2 joint pairs in the layrnx
Cricothyroid joints, cricoarytenoid joints
What are the 2 movements of the cricothyroid joint
Rotate and glide
What are the actions of the cricothyroid joint
1) Cricoid cartilage rotates
2) Gliding produces cricoid cartilage shift on thyroid cartilage
What are the 2 movements of the cricoarytenoid joints
Rotate and glide
What does lateral gliding of the cricoarytenoid joint cause
Lateral rotation and forward, downward movement
What does medial gliding of the cricoarytenoid joint cause
Medial rotation
What type of tissue is the vocal ligament
Elastic
What are the 2 muscles of the vocal cords
Vocalis muscle and thryoarytenoid muscle
What type of cells make up the vocal cords
Stratified squamous epithelium
What are the 4 actions of the vocal cords
Abduction, adduction, shortening, tensing
What actions does the Recurrent Laryngeal Nerve produce
Adduction, abduction, shortening
What action is the Superior Laryngeal Nerve responsible for
Tensing
What is the only intrinsic laryngeal muscle that is not a pair
Transverse arytenoid muscle
What is the only instrinsic laryngeal muscle that is innervated by the Superior Laryngeal Nerve
Cricothyroid muscle
What 3 intrinsic laryngeal muscles adduct the vocal cords
Lateral cricoarytenoid, oblique arytenoid, transverse arytenoid
What instrinsic laryngeal muscle abducts vocal cords
Posterior cricoarytenoid
What intrinsic laryngeal muscle tenses the vocal cords
Cricothyroid
What 2 intrinsic laryngeal muscles shorten the vocal cords
Thyroarytenoid, vocalis
What 2 intrinsic laryngeal muscles close the glottis
Aryepiglottic, thryoepiglottic
What action of the cricoid cartilage do the cricothyroid muscles produce
Tip and move cricoid cartilage posteriorly
What nerve provides supraglottic sensory innervation to the cricothyroid muscle
Internal branch of the Superior Laryngeal Nerve
What nerve provides motor innervation to the cricothyroid muscle
External branch of the SLN
What is the landmark for blocking the SLN
Superior horn of the hyoid bone
What 2 muscles oppose the action of the cricothyroid muscle
Vocalis and thyroarytenoid muscles, they contract and pull arytenoids and shorten the vocal cords
What muscle extends from the oblique arytenoids to the lateral epiglottis
Aryepiglottic muscle
What artery does the Right RLN travel around
Subclavian
What artery does the Left RLN travel around
Aortic arch
What membrane is pierced by the internal branch of the SLN
Thyrohyoid
Is the internal branch of the SLN sensory or motor
Sensory
What region does the internal branch of the SLN innervate
Supraglottic region
Is the external branch of the SLN sensory or motor
Motor
What muscles do the external branch of the SLN innervate
Cricothyroid muscles
How do you confirm oxygen is flowing in a hand-operated, self-inflating bag
Listen to the distal end
How do you confirm oxygen is flowing in an oxygen source with a reservoir
Reservoir bag fills up
How do you confirm that you can manually ventilate before attaching the patient to the device
Occlude patient port and squeeze bag so you can generate and hold positive pressure
What ventilatory rate do you provide patients during transport from the ICU?
6-8 breaths/minute for effective alveolar ventilation without hyperventilation
What can happen to the brain if you hyperventilate your patient during transport from the ICU
Hyperventilation will drive the CO2 down which decreases cerebral blood flow and increases chance of cerebral ischemia
What can happen to the brain if you hypoventilate your patient during transport from the ICU
Hypoventilation will drive the CO2 up and increase cerebral blood flow, thus increasing chance for edema in the brain
What is the prevalence of anisocoria
40%
What is acromegaly
Abnormally large head and neck features
What are the largest salivary glands
Parotid
What glands should be examined during airway exam
Lacrimal, parotid, submandibular, sublingual, thyroid
What is another name for parotid duct
Stensen duct
What is another name for submandibular duct
Wharton’s duct
What is a treatment of dry eyes
Punctal plugs
What does PERLA stand for regarding an eye examination
Pupils Equal and Reactive to Light and Accommodation
What is exophthalmus
Bulging eyes, may not close completely
What causes bilateral exophtalmus
Hyperthyroidism
What causes unilateral exophthalmus
Orbital tubor
What is ptosis
Drooping of the eyes
What types of edema can occur with the eyes
Periorbital edema, conjunctival edema, scleral edema
What is angle of the atlanto-occipital gap
35 degrees
What is leukoplakia
White patches inside the mouth
What is the condition where the pharyngeal arches and wall are severely swollen and red
Pharyngitis
What is the condition where the palatine tonsils are coated with a liquidy white substance
Exudate
What is the condition where the gums grow over the teeth
Gingival hyperplasia
What is the therapy for gingival hyperplasia
Dilantin
What is the condition where the gums appear red and irritated
Gingivitis
What condition results in receding gums
Peridontitis
What is the I:E ratio of a normal flow-volume loop
I:E equal, 50:50
What is the I:E ratio of a flow-volume loop with extrathoracic variable obstruction
E > I
What shows up on the flow-volume loop when there is an extrathoracic variable obstruction
Inspiratory plateau
What shows up on the flow-volume loop when there is an intrathoracic variable obstruction
Expiratory plateau
What is the I:E ratio of a flow-volume loop with intrathoracic variable obstruction
I > E
What shows up on the flow-volume loop when there is a fixed obstruction
Inspiratory and expiratory plateaus
What is on X axis of flow volume loop
Time
What is on Y axis of flow volume loop
Flow
What surgeries can fix a partial airway obstruction
Tracheostomy
Cricothryotomy (emergency only)
What would you hear during auscultation of a patient with a partial airway obstruction
Inspiratory and expiratory stridor
What observations would you make on a patient with partial airway obstruction
Dyspnea, stress, breathing pattern, retractions
Pharmacologic support of a partial airway obstruction must acheive what
Improved flow across an orificial lesion
What nonsurgical techniques could help manage a partial airway obstruction
Intubation or other physical airway device
What is the change in flow when going from air to 100% O2
90%
What is the change in flow when going from 100% O2 to 70% heliox
260%
What is the change in flow when going from 100% O2 to 80% heliox
330%
What is the flow volume loop pattern of a goiter
Fixed
What is the flow volume loop pattern of a tracheal obstruction
Fixed
What is the flow volume loop pattern of subglottic stenosis
Fixed extrathoracic (maybe variable?)
What is the flow volume loop pattern of glottic SCCa
Fixed
Who invented the LMA
Brain
What are some advantages of an LMA
Less stimulating, no muscle relaxant required, less increase in intrathoracic, intra-abdominal, and intraocular pressures, less CV stimulation, provides post op airway
What are some disadvantages of an LMA
Failure rate, complications and adverse events
Where does the LMA seat
Above the larynx (supraglottic seal)
What material is an LMA made of
Silicone
What’s the angle between the airway tube and body of the mask
30 degrees
OD of the LMA connector
15mm
What are some contraindications for LMA use
GERD, not NPO, hiatal hernia, obesity, pregnancy, bowel obstruction, acute pancreatitis, high resistance/low compliance respiratory disease, patient positioned with limited airway access, upper airway pathology
How can you prevent torque when securing an LMA
Tape to zygomatic region, use circuit tree
What cathether on an LMA can facilitate endotracheal intubation
Aintree
What nerves can be stimulated with an LMA
IX and X
What are some acute risks that could occur with LMA use
Failure to acheive a good seal, failure to provide safe PPV, hypoxemia, hypoventilation
What does ACDF stand for
Anterior cervical discectomy and fusion
What is the endpoint for fiberoptic airway procedures
To have a patient answering yes-no questions after the ETT is in place
What sedation is used for airway anesthesia
Propofol infusion or a neuroleptic technique with fentanyl and droperidol
What anesthetic method is directly applied for anesthesia of the oral cavity and oropharynx
Topical spray - Lidocaine 4%
What anesthetic method is indirectly applied for anesthesia of the oral cavity, nasal passage, pharynx, larynx, and trachea
Aerosol - use an aerosol generator (particles 10-100 microns) with heliox and Lidocaine 4%
What anesthetic method is directly applied for anesthesia of the VCs, trachea, and carina
FFOB injection via suction port or injection port - Lidocaine 4%
What anesthetic method is indirectly applied for anesthesia of the supraglottic region
Transtracheal injection
What is transtracheal injection
Using a 20 gauge catheter to inject ~5mL of Lidocaine 4% through the cricothyroid membrane
How much Lidocaine 4% is used for a transtracheal injection
5mL
What membrane is pierced during a transtracheal injection
Cricothyroid membrane
What area is anesthesized with a Superior Laryngeal Nerve Block
Supraglottic region
What muscle can you block with an SLN block
Cricothyroid
What drug do you use with an SLN block and how much do you use
3mL of 1% Lidocaine
Where is the Lidocaine 1% injected during an SLN block
Greater horns of hyoid bone
What anesthetic is used for a Sphenopalatine Nerve Block and how much
10mL of Cocaine 4%
What topical application is used for a Sphenopalatine Nerve Block
Pledget strips for anesthesia and vasoconstriction of both nasal passages
What 2 drugs, when mixed with 4mL of Lidocaine 4%, are used as topical anesthetics and vasoconstrictors for the nasal passages
Oxymetazoline 0.05% (1.5mg or 3mL), Phenylephrine 10% (2000mcg or 0.2mL)
What drug is administered preoperatively as an antisialogogue and how is it administered
0.3mg glycopyrrolate intramuscularly
What is the preferred technique for anesthesia of the airway
1) Glycopyrrolate injection preop
2) Aerosol lidocaine treatment in POHA
3) Nasal preparation with spray combination
4) Propofol infusion
5) Lidocaine 4% injection through FFOB
Who developed early endotracheal equipment
Magill
What is the purpose of the bevel on ETTs
Facilitate passage through vocal cords
OD of ETT machine connector
15mm
What are some benefits of the ETT cuff
Prevent aspiration, PPV, decreased cost of gases
What determines ETT size
Patient height
What is a Cole ETT
Pediatric - no cuff, has a shoulder, is tapered
What volume should be in syringe for ETT cuff inflation
6mL
What is stridor
High-pitched, shrill vibrating sound
What produces a stridor sound
Orificial partial airway obstruction in the upper conducting airway
What does wheezing sound like
High-pitched musical or whistling sound
What produces a wheezing sound
Tubular partial airway obstruction in lower conducting airway
What is stertor
Snoring sound
What produces a stertor
Moveable tissue or loose material in upper conducting airways
What does rhonchi sound like
Low-pitched, vibrating
What produces rhonchi sounds
Turbulent flow around loose material (mucus) in the larger bronchi
What does rales sound like
High-pitched, crackling sound; crepitations
What produces rales
Opening of small airways closed by increased lung water, in the lower airways
Are rales heard during inspiration, expiration, or both
Inspiration
Ruleouts for direct VC involvement in hoarseness
NECK - Recent URI, chronic inflammation, allergy, excessive voice use, malignancy, polyps, VC dysfunction
Ruleouts for indirect VC involvement in hoarseness
NECK - Contiguous infection or inflammatory disease, lyphadenopathy, malignancy, thyroid disease
What nerves are subject to infectious, inflammatory, or malignant processes
RLN, SLN, Vagus
Ruleouts in the chest for hoarseness
Bronchial malignancy, mediastinal mass, TB, aortic arch aneurysm, right subclavian artery disease
What artery does the right RLN pass
Subclavian
What artery does the left RLN pass
Aortic arch
Ruleouts for cricoarytenoid joint disease for hoarseness
Dislocation of joint, arthritis, gout
How long must hoarseness last to require otolaryngologic workup
2 weeks
Pathophysiology of routine post hoarseness (pharyngitis)
Denudation of epithelium, edema, cricoarytenoid inflammation
Incidence of postop pharyngitis
3%
Do more males or females complain of postop pharyngitis
More females than males
Incidence of postop ulceration
1%, more females than males
Incidence of postop granuloma formation
1:10,000, more female than male, 50% bilateral
Occurence and onset of cicatricial stenosis
Rare, onset 2+ weeks
What percentage of closed claims included death or brain damage
85%
What percentage of closed claims included difficult intubation
17% (87 cases)
What percentage of closed claims included esophageal intubation
18% (94 cases)
Auscultation proved to be unreliable in what percentage of closed claim cases
48%
Occurence of anethesia related obstetric mortality
1:500,000
Leading cause of obstetric anesthetic mortality
Failure to secure airway, aspiration
Name for the medial cleft of upper lip
Philtrum
What connects the tongue to the base of the mouth
Lingual frenulum
5 branches of the facial nerve
Temporal, zygomatic, buccal, mandibular, cervical
Vertebral levels of the esophagus
C6-T11
What pressure is needed to open the GE junction of someone with a hiatal hernia
4 cmH2O
What pressure is needed to open the GE junction of someone with GERD
1 cmH2O
What pressure is needed to open GE junction
16 cmH2O
What are the 5 different radiodensities
FABBM
Fat, air, bone, barium, metal
Which Lefort fracture still allows you to perform nasal intubation
Lefort 1
Where is the anterior commissure
Superior to the cords in a DL view
What is otisis media
Inflammation of the middle ear
Which vertebrae allows the head to rotate
C1 - atlas
Which vertebrae allows the head to move up and rown
C2 - axis
What passes through the foramen of the thyrohyoid membrane
Internal superior laryngeal nerve
What does BSSO stand for
Bilateral sagittal split osteotomy
What is the Valsalva maneuver
Moderately forceful attempted exhalation against a closed airway, usually done by closing one’s mouth, pinching one’s nose shut while pressing out as if blowing up a balloon. Deviation from normal results indicates problems with vagus reflex
Effect of Mueller maneuver
Decreases intrathoracic pressure by breathing against a closed glottis.
What is a pathophysiologic effect of a bilateral RLN injury
Stridor
What is ankyloglossia?
Stiff tongue
How can you calculate the time it will take for an apneic patient to become hypoxic
FRC (35ml/kg)/VO2(kg^0.75*10)
What does “RAE” stand for, as in an Oral RAE tube
Ring, Adair, Elwyn
The infraorbital nerve provides sensory innervation to which part of the nose?
Vestibules
How can you calculate the correct inflation volume for LMAs
5mL x size of LMA
How can you confirm proper placement of an LMA
Observe capnogram and auscultate for proper placement
Proper action order for RSI
1) Preoxygenate
2) Cricoid pressure (Sellick maneuver)
3) Induction
4) Place tube
5) Confirm
6) Remove cricoid pressure
Insufflation pressure for a laparoscopic nephrectomy
15 cmH2O
Identification of the arytenoid muscular process
Outside ring
Physical attributes of heliox
Increases heat capacity, increases viscosity, decreases density
What is the etiology of otitis media with nasotracheal instrumentation
Blockage of eustachian tube
What airway generation are the terminal bronchioles
17th
How much phenylephrine is required for nasal vasoconstriction
2000mcg
How can you manipulate the larynx during a DL
Dorsal depression of the thyroid cartilage
What branch do you block with an SLN block
Internal sensory branch
What is the definition of abnegation
Denial or refusal
Who invented the grade views of the airway
Cormack and Lehane
What hemodynamic effects does Mueller manuever cause
It lowers pulmonary blood pressure
Indication for ETT introducer
When you don’t have a direct visualization of vocal cords
What happens to vocal cords immediately following injury to both RLNs
Adduction
What happens to vocal cords immediately following interruption of both RLNS
Paralyzed to paramedian position
Which lobe of the lungs is most often affected when inadvertent endobronchial intubation occurs
Right upper lobe
What does an extra thoracic flow volume loop tell you about the position of your ETT
The tip of the tube is behind the lesion
Compared to air and oxygen, what advantages does heliox offer for various airway management situations?
Heliox has less density so it improves gas flow past partial airway obstructions
Describe the anterior attachments of the vocal cords
Thyroid cartilage, midline inferior
Describe the posterior attachments of the vocal cords
Vocal process of arytenoids
TMJ compartment for initial mouth opening
Inferior - 50% - rotate
TMJ compartment for late mouth opening
Superior - 50% - gliding
How do you measure for the correct nasal airway size
Distance from nares to tragus
During which phases of deglutition does peristalsis occur
Pharyngeal and esophageal
During which phase of deglutition does larynx closure occur
Pharyngeal
During which phase of deglutition does nasopharynx occlusion occur
Pharyngeal
What is the true joint of the larynx
Cricoarytenoid
