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Principles I -Josh > Basic Airway /Advanced Airway > Flashcards

Basic Airway /Advanced Airway Flashcards

1
Q

Problems that can occur in association with difficult airway

A 
Dental damage
pulmonary aspiration
airway trauma
unanticipated trach
anoxic brain injury
cardiopulmonary arrest
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2
Q

The upper and lower airway is divided where?

A

cricord cartilage

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3
Q

5 parts of upper airway

A 
Nose
mouth
pharynx
hypopharynx
larynx
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4
Q

6 parts of lower airway

A 
Trachea
Bronchi
Bronchioles
terminal brinchioles
respiratory bronchioles
alveoli
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5
Q

Function of the nose

A

warm and humidify air

primary source of filtration

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6
Q

Anatomy of the mouth/oral cavity

A 
Hard palate
soft palate
tongue
Uvula
tonsils
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7
Q

What structure of the mouth is at high risk for obstruction

A

tongue

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8
Q

Parts of the pharynx

A

Nasopharynx
oropharynx
hypopharynx

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9
Q

What are S/S of SLN injury, both unilateral and bilateral

A

Unilateral- minimal ( no real signs)

Bilateral- hoarseness

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10
Q

What are S/S of RLN injury, both unilateral and bilateral (acute and chronic)

A

Unilateral- Hoarseness
Bilateral-
—Acute-stridor, resp distress
– Chronic- Aphonia

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11
Q

3 paired cartilages that make up the larynx

A
  • 2 arytenoids
  • 2 corniculate
  • 2 cuneiform
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12
Q

Vallecula

A

Space between the epiglottis and base of the tongue

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13
Q

2 types of muscles in the larynx

A

Intrinsic

extrinsic

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14
Q

What do the intrinsic muscles of the larynx do

A

control of vocal cords

opening and closing of the glottis

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15
Q

What do the extrinsic muscles of the larynx do

A
  • connect larnyx with the hyoid bone and other structure

- adjust position of trachea for phonation, breathing, and swollowing

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16
Q

How long is the adult trachea

A

10-20 cm

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17
Q

What is the only cartilage with a complete ring in the trachea

A

Cricord ring

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18
Q

What is pertinent to airway assessment (questions to ask or look up; not physical)

A
  • prior sx or hx of intubation/trach
  • pror hx of diff intubation
  • Hx of OSA
  • Hx of oral, pharyngeal, esophageal disease
  • trauma, burns, chemicals, radiation exposure to neck
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19
Q

S/S that indicate a pt has an increased risk for aspiration

A
  • Loss of airway reflex
  • LOC
  • full stomach
  • obese, pregnant, hiatial hernia
  • GERD
  • Decrease GI motility (DM, Trauma)
  • volume > 25 ml (ph < 2.5)
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20
Q

Mendelson Syndrome

A

chemical pneuminitis due to the parenchymal inflammatory reaction caused by a large volume of gastric contents in lungs from aspiration ( independent of infection)

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21
Q

Ways to decrease risk of aspiration

A
  • NPO
  • Block histamine release (H2 blockers)
  • increase gastric PH (antacids)
  • Increase GI motility (reglan)
  • use caution with sedationa and opiods
  • ETT vs LMA
  • RSI vs awake FOI
  • Awake vs deep extubation
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22
Q

Liter flow rates and Fi02 delivered
Nasal cannula
Simple face mask
Non-rebreather

A

NC- 1-6 LPM / 24-44%
SFM- 5-12 LPM / 30-85%
NRB- 10-15 LPM / 60-85%

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23
Q

4 techniques to manipulate head, neck, and jaw for airway patency

A
  • chin lift
  • head tilt and chin lift
  • Jaw thrust
  • Hyperextension of Neck (head tilt)
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24
Q

3 axis to align for maximal exposure with intubation

A
  • Oral axis
  • pharyngeal axis
  • laryngeal axis
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25
Q

3 main types of LMAs

A

Classic
Proseal
Fast track

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26
Q

What is unique about the proseal LMA

A

-drain tube

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27
Q

What is unique about the fast track LMA

A

Allows you to place an OETT

has an epiglottis flap

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28
Q

Tracheal intubation is recommended when?

A
  • compromised airway
  • long procedures
  • procedures of head/neck/chest/abd
  • Need for positive pressure ventilation
  • inability to maintain mask ventilation
  • disease of the airway
  • risk of aspiration
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29
Q

What are indications for Awake FOI

A
  • anticipated difficult airway
  • unstable neck fx
  • Halo
  • small / limited oral opening
  • critical care settings
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30
Q

What airway structures are most vulnerable to injury during intubation

A

arytenoids
posterior half of vocal cords
posterior tracheal wall

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31
Q

What can occur up to 3 hours post extubation

A

Croup

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32
Q

LMA size compared to weight and max inflation (only adult sizes)

A 
LMA size           Weight         MAX inflate
#3                    30-50kg            20 ml
#4                    50-70kg            30 ml
#5                    70-100kg          40 ml
#6                      >100kg           50 ml
* how to remember the max inflate for test- minus 1 and add 0 to the size. ex #3 -1=2 add 0 = 20 ml
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33
Q

What muscle acts as a barrier to regurgitation in conscious Pts.

A

cricopharyngeos muscle

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34
Q

Extubation criteria

A
  • adequate TV and rate
  • open eyes to commands no diplopia
  • sustained protrusion and purposeful movements of the tongue
  • effective swollow
  • head lift >5 sec
  • effective cough
  • sustained titanic response to 50 hrz for 5 sec’s
  • TOF > 90 ratio with NO fade
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35
Q

Whats the difference in airway resistance between the nasopharynx and oropharynx

A

the resistance to airflow through the nasopharynx is twice that of the oropharynx and accounts for about 2/3rds of the total airway resistance

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36
Q

Disadvantages of oropharyngeal airways

A
  • cut lips, tongue, oral mucose
  • Can cause a gag reflex
  • obstruction of glottis (if to large)
  • Push tongue posterior and cause obstruction (if too small)
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37
Q

Advantages of oropharyngeal airways

A
  • air can pass around or through

- keeps teeth/lips open

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38
Q

Advantages of nasopharyngeal airways

A
  • better tolerated in light planes

- prefered with pts with limited mouth openings or dental caries

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39
Q

Disadvantages of nasopharyngeal airway

A

nose bleeds

-contraindicated with coagupathies and basilar skull fx

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40
Q

LMA contraindications

A
  • pharyngeal pathology
  • pharyngeal obstruction
  • full stomach
  • decreased pulmonary compliance (RAD), that requires > 30 cmH20 pressure
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41
Q

What LMA is designed for anticipated difficult airways situations and CPR, b/c it can facilitate continuous ventilation during intubation

A

Fast track

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42
Q

Which LMA is a reusable airway that has a cuff made of softer material than the classic, it is designed to conform to the hypopharynyx, although it can be used with spont breathing pts, it is designed for PPV with or without muscle relaxants

A

proseal

43
Q

How do you confirm appropriate tracheal intubation

A

MOST RELIABLE - end tidal CO2

PCO2 > 30 mmhg for 3-5 breaths

44
Q

S/S ETT not olaced correctly

A
  • no rise in CO2
  • decrease O2 sat
  • Unilateral breath sounds
  • inability to palpate ETT cuff @ sternal notch
  • Increased Peak Pressures
  • Tachycardia
45
Q

Afferent is _____ and carries nerve impulses _____?

A

Sensory

carries impulses to the CNS

46
Q

Efferent is _____ and carries nerve impulses ________?

A

Motor

carries impulses away from CNS to periphery

47
Q

Mallampatti I

A 
Hard palate
Soft palate
tonsillar fauces
tonsilar pillars
uvula
48
Q

Mallampatti II

A

Hard palate
Soft palate
tonsilar fauces
uvula

49
Q

Mallampatti III

A

Hard palate
Soft palate
base of uvula

50
Q

Mallampatti IV

A

Hard palate

51
Q

Cormack and Lehane Gade I

A

Entire laryngeal aperature

52
Q

Cormack and Lehane Gade II

A

posterior portion of laryngeal aperature only

53
Q

Cormack and Lehane Gade III

A

epiglottis only

54
Q

Cormack and Lehane Gade IV

A

soft palate only

55
Q

Unilateral RLN injury causes what

A

hoarsness

56
Q

NPO fasting guidelines

A

clear liquids -2hours
Breast milk- 4 hours
everything else @ least 6 hours

57
Q

The antacid sodium citrate (bicitra) has what disadvantage

A

increased gastric volume

58
Q

ASA Scores

A

I- Normal healthy adult
II- Pt with mild systemic disease
III- pt with severe systemic disease
IV- pt with severe systemic disease THAT IS A CONSTANT THREAT TO LIFE
V- morbid pt who is not suspected to live without Sx
VI- brain dead/ organ donor

59
Q

Four Ds that make a difficult airway

A

dentation
distortion
disproportion
dysmobility

60
Q

what mallampatti scores are good

A

I-II

61
Q

3 single cartilages that make up the larynx

A

thyroid
cricoid
epiglottis

62
Q

What does the external SLN innervate

A

motor fxn to cricothyroid muscle of larynx

63
Q

What 2 things does the RLN innervate

A
  • sensory innervation to the subglottic area and trachea

- motor to all muscles of larynyx EXCEPT cricothyroid

64
Q

The SLN divides into what?

A

Internal and external SLN

65
Q

What does the internal SLN innervate

A

sensory input above the cords

66
Q

The vagus nerve branches into what in the pharynx

A

Superior laryngeal nerve (SLN)

Recurrent Laryngeal Nerve (RLN)

67
Q

The MOTOR response of the pharynx that Results in a gag is what nerve

A

CN X- (Vagus nerve)

68
Q

SENSORY response elicited when the posterior wall of pharynx is touched and stimulated are carried to the brain by what nerve

A

Glossopharyngeal (CN IX)

69
Q

Difficult intubation is defined as what

A

3 or more attempts

more than 10 minutes

70
Q

Difficult mask ventilation is defined as what

A

inability to maintain SPO2 > 90% or signs of inadequate ventilation

71
Q

The nasopharynx is separated from the oropharynx by what

A

soft palate

72
Q

The oropharynx is separated from the hypopharynx by what

A

epiglottis

73
Q

The trachea begins and ends where

A

C6-T5 (the carina)

74
Q

How many horseshoe shaped cartilages make up the trachea

A

16-20

75
Q

What supplies the infraglottic region and comes off of the inferior thyroid artery

A

Inferior laryngeal artery

76
Q

What supplies the supraglottic region of the larynx, comes from the superior thyroid artery

A

superior laryngeal artery

77
Q

What part of the oral cavity remains stationary

A

hard palate

78
Q

What part of the mouth covers the posterior 3rd to half of the oral cavity, rises during eating to prevent passage of contents into the nasal passage way

A

soft palate

79
Q

What part of the mouth guards the passageway from the oral cavity to the oropharynx

A

uvula

80
Q

What structure of the mouth is walnut shaped and sits on both sides of the posterior opening of the oral cavity

A

tonsils

81
Q

Function of the larynx

A
  • protect airway from aspiration
  • provide airflow b/t hypopharynx and trachea
  • cough and gag reflex
  • phanation
82
Q

5 intrinsic muscles of the larynx

A 
posterior cricoarytenoid
lateral crioarytenoid
arytenoids
cricothyroid
thyroarytenoid
83
Q

Common physical assessments for airway

A 
interincisor gap
thyromental distance
head and neck extension
mallampatti
body weight
84
Q

what is the best/ideal way to determine a difficult airway

A

there isn’t one dummy!!!

85
Q

Signs that may indicate a pt will be a difficult mask ventilation

A 
elderly
endentulous
obese
snores/ OSA
bearded (RTFF)
stridor
86
Q

Difficult airway adjuncts

A 
blades
fiberopticscope
lightwand
bullard scope
LMA
stylet
retrograde intubation
bougie
TTJV
combitube
87
Q

What do the intrinsic muscles of the larynx do

A

control the tension of the vocal cords and the opening and closing of the glottis

88
Q

What is the ideal BVM positioning

A

aligning the external auditory meatus with the sternal notch

89
Q

How do you break a laryngospasm

A
  • positive pressure
  • anesthestic gasses
  • 10-20 mg sux’s
  • lidocaine
  • push on trigger point in sternocleido muscle
90
Q

If not treated with positive pressure the laryngospasm can cause what

A

negative pressure pulmonary edema

91
Q

Why would you never wake a pt is stage II anesthesia

A

will cause laryngospams

92
Q

Per the literature what adjunctive tool is most superior for difficult airways

A

Awake-FOI

93
Q

Per real life what adjunctive tool is most superior for difficult airways

A

the one you are most comfortable using

94
Q

How do you prepare for a nasal intubation

A
  • prep with astringent (afrin or neosynephrin)
  • dialate nares with progressive lubricated nasal trumpets
  • Introduce and advance the ETT
95
Q

Steps for an Awake-FOI

A
  • discuss steps with pt
  • local anesthetic
  • antisialogoue
  • monitors, 02, sedation
  • semi-fowlers or supine
  • insert ETT
  • advance Fiberoptic
  • identify anatomy
  • advance through cords
  • go till you see the carina
  • advance ETT over fiberoptic
  • withdraw fiberoptic
  • conform with ETCO2
  • IV or inhalation induction
96
Q

What is important about sedation during an awake-FOI

A

sedation should not obtund the protective reflexes of pt

97
Q

Sedation choices for awake-FOI

A

midazolem
fentanyl
dexmetomodine

98
Q

How should you extubate the difficult to intubate pt

A 
awake and responsive
good grip/ head lift sustained 
adequate reversal
NIF > 20mmhg (neg inspiratory force)
VC> 15 ml/kg (vital capacity)
99
Q

Can’t ventilate + can’t intubate = what

A

sugical airway

100
Q

What must you remember about TTJV

A
  • MUST USE INTERMEDIATE PRESSURE 02 SUPPLY
  • allow time for expiration (1:4)
  • risk of barotrauma
  • buys the anesthesia team time before surgical airway
101
Q

Why do we use RSI

A

for pt’swho are at increased risk for aspiration requireing minimal time with an unrotected airway

102
Q

Steps for RSI

A
  • aspiration prophylaxis
  • airway eqipment - suction
  • optimize intubation conditions
  • denitrogenate
  • STP + Sux IV push
  • proper cricord pressure
  • no bag ventilation
  • intubate
  • on emergence- awake extubation
103
Q

What 3 intrinsic muscles are responsible for laryngospasms

A

lateral cricoarytnoid
cricothyroid
thyroarytnoid

remember CAT

Principles I -Josh (7 decks)

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