basic airway exam and evaluation Flashcards
why be an expert at airway mgmt?
1) lots of risk = real $$ loss 2) you’re on the front line
you’re responsible for airway once you give a _____
muscle relaxant
why do we examine and evaluate pt airways preoperatively?
do no harm, determine risks to discuss w family and document in chart, obtain info needed for bag/mask LMA DL ETT, obtain info needed for postop airway management
what is risk?
probability of injury or loss; the likelihood of doing harm
if plan A is DL and intubation, what is needed?
info concerning establishing direct visualization of glottis – vocal cords
head and neck exam must include gathering information concerning:
axial alignment
what are the 3 axes of alignment?
laryngeal, oral, pharyngeal
what information do you obtain in head and neck movement?
ROM: rotation, flexion, extension
what is rotation in airway exam?
head right to left
what is flexion in airway exam?
lower cervical spine
what is extension in airway exam?
atlanto-occipital joint (can they close their occipital joint?)
not being able to extend atlanto occipital joint even after asleep is an example of what?
a mechanical limitation (means it wont be fixed despite being under anesthesia)
“do you drop things when you look to the left or right? is an example of
an that produces motor weakness
pain, paresthesia, and motor weakness are issues that can _____ when you anesthetize patient
go away
what is the term for the potential space under the chin?
submental compartment
what is fligmon?
it’s the infected area of submandible where floor of mouth is full and fixed
what is OPE?
oralpharyngeal exam
what is the minimum inter-incisor distance?
greater than or equal to 4 cm
what do you see when you observe the tongue?
1) size 2) disease
what do you look for in floor of mouth?
lesions such as white patches (leukoplakia)
what do you expect to see in OPE?
hard and soft palate, uvula, palatine tonsils or fossae, and palatoglossal arches and palatopharyngeal arches
soft palate terminates at the
uvula
you need to locate where the ____ are in an OPE
palatine tonsils or fossae
____ live between the 2 arches
palatine tonsils
what do you document in OPE according to Dr. Hall?
1) tonsil viz 2) uvula viz 3) soft palate viz 4) hard palate viz (this indicates you only see what you see)
what is a torus?
it is a bony outgrowth from the hard palate (normal variance)
what do you look for in teeth?
caps, crowns, bridges, dentures, dental jewelry, braces, retainers
when it comes to teeth, you need to distinguish with whether or not an item is ____ or _____
permanent or removable
examine the TMJ; what two things are you looking for?
1) rotation 2) gliding
what do you look for in maxillo-mandibular size and relationship?
dental occlusion, prognathism, retrognathism
why might the larynx not move?
1) patients that might have been radiated for pharyngeal cancer 2) the region is involved with an infection like indurated erythema
what do you visualize and palpate during an OPE?
prominentia laryngis, proximal trachea, hyoid bone including greater cornu, thryoid notch, cricothyroid membrane, cricoid cartilage, and thyroid cartilage.
what do you look for in laryngeal movement during OPE?
lateral movement, dorsal depression, swallowing.
what is the common term for the prominential laryngis
adam’s apple
significant for the minimum distance for mouth opening?
conventional DL may not be possible
what is the minimum thyromental distance?
greater than or equal to 6.5 cm
significance of thyromental distance?
submental compartment may be reduced thereby limiting DL (it’s the quantitative measure of submandibular space)
how do you measure thyromental distance?
mentis to the thyroid notch
what is the minimum mandibular length?
greater than or equal to 9 cm
significance for mandibular length?
limited space for soft tissue displacement during DL
auscultate neck to listen for what?
normal inspiration/expiration, stridor, stertor
what do you test for in cervical flexion?
To assess the ability of utilizing the deep neck flexors (performed by a head nod in the upper cervical spine)
what do you test for in the atlanto-occipital extension?
do this to achieve the sniffing or magill position which aligns the oral, pharyngeal, and laryngeal axes.
