basic airway exam and evaluation

Question 1

why be an expert at airway mgmt?

Answer 1

1) lots of risk = real $$ loss 2) you’re on the front line

Question 2

you’re responsible for airway once you give a _____

Answer 2

muscle relaxant

Question 3

why do we examine and evaluate pt airways preoperatively?

Answer 3

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

Question 4

what is risk?

Answer 4

probability of injury or loss; the likelihood of doing harm

Question 5

if plan A is DL and intubation, what is needed?

Answer 5

info concerning establishing direct visualization of glottis – vocal cords

Question 6

head and neck exam must include gathering information concerning:

Answer 6

axial alignment

Question 7

what are the 3 axes of alignment?

Answer 7

laryngeal, oral, pharyngeal

Question 8

what information do you obtain in head and neck movement?

Answer 8

ROM: rotation, flexion, extension

Question 9

what is rotation in airway exam?

Answer 9

head right to left

Question 10

what is flexion in airway exam?

Answer 10

lower cervical spine

Question 11

what is extension in airway exam?

Answer 11

atlanto-occipital joint (can they close their occipital joint?)

Question 12

not being able to extend atlanto occipital joint even after asleep is an example of what?

Answer 12

a mechanical limitation (means it wont be fixed despite being under anesthesia)

Question 13

“do you drop things when you look to the left or right? is an example of

Answer 13

an that produces motor weakness

Question 14

pain, paresthesia, and motor weakness are issues that can _____ when you anesthetize patient

Answer 14

go away

Question 15

what is the term for the potential space under the chin?

Answer 15

submental compartment

Question 16

what is fligmon?

Answer 16

it’s the infected area of submandible where floor of mouth is full and fixed

Question 17

what is OPE?

Answer 17

oralpharyngeal exam

Question 18

what is the minimum inter-incisor distance?

Answer 18

greater than or equal to 4 cm

Question 19

what do you see when you observe the tongue?

Answer 19

1) size 2) disease

Question 20

what do you look for in floor of mouth?

Answer 20

lesions such as white patches (leukoplakia)

Question 21

what do you expect to see in OPE?

Answer 21

hard and soft palate, uvula, palatine tonsils or fossae, and palatoglossal arches and palatopharyngeal arches

Question 22

soft palate terminates at the

Answer 22

uvula

Question 23

you need to locate where the ____ are in an OPE

Answer 23

palatine tonsils or fossae

Question 24

____ live between the 2 arches

Answer 24

palatine tonsils

Question 25

what do you document in OPE according to Dr. Hall?

Answer 25

1) tonsil viz 2) uvula viz 3) soft palate viz 4) hard palate viz (this indicates you only see what you see)

Question 26

what is a torus?

Answer 26

it is a bony outgrowth from the hard palate (normal variance)

Question 27

what do you look for in teeth?

Answer 27

caps, crowns, bridges, dentures, dental jewelry, braces, retainers

Question 28

when it comes to teeth, you need to distinguish with whether or not an item is ____ or _____

Answer 28

permanent or removable

Question 29

examine the TMJ; what two things are you looking for?

Answer 29

1) rotation 2) gliding

Question 30

what do you look for in maxillo-mandibular size and relationship?

Answer 30

dental occlusion, prognathism, retrognathism

Question 31

why might the larynx not move?

Answer 31

1) patients that might have been radiated for pharyngeal cancer 2) the region is involved with an infection like indurated erythema

Question 32

what do you visualize and palpate during an OPE?

Answer 32

prominentia laryngis, proximal trachea, hyoid bone including greater cornu, thryoid notch, cricothyroid membrane, cricoid cartilage, and thyroid cartilage.

Question 33

what do you look for in laryngeal movement during OPE?

Answer 33

lateral movement, dorsal depression, swallowing.

Question 34

what is the common term for the prominential laryngis

Answer 34

adam’s apple

Question 35

significant for the minimum distance for mouth opening?

Answer 35

conventional DL may not be possible

Question 36

what is the minimum thyromental distance?

Answer 36

greater than or equal to 6.5 cm

Question 37

significance of thyromental distance?

Answer 37

submental compartment may be reduced thereby limiting DL (it’s the quantitative measure of submandibular space)

Question 38

how do you measure thyromental distance?

Answer 38

mentis to the thyroid notch

Question 39

what is the minimum mandibular length?

Answer 39

greater than or equal to 9 cm

Question 40

significance for mandibular length?

Answer 40

limited space for soft tissue displacement during DL

Question 41

auscultate neck to listen for what?

Answer 41

normal inspiration/expiration, stridor, stertor

Question 42

what do you test for in cervical flexion?

Answer 42

To assess the ability of utilizing the deep neck flexors (performed by a head nod in the upper cervical spine)

Question 43

what do you test for in the atlanto-occipital extension?

Answer 43

do this to achieve the sniffing or magill position which aligns the oral, pharyngeal, and laryngeal axes.