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AAN2 > Class 2 ENT > Flashcards

Class 2 ENT Flashcards

1
Q

What is a frequent problem associated with inner ear surgery?

A
  • PONV

- Keep hydrated and treat aggressive

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2
Q

Most ear anesthesia is delivered how?

A

Topically

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3
Q

What are the main sensory ear nerves?

A
  • Auriculotemporal
  • Greater auricular
  • Auricular branch of vagus
  • Tympanic
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4
Q

How does N2O affect the middle ear? Ear graft? How should N2O be used ear procedures?

A
  • Increase pressure
  • May displace graft
  • used in PE tubes, but otherwise N2O should be avoided or less than 50%
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5
Q

What is a NIM monitoring? and when is it used?

A
  • Nerve integration monitoring (facial nerve monitor)

- Middle, inner or mastoid procedures

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6
Q

Bleeding can obscure the surgical field what can be done to help?

A
  • Head up (reduces venous pressure)
  • ASA 1 hypotension (Map 50-60)
  • Beta blockers, clonidine, opioids
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7
Q

What is Samter’s triad and what does it lead to?

A
  • NSAID sensitivity, Asthma, and Nasal Polyps

- Leads to broncho spasm

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8
Q

What are 4 coommon Nasal vasoconstrictors?

A
  • Cocaine
  • Epi
  • Phenylepherine
  • Lido w/ epi
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9
Q

What does low dose cocaine do?

A
  • Vagotonic

- Decrease HR

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10
Q

What doe high dose cocaine do?

A
  • Tachy / HTN
  • Vtach
  • Myocardial depression
  • Leading to MI,VF or sudden death
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11
Q

How does cocaine cause CV effects?

A
  • Blocks reuptake of epi at sympathetic nerve terminals

- potentate sympathetic activity

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12
Q

What should be done prior to extubation?

A
  • Thorough suctioning

- Inspect airway for clots

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13
Q

What my happen after relief of airway obstruction? When?

A
  • Pulmonary edema

- Minutes to hours

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14
Q

What should be assessed preop in kids prior to ENT procedures?

A
  • OSA
  • Loose teeth
  • Bleeding disorders
  • Anemia
  • URI
  • Sickle cell
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15
Q

When the mouth gag is inserted what should be watched for?

A

-Reflex tach and HTN

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16
Q

What are the benefits of steroids?

A
  • Decreased postop emesis
  • Better diet tolerance
  • Reduced pain
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17
Q

How would you avoid the increased risk laryngospasm after extubation with throat procedures?

A
  • Extubate deep or awake
  • IV lidocaine
  • Propofol
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18
Q

What is Larson’s maneuver?

A

-Positive pressure with pressure at angle of ramus

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19
Q

Who are at an increased risk for bleeding tonsil?

A
  • Increases with age (adults)
  • Males
  • Quinsy (abscess)
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20
Q

When are post tonsillectomy most at risk for bleeding?

A
  • 6 hours post

- 7-8 days after (scab falls off)

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21
Q

What are the signs of post tonsillectomy bleed?

A
  • Tachy
  • Excessive swallowing
  • pallor
  • restlessness
  • sweating
  • Increased cap refill time
  • Hypotension (late sign)
22
Q

Presence of stridor indicate how large of an airway?

A

-<4-5 mm

23
Q

Why is a post op EKG ordered after microlaryngoscopy?

A

-CV response of airways reflexes throughout entire case can cause MI/Ischemia

24
Q

Microlaryngoscopy tubes are double cuffed and the balloons are filled with what and why?

A
  • Saline and methylene blue

- Act as heat sink and to identify breached cuff

25
Q

What type of laser is used for microlaryngoscopy? what are the risks?

A
  • CO2 Laser

- airway fire, stray beams

26
Q

What 3 things are needed for a fire? What should be done to reduce fire risk?

A
  • Fuel, oxidant, ignition (heat)

- Keep O2 to lowest setting, avoid N2O, use air

27
Q

What are the 3 different laser types and their colors?

A
  • YAG = Green
  • Argon = Amber
  • Co2 = Clear
28
Q

What should be done if airway fire happens?

A
  • Disconnect circuit
  • Extubate
  • Mask ventilate
  • Reintubate
  • Bronch to assess damage
29
Q

What pulmonary care should be given after airway fire?

A
  • Humidity
  • PEEP
  • Steroids
  • Abx
  • Racemic Epi
30
Q

Supraglottic Jet Ventilation problems?

A
  • Debris can be blown into trachea
  • Vocal cord vibration
  • Poor End Tidal CO2 monitoring
31
Q

What are the risks of subglottic Jet ventilation?

A
  • pneumomediastinum
  • pneumothorax
  • SQ emphysema
32
Q

What are the benefits of subglottic jet vent vs. supra glottic?

A
  • Reduced driving pressure

- Minimal VC movement

33
Q

What is at greater risk with subglottic vs supraglottic jet vent?

A

-Greater risk of barotrauma

34
Q

What is spontaneous ventillation? When is it used?

A
  • Mask induction w/ Sevo and 100% O2. Sevo given with suction catheter in nose
  • Used for FB removal, airway eval, simple glottic lesions
35
Q

What are the problems with spontaneous ventillation?

A
  • Cant be too deep (resp depression) cant be too light (coughing)
  • Airway soiling
  • OR pollution
  • Cant control respirations
36
Q

If fiberoptic bronch is done with local, what is a potential risk? and what should be done to minimize this risk?

A
  • Aspiration (lack of gag reflex)

- NPO until gag reflex returns

37
Q

What can happen if there is too much suctioning through a bronchoscope?

A

-Hypoxemia

38
Q

What are the main complications with bronchs?

A
  • Bronchospasm
  • Hypoxemia
  • CO2 retention
  • Pneumo
  • SQ emphysema
  • intraop awareness
39
Q

When can resistance to ventilation occur with a bronch?

A

-When the scope or foreign body occupies too much cross section of the ETT.

40
Q

What are the complications of esophagoscopy?

A
  • Perforation
  • Hemorrhage
  • Dysrhythmias (heart stimulated by scope passage)
41
Q

If FB is potentially sharp, what should be avoided?

A

-Crichoid pressure

42
Q

Who is most at risk for inhaled FBs?

A

-1-3 yo males

43
Q

What is worse to inhale, organic or inorganic material and why?

A

-Organic, can fragment, soften, and expand

44
Q

What type of Xray is helpful in airway foreign body diagnosis and why?

A
  • Expiratory CXR

- Will see mediastinal shift away from affected side or atelectasis toward affected side

45
Q

What should be done with inhaled organic FB?

A

-Position patient on lateral side with affected side down.

46
Q

Name the main complications with FB removal and what should be done?

A
  • Mucosal edema/Stridor

- Humidify, racemic epi, Decadron

47
Q

What bacteria can cause epiglottits?

A
  • Influenza type B

- Group A strep

48
Q

What are the 4 D’s of epiglottits?

A
  • Dysphagia
  • Dysphonia
  • Dyspnea
  • Drooling
49
Q

How should a child w/ epiglottitis be induced?

A
  • O2 ASAP
  • Start IV only w/o crying
  • Mask induction w/ Sevo and 100% O2
  • Maintain spontaneous resp
  • add CPAP 5-10
  • Intubate with smaller tube
50
Q

What are the immediate complications with trachs?

A
  • Bleeding
  • Pneumo
  • esophageal perf
  • misplaced tube in false passage
  • Edema
  • RLN damage
51
Q

Why are trach ties not changed for the 1st 7 days?

A

-collapse of tissue around stoma can make passage difficult to find

52
Q

What are the late complications of a trach?

A
  • Tracheal stenosis
  • Erosion of blood vessels
  • Erosion of esophagus

AAN2 (11 decks)

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