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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?

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
What type of laser is used for microlaryngoscopy? what are the risks?
- CO2 Laser | - airway fire, stray beams
26
What 3 things are needed for a fire? What should be done to reduce fire risk?
- Fuel, oxidant, ignition (heat) | - Keep O2 to lowest setting, avoid N2O, use air
27
What are the 3 different laser types and their colors?
- YAG = Green - Argon = Amber - Co2 = Clear
28
What should be done if airway fire happens?
- Disconnect circuit - Extubate - Mask ventilate - Reintubate - Bronch to assess damage
29
What pulmonary care should be given after airway fire?
- Humidity - PEEP - Steroids - Abx - Racemic Epi
30
Supraglottic Jet Ventilation problems?
- Debris can be blown into trachea - Vocal cord vibration - Poor End Tidal CO2 monitoring
31
What are the risks of subglottic Jet ventilation?
- pneumomediastinum - pneumothorax - SQ emphysema
32
What are the benefits of subglottic jet vent vs. supra glottic?
- Reduced driving pressure | - Minimal VC movement
33
What is at greater risk with subglottic vs supraglottic jet vent?
-Greater risk of barotrauma
34
What is spontaneous ventillation? When is it used?
- Mask induction w/ Sevo and 100% O2. Sevo given with suction catheter in nose - Used for FB removal, airway eval, simple glottic lesions
35
What are the problems with spontaneous ventillation?
- Cant be too deep (resp depression) cant be too light (coughing) - Airway soiling - OR pollution - Cant control respirations
36
If fiberoptic bronch is done with local, what is a potential risk? and what should be done to minimize this risk?
- Aspiration (lack of gag reflex) | - NPO until gag reflex returns
37
What can happen if there is too much suctioning through a bronchoscope?
-Hypoxemia
38
What are the main complications with bronchs?
- Bronchospasm - Hypoxemia - CO2 retention - Pneumo - SQ emphysema - intraop awareness
39
When can resistance to ventilation occur with a bronch?
-When the scope or foreign body occupies too much cross section of the ETT.
40
What are the complications of esophagoscopy?
- Perforation - Hemorrhage - Dysrhythmias (heart stimulated by scope passage)
41
If FB is potentially sharp, what should be avoided?
-Crichoid pressure
42
Who is most at risk for inhaled FBs?
-1-3 yo males
43
What is worse to inhale, organic or inorganic material and why?
-Organic, can fragment, soften, and expand
44
What type of Xray is helpful in airway foreign body diagnosis and why?
- Expiratory CXR | - Will see mediastinal shift away from affected side or atelectasis toward affected side
45
What should be done with inhaled organic FB?
-Position patient on lateral side with affected side down.
46
Name the main complications with FB removal and what should be done?
- Mucosal edema/Stridor | - Humidify, racemic epi, Decadron
47
What bacteria can cause epiglottits?
- Influenza type B | - Group A strep
48
What are the 4 D's of epiglottits?
- Dysphagia - Dysphonia - Dyspnea - Drooling
49
How should a child w/ epiglottitis be induced?
- 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
What are the immediate complications with trachs?
- Bleeding - Pneumo - esophageal perf - misplaced tube in false passage - Edema - RLN damage
51
Why are trach ties not changed for the 1st 7 days?
-collapse of tissue around stoma can make passage difficult to find
52
What are the late complications of a trach?
- Tracheal stenosis - Erosion of blood vessels - Erosion of esophagus

AAN2 (11 decks)

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