ENT Flashcards
Waldeyer’s ring
soft palate
the base of the tongue
uvula
palatine tonsils
adenoid
What is the pharynx composed of?
Composed of the terminal end of the nasopharynx
Oropharynx
Laryngopharynx
Hypopharynx
Upper airway Sensory and Motor supply originates what nerves?
5, 7, 9, 10
med for nasal congestion
Afrin aka Oxymetazoline
the floor is composed of
1 palatine process of maxilla
2 horizontal plate of the palatine bone.
Extensive vascular supply leads to severe bleeding if an endotracheal tube is not inserted along the what?
The superior margin of the hard palate.
Tonsils and blood supply are the causes of concern for bleeding.
Branches from the
1 facial arteries
2 external and internal carotid
3 maxillary arteries
How does the epiglottis cover the larynx during swallowing?
The larynx is pulled cephalad, allowing the epiglottis to cover the trachea.
Swallowing
1 RLN (10)
2 SLN (10)
3 Glossopharyngeal (9)
3 unpaired cartilages
Thyroid
Cricoid
Epiglottis
3 paired cartilages
§ Arytenoid
§ Corniculate
§ Cuneiform
What connects the oropharynx to trachea
larynx
What is the narrowest portion of the larynx in the adult?
Rima Glottis (Glottidis) or the area of the vocal cords.
What is the narrowest portion of the larynx in the pediatric patient?
The narrowest portion of the Larynx is the CRICOID RING until 10 years of age
Cuffed tubes are generally recommended for those older than
8-10 years of age to allow for better airway seal, prevent subglottic edema, and reduce the incidence of postoperative airway compromise.
Which Law applies to non-ideal fluids to explain the change in ventilation?
Poiseuille
What cranial nerve is responsible for gag reflex
glossopharyngeal
vagal
what act as a significant dilating muscle of the nasopharynx?
The stylopharyngeus muscle
where does SLN end ?
above the vocal cord
where does RLN end ?
Subglottic area
Provides motor function to the cricothyroid muscle of the larynx
external SLN
branches from the vagus nerve and loops around the brachiocephalic artery
Right RLN at T1 - T2
branches from the vagus nerve and loops around the aorta
Left RLN at T2
The heart is on the left, and so is the aorta
Common Local anesthetic (amides) & max doses
Lido 5 mg/kg max 300
Lido w epi 7 mg/kg max 500
Bup 2.5 mg/kg max 175
Bup w epi 3 mg/kg max 225
Ropi 2 mg/kg max 200 mg
Why should you give decadron after the patient is asleep?
IV injection can cause Perineal Pain and Pruritus
What is avascular necorosis and what medication may cause it?
corticosteroids
A condition where bone tissue dies due to a lack of blood supply. This can lead to the collapse of the bone structure and subsequent joint dysfunction.
Why do ENT procedures have especially high-risk PONV?
swallowing blood
Drain the stomach at the end of a bloody procedure with OG tube carefully.
benefits of anticholinergics (glyco)
helps reduce or diminish vagal tone
reduces secretions
increases bronchodilator.
Can cause closed-angle glaucoma
what color glasses for Nd: YAG?
Green
What color glasses for the CO2 laser?
clear or plastic
What color glasses for argon laser?
Orange-tinted glasses are required for the Argon Laser
A pediatric sized standard ETT with an adult length OR an adult sized ETT with a pediatric sized diameter.
Microlaryngeal Endotracheal Tube or MLTs
The surgeon will remove the ETT, operates for a brief period of apnea, and then allows the anesthesia provider to reintubate the patient.
Intermittent Apnea
For when the trachea is not intubated, a metal needle is mounted in the operating laryngoscope or passed through the cords.
Jet Ventilation
With the tip of the needle either above or below the glottis, the anesthetist directs a high velocity stream of O2 into the airway lumen, typically low tidal volumes with high respiratory rates.
High Frequency Jet Ventilation
What kind of expiration happens with High Frequency Jet Ventilation?
passive expiration
when is HFJV contraindicated?
Contraindicated in any situation in which an unprotected airway is a concern (full stomach, hiatal hernia or trauma)
Most common site of Foreign Body Aspiration ?
right bronchus
Lying down? upper R lobe
Sitting? Lower R lobe
How to treat Foreign Body Aspiration that is superior or level of the larynx?
simple laryngoscopy with Magill forceps
How to treat Foreign Body Aspiration that is distal to larynx?
The patient should have an inhalational induction in the OR, maintaining spontaneous respiration without cricoid pressure or positive pressure ventilation.
+ Rigid Bronchoscope
What cranial nerves are involved in ear and face surgery?
9 10 11 12
Can you use paralysis for facial nerve monitoring?
Yes, may be performed despite significant neuromuscular blockade detected by conventional ulnar TOF.
However, profound skeletal muscle relaxation should be avoided, and volatile anesthetic drug should be used judiciously as a primary anesthetic.
Remifentanil and ½ MAC VA could be employed and adequate enough for the procedure.
Nitrous oxide is how much more soluble than air?
NO diffuses into air-containing cavities in the body 34, which is more soluble than nitrogen.
“The blood: gas partition coefficient of nitrous oxide (0.46) is about 34 times greater than that of nitrogen (0.014)”
may elicit a vagal response.
1Stimulation of the epiglottis with the tip of a straight laryngoscope
2 blades
3 suction catheters
4 placement of an endotracheal tube
this allows the pressure to equalize between the middle ear and the atmosphere, reducing the pressure in the middle ear compartment.
Myringo Tube Placement
anesthesia set up for tubes
-No need to intubate
-mask induction
-mask ventilation (CPAP for TV)
-tylenol suppository
-Keep patient deep, 3% Sevo, assist with breathing if you have to.
what is the signal of procedure end for tube placement?
ear drops and cotton ball placed in ear.
Uvulopalatopharyngoplasty (UPPP) may be apart of T&A for what?
Pickwickian syndrome or Obstructive Sleep Apnea.
ICU / OR standard tubes
TUBES WE USE ARE LOW PRESSURE/HIGH VOLUME
when not to use a nasal rae?
Facial trauma
Known facial trauma in the unconscious patient should be avoided to prevent possible penetration into the brain.
Where should rae tubes face?
Oral RAE- South facing-towards feet
Nasal RAE- North facing-towards head
USE BITE BLOCK WITH THIS TUBE
Wire Embedded ETTs
Induction for T&A in peds
- Inhalation induction, 8% Sevoflurane
- Prop, opiod, decadron
- intubate gently
- A cuffed oral RAE ETT is recommended for children older than 8-10 years of age.
- Neck roll
- Mouth gag removal (may vagal)
- suction out stomach
- Move the bed back to the induction position, back from 90 degrees
incidence of bleeding tonsils
Incidence of post tonsillectomy bleeding requiring surgery is 0.3%-0.6%.
75% of post op hemorrhages occur within 6 hours of surgery.
Remaining 25% of post op bleeds occur within 24 hours of surgery.
** Slow Ooze **
the bones of the face develop between what weeks?
between 5th and 9th week
growth of palatal bones develop what weeks?
between the 6th and 11th week.
where does the cleft occur?
The cleft develops when the bones of the NASAL and MAXILLARY or the palatal bones fail to fuse.
How do you prime your lines for cleft lip repair babies?
All air bubbles removed from IV lines to prevent air embolus due to increased incidence of cardiac anomalies (atrioventricular defect).
extubation for cleft lip happens only after airway reflexes have _____ .
returned
Symptoms seen in Downs SYndrome
Unstable atlantoaxial instability (C-spine cleared?)
Large tongue
Large occiput and fat pad
Congenital heart disease
Small oropharynx
Enlarged tonsils
Increased secretions
Patients on Phenytoin for seizures may present with gingival hyperplasia.
Presents with nasal polyps, asthma, and aspirin allergy.
Samter Syndrome
what med is used to vasoconstirct in sinus surgery?
cocaine max 300mg
epinephrine max 200mcg??
How do you keep the neck neutral during intubation on a trauma patient?
1 manual in line axial stabilization
2 cervical collar
when should trauma patients with smoke inhalation be intubated?
immediately
Le Fort 1
horizontal fracture through hard palate, nasal septum, and pterygoid plates.
Fe Fort 2
triangular fracture from nose, orbit, cheek, maxilla, and pterygoid plates.
Le Fort 3
totally separates the midfacial skeleton from the cranial base.
(nose, the ethmoid bone, the eye orbits, and the sphenopalatine fossa)
what La Fort Procedures are you strongly advised NOT to nasally intubate?
2 and 3 may place the tube into the cranial vault.
3 words: Basilar Skull Fracture.
what do you need to always have on you incase of maxillofacial trauma
Make sure you have wire cutters available at all stages of stay in case of airway emergency at extubation to PACU to transport to ICU/floor.
