ENT Flashcards
which nerves supply the ear
auriculotemporal. greater auricular, auricular branch of vagus, tympanic
N20 diffuses into the middle ear, so you should avoid it or limit to less than __ %
50
when would you use facial nerve monitoring
during middle ear, mastoid, and inner ear procedures near facial nerve
head ___ position will reduce venous pressure and bleeding
up
ASA 1 hypotensive technique consists of MAP __-___, intraopsystolic >preop diastolic, HR __
50-60
hr 60
small doses of cocaine are ___, decrease HR.
while higher doses of cocaine do what on the CV system?
vagotonic.
tachy, htn, VT, direct myocardial depression leading to MI VF sudden death
what is Samter’s triad?
NSAID sensitivity in patients with asthma and nasal polyps leading to severe bronchospasm
whats the dose for rectal tylenol
10-15mg/kg
whats the dose for zofran
100-150mcg/kg
what is larsons maneuver
gentle positive pressure with anterior pressure at angle of ramus check
bleeding tonsil - post-op bleeding ____ with age
increases
bleeding tonsil - primary bleeds occur within __h and are usually ____
6h, venous or capillary
what are suggestive s/s of bleeding tonsil?
unexplained tachycardia, excessive swallowing, pallor, restlessness, sweating, increased capillary refill time.
what is a late light of bleeding tonsil?
hypotension
how should you intubate a bleeding tonsil patient?
RSI, head down if tolerated
how should you mask the patient?
lateral or head down
presence of stridor indicates
4-5
Dysphagia: significant and suggests ____ obstruction; if associated with carcinoma, implies ____ ____ extension
surpaglottic. upper esophageal
___ stridor suggests extra thoracic airway obstruction
inspiratory
____ stridor suggests intrathoracic airway obstuction
expiratory
___ laser is most commonly used in microlaryngoscopy
CO2
what are the risks associated with the laser?
airway fire, stray laser beam hazardous to OR personnel
what are the 3 things needed for fire
fuel, oxidant, and ignition(heat) source
YAG laser = ___ lens googles
green
Argon laser = ____ lens googles
amber
CO2 = ___ lens
clear
what is the fastest way to stop O2 in the case of an airway fire
disconnect circuit
what are the issues associated with supraglottic jet ventilation
misalignment leads to poor ventilation, blood smoke, debris blown into trachea, VC may vibrate, cant monitor etCO2, spike pneumomediastinum, pneumothorax, sq emphysema
subglottic jet vent has ___ risk barotrauma than supraglottic
greater
High frequency ventilation (HFV) involves ___ tidal volumes with ___ rates via 3.5-4mm catheter
small, rapid
HFPPV (positive pressure ventilation) resp rates =
60-120
HFJV (jet ventilation) resp rates = ____ and tidal volumes = ?
resp rates =100-140.
tidal volumes less than dead space
what do you do to avoid OR pollution by anesthetic gases if you are insufflating agent via a small catheter in the nose or nasopharynx?
use a high intensity suction catheter near the mouth to clear
how can you assess for adequacy of ventilation with a riding bronchoscope?
chest rise - tidal volume and etco2 will not return via circuit
T/F A rigid bronchoscope provides better visualization, suction, and control of bleeding. Control ventilation d/t danger of movement and risk of hypoventilation.
TRUE.
the venturi bronchoscope uses the same principles of ____
sanders type injector
16g jet on side arm of laryngoscope or bronchoscope
PCO2 accumulates ____ for every minute of apnea
3-4torr
Risks of fiberoptic bronchoscope: ___ from over zealous suctioning, and ____ from sedation
hypoxemia, hypoventilation
GETA fiberoptic - ETT no smaller than ____
8-9
If FOB occupies too much cross section of eat or scope too tight in larynx, ____ occurs, which ____ venous return and CO
PEEP, decreases
T/F Esophagoscopy requires a large ETT
false. use smaller size ETT. may need to drop cuff to allow passage of scope
which procedure carries the complications of perforation of hypopharynx, massive hemorrhage, dysrhythmia as heart is stimulated by passage of scope
Esophagoscopy
If FB is in the esophagus, cried pressure can cause?
perforation, esp if object is sharp
FB can cause collapse of trachea if it presses on post tracheal wall (absence of cartilage support). what could be useful?
reinforced tube
inhaled foreign body - which is worse - organic or inorganic ?
organic. it can soften, expand, and fragment.
T/F In near complete occlusion, pushing laryngeal/tracheal fb into mainstream bronchus has resulted in reducing obstruction temporality.
TRUE
If known organic material, position ___ with affected side _____ to minimize fragment spread
lateral, affected side DOWN
racemic epi treatments may be repeated every ___ min
30
whats the dose for decahedron for foreign body removal?
0.5-1.5 mg/kg
what is the etiology of epiglottis? haemophilus influenza type ___ (less now) and ___ ___ ____. viral cause is _____ virus.
haemophilus influenza type B and group A strep.
viral - parainfluenza virus
epiglottitis is typical in which age group?
3-5yo
epiglottitis peaks which time of year ?
spring and fall
what are the 4 D’s associated with epiglottitis?
dysphagia, dysphonia, dyspnea, and drooling
T/F epiglottitis patients present with hoarseness.
FALSE. stridor maybe on inspiration, NO hoarseness is present.
lateral neck x-ray “____” at epiglottis
thumb sign
epiglottitis patient sitting upright, leaning in a sniffing position is referred to the __ position
tripod
T/F induce child with epiglottitis with sevo, N20, O2
FALSE just sevo and 100% fio2
How should you determine your ETT size for epiglottitis?
intubate orals or nasally with tube 0.5-1.0 size smaller than usual
Does the epiglottitis patient usually get extubated?
no they remain intubated for 24-48h
Trach ties are not to be changed for the first ___ days. Collapse of tissue around stoma makes correct passage hard to find
7
T/F Late complications of tracheostomy include tracheal stenosis, erosion of major blood vessels, erosion of esophagus.
TRUE
If tracheostomy tube is dislodged in early postop period what do you do?
reintubate from larynx. try a smaller size tube.
if you emergently need to ventilate a patient with an uncuffed trach tube in place…. ?
may pass small 5.5ett thru plastic trach tube to establish positive pressure.
