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ENT/Airway Fire Flashcards

1
Q

Trismus

A

Sustained tetanic spasms of the muscles of mastication
-any bilateral restriction in mouth opening

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2
Q

Steroids pain pathway

A

Prostaglandin pathway inhibition

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3
Q

Anesthetic considerations/prep for ENT surgery

A

Decongestants- oxymetazoline- afrin

Anticholinergics- glyco- secretions

Steroids- edema/ponv/pain

Antiemetics

Eye protection

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4
Q

Only LA with vasoconstriction ability

A

Cocaine

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5
Q

Max epi dose in lidocaine

A

1.5 mcg/kg or 200mcg

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6
Q

Sphenopalatine ganglion

A

Innervates- nasal cavity/mucosa and superior potion of pharynx, uvula/tonsils

Trigeminal nerve (V), maxillary and ophthalmic
Facial (VII)

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7
Q

Considerations with nasal surgery and bleeding

A

Throat packs
-OG decompression from blood
-PONV
-post op airway obstruction- high risk of rebleed and laryngospasm

-if rebleed, treat as full stomach

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8
Q

Ear cranial nerves

A

VII - facial

VIII- vestibulocochlear

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9
Q

Conduction hearing loss

A

External canal- cerumen

Tympanic membrane- perforation or scarring

Middle ear- effusions due to adenoids/tumor

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10
Q

Sensorineural hearing loss

A

Typically permanent
Auditory or cochlear nerve

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11
Q

Bilateral myringotomy tubes

A

Most common ear procedure

-chronic serous otitis

-quick-mask IA only no intubation

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12
Q

Stapedectomy

A

For otosclerosis

Replacement of stapes bone with prosthesis

GA or MAC

45 min

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13
Q

Tympanoplasty

A

Requires bloodless field, remifent may help with this

Placement of an artificial tympanic membrane

Not sutured so avoid coughing!!

No nitrous

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14
Q

Mastoidectomy

A

Drilling/cleaning of mastoid area secondary to infection
GA/no paralysis
1-2 hrs

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15
Q

Cochlear implant

A

Treat as craniotomy
-may require hypocapnea
-careful fluids

Implant neuro sensory pack in base of brain via mastoid

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16
Q

Components of airway evaluation

A

Mallampati
Oral opening
Thyromental distance
Atlanto-occipital
ULBT

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17
Q

Airway considerations in tonsillar and adenoidal hyperplasia

A

HIGH ALERT for airway obstruction

Chronic OSA syndrome –

Chronic hypoxia, hypercarbia = Inc. Airway resistance = Pulm. Vascular constriction = PA HTN = R CHF =Cor pulmonale

Cardiac valvular disease increased risk of endocarditis r/t
recurrent tonsillar streptococcal bacterial inf.
May be indicated: Hct, Coags, CXRay, EKG

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18
Q

Tonsillectomy extubation

A

MUST be awake, clearing secretions

High risk PONV and rebleed

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19
Q

Laryngotracheobronchitis

A

Croup!

Usually viral, <3 yrs old

Stridor/barking cough

Subglottic narrowing

TXA: cool O2 mist, arosolized racemic epi, steroids

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20
Q

Epiglottitis

A

Pediatrics
Haemophilius influenza B

Rapid onset, high fever, drooling, inspiratory Stridor

Direct to OR! Keep pt calm
Consider Trach
Maintain spontaneous. Respirations
Small ETT

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21
Q

Foreign body aspiration

A

High risk: edema, bronchospasm, cardiac arrest, bronchial/tracheal laceration, hypoxia, brain death….

Most commonly Rt main

Maintain respirations
Full stomach precautions

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22
Q

Jet ventilation

A

• Driving pressure: 15-35 psi
• I:E ratio: 30-50%
• Inc ratio will Inc. Vt & VM
• Cath size/configuration
• f : 10 – 400(HFJV)
• FiO2
• Humidity

• Manage: Chest excursion, precor

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23
Q

Magic number in airway fire

A

FiO2< 30%

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24
Q

Most common type of OR fire

A

MAC
Supplemental O2
Head and neck

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25
APSF recommendation for MAC procedures
If they can’t tolerate <30% you shouldn’t be doing a MAC and just secure the airway to prevent OR fire
26
Modified draping techniques for mac with supp O2, head and neck surgery
– Adhesive drapes – Drapes clear of face – When drapes over face, deliver 5-10LPM blowby Air under drape to dilute trapped gases – Under drapes suction – Allow > 1min of O2 off before ESU or laser
27
Fire triad
Ignition source- lasers, bipolar ESU preferred Fuel- alcohol preps, drapes Oxidizer- O2
28
ERASE OR fires
Extinguish Rescue Alarm Shut Evaluate
29
What to do in airway fire
Simultaneously and immediately!!: -Remove ETT and remove oxidizer -saline in airway Mask ventilate Reintubate after assessment
30
Lefort I
Horizontal fracture of maxilla
31
Lefort II
Pyramidal
32
Lefort III
Completely displaced/ seperated midface from base of cranium
33
Tooth 8
RU central incisor
34
Tooth 9
LU Central incisor
35
Breakdown of Trigeminal nerve
CN V – V1: Ophthalmic branch • sensory – V2: Maxillary branch • sensory – V3: Mandibular branch • Largest branch • Sensory – General sensory ant. 2/3 of Tongue
36
Break down of Facial nerve
CN VII To Zanzibar By Motor Car 5 branches: Temporal, Zygomatic, Buccal, Mandibular, Cervical Sensory Taste from ant. 2/3 of tongue Motor Muscles of facial expression Corneal reflex (V1) Orbicularis oculi
37
Glossopharyngeal breakdown
CN IX – Sensory: • Taste/sensation to posterior 1/3 Tongue • Sensory down to top of Epiglottis – Motor: • Stylopharyngeous muscle • Secretomotor to Parotid gland
38
Larynx anatomy- cartilages and location
• Located at C4-6 level • Consists of 3 unpaired cartilages – Thyroid – Cricoid – Epiglottis • Consists of 3 paired cartilages – Arytenoid – Corniculate – Cuniform
39
Innervation of motor cricothyroid muscle
external SLN
40
Internal SLN
Sensory innervation inferior epiglottis and supraglottic compartment of larynx
41
Muscle implicated in laryngospasm
Cricothyroid muscles -contraction shifts anatomical orientation of larynx-causing cord stretch and tension
42
RLN innervation
CN X Sensory-below cords Motor- all intrinsic muscles of larynx
43
Posterior cricoarytenoids
PCA- Pulls cords apart
44
Lateral cricoarytenoids
LCA- leave cords alone- adduction
45
Thyroplasty
For permanently paralyzed vocal cords- increased size to match the other
46
When is thyroid storm most likely?
6-18 hr postop
47
What can cause thyroid storm?
Untreated hyperthyroid Stress, illness, surgery Amiodarone (iodine?)
48
Thyroid storm management
Stop stimulus/correct underlying cause Propylthiouracil- 200-400 mg PO Beta antagonists, esmolol or propranolol — inhibit T4 conversion K iodide- 250mg Dexamethasone 10 mg
49
Hyperthyroid anesthesia considerations
-cancel elective until euthyroid - avoid SNS stimulation, i.e. ketamine -cooling blankets -higher incidence of Myasthenia in this population -regional is great
50
Tracheomalacia
Airway collapse, particularly during exhalation
51
Thyroidectomy considerations
-hematoma -tracheomalacia -RLN injury- unilateral/bilateral Use NIM ETT
52
Emergency Hypercalcemia
>15mg/dL Fluids Lasix Dialysis Calcitonin/glucocorticoids
53
Hypocalcemia- what causes it and what are the symptoms
<8mg/dL Neuronal irritability, spasms, seizures Chvostek-facial muscle contracture Trousseau-finger contraction with tourniquet CHF, hypotension, insensitive to beta agonists!!
54
Nerve that senses light in the eye
Optic
55
Nerve that causes pupillary contraction
Oculomotor
56
Blink reflex
Ophthalmic branch of the CN V to the sensory nucleus → projects to motor nucleus of CN VII → Orbicularis Oculi Muscle
57
Intraocular pressure values
Somewhat mimic ICP Normal 10-20mmhg High IOP impairs corneal metabolism and sudden changes can cause permanent vision loss
58
What does a rapid decrease in IOP cause?
Retinal detachment and vision loss
59
Factors that increase extraocular pressure
Contraction of orbicularis and EOMs Venous congestion of orbital veins Tumors Trauma
60
Causes of increased IOP
Fluid content- aqueous fluid formation and outflow Sclera rigidity Tumors
61
Anesthetic impacts on IOP
Succinylcholine is the only drug that probably increases IOP -8mmhg Ketamine will cause nystagmus so it is not suitable for most eye surgeries
62
Glaucoma
Elevated IOP- impairment of capillary blood flow to the optic nerve= eventual loss of optic nerve function
63
Types of glaucoma
Open angle- chronic-most common Closed angle- acute, avoid scopolamine
64
Surgical options for glaucoma
Small puncture to iris Create canal between anterior chamber and subconjunctival space Destroy the ciliary body by freezing (point of aqueous humor production)
65
Intravitreal injection of gas or fluid, why?
To temporarily increase IOP to promote reattachment of the detached retina May need to remain prone post op No N2O!
66
Cataract surgery
Replace lens Phacoemulsification; small incision, no sutures- < 10min/eye LA and sedation
67
Stabismus surgery
Corrects crossed eyes Can be lengthy Avoid succ- correlation with MH and muscular dystrophy patients High incidence of oculocardiac reflex and PONV
68
Five and dime
Trigeminal and vagus Stimulated by pressure on the globe or traction on the EOMS Bradycardia, dysrhythmias and asystole
69
Retrobulbar block
Local behind the eye Abolishes oculocardiac reflex-can also cause stimulation of this reflex Risk of globe puncture, intraocular injection, hemorrhage
70
Big CRNA consideration during retrobulbar block
Blunt the startle reflex (needle coming at the eye) -slug them with prop and let them immediately recover
71
Peribulbar block
LA injection outside extraocular muscle cone Safer than retrobulbar Slower onset
72
Mydriasis
Dilation of pupil
73
Why don’t we use epi in narrow angle glaucoma?
Decreases aqueous production and increases outflow to decrease IOP
74
Acetazolamide in Eye surgery
Diamox Decrease IOP by carbonic anhydrate inhibition thus decreasing Aqueous humor production
75
Echothiphate
Decrease IOP by Miosis Cholinesterase ihibitor- may prolong succ
76
Timolol
Systemic, decreases aqueous humor production Newer drugs (betaxolol- more oculospecific)
77
Ventilation in eye surgery
Hypoventilation/ hypercarbia increases IOP
78
Ischemic optic neuropathy
ION vs posterior ION Factors: -extrinsic compression -prone -head dependent -large volume crystalloids -men
79
Corneal abrasion
Most common ocular complication of GA Most likely due to desiccation instead of abrasion Prevention: Tape post induction/pre DL Ointment Goggles Q15 eye checks prone patients Treatment: Antibiotic ointment Usually heal in 24 hrs/ highly vascular
80
Differences between croup and epiglottitis
Croup- subglottic, barking cough Epi- supraglottic, inspiratory stridor
81
How do you extubate epiglottitis?
In OR after 48-72 hrs -take a look with fiber optic and check a leak test
82
Inspiratory stridor-location of obstruction
Supraglottic
83
Expiratory stridor-location of obstruction
Subglottic/ thoracic trachea and bronchi
84
What happens when plastic burns in the airway
carbon monoxide, ammonia, hydrogen chloride, and cyanide = asphyxia
85
Treatment of corneal abrasion
Erythromycin X3 days Clears in first 24hrs typically

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