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Sim Lab 3 > ENT and Eye > Flashcards

ENT and Eye Flashcards

1
Q

Basic part of the ear

3

A
  1. Inner
  2. Middle
  3. Outer
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2
Q

Basic Inner Ear anatomy

A

Cochlea
Cochlear nerve
Vestibular nerve
Eustachian tube

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3
Q

Basic Middle Ear anatomy

A

Semicircular canals
Eustachian tube
Stapes
Incus
Malleus
Tympanic membrane

SIM-> Proximal to distal

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4
Q

Basic Outer Ear anatomy

A

External acoustic meatus
Temperal bone

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5
Q

External ear surgeries

A

Reconstruction of ear or auditory canal

GA with LMA and local

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6
Q

Middle Ear procedures: OCR

A

Ossicular chain reconstruction (OCR) is a surgical method used to repair conductive hearing loss.

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7
Q

Middle Ear procedures: Myringotomy and Tube Insertion

Classic BMT

A

Helps drain middle ear because the eustachian tube isnt working

Facemask induction for shorter cases. LMA or ETT for longer ones

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8
Q

Middle Ear procedures: Cholesteatoma

A

Cholesteatoma is a skin-lined cyst that begins at the margin of the eardrum and invades the middle ear and mastoid

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9
Q

Middle Ear procedures: Stapedectomy

A

Stapedectomy is a surgical procedure to treat hearing loss caused by otosclerosis

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10
Q

Inner Ear Procedures: Neoplasm or chochlear implant

Meneirs Dx: common issues with Labyrinth/Semicurcular canals

A

Complex, GA with muscle relaxation
Increased PONV risk

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11
Q

A microscope is common in ear surgery. What things do we have an impact on while the doc is working under the scope?

A

Movement: Relaxation
Breathing: Spontaneous / Belly breathing

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12
Q

Ear surgery considerations

A

Avoid coughing
NO N2O
Increased PONV risk
Monitoring negates use of NMB’s

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13
Q

Basic Nasal Anatomy

A
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14
Q

Sinus Anatomy

A
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15
Q

4 types of nasal surgery

A
  1. External
  2. Nasal Cavity
  3. Nasal Sinus
  4. Nasal Bony Structures
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16
Q

LMA’s in Nasal surgery?

A

No, they get in the way. Use an ETT and tape it to the side

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17
Q

Nasal Surgery: Throat packs

A

Remove BEFORE wakeup
OG tubes sometimes used

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18
Q

Nasal Surgery: Nasal ETT or Nasal Airway

A

Do not use

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19
Q

Throat surgery: Pearls

A
  • Decadron for swelling, pain, PONV (0.05-0.15mg/kg)
  • Abx not indicated
  • NMB not indicated
  • NSAIDS (minus aspirin) are fine
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20
Q

Throat surgery: Complications

A
  • Post extubation laryngospasms
  • Bleeding Tonsils
  • Reintubation difficult (swelling and bleeding)
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21
Q

How can we decrease post extubation spasms?

LITIES

A
  • Lay on side, decrease secretions on vocal chords
  • IV Lido 1mg/kg
  • Topical Lido 4mg/kg
  • IV Magnesium (not really just in the book)
  • Ensure proper narc level
  • Small bolus of propofol
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22
Q

General info on bleeding tonsils

A

Venous in nature
bleeds more often in adult males (2-5%)
Usually in a 6 hour window
Blood loss is hard to measure since it is swallowed
Check H/H if low
Use smaller ETT if reintubating
OG Tube for blood in stomach

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23
Q

Vocal Cord surgeries

A

Pathology: Bx and resections
Injections: for RLN/Cord dysfunction (usually a filler)

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24
Q

Types of tubes: MLT

A

Micro Laryngeal Tube
Smaller in diameter, less in the way

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25
Q

Types of tubes: Dual cuff laser

A

Yellow cuff: air
Clear cuff: saline

Sometimes add dye to saline to see if ruptured easier

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26
Q

Types of tubes: Armored

A

won’t kink but can be compromised by compression

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27
Q

Types of tubes: Montandon

A

J shaped and inserted into a temp tracheostomy if larynx is to be removed.

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28
Q

Head and Neck considerations

A
  • Usually for cancer resections
  • avoid jugular veins for central line
  • carotid sinus may be manipulated
  • risk for blood loss
  • neuromonitoring common
  • airway issues by manipulations, lesions, or radiation scarring
  • Remifent infusions are great for these
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29
Q

Tracheostomy steps

6

A
  1. Dissection down to trachea
  2. We advance ETT further to avoid puncture
  3. Doc has us SLOWLY retract for visualization
  4. Once our tube goes past they will introduce the trach device
  5. Leave out tube just past the vocal cords for emergency
  6. Disconnect circuit and pass to surgeon. Confirm EtCO2
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30
Q

Three parts to a trach tube

A
  1. Outer cannula
  2. Obturator
  3. Inner cannula
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31
Q

Cuffed with disposable inner cannula

A

Used to obtain a closed circuit for ventilaiton

32
Q

Cuffed with resuable inner cannula

A

Used to obtain a closed circuit for ventilaiton

33
Q

Cuffless with disposable inner cannula

A

Used in pts with tracheal problems and pts ready for removal of trach tube

34
Q

Cuffless with resuable inner canula

A

Used in pts with tracheal problems and pts ready for removal of trach tube

35
Q

Fenestraded cuffed

A

Pts on the vent but are not able to tolerate a speaking valve

36
Q

Fenestrated cuffless

A

Used for pts who have difficulty with a speaking valve

37
Q

Which type of trach tube is in most patients?

A

Cuffless

38
Q

Which type of trach tube is needed to PPV?

A

Cuffed, needed to make a seal

39
Q

Why don’t we replace a trach tube if it is still new?

A

Tissues inflammed and can create a flase passage
May close before we can get a new one in

40
Q

Info printed on trach tubes?

A

Manufacture (Shiley)
Size (inner diamter i.e. 8)
DCT: dual cannula tracheostomy
I.D.: inner diameter (mm)
O.D.: outer diameter (mm)
Tube length: XLT Proximal or Distal

41
Q

What the heck does an XLT Proximal indication on a trach tube mean?

A

Longer proximally because the pt has a thick neck

42
Q

What the heck does an XLT Distal indication on a trach tube mean?

A

Longer distally to help bypass a stenotic trachea

43
Q

OMFS?

A

Oral and Maxillofacial Surgery

44
Q

OMFS surgeries

A

Cleft palate
jaw deformity
facial trauma
oral cancer
dental procedures

45
Q

What is a LeFort fx?

A

facial fx, 3 types

Don’t need to know the 3 types

46
Q

Cleft Palate / LeFort pearls

A

High risk for blood loss
Usually young healthy pts: permisive hypotension
Tons of Local used with high amounts of EPI
Most often nasal RAE used
Remi infusions good here

47
Q

What does RAE stand for?

A

Ring Adair Elwyn

48
Q

OMFS trauma

A

Usually a zygomatic arch or mandible fx

49
Q

OMFS trauma management

A

Bleeding not always an issue
massive exposure and plating
nasal rae
throat pack
wired jaw

50
Q

What do we make sure of before wiring the jaw shut?

A

Throat pack is removed and we have wire cutters ready to go

51
Q

To Zanzibar By Motor Car

Facial nerve branches

A
  • Temporal
  • Zygomatic
  • Buccal
  • Mandibular
  • Cervical
52
Q

Eye cranial nerves: CN 2

A

Optic Nerve
neural signal from retina

53
Q

Eye cranial nerves: CN 3

A

Oculomotor Nerve

54
Q

Eye cranial nerves: CN 4

A

Trochlear Nerve

55
Q

Eye cranial nerves: CN 5

A

Trigeminal
touch and pain

56
Q

Eye cranial nerves: CN 6

A

Abducens
controls extrinsic eye muscles

57
Q

IOP normal pressure?

A

10-20mmHg

58
Q

Does blood flow increase or decrease with a reduction in IOP?

A

Increase

59
Q

Oculocardiac Reflex

A

retraction on eye muscles causes profound bradycardia via the trigeminal to vagus route

Medial Rectus muscle more profound, possible with injections

60
Q

How do we overcome the oculocardiac reflex

A

Stop retracting
0.2mg Glyco

61
Q

Acetazolamide

A

carbonic anhydrase inhbitor
deceases IOP for glaucoma

62
Q

Echothiphate

A

topical anticholinesterase
treats glaucoma

Chronic use will lead to prolonged succs effects

63
Q

Pilocarpin and Acetylcholine

A

Cholinergic agonists
constricts pupil

Bradycardia and bronchospasm may occur with use

64
Q

Timolol

A

BB for glaucoma
Bronochospasm, bad for CHF and COPD

65
Q

Cataract surgery

A

No blood loss, little pain, extreme anxiety as pt is awake
HTN and T2D common in pt population
Possible pulmonary issues when lying flat
Coughing an issue
OSA potential issue

66
Q

Regonal Anesthesia for eye surgeries

A

Facial nerve block
Retrobulbular block
Posterior Peribublar
Sub-Tenon block

67
Q

Facial Nerve Blocks

A

van Lint
O’Brien
Nadbath-Rehman

prevents eye movement

Just know these names

68
Q

Retrobubular Blocks

A

Retrobubular hemorrhage may occur
IOP can increase
IV injection possible (small dose no worry for LAST)
Intra-arterial injection possible (will cause transient seizure)

prevents movement and good analgesia

69
Q

Posterior Peribubular Blocks

A

Modified retrobubular with lower hemorrhage risk
two different injection sites
longer onset
potential for incomplete block of movement

70
Q

Sub-Tenon Block

A

Sedation and topical anesthesia needed for this
much longer onset but most profound

71
Q

Sedation for blocks

A

Benzo’s: Versed (low doses) or PO Alprazolam, Diazepam
Fent: 12.5-50 mcg / Alfentanil: 50-100 mcg
Prop: 30-50 mg

72
Q

What needle is used for a retrobulbular block?

A

Atkinson Needle

73
Q

Two types of anesthetic drops?

A

Tetracaine 0.5%
Lidocaine 4%

74
Q

Pros and Cons of LMA for eye surgery

A

Can get in the way of doc
less secure
more potential for spasms
LMA spontaneous vent can cause rocking under the microscope

Spontaneous vent does not cause increase in IOP

75
Q

Pros and Cons of ETT for eye surgery

A

Can be bent out of the way for doc
more secure
airway protected against spasms
PPV more stable under microscope

PPV can increase IOP

76
Q

N2O in eye surgery

A

Avoid completely

77
Q

Two gases used for vitreous gas bubbles

A

Sulfur hexafluoride
Perfluoropropane

Sim Lab 3 (6 decks)

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