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6901 > ENT Surgery > Flashcards

ENT Surgery Flashcards

1
Q

4 sinus compartments

A
  • ethmoid
  • maxillary
  • frontal
  • sphenoid

**susceptible to trauma

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2
Q

nasal turbinate

A
  • lateral aspect
  • increase surface area
  • highly vascularized
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3
Q

3 parts of pharynx

A
  • naso
  • oral
  • hypo
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4
Q

nerve supply to airway

A

CN 5: trigeminal (ophthalmic, maxillary, mandibular)
CN 9: glossopharyngeal
CN 10: vagus

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5
Q

palatine tonsils

A
  • very vascular: external carotid, maxillary, facial arteries
  • lymphatic system
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6
Q

branches of vagus nerve and innervation

A
  • external superior - motor to cricothyroid
  • internal superior - sensory to larynx above vocal cords
  • recurrent - motor and sensory below vocal cords and motor to cricothyroid
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7
Q

larynx location - infant vs adult

A
  • infant: C3-C5

- adult: C4-C6

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8
Q

narrowest part of larynx, age which this changes

A
  • infant: cricoid ring
  • adult: vocal cords

*at 8 years airway resembles adult

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9
Q

larynx unpaired cartilages

A
  • thyroid
  • cricoid
  • epiglottis
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10
Q

larynx paired cartilages

A
  • arytenoid
  • cuneiform
  • corniculate
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11
Q

hyoid bone

A
  • u-shaped

- joins larynx to the tongue

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12
Q

glossopharyngeal

nerve

A
  • superior aspect of epiglottis and base of tongue

- gag reflex

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13
Q

cases to avoid nitrous oxide

A
  • ear procedures
  • laser
  • foreign body
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14
Q

considerations for ENT

A
  • head of table turned 90-180 degrees
  • NIM-EMG: nerve monitoring, *avoid muscle relaxation
  • smooth and rapid emergence, *IV lidocaine
  • avoid N2O
  • minimize blood loss: use epi-cocaine local anesthetic, controlled hypotension (*vascular tumors)
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15
Q

complications for ENT

A
  • n/v: suction out stomach, IVF, anti-emetics

- use opioids with caution in children with OSA

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16
Q

individuals with elevated oral secretions

A
  • smokers

- African-Americans

17
Q

max doses of epinephrine mixed with local anesthetic

A
  • 200 mg

- 1.5 mcg/kg

18
Q

IM dose - anectine

A
  • 3-4 mg/kg

- 2-3 minutes to onset

19
Q

sublingual dose - anectine

A
  • 0.5-1 mg/kg

- 30 sec-1 min to onset

20
Q

myringotomy and tube placement

A
  • inhalation induction
  • mask case
  • no IV
  • have IM anectine and atropine ready for all kids
21
Q

tonsillectomy and adenoidectomy

“T-n-A”

A
  • oral RAE (cuffed) versus LMA
  • shoulder roll to extend neck
  • throat pack: make sure it comes out
  • suction stomach
  • position on side post-op for drainage
22
Q

complications - tonsillectomy and adenoidectomy

A
  • laryngospasm: Larson maneuver, positive pressure ventilation, and SUX
  • bleeding: RSI, replace blood, extubate fully awake
23
Q

cleft lip and palate

A
  • difficult intubation
  • oral RAE
  • NO oral airway, only nasal
  • large amount of secretions post-op
24
Q

acute epiglottitis signs

A
  • 2-7 year old
  • influenza B
  • sitting position with head extended and leaning forward
  • “thumb sign” on x-ray
25
Q

acute epiglottitis treatment

A
  • 100% O2
  • do not do DL or sedation outside of OR
  • keep patient calm
  • downsize ETT by 1
  • check for air leak prior to extubation
26
Q

sinus and nasal surgery

A
  • oral RAE

- increased bleeding

27
Q

foreign body aspiration

A
  • common in right mainstem
  • @ larynx: DVL with magill forceps
  • @ distal: bronchoscope
  • spontaneous ventilation with no cricoid or positive pressure
  • sitting position
  • use TIVA
  • check for airway edema prior to extubation
  • no N2O
28
Q

trach sizing

A

women: 6.0 shiley with 26 F dilator
male: 8.0 shiley with 28 F dilator

29
Q

complications - radical neck

A
  • carotid sinus stretch can elicit vagal response
  • pneumothorax
  • venous air embolism
  • recurrent laryngeal nerve damage
  • Q-T segment prolongation
  • high circuit pressures
30
Q

Le Fort facial fracture classification

A

I: horizontal, below nose to hard palate
II: U-shaped, under eyes to bridge of nose
III: separation of facial skeleton to cranium

31
Q

facial fracture considerations

A
  • no nasal airways
  • considered to have cervical spine fracture until proven otherwise
  • can be opened to brain
  • need wire cutters at bedside if mouth is wired shut
32
Q

nerve responsible for laryngospasms

A

superior laryngeal: internal sensory, external motor

6901 (18 decks)

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