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P&P Spring 2020 > Exam 1 Airway Anatomy, Assessment, Management > Flashcards

Exam 1 Airway Anatomy, Assessment, Management Flashcards

1
Q

Sensory innervation of nasopharynx

A

Posterior - Sphenopalatine nerve (maxillary division of CN V)
Anterior - Ethmoidal nerve (opthalmic division of trigeminal nerve V)

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2
Q

communication of nasal cavity + ear occurs thru

A

middle ear

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3
Q

primary pathway for breathing

A

nasopharynx

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4
Q

What intervention can be performed to prevent excess bleeding in nasal vasculature?

A

local anesthetic + vasoconstrictor (phenyl or epi)

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5
Q

nasopharynx extends from _____ to _____

A

nares opening inferiorly to soft palate

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6
Q

nasal vascular supply

A

Facial, maxillary, opthalmic artery

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7
Q

Implication - nasal vasculature + Rx administration

A

extensive vascularization = uptake/distribution

*be careful: not caustic to tissue

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8
Q

Paranasal air sinuses

A

4: maxillary, sphenoid, frontal, ethmoid

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9
Q

only sinus not innervated by maxillary nerve

A

frontal sinus

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10
Q

frontal sinus nerve innervation

A

opthalmic nerve

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11
Q

largest sinus

A

maxillary

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12
Q

maxillary sinus nerve innervation

A

maxillary nerve

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13
Q

sphenoid sinus located

A

below optic chiasm/ant. pituitary, within sphenoid bone

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14
Q

risk of ethmoid sinus operation (ethmoidectomy)

A

cribiform plate broken –> brain exposure

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15
Q

ostiomeatal complex

A

cleaning sinuses (drainage of frontal/maxillary/anterior ethmoid sinuses)

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16
Q

External nose: sensory nerve

A

Trigeminal Nerve (V)

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17
Q

External nose: motor nerve

A

Facial Nerve (VII)

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18
Q

Internal nose sensory nerves

A

Vestibule - V
Septum- V
Lateral wall + floor - V, I

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19
Q

avoid nasal intubation/nasogastric tubes in which patients

A

basal skull fracture

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20
Q

What must be checked during nasal endoscopic proceures

A

pupillary checks - ensure instrument has not perforated into skull

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21
Q

Pharynx is divided into

A

3 parts: nasopharynx, oropharynx, laryngopharynx

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22
Q

sphenoid sinus separates

A

pharynx from sella turcica (contains pituitary gland)

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23
Q

sphenoid sinus is important for _____ surgery

A

important landmark for pituitary surgery

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24
Q

oropharynx

A

extends from posterior aspect of nose –> base of vallecula (superior to epiglottis)

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25
Q

separated by hard and soft palate

A

oro and nasopharynx

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26
Q

hypopharynx is located

A

superior border of epiglottis to inferior border of cricoid cartilage
Between C4-C6*

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27
Q

separates hypopharynx from larynx

A

epiglottis

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28
Q

epiglottis location

A

C3 - kids

C5 - adults

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29
Q

Oropharynx sensory innervation - hard and soft palate

A

palatine nerves from trigeminal (CN V) + facial (CN VII)

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30
Q

Oropharynx sensory innervation - tongue

A

anterior 2/3: lingual nerve (mandibular division of CN V)

posterior 1/3: glossopharyngeal nerve CN IX

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31
Q

Oropharynx sensory innervation - tongue for taste sensation

A

branches of CN VII + IX

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32
Q

Larynx lies at level of

A

C3-6

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33
Q

larynx is composed of

A

3 unpaired cartilages

3 paired cartilages

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34
Q

larynx - 3 unpaired cartilages

A

thyroid, cricoid, epiglottis

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35
Q

larynx - 3 paired cartilages

A

arytenoid, corniculate, cuneiform

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36
Q

largest and most prominent cartilage of larynx

A

thyroid

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37
Q

only complete cartilaginous ring in laryngotracheal tree

A

cricoid cartilage

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38
Q

shaped like a signet ring

A

cricoid cartilage

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39
Q

connects thyroid and cricoid cartilage anteriorly

A

cricothyroid membrane

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40
Q

posterior attachments for vocal cords

A

arytenoid cartilage

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41
Q

larynx is innervated by

A

branches of vagus nerve (CN X)

-superior and recurrent laryngeal nerve

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42
Q

All muscles of larynx (except cricothyroid) - motor innervation

A

Recurrent laryngeal nerve

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43
Q

Cricothyroid - motor innervation

A

Superior laryngeal nerve - External

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44
Q

Sensory innervation of epiglottis (anterior surface/vallecula)

A

CN IX

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45
Q

Sensory innervation - between epiglottis and vocal cords

A

Superior laryngeal nerve - internal

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46
Q

Sensory innervation - between vocal cords and trachea

A

recurrent laryngeal nerve

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47
Q

Mnemonic: larynx cartilages

A

The Crocodile Eats Asian Corn Cunningly

9 cartilages: Thyroid, Cricoid, Epiglottis, arytenoid (2), corniculate (2), cuneiform (2)

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48
Q

Mnemonic: intrinsic laryngeal muscles: function

*SLN nerve = muscle ___ + action _____

A

CricoThyroids = increase vocal Cord Tension

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49
Q

intrinsic laryngeal muscles: function

*RLN nerve = muscle ___ + action _____

A

Everything except cricothyroids

PCA, LCA, thyroarytenoids

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50
Q

mnemonic: intrinsic laryngeal muscles: function

* RLN nerve = muscle ___ + action _____

A

Posterior CricoArytenoids: Pulls Cords Apart (abduct)
Lateral CricoArytenoids: Lures Cords Adjacently (adduct)
ThyRoarytenoids: TRanquilizes cords (reduce cord tension)

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51
Q

mnemonic: Motor innervation of larynx

A

REM: Recurrent and External superior for Motor

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52
Q

mnemonic: Sensory innervation of larynx

A

SIR: Sensory supplied by Internal superior + Recurrent

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53
Q

mnemonic: Motor innervation of larynx, specifics

A

SCAR
Superior = Cricothyroid
All other = Recurrent

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54
Q

mnemonic: Sensory innervation of larynx, specifics

A

BRAS
Below cords = Recurrent
Above (+ At) = Superior

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55
Q

pt population prone to having laryngospasm

A

Young, strong, AA males (strong sternal muscles)

*make sure deep extubation

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56
Q

SLN - Unilateral nerve injury results in

A

minimal effects

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57
Q

SLN - Bilateral nerve injury results in

A

hoarseness, tiring of voice

58
Q

RLN - Unilateral nerve injury results in

A

hoarseness

59
Q

RLN - Bilateral nerve injury results in

A

Acute: stridor, resp distress
Chronic: aphonia

60
Q

Vagus Nerve - Unilateral injury results in

A

hoarseness

61
Q

Vagus Nerve - Bilateral injury results in

A

Aphonia (looks like after Sux administration)

airway controls fine

62
Q

Which is worse: acute or chronic RLN injury?

A

acute - remaining unopposed tension of cricothyroid muscle = stridor, resp distress
chronic –> not as bad d/t compensatory mechanisms

63
Q

Trachea begins at

A

opposite C6

inferior border of cricoid cartilage - extends to carina

64
Q

length of trachea

A

10-20 cm in adults

65
Q

trachea is composed of

A

16-20 C-shaped cartilaginous rings

66
Q

Why is right mainstem more common than left?

A

Angle of bifurcation:
R = 25-30
L = 45

67
Q

Bifurcation to right upper lobe from carina

A

2.5 cm

68
Q

bifurcation to left upper lobe from carina

A

5 cm

69
Q

trachea receptors are sensitive to

A

mechanical + chemical stimuli

stretch/irritant/cough receptors

70
Q

______ is richly innervated + sensitive to sensory stimulation

A

carina

71
Q

mnemonic for mallampati classification

A

PUSH
P- Pillars, uvula, soft/hard palate
U - tip of uvula obstructed (+pillars, soft/hard)
S- soft palate (+hard, + base of uvula) NO pillars
H - Hard palate only

72
Q

thyromental distance

A 
mental process (lower border of mandible) to thyroid notch 
 < 3 fingerbreadths/7 cm = difficult laryngoscopy
73
Q

mouth opening

A

-function of TMJ

at least 2 fingerbreadths (3 cm)

74
Q

extension of head at least

A

35 degrees from A-O joint

75
Q

flexion of head at least

A

80 degrees from A-O joint

76
Q

go to intubate, can’t see anything

A 
BURP position (manipulation of larynx -- NOT cricoid)
sniffing position
cricoid - push straight down
77
Q

factors that limit larynx visualization

A 
mouth opening < 3cm
mallampati classification III/IV
neck extension < 35
thyromental distance < 6.5 cm
rigid larynx
78
Q

only test proven to be predictor of difficult airway

A

upper bite lip test (UBLT)

79
Q

difficult airway mnemonic - laryngoscopy

A 
LEMON
Look externally
Evaluate 3:3:2
Mallampati score
Obstruction/obesity
Neck mobility
80
Q

difficult airway mnemonic - extraglottic device

A

RODS
Restricted mouth opening
Disrupted/distorted airway
Stiff lungs/spine

81
Q

difficult airway mnemonic - BAG-valve mask

A 
MOANS
Mask seal
Obstruction/Obesity
Age >55
No teeth
Stiff lungs/sleep apnea
82
Q

difficult airway mnemonic - cricothyrotomy

A 
SHORT
Surgery
Hematoma
Obesity
Radiation
Tumor
83
Q

Nasal Cannula - Maximum O2

A

FiO2 increases by 3-4% per liter of O2

Max up to 40-50%

84
Q

Simple mask - maximum O2

A

FiO2 35-65%

O2 flow rates 6-15 L/min

85
Q

Venturi Mask - maximum O2

A

air entrainment mask - delivers FiO2 up to 50%

86
Q

Nonrebreather mask - max O2

A

FiO2 up to 95%

87
Q

Partial rebreather mask - max O2

A

FiO2 up to 80%

88
Q

Oral/nasal airways are useful with

A
  • loss of muscle tone, collapse of tongue/soft palate against oropharynx when sedated
  • having difficulty w/ mask ventilation
89
Q

nasal airways are preferred over oral airways in ____

A

lightly anesthetized patients

90
Q

biggest issue with nasal airways

A

bleeding

91
Q

risk of oral airways

A

stimulate gag reflex - cough - vomit - laryngospasm - bronchospasm

92
Q

Oral airway - use

A

do not leave in for long time

93
Q

nasal airway - contraindications

A

coagulopathy
basilar skull fracture
nasal infxn/deformities

94
Q

length of nasal airway

A

from tip of nose to meatus of ear

95
Q

biggest complication of oral/nasal airway

A

if placed too deep, can block airway

96
Q

Biggest reason for obstruction during mask/bag ventilation

A

poor positioning

97
Q

mask ventilation should never go above ____ cm H2O

A

PPV never above 30 cm H2O

98
Q

LMA useful for

A

difficult airway (unable to intubate but can oxygenate/ventilate)

99
Q

utilize LMA in

A

spontaneously breathing, anesthetized patient

100
Q

asthmatic patient should avoid

A

ETT

*LMA would be useful

101
Q

LMA not used on vent if

A

pressures > 20 cm H2O

102
Q

LMA does not protect against

A

aspiration, regurgitation, laryngospasm

*i.e. gastroparesis/trauma pt

103
Q

LMA is not a ______ airway

A

definitive

104
Q

Pt adult > 80 kg needs ____ size LMA

A

size 5 LMA
cuff volume up to 40 cc
Largest ETT 7.0

105
Q

Average adult = what size LMA?

A

Size 4 LMA
up to 30 cc cuff volume
largest ETT 6.0

106
Q

Kids/small adults > 30 kg - size LMA?

A

Size 3 LMA
Cuff volume 20 cc
largest ETT 6.0

107
Q

Patient size 20-30 kg, LMA size?

A

2.5 LMA
up to 15 cc
largest ETT 5.0

108
Q

Up to 20 kg, what size LMA?

A

2 LMA
up to 10 cc
Largest ETT 4.5

109
Q

Patient up to 6.5 kg, what size LMA?

A

Size 1 LMA
up to 4 cc cuff volume
largest ETT 3.5

110
Q

Agent of choice for LMA insertion

A

propofol 2.5-3.0 mg/kg

111
Q

NMBA required, which airway is used?

A

Endotracheal intubation

112
Q

Endotracheal intubation indications

A
  • need PPV
  • protection of respiratory tract from GI contents
  • surgical prx of head/neck when airway cannot be supported
  • nonsupine positions in which airway cannot be supported
  • NMBA required
  • unconscious with inability to protect airway
  • protection of healthy lung from dx lung
  • pulmonary toilet
  • severe multisystem injury
113
Q

procedures in ____ req ETT

A

chest, abdomen, cranium, intracranial HTN tx

114
Q

objective measures of endotracheal intubation

A 
RR > 35 
vital capacity < 15 mL/kg (adults) 10mL/kg (kids)
PaO2 < 70 mmHg on 40% FiO2
PaCO2 > 55mmHg
Inability to generate NIF of 20 mmHg
115
Q

Goal PaO2 on 40% FiO2

A 
200 mmHg
(40 x 5 = 200)
116
Q

Most common laryngoscope blade in adults

A

Number 3

117
Q

better tolerated in awake patients

bradycardia less likely

A

macintosh (epiglottis not stimulated)

118
Q

end of the blade sit on the tip of the epiglottis

A

miller laryngoscope

119
Q

end of blade sit in the vallecula

A

macintosh

120
Q

ETT are numbered according to

A

internal diameter

121
Q

cuff pressure of ETT

A

between 17-23 mmHg

122
Q

head of bed should be at your

A

xyphoid process

123
Q

more crowded space in mouth

A

miller blade

124
Q

carina is at level of

A

T4-T6

125
Q

Women - normal ETT size

A

7-7.5

126
Q

Men - normal ETT size

A

7.5-8

127
Q

Women: ____ cm lip to carina

A

24

128
Q

Men: _____ cm lip to carina

A

28

129
Q

Children: ____ cm lip to carina

A

13

130
Q

2 year old - size ETT

A

4.5
(age/4) + 4
if cuffed: decrease by half –> size 4

131
Q

newborns - size ETT

A

3-3.5

132
Q

Newborn to 12 months - size ETT

A

3.5 - 4

133
Q

12 to 18 months - size ETT

A

4.0

134
Q

denitrogenate

A

100% FiO2 for 3-5 min (or 4 vital capacity breaths)

135
Q

ETT should be advanced how far beyond vocal cords?

A

1/2 - 1 inch

as long as cuff goes thru

136
Q

must be aligned to achieve direct visualization of larynx

A

oral, pharyngeal, tracheal axes

137
Q

Cormack and Lehane’s grading of laryngoscopy

A

I-IV based on glottic view during laryngoscopy

138
Q

Cormack + Lehane grading of laryngoscopy - each grade

A

I: full view of glottic opening + vocal cords
II: partial view of glottis + arytenoids
III: only can visualize epiglottis
IV: no visible structures seen

139
Q

minimum ETCO2 tracings to watch for after intubation

A

3 tracings on capnograph

140
Q

auscultate breath sounds

A

L then Right

141
Q

Correct location on XRay - tip of ETT

A

between carina + thoracic inlet (level of aortic notch T5)

P&P Spring 2020 (6 decks)

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