Exam 1 Reading (N.Ch24) Flashcards
Under what structure does the right recurrent laryngeal nerve pass?
Innominate artery
Which branch of the trigeminal nerve provides sensation to the anterior 2/3 of the tongue?
Lingual nerve
When you ramp a patient prior to induction, what axes are you attempting to align?
Pharyngeal
Oral
Laryngeal
Goal of aligning the POL (pharyngeal, oral and laryngeal) axes is to
Align the level of the TRAGUS OF THE EAR with the level of the sternum
Which of the following statements regarding the use of a first generation laryngeal mask airway (LMA) is true? (contraindications)
It is contraindicated in pharyngeal pathology such as tumor or abscess.
LMA is contraindicated in ventilation requiring
Excess of 20 cm H2O
LMA is contraindicated in ventilation requiring? Why?
Excess of 20 cm H2O, may results in insufflation of the stomach
Which complication of an esophageal intubation is associated with the highest mortality rate?
Mediastinitis (50% mortality)
Esophageal intubation associated with 5 complications
Esophageal Tear Subcutaneous Emphysema Retropharyngeal abscess Pneumo Mediastinitis
What is the invasive airway technique of choice in emergency airway situations?
Surgical Cricothyrotomy
Surgical tracheotomy isnt the first choice in the emergeny situation why?
Requires a surgeon and may take up to 30 minutes
In PACU, a pediatric patient exhibits a barking cough and a stridorous sound during respirations. What would be the most appropriate initial treatment?
Racemic epinephrine, Dexamethasone and humidified oxygen
Pediatric patient exhibits a barking cough and a stridorous Sound, what is the likely diagnosis ?
Laryngotracheobronchitis (croup)
When is croup most likely to occur?
within 3 hours of extubation
What is the treatment goal of croup
Decreasing airway edema and inflammation
Other treatment of croup
Mixture of helium and Oxygen (Heliox)
Following a difficult intubation, you suspect that a patient may have obstruction of the submandibular duct due to trauma establishing the airway. This condition would present as
Massive Swelling of the Tongue
Cause of obstruction of submandibular duct?
Impingement by the ETT, extreme flexion of the head or trauma during airway management
What is the primary advantage of the video-assisted laryngoscope (ex. Glidescope)?
Better visualization without manipulation of the head into sniffing position
What structure is most at risk for damage from a tracheotomy?
Recurrent Laryngeal Nerve
Other structure at risk for damage from a tracheotomy other than the RLN
Damage to the blood vessels of the neck
You have injected 4 mL of 2% lidocaine using a needle inserted through the cricothyroid membrane. What nerve are you anesthetizing?
The recurrent laryngeal nerve
What is transtracheal block?
A transtracheal block is performed by injecting 3-5 mL of 2% lidocaine through a needle penetrating the cricothyroid membrane into the trachea.
During a transtrecheal block, The needle is advanced until
air is aspirated
When is the lidocaine injected during a transtracheal block?
At the end of expiration, the lidocaine is injected.
After injection of lidocaine during Transtracheal block this will usually cause a
This will usually precipitate a cough, which will spread the anesthetic throughout the airway.
Which of the following is a description of the linear percent of the glottis that is visible during laryngoscopy?
POGO score
With a POGO score, The clinician describes the
linear percentage of the glottis that is visible from the anterior commissure to the interarytenoid notch.
The Left RLN branches off the vagus nerve and passes where? and the Right passes under where?
under the aorta; innominate artery
Performing a glossopharyngeal block will anesthetize the
posterior 1/3 of the tongue
The glossopharyngeal block is performed by having the patient
open their mouth while using a 25-gauge needle to inject 2 mL of local anesthetic
Where is the local injected during a glossopharyngeal block?
bilaterally at the base of the palatoglossal arch (also called the anterior tonsillar pillar)
Glossopharyngeal block blocks what?
lingual and some of the pharyngeal branches of the glossopharyngeal nerve that provide sensation to the posterior third of the tongue and oropharynx.
Which of the following statements regarding transtracheal block is correct?
appropriate dose is 3-5 mL of 2% lidocaine
The first point in the airway where cartilage tissue is no longer present is the
Respiratory bronchiole.
To block sensory innervation to the nasal cavity, you would need to anesthetize the
V1 and V2 branches of the trigeminal nerve
The sensory innervation for the nasal cavity is provided by the
opthalmic (V1) and maxillary (V2) branches of the trigeminal nerve
Anesthesia airway trauma that leads to a malpractice claim most commonly involves the
Dentition
The mucous membranes of the nose are innervated by what nerve?
Trigeminal nerve
The mucous membranes of the nose are innervated ANTERIORLY by the and posteriorly. These nerves are also known as the anterior ethmoidal and sphenopalatine nerves respectively.
opthalmic division of the trigeminal nerve (V1) anteriorly a.ka Anterior Ethmoidal
The mucous membranes of the nose are innervated POSTERIORLY by
the maxillary division of the trigeminal nerve (V2) aka. SPHENOPALATINE nerves
You are preparing to induce an obese patient with a potentially difficult airway and will ramp the patient prior to induction. You know that the term ramp refers to
elevating the shoulders, head, and neck
Injecting 2 mL of local anesthetic at the base of the palatoglossal arch would anesthetize
the posterior 1/3 of the tongue
The posterior 1/3 of the tongue and tonsillar pillars can be anesthetized by blocking
the lingual and pharyngeal branches of the glossopharyngeal nerve
Which intervention would be least appropriate for a cannot-intubate, cannot-ventilate situation?
Perform a retrograde intubation