FINAL-Basic Airway Flashcards
Thyromental Distance - Indication of difficult airway
< 3 fingerbreadths
< 6 cm or >9 cm
Inter-incisor gap
Indication of difficult airway
< 3 cm (small mouth opening)
Long incisors (reduce the gap)
Buck teeth (increase risk of dental damage0
Atlanto-occipital joint mobility
Indication of difficult airway
Head extension <23 degrees
Patient cannot touch tip of chin to chest or extend neck
Mandibular protrusion test (MPT)/Upper lip bite test
Indication of difficult airway
Class c/III (out of I-III): Lower incisors cannot be moved in line with upper incisors and cannot bite lip
Mallampati Exam
Indication of difficult airway
Class III, IV (out of I-IV)
Mallampati Exam
PUSH
P- Pillars (Anterior and posterior)
U- Uvula
S- Soft palate
H- Hard palate
Mallampati Class I
P- Pillars (Anterior and posterior)
U- Uvula
S- Soft palate
H- Hard palate
Fauces
Mallampati Class II
U- Uvula
S- Soft palate
H- Hard palate
Fauces
Mallampati Class III
S- Soft palate
H- Hard palate
Base of uvula
Mallampati Class IV
H- Hard palate
Cormack + Lehane Grading System
Difficult intubation
Grades III, IV (out of I-IV)
Grade III: Epiglottis only, no glottic opening
Grade IV: Soft palate only, no part of larynx
Cormack + Lehane Grade I
Complete view of glottic opening
Cormack + Lehane Grade II
-Posterior region of glottic opening
-Partial view of vocal cords/no vocal cords
Cormack + Lehane Grade III
-Epiglottis only, no glottic opening
Cormack +Lehane Grade IV
-Soft palate only, no part of larynx
What is the best predictor of a difficult airway?
History of a difficult airway
Adenoids
Eustachian tube
Hard Palate
Soft Palate
Nasopharynx
Palatine tonsil
Tongue
Oropharynx
Epiglottis
Vocal cords
Laryngopharynx/hypopharynx
Upper and lower airways separated by
Cricoid cartilage
Upper airway structures
Nose
Mouth
Pharynx
Laryngopharynx/hypopharynx
Larynx
Cricoid cartilage
Lower airway structures
Trachea
Bronchi
Bronchioles
Terminal bronchioles
Respiratory bronchioles
Alveoli
Nose
Blood supply
-Maxillary; sphenopalatine branch
-Opthalmic
-Facial; septal branch
Nose
Innervation of
-Sensory-somatic
Maxillary branch of trigeminal n. (CN V)
Opthalmic branch of trigeminal n. (CN V)
-Parasympathetic-motor
Facial n. (CN VII)
Pterygopalatine ganglion
-Sympathetic innervation
Superior cervical ganglion
Nasopharynx location, contents
Anterior to C1
Eustacian tubes
Adenoids
Oropharynx location, contents
C2-C3
Bound by soft palate, hard palate
Laryngopharynx/hypopharynx
C5-C6
Posterior to larynx
Landmark for cricothyrotomy
Cricothyroid membrane
Larynx composed of 3 single cartilages
Epiglottis
Thyroid
Cricoid
Larynx composed of 3 paired cartilages
Corniculate
Arytenoid
Cuneiform
Control tension of the vocal cords; opening and closing of the glottis
Intrinsic muscles of larynx
Posterior cricoarytenoids
Lateral cricoarytenoids
Interarytenoid
Thyroarytenoids and vocalis
Aryepiglottic
Cricothyroids
Connects the larynx, hyoid bone, and neighboring anatomic structures; adjusts position of larynx during phonation, breathing, and swallowing
Extrinsic muscles of larynx
ELEVATE LARYNX, suprahyoid muscles
Stylohyoid
Digastric
Mylohyoid
Geniohyoid
PHARYNGEAL MUSCLE
Stylopharyngeus
Depresses hyoid, ELEVATE LARYNX, infrahyoid muscle
Thyrohyoid
DEPRESS LARYNX, infrahyoid muscles
Omohyoid
Sternohyoid
Sternothyroid
Elongates (tenses) vocal cords
ADDuction and increasing tension of vocal cords
Cricothyroid
aBducts vocal folds (opens glottis)
aBduction vocal cords
Posterior cricoarytenoid
aDDucts vocal folds (closes glottis)
aDDuction and lengthening of arytenoids causing glottis closure
Lateral cricoarytenoid
Shortens (relaxes) and aDDucts vocal cords (closes glottis)
Thyroarytenoid
Shortens (relaxes) vocal cords
Vocalis
Closes laryngeal vestibule
Constriction of laryngeal vestibule
Aryepiglottic
Closes posterior commissure of glottis
Interarytenoid (tranverse + oblique)
Intrinsic laryngeal muscles (except for one) innervated by
Recurrent laryngeal nerve
Cricothyroid (intrinsic laryngeal muscle) innervated by
Superior laryngeal nerve (external branch)
“Cords tense”
CricoThyroid
“They Relax”
ThyroaRytenoid
“Please Come Apart’
Posterior CricoArytenoid
“Let’s Close Airway”
Lateral CricoArytenoid
Sternomental distance
Indication of difficult airway
> 12.5 cm
Airway management/Difficult intubation
(acronym)
L- look externally
E- evaluate 3:3:2
M-mallampati
O-obesity/obstruction
N-neck mobility
S-Saturation/situation
Difficult BVM
(acronym)
R- radiation
O-obesity/obstruction/OSA
M-mask seal/male/mallampati
A-aged
N-no teeth
Difficult LMA/EGD
(acronym)
R-restriction
O-obstruction/obesity
D-distorted anatomy
S-short thyromental
Difficulty surgical airway
(acronym)
S-surgery
M-mass
A-anatomy
R-radiation
T-tumor
