General Airway + Policy Review

Question 1

How long is the trachea? What is the area of bifurcation called? Where is it positioned to the esophagus?

Answer 1

• Trachea is 10 cm long
• Area of bifurcation is called CARINA
• Trachea lies ANTERIOR to the esophagus

Question 2

What separates the brain from the nasal cavity?

Answer 2

Cribiform plate (thin layer of bone)

Question 3

With facial or head trauma, the cribiform plate may fracture. What can happen because of this?

Answer 3

Leakage of CSF into the nose (CSF rhinorrhea).

Any tube inserted in the nose can directly touch the cranium, potentially having major consequences (think NPA)

Question 4

What are the 4 nasal sinuses?

Answer 4

Frontal
Ethmoidal
Maxillary
Sphenoid

Question 5

What are 4 important things to know about sinuses?

Answer 5

• Sinus infections can lead to headaches
• Ethmoid sinuses occasionally rupture with pressure changes
• Sinusitis may lead to brain abscess
• Air-fluid level in the sphenoid sinus may indicate a basal skull fracture

Question 6

If an ethmoid sinus ruptures, what will a patient present with?

Answer 6

Facial subcutaneous emphysema

Question 7

What are some common problems that disrupts laryngeal function/structure?

Answer 7

• Laryngeal foreign bodies
• Epiglottitis
• Edema (secondary to burns, chemical inflammation, or allergic reaction)
• Trauma (with secondary bleeding or swelling
• Trauma (with gross disruption of laryngeal structure)

Question 8

How many lobes do the left and right lungs have?

Answer 8

Right - 3 lobes
Left - 2 lobes

Question 9

If an FBO manages to pass the carina, where would it most likely end up in?

Answer 9

Right mainstem bronchus

• 25 degree angle
• Almost in a direct line with the trachea
• Also happens with ETT if inserted too far

Question 10

What is hypoxia?

Answer 10

A state of oxygen deficiency OR lack of oxygen.

• Prolonged hypoxia can cause irreversible damage to the cells

Question 11

Oxygen moves out of the alveoli into the circulation system by?

Answer 11

Diffusion

Question 12

Oxygen is transported in the circulation primarily by _____?

AND minimally by _____?

Answer 12

1) Combining with hemoglobin
2) Dissolving in plasma

Question 13

Oxygen release to the tissues occurs when?

Answer 13

O2 concentration in tissues are LOWER than in the blood

Question 14

What are some factors that affect oxygen release to the tissues?

Answer 14

• pH
• Temperature
• CO2

Question 15

How many mls can an adult BVM hold?

Answer 15

1500 ml

Question 16

How many mls can a paediatric BVM hold?

Answer 16

450 ml

Question 17

How many mls of oxygen does a BVM with two hands deliver?

Answer 17

2 hands = 1100 ml
1 hand = 800 ml

Question 18

What is the Haldane effect?

Answer 18

Shift LEFT

• Decreased H+
• Decreased CO2
• Decreased 2,3 BPG
• Decreased Temp
• Increased affinity of O2 with Hb

Net result? LOWER O2 DISSOCIATION

Question 19

What is the Bohr effect?

Answer 19

Shift RIGHT

• Increased H+
• Increased CO2
• Increased 2,3 BPG
• Increased Temp
• Decreased affinity of O2 with Hb

Net result? HIGHER O2 DISSOCIATION

Question 20

Patho of Pulmonary Embolism (PE)?

Answer 20

Occlusion of pulmonary arteries by thrombi that originate elsewhere (typically from the legs or pelvis)

• Think about people with DVT’s
• S&S include pleuritic chest pain, dyspnea, lightheadedness, and syncope

Question 21

Patho of Pneumothorax?

Answer 21

When air enters pleural space causing partial or complete lung collapse.

• Intrapleural pressure is normally negative (less than atmospheric pressure)
• This is due to factors such as inward pull from elastic tissue
• Surface tension within pleural cavity also pulls lungs outward

When air enters the pleural space, intrapleural pressure increases and lung volume decreases

Question 22

When V/Q is >0.8, what does this mean?

Answer 22

Ventilation EXCEEDS perfusion.

Common causes: emphysema, blood clot, heart failure

Question 23

When V/Q is <0.8, what does this mean?

Answer 23

Perfusion EXCEEDS ventilation.

Common causes: aspiration, FBO, pulmonary edema

Question 24

Patho of Pneumonia?

Answer 24

Infection that inflames the air sacs in one or both lungs.

• The air sacs can fill with pus or fluid, causing coughs, fever, chills, and difficulty breathing

Question 25

How does Epinephrine work during anaphylaxis?

Answer 25

Epi stimulates beta-adrenergic receptors (B2).

• Leads to bronchial smooth muscle relaxation
• Can help with bronchospasm, wheezing, and dyspnea

*Ventolin does the same thing