Induction & Airway Block

Question 0

Goal of pre-oxygenation

Answer 0

• increase O2 concentration in FRC with 100% oxygen and get rid of nitrogen (79% nitrogen, 21% oxygen in RA)
• admin 100% O2 at 8-10L of flow

Question 1

The “sniffing” position aligns what 3 axises

Answer 1

-oral, pharyngeal, laryngeal

Question 2

A healthy patient recieveing pre-oxygention can tolerate how many minutes of apnea?

Answer 2

10 minutes

Question 3

How many vital capacity breath are given in 30 seconds?

Answer 3

4 breaths

Question 4

How many minutes can a healthy patient tolerate after 4 vital capacity breaths?

Answer 4

5 minutes

Question 5

When is vital capacity breaths necessary?

Answer 5

• when a patient is a crash C section

- ruptured abdominal aorta (RSI)

Question 6

Airway Setup

Answer 6

• laryngoscope/blade 2 types
• oral/nasal airways several sizes
• tongue depressor
• ETT: 2 sizes
• suction
• ambu-bag
• stylet
• LMA (difficult airway)

Question 7

ALL cases need to have what # LMA nearby? Why?

Answer 7

• # 4

- it allows practitioner to place a 6.0 ETT in an emergency

Question 8

What size ETT does an intubating LMA allow a practitioner place?

Answer 8

-8.0 ETT

Question 9

Complications of an oral airway?

Answer 9

• LARYNGOSPASM
• bleeding
• soft tissue damage

Question 10

Nasal airway/trumpet

Answer 10

provides passageway from nose to pharynx beneath the relaxed and obstructing tongue

Question 11

Nasal airway length is measured from:

Answer 11

-nares to meatus of ear

Question 12

Complications/Precautions of nasal airways:

Answer 12

-epitaxis, nasal or basal skull fracture, adenoid hypertrophy, anticoagulants

Question 13

Laryngoscope and name of blades:

Answer 13

• Mac (1-4): curved blade

- Miller (0-4) straight blade

Question 14

Mac blade does what?

Answer 14

-blade fits into veleculla and pulls tongue forward

Question 15

Miller blade does what?

Answer 15

-picks up epiglottis

Question 16

Typical adult ETT sizes for men and women?

Answer 16

• females: 7.0 and 6.5

- males: 7.5 and 8.0

Question 17

Desirable position of an ETT? Typical placement from men and women?

Answer 17

• 4cm above the carina and 2cm below the vocal cords
• males approx 23cm
• females approx 21cm

Question 18

Airway innervation: Sensory

Answer 18

• glossopharyngeal
• internal branch of superior laryngeal (vagus)
• recurrent laryngeal

Question 19

Airway innervation: Motor

Answer 19

• external branch of superior laryngeal

- recurrent laryngeal

Question 20

Sequence of steps prior to intubating someone:

Answer 20

• admin induction drug
• lash reflex
• test ventilate
• then intubate

Question 21

Sensory innervation of the larynx:

Answer 21

• glossopharyngeal
• interior (internal) superior laryngeal
• recurrent laryngeal

Question 22

Glossopharyngeal (CN 9) innervates:

Answer 22

-posterior 1/3 of tongue and oropharynx to vallecula

Question 23

Internal Superior Laryngeal nerve (branch of vagus) innervates:

Answer 23

-supplies sensory to vocal cords and above

Question 24

Recurrent Laryngeal nerve (branch of vagus) supplies:

Answer 24

-supplies mucosa below vocal cords

Question 25

Motor innervation of Larynx

Answer 25

- external branch of superior laryngeal nerve (vagus) | - recurrent laryngeal

Question 26

External branch of superior laryngeal nerve (vagus) supplies:

Answer 26

-supplies the cricothyroid muscle- puts tension on VCs

Question 27

The recurrent laryngeal nerve (vagus) supplies:

Answer 27

-supplies ALL intrinsic muscle of larynx EXCEPT the cricothyroid membrane

Question 28

Complications of tracheal intubation:

Answer 28

- trauma to airway structures - esophageal intubation - endobronchial intubation - endotracheal tube ignition - sore throat - laryngospasm - croup

Question 29

Indications for airway blocks:

Answer 29

- abolish or blunt reflexes | - provide patient comfort and airway anesthesia during performance of procedures

Question 30

Complications of airway blocks:

Answer 30

- systemic toxicity | - hematoma formation

Question 31

Indications for a transtracheal block:

Answer 31

- block the recurrent laryngeal nerve (for awake laryngoscopy etc.) - abolition of the gag reflex or hemodynamic responses to laryngoscopy and brochoscopy

Question 32

Transtracheal block results in anesthesia:

Answer 32

- anesthesia of the trachea and below the vocal cords | - (the injection of local anesthesia stimulates the cough reflex which spreads the lidocaine above the vocal cords)

Question 33

For the transtracheal block the needle is injected caudad in what membrane?

Answer 33

-cricothyroid membrane

Question 34

Indications for superior laryngeal block:

Answer 34

- blocks the internal (sensory) branch of SLN - blocks the supraglottic region - results in abolition of the gag reflex or hemodynamic responses to larygoscopy or bronchoscopy

Question 35

Indications for the glossopharyngeal nerve block

Answer 35

- lingual branch of glossopharyngeal nerve supplies sensory to the back of the tongue - abolition of the gag reflex or hemodynamic response to laryngoscopy - when topical application is not effective

Question 36

For an airway block, which 3 blocks need to be done?

Answer 36

- transtracheal block - superior laryngeal nerve block - glossopharyngeal block

Question 37

The thyromental distance is assessing what axises?

Answer 37

-pharyngeal and laryngeal axis