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Adv. Health Assessment (Spring 2024) > Preop Assessments > Flashcards

Preop Assessments Flashcards

1
Q

How do you assess mouth opening?

A

Inter-incisor distance
Prefer > 6 cm (3 finger breadths)

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2
Q

What is the Mallampati Test?
How many classes are there?
How do you perform the test?

A

Visibility of oropharyngeal structures
Class I - IV

The patient is seated upright with head neutral
Mouth open
Tongue protruded
No phonation (Phonation will lift the uvula up)

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3
Q

What can be visualized in a Mallampati Class I?

A

Fauces (arch opening in the back of the throat)
Pillars (tonsils)
Entire Uvula
Soft palate

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4
Q

What can be visualized in a Mallampati Class II?

A

Fauces (arch opening in the back of the throat)
A portion of the Uvula
Soft palate

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5
Q

What can be visualized in a Mallampati Class III?

A

Base of the uvula and soft palate

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6
Q

What can be visualized in a Mallampati Class IV?

A

Only hard palate

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7
Q

What are the two types of Laryngeal Manipulation?

A
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8
Q

What is the Cormack-Lehane classification?

A

Classification of laryngeal view
Grade I-IV

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9
Q

What is seen with a Cormack-Lehane Grade 1 View?

A

Entire Glottis

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10
Q

What is seen with a Cormack-Lehane Grade 2 View?

A

Only the posterior portion of the glottis

May need to lift the blade up more, or perform laryngeal positioning

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11
Q

What is seen with a Cormack-Lehane Grade 3 View?

A

No part of the glottis and only the epiglottis

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12
Q

What is seen with a Cormack-Lehane Grade 4 View?

A

Epiglottis cannot be seen. All you see is the tongue.

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13
Q

Criteria associated with difficult mask ventilation (OBESE).

A

O: Obesity, BMI > 30 kg/m2
B: Beard
E: Edentulous
S: Snorer, OSA
E: Elderly, male, age > 55

Mallampati 3 or 4

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14
Q

Difficult Airway Algorithm
During pre-intubation choose between ________ or ________ strategy.

A

During pre-intubation choose between an awake or post-induction airway strategy.

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15
Q

What are the 5 questions asked in the Difficult Airway Algorithm?

A
  1. Suspected difficult laryngoscopy?
  2. Suspected difficult ventilation with face mask/supraglottic airway?
  3. Significant increased risk of aspiration?
  4. Increased risk of rapid desaturation?
  5. Suspected difficult emergency invasive airway?

Any one factor alone may be clinically important to warrant awake intubation. Minimize airway risk.

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16
Q

Optimize _________ throughout the difficult airway algorithm.

A

oxygenation

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17
Q

If an intubation attempt after induction of general anesthesia is a failure. What is the next step according to the difficult airway algorithm?

A

Limit attempts, consider calling for help
or
Limit attempts, and consider waking the patient up.

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18
Q

In the emergency pathway, if mask ventilation is not adequate and the supraglottic airway is not adequate, what should be considered?

A

Call for help for invasive access and attempt alternative intubation approaches as you prepare for an emergency invasive airway.

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19
Q

in what pts do you wanna intubate early

A

dynamic airways, burns (airway swells),

bullets (rapidly expanding hematoma),

bites (anaphylaxis, angioedema)

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20
Q

candidates for awake intubation

A
  • Stable GI bleed requiring endoscopy
  • Slowly progressive neuromuscular weakness requiring transfer
  • Fixed flexion deformity of the neck cannot open mouth
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21
Q

Where is the cervical plexus located?

A

It is located in the posterior triangle of the neck, halfway up the sternocleidomastoid muscle, and within the prevertebral layer of cervical fascia.

  • The plexus is formed by the anterior rami (divisions) of cervical spinal nerves C1-C4.​
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22
Q

What is the Stellate Ganglion?

A
  • a collection of sympathetic nerves found anterior to the neck of the first rib.
    Stellate ganglion block indication
  • refractory angina
  • scleroderma
  • it is star-shaped (“stellate” meaning star-shaped)
  • When blocking the stellate ganglion: we have horner’s syndrome
  • Downside: carotid artery and phrenic nerve are running along the stellate ganglion. So it can be dangerous
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23
Q

What is Horner’s Syndrome?

A
  • Partial ptosis (drooping or falling of the upper eyelid)​
  • Miosis (constricted pupil)​
  • Facial anhidrosis (absence of sweating) due to a disruption in the sympathetic nerve supply​: Anhidrosis, only on the side where it is blocked​
    ​- Phrenic Nerve Blockade
  • Horner’s syndrome results from paralysis of the ipsilateral sympathetic cervical chain (stellate ganglion)
  • caused by blockade of stellate
  • associated with blockade of phrenic, which gives breathing issues
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24
Q

What and where is the brachial plexus?

A
  • The brachial plexus is a network of nerve fibers that supplies the skin and musculature of the upper limb.
  • It begins in the root of the neck, passes through the axilla, and runs through the entire upper extremity.​
  • The plexus is formed by the anterior rami (divisions) of cervical spinal nerves C5, C6, C7 and C8, & T1.
25
Q

Axillary nerves

A

Spinal roots: C5 and C6.​

Sensory functions: Gives rise to the upper lateral cutaneous nerve of arm, which innervates the skin over the lower deltoid (‘regimental badge area’).​

Motor functions: Innervates the teres minor and deltoid muscles.

26
Q

Musculocutaneous nerves

A

Nerve roots – C5-C7.​

Motor functions – muscles in the anterior compartment of the arm (coracobrachialis, biceps brachii and the brachialis).​

Sensory functions – gives rise to the lateral cutaneous nerve of forearm, which innervates the lateral aspect of the forearm.

27
Q

Ulnar Nerve

A

Spinal roots: C8-T1.​

Motor functions: ​
Two muscles of the anterior forearm – flexor carpi ulnaris and medial half of flexor digitorum profundus​
Intrinsic muscles of the hand (apart from the thenar muscles and two lateral lumbricals)​

Sensory functions: Medial one and half fingers and the associated palm area.

28
Q

Radial nerve

A

Nerve roots – C5-T1.​

Sensory – Innervates most of the skin of the posterior forearm, the lateral aspect of the dorsum of the hand, and the dorsal surface of the lateral three and a half digits.​

Motor – Innervates the triceps brachii and the extensor muscles in the forearm.

29
Q

Lumbar Plexus :

A

The anterior rami of the L1-L4 spinal roots divide into several cords. These cords then combine together to form the six major peripheral nerves of the lumbar plexus. These nerves then descend down the posterior abdominal wall to reach the lower limb, where they innervate their target structures.​
​
A useful memory aid for the branches of the lumbar plexus is: I, I Get Leftovers On Fridays. This stands for the Iliohypogastric, Ilioinguinal, Genitofemoral, Lateral cutaneous nerve of the thigh, Obturator and Femoral.

30
Q

Iliohypogastric nerve:

A

The iliohypogastric nerve is the first major branch of the lumbar plexus. It runs to the iliac crest, across the quadratus lumborum muscle of the posterior abdominal wall. It then perforates the transversus abdominis, and divides into its terminal branches.​

Roots: L1 (with contributions from T12).​

Motor Functions: Innervates the internal oblique and transversus abdominis.​

Sensory Functions: Innervates the posterolateral gluteal skin in the pubic region. (Tip: an easy way to remember that the IlioHypogastric comes before the IlioInguinal is that Hcomes before I in the alphabet!)

31
Q

Ilioinguinal nerve:

A

The ilioinguinal nerve follows the same anatomical course as the larger iliohypogastric nerve. After innervating the muscles of the anterior abdominal wall, it passes through the superficial inguinal ring to innervate the skin of the genitalia and middle thigh.​

Roots: L1.​

Motor Functions: Innervates the internal oblique and transversus abdominis.​

Sensory Functions: Innervates the skin on the superior antero-medial thigh. In males, it also supplies the skin over the root of the penis and anterior scrotum. In females, it supplies the skin over mons pubis and labia majora.

32
Q

Lateral Femoral Cutaneous Nerve

A

This nerve has a purely sensory function. It enters the thigh at the lateral aspect of the inguinal ligament, where it provides cutaneous innervation to the skin there.​

Roots: L2, L3​

Motor Functions: None.​

Sensory Functions: Innervates the anterior and lateral thigh down to the level of the knee.

33
Q

Obturator nerve

A

Roots: L2, L3, L4.​

Motor Functions: Innervates the muscles of the medial thigh – the obturator externus, adductor longus, adductor brevis, adductor magnus and gracilis.​

Sensory Functions: Innervates the skin over the medial thigh.

34
Q

Femoral nerve

A

Roots: L2, L3, L4.​

Motor Functions: Innervates the muscles of the anterior thigh – the illiacus, pectineus, sartorius and quadriceps femoris.​

Sensory Functions: Innervates the skin on the anterior thigh and the medial leg.

35
Q

Sacral plexus nerve

A

The sacral plexus is a network of nerve fibers that supplies the skin and muscles of the pelvis and lower limb. It is located on the surface of the posterior pelvic wall, anterior to the piriformis muscle.​
The plexus is formed by the anterior rami (divisions) of the sacral spinal nerves S1, S2, S3 and S4. It also receives contributions from the lumbar spinal nerves L4 and L5.

36
Q

Sciatic nerve:

A

The sciatic nerve is a major nerve of the lower limb. It is a thick flat band, approximately 2cm wide – the largest nerve in the body.​

​

Nerve roots: L4-S3.​

Motor functions:​

Innervates the muscles of the posterior thigh (biceps femoris, semimembranosus and semitendinosus) and the hamstring portion of the adductor magnus (remaining portion of which is supplied by the obturator nerve).​

Indirectly innervates (via its terminal branches) all the muscles of the leg and foot.​

Sensory functions: No direct sensory functions. Indirectly innervates (via its terminal branches) the skin of the lateral leg, heel, and both the dorsal and plantar surfaces of the foot

37
Q

Median Nerve

A

Nerve roots: C6 – T1 (also contains fibers from C5 in some individuals).​

Motor functions: Innervates the flexor and pronator muscles in the anterior compartment of the forearm (except the flexor carpi ulnaris and part of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand.​

Sensory functions: Gives rise to the palmar cutaneous branch, which innervates the lateral aspect of the palm, and the digital cutaneous branch, which innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand.

38
Q

What is C5-7 (Interscalene) ?

A

Part of brachial plexus​
Covers shoulder​
On US image on right: shows how close we are to important things​
Downside: sits around carotid and vertebral artery, stellate ganglion, phrenic nerve ​
When you deposit local anesthetic here… you can block everything else as well

39
Q

Time to wait for Elective Surgery for the following procedures:

Angioplasty w/o stent:
Bare-metal stent placement:
Coronary artery bypass grafting:
Drug-eluting stent placement:

A
  • Angioplasty w/o stent: 2-4 weeks
  • Bare-metal stent placement: 30 days - 12 weeks
  • Coronary artery bypass grafting: 6-12 weeks
  • Drug-eluting stent placement: 6-12 months
40
Q

Revised Cardiac Risk Index (RCRI)

A
41
Q

Lead: I and aVL
Coronary Artery Responsible for Ischemia:
Area Involved:

A

Lead: I and aVL
Coronary Artery Responsible for Ischemia: Circumflex
Area Involved: Lateral aspect of LV

42
Q

Lead: V3-V5
Coronary Artery Responsible for Ischemia:
Area Involved:

A

Lead: V3-V5
Coronary Artery Responsible for Ischemia: LAD
Area Involved: Anterolateral aspect of LV

43
Q

Lead: II, III, aVF
Coronary Artery Responsible for Ischemia:
Area Involved

A

Lead: II, III, aVF
Coronary Artery Responsible for Ischemia: RCA
Area Involved: RA, RV, SA & AV Node, Inferior Aspect of LV

44
Q

What type of individual will be classified as ASA 1?

A

A normal healthy patient.

Healthy non-smoker, little to no EtOH use.

45
Q

What type of individual will be classified as ASA 2 ?

A

A pt with mild systemic disease.

Mild disease only, w/o substantial functional limitations: current smokers, social drinkers, pregnancy, BMI 30-40, well-controlled DM/HTN, mild lung disease.

46
Q

What type of individual will be classified as ASA 3?

A

A pt with severe systemic disease

Substantive functional limitations: one or more moderate to severe disease.
Poorly controlled DM, HTN, COPD, morbid obesity BMI >40, hepatitis, severe EtOH, pacemaker, moderately reduced EF, ESRD w/ dialysis, premature infants <60 weeks, Hx (greater than 3 months) of MI, CVA, TIA, CAD/stents

47
Q

What type of individual will be classified as ASA 4?

A

A patient with severe systemic disease that is a constant threat to their life

Recent (<3 months) MI, CVA, TIA, CAD/stents, ongoing cardiac ischemia, severe valvular disorder, severe reduced EF, sepsis, DIC, ARDS, ESRD w/o dialysis.

48
Q

What type of individual will be classified as ASA 5?

A

A pt not expected to survive w/o operation.

Ruptured AAA, massive trauma, intracranial bleeding with mass effect, ischemic bowel with multi-organ dysfunction.

49
Q

What type of individual will be classified as ASA 6?

A

A declared brain-dead patient whose organs are being removed for donor purposes.

50
Q

Perineum

A

Sensory dermatome S2-S4

51
Q

Lateral Foot

A

Sensory dermatome S1

52
Q

Knee and distal thigh

A

Sensory dermatome L3-L4

53
Q

Inguinal Ligament

A

Sensory dermatome T12

54
Q

Umbilicus

A

Sensory dermatome T10

55
Q

Tip of Xyphoid Process

A

Sensory dermatome T6

56
Q

Nipple

A

Sensory dermatome T4

57
Q

Inner aspect of forearm

A

Sensory dermatome T1-T2

58
Q

Thumb and Index finger

A

Sensory dermatome C6-C7

59
Q

Shoulder and Clavicle

A

Sensory dermatome C5-C4

Adv. Health Assessment (Spring 2024) (25 decks)

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