SM_23b: Pediatric Airway Flashcards
Upper airway is the airway starting at the ____ and extending down the ____ and is involved in ____, ____, and ____
Upper airway is the airway starting at the nose and extending down the trachea and is involved in airway / breathing, swallowing, and voice / speech
(voice and speech are separate)
Sterter is ___ and occurs when there is obstruction at the ___ or ___
Sterter is snoring and occurs when there is obstruction at the nose / nasopharynx and oropharynx / hypopharynx
(top of the airway)
Stridor is ____ and occurs when there is obstruction that is ____, ____, ____, and ____
Stridor is seal-like and occurs when there is obstruction that is supraglottic, glottic, subglottic, and tracheobronchial
- If inspiratory, comes from supraglottis being sucked down
- If biphasic, comes from glottis or subglottis
- Trachea: obstruction in neck -> expiratory stridor
Wheezing occurs when obstruction is ___
Wheezing occurs when obstruction is pulmonary
Nose functions in ____, ____, and ____
Nose functions in filtration, humidification, and smell
Neonates are ____ breathers
Neonates are obligate nasal breathers
- Choanal atresian and nasal vestibular stenosis are emergencies
- Inferior turbinate, middle turbinate, and choana are common areas for foreign body impaction
Foreign body risk is high in ____ and ____
Foreign body risk is high in children < 18 months old and toddlers / older children
- Children < 18 months are obligate nasal breathers: nasal foreign body leads to significant airway obstruction
- Toddlers and older children: unilateral rhinorrhea, risk dislodgement into larynx, risk of aspiration into trachea or esophagues increases in neurologically impaired
Hypopharynx and larynx function in ____, ____, ____, and ____
Hypopharynx and larynx function in swallowing conduit, respiration, phonation, and airway protection against aspiration
Recurrent (inferior) laryngeal nerve provides most of the ____ innervation to the larynx, while the superior laryngeal nerve provides most of the ____ innervation to the larynx
Recurrent (inferior) laryngeal nerve provides most of the motor innervation to the larynx, while the superior laryngeal nerve provides most of the sensory innervation to the larynx (except for cricothyroid)
- Superior laryngeal nerve provides most of the sensory innervation to the cricothyroid muscle
Describe the laryngeal adductor reflex
Laryngeal adductor reflex
- Stimulus
- Larynx
- Aferent via SLN
- Nodose ganglion
- Nucleus solitarious
- Nucleus ambiguous
- Efferent via vagus
- Larynx
- Glottic closure, inhibition of respiration, swallow
Describe airway protection during swallowing
Airway protection during swallowing
- Larynx elevates
- Vocal cords adduct
- Pharynx contracts
- Palate elevates to seal off nasopharynx
- Upper esophageal sphincter opens
Larynx includes the ____, ____, ____, and ____
Larynx includes the epiglottis, false vocal folds, true vocal folds, and arytenoid cartilages
(arytenoids give tension to vocal cords and move them)
Bilateral vocal cord paralysis is usually ___
Bilateral vocal cord paralysis is usually congenital
(can be associated with brain abnormality)
Laryngomalacia is a ____ obstruction that presents with ____
Laryngomalacia is a supraglottic obstruction that presents with inspiratory stridor
- Additional symptoms; cyanosis, feeding difficulty / failure to thrive, reflux, apnea
- Symptom severity: mild, moderate (feeding symptoms), severe (life threatening airway obstruction)
Vallecular cyst collapses the ____ and causes ____ problems
Vallecular cyst collapses the voice box posteriorly and causes feeding problems
Subglottis is the undersurface of the ____ and includes the ____
Subglottis is the undersurface of the vocal folds and includes the cricoid cartilage
- Cricoid cartilage is only complete ring of cartilage in airway - makes it susceptible to injury
- A little obstruction makes a large difference: Poiseuille’s Law
Congenital subglottic stenosis causes ___
Congenital subglottic stenosis causes cricoid ring to not be as patent as it should be
Subglottic hemangioma presents with ____ at ____
Subglottic hemangioma presents with biphasic stridor at 4-6 weeks
- 50% occur with cutaneous hemangioma
- Barky cough, hoarseness, recurrent or persistent croup
Trachea is composed of ____, ____, and ____
Trachea is composed of U-shaped cartilages, trachealis muscle, and respiratory epithelium with cilia
- Diameter varies at different levels and with respiration: posterior membrane may move anteriorly
Trachea has ____ and ____ components
Trachea has intrathoracic and extrathoracic components
- Carina is usually sharp
Tracheomalacia is ____
Tracheomalacia is narrowing of the airway due to abnormally shaped rings
- Trap secretions during URTIs so longer viral syndromes
Slide tracheoplasty ____
Slide tracheoplasty borrows part of trachea from itself, sacrificing length for width
Inominate artery can cross the trachea and cause ____
Inominate artery can cross the trachea and cause tracheal compression
