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Adv. Health Assessment (Spring 2024) > Spring 2024 (Exam II) Airway Assessment > Flashcards

Spring 2024 (Exam II) Airway Assessment Flashcards

1
Q

The internal nose is dived by the ______.

A

Septum

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2
Q

The internal structure of the nose is composed of what structures?

A

Cribriform Plate
Turbinates (Superior, Middle, and Inferior)

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3
Q

The internal nasal cavity is very vascular. What do you need to use before nasal intubation to mitigate bleeding?

A

Vasoconstrictors
* Afrin(Oxymetazoline),Neo, Cocaine

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4
Q

The roof of the mouth consist of what four structures?

A

Maxilla and palatine bones
Hard palate
Soft palate
Teeth

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5
Q

What makes up the floor of the mouth (3 structures)?

A

Tongue
Mandible
Teeth

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6
Q

What is a muscular tube that extends from the base of the skull to the lower border of the cricoid cartilage?

A

Pharynx (Responsible for airway patency and a common site of airway obstruction.)

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7
Q

What can be performed to elongate pharyngeal muscles and maintain airway patency?

A

Chin lift

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8
Q

What are the 3 parts of the pharynx?

A

Nasopharynx -nose to the soft palate
Oropharynx- soft palate to the epiglottis
Hypopharynx- epiglottis to the cricoid cartilage

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9
Q

The larynx extends from the __________ to the lower end of the circoid cartilage at the ______ cervical vertebrae.

A

The larynx extends from the epiglottis to the lower end of the cricoid cartilage at the 6th cervical vertebrae.

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10
Q

What are the functions of the Larynx?

A

Phonation
Airway Protection
Inlet to the Trachea

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11
Q

Name the unpaired Laryngeal cartilage

A
  • Thyroid cartilage (This is the largest of the three and supports most of the soft tissue.)
  • Epiglottis cartilage
  • Cricoid cartilage - (complete ring)
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12
Q

Name the paired Laryngeal cartilages.

A

Arytenoid
Corniculate
Cuneiform

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13
Q

The vocal cords are attached to what two cartilages?

A

Thyroid cartilage at the thyroid notch and posteriorly in the arytenoid cartilage.

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14
Q

The trachea extends from the __________ membrane to the carina.

What is the length of the trachea in an adult?

A

inferior cricoid

10-15 cm

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15
Q

The trachea anteriorly is bounded by __________ and closed posteriorly by ___________ muscle.

A

The trachea anteriorly is bounded by tracheal C-shape rings and closed posteriorly by longitudinal trachealis muscle.

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16
Q

Actions to take when you know you can not mask ventilate a patient during an airway assessment?

A

Maintain spontaneous ventilation
Use awake endotracheal intubation
Create a surgical airway (emergency situation)

Airway assessment should be conducted before the initiation of anesthesia in all patients thoroughly.

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17
Q

History concerns for airway assessment (6 factors).
What is the most predictive factor?

A
  1. Past difficult intubation (most predictive factor)
  2. Report of excessive sore throat
  3. Report of cut lip/broken tooth
  4. Recent onset of hoarseness - issue with vocal cords or tumor
  5. History of OSA - related to anatomy or size
  6. Lesions intra-orally…. base of the tongue, lingual tonsils
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18
Q

Airway evaluation components (6 components).

A
  1. Visual inspection of the face and neck
  2. Assessment of mouth opening
  3. Evaluation of oropharyngeal anatomy and dentition
  4. Assessment of neck range of motion (sniffing position)
  5. Assessment of the submandibular space
  6. Assessment of the patient’s ability to slide the mandible anteriorly
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19
Q

What visual inspections will indicate difficult intubation? neck length?

A

Short or thick neck (>43 cm = difficulty w/ intubation, more predictive than high BMI)
Facial deformities
Head and neck cancers
Burns
Goiter
Receding mandible
Beard (Santa Claus)
C-collar (Don’t touch C-collar, have the MD do it, chart it.)

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20
Q

How do you assess mouth opening?

A

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

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21
Q

What are pathologic characteristics that can be identified during oropharyngeal anatomy assessment?

A

Tumor
Palate deformities (High arched palate, cleft palate)
Macroglossia - giant tongue

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22
Q

What are pathologic characteristics that can be identified during oropharyngeal anatomy assessment?

A

Tumor
Palate deformities (High arched palate, cleft palate)
Macroglossia - giant tongue

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23
Q

What do you look for during a dental assessment?

A

Long upper incisors - (fangs, work around them.)
Poor dentition/loose teeth
Cosmetic work
Edentulousness (lack of teeth)

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24
Q

Dental injuries account for _____% of closed insurance claims against anesthesia providers.

______% of dental injuries occur during tracheal intubation. A lot of these are related to difficult and emergency airway management.

A

25%
75%

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25
Q

What are the factors that can cause dental injuries (5 factors)?

A

Laryngoscope blade
Rigid suction catheters
Oropharyngeal airway placement
Rigorous removal of airways
Biting down on ETT/LMA/airways during emergence

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26
Q

What two teeth have the highest incidence of dental injuries?

A

Left Central Incisor (47%)
Left Lateral Incisor (20%)

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27
Q

The sniffing position evaluates what neck movements?

What three axis are aligned in a perfect sniff position?

A

Cervical flexion and atlanto-occipital extension. How well does the head move on the neck?

Alignment of the oral, pharyngeal, and laryngeal axis (Letter C in the picture)

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28
Q

What is the position called?

A

‘Ramping’
The ideal ramping position is to bring the ears up to the level of the sternum so that they are leveled.

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29
Q

What is the sternomental distance?
What is the preferred distance?

A

Distance between the sternal notch and chin with head in full extension and mouth closed.

> 12.5 cm preferred

30
Q

What is the thyromental distance?
What is the preferred distance?

A

Assess submandibular compliance. Measurement is from the tip of the chin to the thyroid notch.

Basically, do we have a chin that is not connected to the neck?

Prefer > 6.5 cm (3 finger breadths)

31
Q

How do you test prognathic ability (two movements)?

A
  1. Extension of lower incisors beyond upper incisors.
  2. Upper lip bite test.
32
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)

33
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

34
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

35
Q

What can be visualized in a Mallampati Class III?

A

Base of the uvula and soft palate

36
Q

What can be visualized in a Mallampati Class IV?

A

Only hard palate

37
Q

What are the two types of Laryngeal Manipulation?

A
38
Q

What is the Cormack-Lehane classification?

A

Classification of laryngeal view
Grade I-IV

39
Q

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

A

Entire Glottis

40
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

41
Q

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

A

No part of the glottis and only the epiglottis

42
Q

area of the pharynx that causes the most problems?

A

oropharynx because the tongues gets in the way

43
Q

opening between the nose and mouth where the oral and nasal cavities join. where nasopharynx ends at soft palate.
common site of airway obstruction

A

Velopharynx

44
Q

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

A

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

45
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

46
Q

Criteria associated with difficult airway (11 of them)- Overview Flashcard.

A
47
Q

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

A

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

48
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.

49
Q

Optimize _________ throughout the difficult airway algorithm.

A

oxygenation

50
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.

51
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.

52
Q

in what pts do you wanna intubate early

A

dynamic airways, burns (airway swells),

bullets (rapidly expanding hematoma),

bites (anaphylaxis, angioedema)

53
Q

awake technique steps

A

Glycopyrolate 0.2 mg or Atropine .01 mg/kg glyco preferred, ideally given 15 min prior to next step

Suction then pad dry mouth with gauze

Nebulized Lidocaine
Atomized Lidocaine =
Viscous Lidocaine

Preoxygenate □ Position □ Restrain prn □ Switch to nasal cannula

Lightly sedate with Versed 2-4 mg or Ketamine 20 mg

Intubate awake or place bougie, then paralyze, then pass tube

54
Q

seat the blade: either in the ____

A

seat the blade: either in the vallecula, or on the epiglottis itself, then gently lift

55
Q

what med causes angioedema

A

ace inhibitor, lisinopril

56
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
57
Q

DOC for induction of asthmatics

A

ketamine cuz it bronchodilates

58
Q

etomidate downsides

A

adrenal suppression

lowers seizure threshold

59
Q

DOA of roc vs succ

A

succ: 5-10 min
roc: 30-90 min

60
Q

What are physiologic killers while intubating?

A

hypotension
hypoxemia
metabolic acidosis

61
Q

Shoot for a higher than normal BP before intubating if possible with pts that were hypotensive to begin with whats the range?

A

(SBP ≥140mmHg)

62
Q

induction agent of choice in shock and what dose?

and paralytic of choice for shock? and what dose?

A

ketamine (low dose 0.5mg/kg)

gives simultaneous SNS surge and pain control

roc 1.6mg/kg

63
Q

push dose pressors for shock pts

A
  • Epi- 10 mcg/ mL
  • Neo- 100 mcg/ mL
  • Vaso- 1 unit/ mL
64
Q

how to oxygenate pt prior to intubating a hypoxic pt

A

NC 15LPM + BVM 15LPM + PEEP Valve 5 – 15cmH20

dont need to bag, keep a tight seal

65
Q

downside of bicarb administration in acidotic pts

A

when giving bicarbonate it eventually gets turned into CO2.

Patients in severe metabolic acidosis are already tachypneic in an effort to blow off CO2, so any further CO2 could make them more acidotic and lead to cardiac dysrhythmias

66
Q

which pts are high aspiration risk

A

upper gi bleeds
bowel obstructions
pre-induction vomiting

67
Q

size of hard palate?

A

makes up the anterior 2/3rds of the roof

68
Q

adverse effects succ

A

predisposition to MH
hyperthermia
bradycardia
fasciculation–>increased ICP, myalgias,
hastened desaturation
masseter spasm

69
Q

VAPOX settings

Even a brief apneic period can worsen acidosis

A

SIMV+PSV
VT 8ml/kg Predicted Body Weight
FiO2 100%
Pressure Support 5-10cmH20
PEEP-5
Inspiratory Flow Rate- 30 LPM
Decrease flow rate to avoid stomach insufflation but meet needs of minute ventilation

70
Q

Nasal trumpet to ETT conversion

A

conversion factor is 4
28f NPA = 7.0 ETT

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

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