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AP + Phys > The Airway > Flashcards

The Airway Flashcards

1
Q

How to size Pedi ETT

A

Without cuff- (Age/4)+4
With cuff- (Age/4)+3.5

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2
Q

LMA size

A

1= <5kg
1.5= 5-10kg
2= 10-20kg
2.5= 20-30kg
3= 30-50kg
4=50-70kg
5=70-100kg

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3
Q

LMA Variations

A

Proseal- has a spot to place gastric drain tube for decompression
Fastrach- intubations
C Tach- intubations with camera
Flexible- for head and neck surgery
Igel

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4
Q

When not to use LMA

A

Risk of aspiration
Airway obstructin
Tracheal collapse
Poor lung compliance
High airway resistance

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5
Q

What to do if pt vomits with LMA

A

Leave LMA in
Trendelenburg
Deepen anesthetic
100% fio2
Low FGF
Suction through LMA
Use FOB to evaluate and consider intubation

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6
Q

Comitube

A

Trauma only via EMT
Blind technique
Double lumen
Secures airway and demprosses stomach
Sizes- 37 for 4-6ft
41 for over 6 feet

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7
Q

King Airway

A

Similar to comitube but single lumen and has pedi sizes

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8
Q

FOB

A

Flexible fiberoptic bronchoscope
Used for IL in awake or asleep pt
Good for difficult airway
Cx- refusal, no skills, trauma and blood, lack of time

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9
Q

Intubating stylet

A

Bougie
Best used with grade 3 view
Worst used with grade 4 view
Feel tracheal rings

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10
Q

Retrograde intubation

A

When upper airway is completely obstructed
Needle thru cricothyroid membrane up into mouth
Then use as bougie

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11
Q

Invasive airways

A

Percutaneous cricothyrotomy
surgical circothyrotomy
Treacheotomy

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12
Q

Tracheal extubation criteria

A

Acceptable hemodynamics
Normothermia
Reflexes
Consciousness
Strength- hold head up 5 seconds and hand grip
Reversal of NMB TOF >0.9
HGB 7
Analgesia
Metabolics like electrolyes and PH
VC >15ml/kg
Neg IP 20cmH2O
Vt 4-5ml/kg
Fio2 under .5
Spo2 >90%
PaO2 60mmHg
PaCO@ <50
Acceptable spontaneous RR

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13
Q

Intubation complications

A

Aspiration (1 in 35,000)
Biting
Advancement to bronchi
Trauma- dental most common
Vocal cord paralysis
Esophageal laceration

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14
Q

Upper airway Location and function

A

Location- mouth/ nares to cricoid cartiledge
Function- warming and humidify air, filter particulates, prevents aspiration

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15
Q

Nose and Nasal Passages

A

Tubrinates- 3 on each side, highly vasculature so to reduce trauma
Device should be directed between inferior turbinate and the floor of nasal cavity
2x increased resistance thru nose vs mouth

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16
Q

Mouth and jaw

A

Separated by soft and hard palate
Obstructive structures (tongue, soft palate) may collapse over nasal passage causing sleep apnea
Disorders- micrognathia, macroglossia

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17
Q

Nasopharynx

A

Leads to oropharynx
Anterior C1 between base of skull and soft palate
Estuchian tubes
Trigeminal nerve

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18
Q

Oropharynx

A

Leads to hypopharynx
C2-C3
Soft palate to epiglottis

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19
Q

Hypopharynx

A

C5-C6, below C3
Epiglottis to inferior cricoid cartiledge
Vagus nerve- RLN & SLN

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20
Q

Epiglottis location

A

Separates hypopharynx from larynx
C2-C3

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21
Q

What covers the glottis during swallowing?

A

Epiglottis

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22
Q

Glottis location

A

Adults- C4 C5 C6
Children- C3 C4 C5

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23
Q

Larynx anatomy and components

A

Leads to trachea
Glottic opening to inferior border of cricoid cartilage
Hyoid bone
Ligaments- thyroid and cricothyroid
Cartilages- epiglottis, thyroid, cricoid
Corniculate, artenoid, cuneiform

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24
Q

Larynx function

A

Protects airway from aspiration
Patency between pharynx and trachea
Gag and cough reflex
Phonation

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25
Q

The only bone that doesn’t articulate with another bone

A

Hyoid

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26
Q

Hyoid function

A

Main support of the larynx
Attaches to thyroid cartilage via the thyrohyoid membrane

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27
Q

Anterior ligaments

A

Thyrohyoid- attaches larynx to the hyoid bone
Cricothyroid- attaches cricoid to the thyroid, cricothyroidotomy in airway emergence, and can place a transtracheal block here for RLN

28
Q

3 unpaired cartilages

A

Epiglottis- mechanical barrier between pharynx and larynx, thyroepiglottic ligament connects it to thyroid cartilage
Thyroid- Provides structure and protection to larynx, vocal cords are attached interiorly
Cricoid- Most caudal cartilage in larynx, only complete ring,

29
Q

Paired cartilages

A

Aryetnoids
Corniculates
Cuneiform

30
Q

Aryetnoids

A

Attach to posterior cricoid and posterior vocal cords to help open and close them
Can be restricted with Lupus and arthritis

31
Q

Thyroid

A

Provides structure and protection to larynx
Vocal cords are attached interiorly

32
Q

Cricoid

A

Most caudal cartilage in larynx
Only complete ring
C4-6 adults
C3-5 children

33
Q

Epiglottis

A

Mechanical barrier between pharynx and larynx
Thyroepiglottic ligament connects it to thyroid cartilage
Covers glottis when swallowing

34
Q

Corniculates & Cuneiforms

A

Provides structure to aryepiglottic folds

35
Q

Narrowest airway

A

Adults- glottic opening
Children- Cricoid ring (dynamic- vocal cords)

36
Q

Larynx anatomic position

A

Adult- C4-C6
Children- C3-C5

37
Q

What decreases as airway bifurcates?

A

Airflow velocity
Amount of cartilage
Goblet cells
Cilliated cells

38
Q

What increases as airway bifurcates?

A

Number of airways
Cross sectional area

39
Q

Trachea anatomical position and function

A

15cm long
C6-T5
16-20 rings
Posterior accomodates esophagus during swallowing

40
Q

L vs R bronchus

A

R- 2.5 cm and 25 degrees- easier to intubate
L- 5cm and 45 degrees
Up to age 3- both bronchi are 55 degrees

41
Q

Distance from incisors to larynx
Distance from larynx to carina

A

13cm
13cm
26cm total

42
Q

Intrinsic muscles

A

PHONATION
Cricothyroid- only one innervated by the superior laryngeal nerve (SLN)
Thyroarytenoid- innervated by the recurrent laryngeal nerve (RLN)
Posterior Cricoarytenoid- innervated by RLN
Lateral Cricoarytenoid- innervated by RLN
Vocalis- innervated by RLN
Aryepiglottic- innervated by RLN
Interarytenoid- innervated by RLN

43
Q

Extrinsic muscle

A

SUPPORT LARYNX
ASSISST SWALLOWING
Cricothyroid muscle has both an intrinsic and extrinsic function
Extrinsic function = contracts during swallowing to pull anterior region of the cricoid cartilage toward the lower border of the thyroid cartilage
Muscles that depress the larynx
Omohyoid
Sternohyoid
Sternothyroid
Muscles that elevate the larynx
Digastric (anterior belly)
Mylohyoid
Stylohyoid
Digastric (posterior belly)
Thyrohyoid

44
Q

Trigeminal nerve (5)

A

Primary sensory innervation to face and head
3 branches
V1- opthalmic (anterior ethmoidal) Nares and 1/3 septum
V2- Maxillary (Spenopalatine) Turbinates and septum
V3- Mandibular (tongue) Anterior 2/3 of tongue

45
Q

Glossopharyngeal nerve (9)

A

Sensory innervation of oropharynx to anterior side of epiglottis
Afferent limb of gag reflex

46
Q

Vagus nerve (10)

A

Innervates larynx
Divides into SLN and RLN

47
Q

Superior laryngeal nerve

A

IB- penerates thyrohyoid membrane and is sensory above the glottis
EB- innervations cricothyroid muscle

48
Q

Recurrent laryngeal nerve

A

R loops under subclavian artery
L loops under aortic arch, more susceptible to injury
Motor to all except cricothyroid

49
Q

SLN EB injury

A

Affects cricothyroid muscle
Causes hoarseness

50
Q

RLN Injury

A

Unilateral- Paralysis ipsilateral vocal cord, hoarseness
Bilateral- paralysis of both vocal cords, acute= tensing action are unopposed, can be an emergency if stridor and respiratory distress present, chronic= pt is typically fine

51
Q

RLN Injury causes

A

Either side- External pressure, surgery on thryoid, neck stretching, neck tumor
L side only- PDA ligatoin, LA enlargment, AA, thoracic tumor

52
Q

BONES

A

Assesses mask ventilation
Beard
Obese 26bmi
No teeth
Elderly 55
Sleep aonea

53
Q

4D’s

A

Assesses laryngeal visualization
Disproportion
Distortion
Dismobility
Dentition

54
Q

What is difficult intubation?

A

When a trained anesthesia provider using conventional larygoscopy requires over 3 attempts or 10 minutes

55
Q

What is difficult to ventilate?

A

When saturation can’t be maintained at 90%

56
Q

RODS

A

Assessment for SGA (LMA)
Restricted mouth opening
Obstruction
Distorted airway
Stiff lungs

57
Q

SHORT

A

Assessment for surgical airway
Surgery in neck previously
Hematoma
Obesity
Radiation
Tumor

58
Q

What is difficult airway?

A

A trained anesthesia provider experiences difficulty with masking, laryngoscope, or intubation

59
Q

What is the best position for DL?

A

Sniffing
Brings into alignment

60
Q

What is aggressive jaw thrust?

A

Half of face may sag, patient may drool, chewing will be affected

61
Q

How to tell if face mask is too tight?

A

Can compress CN7 (buccal branch of facial nerve)
Pt will have difficulty opening and closing lips

62
Q

What if ETT connector is resting on pt face?

A

Can compress supraorbital nerve
Pt will have eye pain, forehead numbness, and photophobia

63
Q

Contraindications of NPA

A

Cribiform plate injury
Coagulopathy
Nasal fracture
Previos Transsphenoidal huposectomy
Previous caldwell-luc procedure

64
Q

MAC vs Miller

A

MAC Curved
Miller striaght

65
Q

BURP Maneuver

A

If struggling with DL
Backup
Upward
Rightward
Pressure on thyroid

66
Q

Pros and cons of cuffed ETT

A

Pro- PPV, protection from aspiration
Con- tracheal ischemia if pressure above 25cm H2o

67
Q
A

AP + Phys (38 decks)

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