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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
The only bone that doesn't articulate with another bone
Hyoid
26
Hyoid function
Main support of the larynx Attaches to thyroid cartilage via the thyrohyoid membrane
27
Anterior ligaments
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
3 unpaired cartilages
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
Paired cartilages
Aryetnoids Corniculates Cuneiform
30
Aryetnoids
Attach to posterior cricoid and posterior vocal cords to help open and close them Can be restricted with Lupus and arthritis
31
Thyroid
Provides structure and protection to larynx Vocal cords are attached interiorly
32
Cricoid
Most caudal cartilage in larynx Only complete ring C4-6 adults C3-5 children
33
Epiglottis
Mechanical barrier between pharynx and larynx Thyroepiglottic ligament connects it to thyroid cartilage Covers glottis when swallowing
34
Corniculates & Cuneiforms
Provides structure to aryepiglottic folds
35
Narrowest airway
Adults- glottic opening Children- Cricoid ring (dynamic- vocal cords)
36
Larynx anatomic position
Adult- C4-C6 Children- C3-C5
37
What decreases as airway bifurcates?
Airflow velocity Amount of cartilage Goblet cells Cilliated cells
38
What increases as airway bifurcates?
Number of airways Cross sectional area
39
Trachea anatomical position and function
15cm long C6-T5 16-20 rings Posterior accomodates esophagus during swallowing
40
L vs R bronchus
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
Distance from incisors to larynx Distance from larynx to carina
13cm 13cm 26cm total
42
Intrinsic muscles
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
Extrinsic muscle
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
Trigeminal nerve (5)
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
Glossopharyngeal nerve (9)
Sensory innervation of oropharynx to anterior side of epiglottis Afferent limb of gag reflex
46
Vagus nerve (10)
Innervates larynx Divides into SLN and RLN
47
Superior laryngeal nerve
IB- penerates thyrohyoid membrane and is sensory above the glottis EB- innervations cricothyroid muscle
48
Recurrent laryngeal nerve
R loops under subclavian artery L loops under aortic arch, more susceptible to injury Motor to all except cricothyroid
49
SLN EB injury
Affects cricothyroid muscle Causes hoarseness
50
RLN Injury
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
RLN Injury causes
Either side- External pressure, surgery on thryoid, neck stretching, neck tumor L side only- PDA ligatoin, LA enlargment, AA, thoracic tumor
52
BONES
Assesses mask ventilation Beard Obese 26bmi No teeth Elderly 55 Sleep aonea
53
4D's
Assesses laryngeal visualization Disproportion Distortion Dismobility Dentition
54
What is difficult intubation?
When a trained anesthesia provider using conventional larygoscopy requires over 3 attempts or 10 minutes
55
What is difficult to ventilate?
When saturation can't be maintained at 90%
56
RODS
Assessment for SGA (LMA) Restricted mouth opening Obstruction Distorted airway Stiff lungs
57
SHORT
Assessment for surgical airway Surgery in neck previously Hematoma Obesity Radiation Tumor
58
What is difficult airway?
A trained anesthesia provider experiences difficulty with masking, laryngoscope, or intubation
59
What is the best position for DL?
Sniffing Brings into alignment
60
What is aggressive jaw thrust?
Half of face may sag, patient may drool, chewing will be affected
61
How to tell if face mask is too tight?
Can compress CN7 (buccal branch of facial nerve) Pt will have difficulty opening and closing lips
62
What if ETT connector is resting on pt face?
Can compress supraorbital nerve Pt will have eye pain, forehead numbness, and photophobia
63
Contraindications of NPA
Cribiform plate injury Coagulopathy Nasal fracture Previos Transsphenoidal huposectomy Previous caldwell-luc procedure
64
MAC vs Miller
MAC Curved Miller striaght
65
BURP Maneuver
If struggling with DL Backup Upward Rightward Pressure on thyroid
66
Pros and cons of cuffed ETT
Pro- PPV, protection from aspiration Con- tracheal ischemia if pressure above 25cm H2o
67

AP + Phys (38 decks)

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