Week 7 Airway

Question 0

What cranial nerve supplies sensation to the nasal mucosa and turbinates? If you were going to do an awake nasal intubation…

Answer 0

Trigeminal

Question 1

What is the Gold Standard of difficult airway management?

Answer 1

Flexible fiber optic bronchoscopy

Question 2

If you were going to do an oral awake intubation, what cranial nerve supplies the gag reflex?

Answer 2

Glossopharyngeal

Question 3

If you were going to do an awake nasal or oral intubation, it is nice to block the __ nerve, why? Because it anesthetizes the vocal cords on down.

Answer 3

Recurrent laryngeal (comes from vagus)

Question 4

“So if you don’t want them to cough on you as your scope traverses the glottic opening and on down, anesthetize the __”

Answer 4

recurrent laryngeal nerve

Question 5

the superior laryngeal nerve comes from the __ __ ganglion

Answer 5

superior cervical ganglion

Question 6

the superior laryngeal branches into two nerves. What are they and what do they innervate?

Answer 6

Internal laryngeal nerve- sensory

external laryngeal nerve- motor

Question 7

What nerve gives us the recurrent laryngeal?

Answer 7

Vagus

Question 8

What does the recurrent laryngeal innervate?

Answer 8

vocal cords down

Question 9

Do you think you should attempt a nasal intubation on someone on coumadin and an INR or 2.8?

Answer 9

no way jose

Question 10

Where does the Palatine nerve come from? What does it innervate?

Answer 10

Trigeminal

Nasal turbinates and most of septum

Question 11

Where does the Anterior Ethmoid come from? What does it innervate?

Answer 11

Olfactory

innervates NARES and ANTERIOR 1/3 of SEPTUM

Question 12

What three cranial nerves innervate the oropharynx?

Answer 12

Facial 7
Glossopharyngeal 9
Vagus 10

Question 13

three branches of glossopharyngeal nerve

Answer 13

lingual (posterior 1/3 of tongue, vallecula, epiglottis)
pharyngeal (walls of pharynx)
tonsillar (tonsils)

Question 14

what nerve supplies the cricothyroid muscle?

Answer 14

external branch of superior laryngeal

Question 15

what nerve provides sensory to vocal fold and trachea, and motor to all intrinsic muscles except cricothyroid muscle?

Answer 15

recurrent laryngeal

Question 16

what nerve supplies sensory to base of tongue, posterior epiglottis, aryepiglottic folds, and arytenoids?

Answer 16

internal branch of superior laryngeal

Question 17

a negative side effect of too much benzocaine

Answer 17

methemoglobinemia

Question 18

Would a long acting respiratory depressant like morphine be a good idea for your awake fiberoptic intubation?

Answer 18

probably not

Question 19

after you topically anesthetize the oral mucosa with cetacaine spray, how much lidocaine would you deposit just under the skin at the base of the palatoglossal folds? Which nerve are you blocking? What is the major benefit of this block?

Answer 19

2-4 ml’s of 4% lidocaine with epi per side

glossopharyngeal

block gag reflex

Question 20

blocking the glossopharyngeal by injecting LA into the pallatoglossal folds will desensitize four areas, what are they

Answer 20

1. oropharynx
2. soft palate
3. posterior tongue
4. pharyngeal surface of epiglottis

basically rear of oral cavity down to epiglottis

Question 21

internal branch of superior laryngeal (a branch of vagus) provides sensory to the

Answer 21

1- base of tongue
2- posterior surface of epiglottis
3- aryepiglottic fold
4- arytenoids

basically back side of epiglottis to cords

Question 22

where and how would you block the internal branch of superior laryngeal nerve?

Answer 22

2 ml’s of 2% lidocaine infiltrated with SHORT 5/8” 25 ga needle
lateral to greater cornu of hyoid bone

please be careful, on myself this feels very close to the carotid just under the mandible, aspirate carefully

Question 23

Keep your hands, arms, digits out of the path of needles.

Answer 23

“I was married, that was a bummer.”

Question 24

recurrent laryngeal nerve provides sensory innervation to __

blocking the recurrent laryngeal nerve prevents __

Answer 24

vocal folds and trachea

blocking prevents coughing while ETT passes through vocal cords

Question 25

how to block recurrent laryngeal nerve

Answer 25

4ml’s of 4% lidocaine, insert needle straight in to trachea (above cricoid / below thyroid cartilage), aspirate until air bubbles (you’re in the trachea), tell patient to take a deep breath and exhale deeply, inject quick and get out before your patient has a coughing fit.