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ANES 512b Midterm > Chapter 28: Partial Airway Obstruction > Flashcards

Chapter 28: Partial Airway Obstruction Flashcards

1
Q

Abnormal, high-pitched sound produced by turbulent airflow through a partially obstructed airway at the level of the supraglottis, glottis, subglottis, or trachea

A

Stridor

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2
Q

Three types of stridor? Most common?

A

Inspiratory, expiratory, biphasic; inspiratory is most common

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3
Q

What type of stridor suggests a laryngeal obstruction?

A

Inspiratory stridor

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4
Q

What type of stridor implies tracheobronchial obstruction?

A

Expiratory stridor

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5
Q

What type of stridor implies suggests a subglottic or glottic anomaly?

A

Biphasic stridor

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6
Q

Stridor acts according to what principle of Physics?

A

Bernoulli principle

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7
Q

Condition defined by turbulent flow over an orificial lesion in the airway

A

Stridor

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8
Q

Relationship of diameter and length in stridorous airway:

A

Diameter > length

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9
Q

What causes turbulent flow in stridor?

A

Patient makes larger inspiratory/expiratory effort against a narrowed airway, which creates a pressure difference and results in stridor.

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10
Q

Three management techniques for partial airway obstruction:

A

Pharmacologic agents
Non-surgical techniques
Surgery

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11
Q

Which equation is the mathematical basis for laminar flow?

A

Hagen-Poiseuille equation

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12
Q

The H-P equation for laminar flow vs. turbulent flow:

A

Laminar flow: r^4, viscosity

Turbulent flow: r^5, density

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13
Q

Which H-P equation involves viscosity?

A

Laminar flow

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14
Q

Which H-P equation involves density?

A

Turbulent flow

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15
Q

What portion of the H-P equation can we manipulate when we treat partial airway obstruction? What about the surgeon?

A

We can manipulate air density (decreasing density = increasing flow).
Surgeons can manipulate airway radius. (Increasing radius = increasing flow)

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16
Q

Visible signs of partial airway obstruction?

A

Dyspnea, stress, breathing pattern (stridor), retractions

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17
Q

What are retractions and where will you see them in a patient with a partial airway obstruction?

A

Retractions = when the area between the ribs and in the neck sinks in when a person attempts to inhale

Seen in supraclavicular, sternal notch, intercostal, and subcostal areas of body

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18
Q

What can we infer from flow-volume loops?

A

Whether or not lesion exists
Whether lesion if fixed or variable
And if variable, whether intrathoracic or extrathoracic

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19
Q

What radiologic exams might we perform if we suspect a partial airway obstruction?

A

CT scan

MRI

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20
Q

What does a CT scan tell us about partial airway obstructions?

A

We use them to define location, cross-sectional area, and length.
Also, for diagnosis

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21
Q

Which method of diagnosis can be performed bedside?

A

Flow-volume loop, though it requires patient cooperation

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22
Q

On flow-volume loop, x-axis is:

A

time

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23
Q

On flow-volume loop, y-axis is:

A

flow

24
Q

Which phase of breathing is below the x-axis on a flow-volume loop?

A

inspiratory

25
Q

Which phase of breathing is above the x-axis on a flow-volume loop?

A

expiratory

26
Q

Phase of breathing defined by negative pressure:

A

Inspiration

27
Q

Phase of breathing defined by positive pressure:

A

Expiration

28
Q

Lesions at/near the glottic level are what type of lesion? Affects what phase of breathing? Resulting flow-volume loop?

A

Extrathoracic variable obstruction

Inspiratory loop has attenuated inspiratory limb–inspiratory plateau–and normal expiratory phase.

29
Q

In a normal airway, I:E =

A

50:50

30
Q

In an extrathoracic variable lesion airway, I:E =

A

I < E

31
Q

Inspiration has what affect to extrathoracic variable lesion?

A

Forces lesion open

32
Q

Lesions within chest? Affects what phase of breathing? Resulting flow-volume loop?

A

Intrathoracic variable obstruction
Affects expiratory phase
Normal inspiratory limb with expiratory plateau

33
Q

In an intrathoracic variable lesion airway, I:E =

A

I > E

34
Q

In an intrathoracic variable lesion, what kind of forces pull on the parynchema?

A

Retractive forces

35
Q

Fixed obstruction shows what kind of flow-volume loop?

A

Inspiratory + expiratory plateaus

36
Q

Fixed obstruction has what kind of I:E ratio?

A

50:50

37
Q

From which flow-volume loop can we not determine location of lesion? Why not?

A

Fixed obstruction F-V loop; Cannot determine location of lesion because it doesn’t move i terms of cross-sectional area

38
Q

From which type of lesion are both limbs of a flow-volume loop attenuated?

A

Fixed lesion

39
Q

What is your goal in a patient that presents with a PAO?

A

OXYGENATION

40
Q

What role might steroids play in treating a PAO?

A

They are NOT useful acutely in treating PAO–only useful in treating respiratory distress due to asthma (inflammatory condition).

41
Q

In order to qualify as support to a patient, your efforts must have what effect in regards to the PAO?

A

They must improve flow across an orificial lesion

42
Q

Non-surgical techniques to improve flow and achieve oxygenation in a patient with a PAO:

A

Intubation or other airway device

43
Q

Surgeries that may be performed in the event of a PAO? Which is an emergent procedure only?

A

Tracheostomy: could be emergent or could provide intermediate support
Cricothyrotomy: ALWAYS EMERGENT

44
Q

What does salient mean?

A

Most notable; most important

45
Q

What test should you call for in a patient of whom you suspect a PAO?

A

ABG

46
Q

Molecular weight of O2?

A

32

47
Q

Molecular weight of N2?

A

28

48
Q

Molecular weight of He?

A

4

49
Q

Which heliox mixture is the best choice for oxygenation of patient w/ PAO? Molecular weight? Density?

A

He:O2 = 80:20
MW: 9.6 g/mol
Density: 0.43

50
Q

He:O2 = 70:30
MW?
Density?

A

MW: 12.4
Density: 55

51
Q

If you change from air to 100% oxygen, what is your change in flow?

A

90%

52
Q

What is density of O2?

A

1.43

53
Q

What is density of He?

A

0.18

54
Q

What is density of air?

A

1.29

55
Q

Change from 100% O2 to 70:30 Heliox = what change in flow?

A

260%

56
Q

Change from 100% O2 to 80:20 Heliox = what change in flow?

A

330%

ANES 512b Midterm (12 decks)

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