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Anaesthetics > Airway and Respiratory Anatomy > Flashcards

Airway and Respiratory Anatomy Flashcards

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1
Q

Trachea extends from where to where? Levels!

A

Cricoid cartilage at C6
Tracheal bifurcation at carina T5-6
Lies midline anterior to oesophagus

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2
Q

Length of trachea

A

15cm

5cm above sternal notch or 8cm if neck fully extended

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3
Q

Patency of trachea is maintained by what?

A

C rings of cartilage anteriorly

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4
Q

The thyroid isthmus overlies which tracheal rings?

A

2-4

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5
Q

Characteristics of right main bronchi

What relevance is this to aspiration?

A

Shorter wider and vertically placed compared to left
RUL arises 2.5cm from carina
More likely to aspirate into apical bronchus of right lower lobe as it is the first segmental bronchus arising posteriorly.

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6
Q

Lung lobes

A

Right - 3 split by horizontal and oblique fissure

Left - 2 plus lingula (middle lobe remnant)

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7
Q

What are the layers that enclose the lung?

A

Visceral
Parietal attached to chest wall and mediastinum
Pleural cavity in between layers which contains serous fluid

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8
Q

What causes negative intrapleural pressure?

A

Outward spring of rib cage and elastic recoil of lungs

Thoracic cage volume increases the negative intrapleural pressure and the lungs inflate

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9
Q

Which part of the lung remains vulnerable during some procedures?

A

2-4cm above mid third of clavicle exposed to intravenous procedures and nerve blocks (intercostal and brachial plexus)
Surgery on adrenal and kidney also problematic as lung extends to Costo diaphragmatic recess.

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10
Q

How many bronchopulmonary segments are there?

A

10 each with own blood supply and distinct lung parenchyma

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11
Q

Bronchioles is also called what? What condition occurs at this lung level?

A

Primary lung lobule

Asthma as it contains smooth muscle and no cartilage

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12
Q

Alveoli are lined with what?

A

Single layer of fine non ciliated cuboidal epithelium

Separated from capillary network by fine basement membrane

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13
Q

What produces lung surfactant?

A

Type II pneumocytes situated in alveoli

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14
Q

How does lung surfactant work?

A

Prevents air sacs from collapsing

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15
Q

Mediastinum is made up of how many compartments?

A

Space between the 2 pleural cavities

4 - ant, post, middle and superior

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16
Q

A mass in which mediastinal compartment would concern anaesthetists?

A

Anterior

Loss of muscle tone post-induction would allow mass to fall back against the heart and great vessels and major airway

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17
Q

What is the most important muscle of respiration?

A

Diaphragm
Contributes to 60-75% tidal volume
Flattens to push Abdominal contents down and ribs up and out
1.5cm in quiet resp, 13cm movement in deep resp

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18
Q

What is the nerve supply of the diaphragm?

What happens if this nerve is damaged?

A

C3-5 phrenic

Damage causes a upward ipsilatersl paradoxical movement of diaphragm

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19
Q

What else does the diaphragm contribute to?

A

LOS

Disrupted in hiatus hernia

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20
Q

What muscles help with forced expiration?

A

Abdominal and diaphragm

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21
Q

What limits diaphragmatic movement?

A

Abdominal distension -pregnancy/ obesity/ pneumoperitoneum

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22
Q

What is the function of the external intercostal muscles?

A

Slope down and forward to pull ribs up and out on inspiration
Increases anteroposterior and lateral thorax diameter

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23
Q

What are the functions of the internal intercostal muscles?

A

Slope down and back

Only use in active expiration pulling ribs down and in

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24
Q

What do the innermost intercostal muscles do?

A

Stabilise chest wall linking ribs

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25
What is the nerve supply to the intercostal muscles? | Why do nerve blocks at this nerve not affect respiration significantly?
T1-T11 | Diaphragmatic contribution 65-70%
26
Accessory muscles function how?
Scalene - elevate first 2 ribs SCM - elevate sternum Small muscles of head and neck and nasal flaring
27
What is the depth of trachea tube insertion?
F - 21cm at the lips | M - 23cm at the lips
28
What phase is a CXR taken in?
Full inspiration | At lest 6 ribs visible anteriorly and 10 posteriorly
29
What is the safe triangle in chest drain insertion?
Emergency - 2nd ICS Midclavicular line just above 3rd rib | Formal drain - 5th ICS (below 5th rib but just above 6th rib, midaxillary line
30
Airway assessment consists of what?
``` Mouth opening Dental MP Jaw protrusion Neck extension Thyromental distance ```
31
What anatomical variants prove tricky for airway management?
``` High arched palate Small mouth Receding chin Large tongue Beard Poor dentition TMJ disease Tonsilar hypertrophy ```
32
What acquired issues are difficult in airway management?
``` Burns Tumours Abscess Radiotherapy Scarring ```
33
What happens to the airway under anaesthesia?
Loss of muscle tone | Pharyngeal airway loses patency
34
What manoeuvres aid airway patency?
Jaw thrust | Chin lift
35
What adjuncts can be used to improve airway patency?
NPA/OPA LMA ETT
36
What is the function of the nose?
Warm humidify air by pseudostratified ciliated columnar epithelium and mucous serous glands Smell Speech resonation
37
What is the widest part of the nasal airway?
Below the inferior turbinate
38
What are the advantages and disadvantages of nasal intubation?
A- Better tolerated. Leaves oral cavity free for surgery | D- Bleeding, false passage in skull fractures, infection
39
What is the function of the palate?
Separates nose and mouth during swallowing
40
What does the hard palate consist of?
Palatine process of the maxilla and the horizontal sort of the palatine bone
41
What nerves supply the gag reflex?
Afferent - glossopharyngeal CN IX | Efferent - vagus CN X
42
Pharynx is made up of what?
Oropharynx, nasal pharynx and laryngopharynx
43
Where do fish bones lodge?
Piriform fossae, recesses either side of the larynx
44
What are the pillars of fauces?
Palatine tonsils lymphoid tissue between palatoglossal and palatopharyngeal arches Hypertrophy in childhood
45
What is the nerve supply to the tonsils?
3 nerves Glossopharyngeal, maxillary,mandibular Anaesthetic to the tonsilar bed most effective analagesia
46
Swallow reflex
Closure of laryngeal sphincter Upward movement of larynx behind base of tongue Inhibited breathing Lateral channeling of food by epiglottis into piriform fossae Epiglottis lid over trachea
47
What are the articulating cartilages of the larynx?
``` Thyroid Cricoid Epiglottis Arytenoid (with superior cricoid) Corniculate Cuneiform visible on laryngoscopy at aryepiglottic folds ```
48
Where do the intrinsic muscles of the larynx attach
Arytenoids, pivot to adjust vocal cord position
49
What are the false cords?
Vestibular folds (mucous membrane that covers the free borders of the intrinsic ligaments of the larynx)
50
Where is the narrowest part of the airway?
The glottis - gap between true vocal cords | Also known as the Rima glottidus
51
What do the extrinsic larynx muscles do?
Attach to hyoid and work with other muscles to move the larynx up and down during swallowing
52
What do the intrinsic larynx muscles do?
Open the vocal cords during inspiration Close cords and laryngeal inlet during swallowing Alter tension of cords during phonation
53
What are the vocal cord abductors?
Posterior cricoarytenoids
54
How does abduction of vocal cords on inspiration occur?
Pull posterior ends of arytenoid cartilages together. Pivot then abducts the anterior ends of the cartilages to which vocal cords are attached.
55
What are the vocal cord adductors? (Close)
Lateral cricoarytenoids and transverse arytenoids
56
Aryepiglottis and thyroepiglottis do what?
Laryngeal sphincters -close laryngeal inlet during swallowing
57
Cricothyroid muscle does what?
Tensor of cords | Pivot at cricoid cartilage on the thyroid cartilage
58
What muscle relaxes the cords?
Thyroarytenoids
59
Vocalis muscle does what?
Fine tunes cords
60
What is the sensory supply to the larynx?
``` Vagus Branches to: Superior laryngeal nerve (Above cords) internal branch Recurrent laryngeal nerve (below cords) ```
61
What branches of the superior laryngeal nerve are there?
Internal - sensory to interior larynx and vallecula | External - motor supply to cricothyroid muscle
62
What happens with superior laryngeal nerve damage?
Temporary Hoarseness | Aspiration risk
64
What does RL nerve supply?
Sensation below vocal cords | Motor to all intrinsic muscles of larynx apart from cricothyroid
65
Bilateral vocal cord/ SLN palsy causes what?
Severe respiratory distress | Stridor due to flaccid cords
66
Cricothyroid membrane lies where?
Between thyroid and cricoid cartilage | Avascular band
67
What can be damaged in a surgical airway?
Vocal cords | Causes subglottic stenosis
68
What are the paths of the right and left RL nerves?
Right passes under subclavian artery then ascend to larynx in tracheo-oesophageal groove Left passes under aortic arch to ascend in same groove
69
What equipment do you need for an emergency cricothyroidotomy?
6 ett 10 blade scalpel GEB Suction
72
Unilateral RL nerve damage results in?
``` Vocal cord palsy Hoarseness Poor glottis closure Poor cough (cannot generate positive intrathoracic pressure) Aspiration risk ```
73
Neurovascular bundle lies where in relation to run surface?
Inferior surface

Anaesthetics (12 decks)

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