Airway assessment & Management Flashcards
(141 cards)
1
Q
What is the primary passage for air into lungs
A
Nose
2
Q
What allows for humidification & filtration of air?
A
Large surface area of the turbinates
3
Q
Blood supply to the nose includes
A
Maxillary artery
Ophthalmic artery
Facial artery
4
Q
What nerves innervate the nose
A
Maxillary & Ophthalmic branches of the Trigeminal nerve
5
Q
Characteristics of the hard palate
A
Anterior 1/2-2/3 of the top of the mouth
Fixed
6
Q
Characteristics of the Soft palate
A
Posterior 1/2-1/3 of the top of the mouth
Contributes to airway obstruction
7
Q
What structures are apart of the oropharynx
A
Hard & soft palate
Tonsils
Tonsillar pillars
Uvula
8
Q
The opening into the oropharynx is knows as the
A
Fauces, which is located behind the oral cavity
9
Q
Identifying the _____ is important when using Mallampati
A
Fauces
10
Q
What are the subdivisions of the pharynx?
A
TOP to BOTTOM
Nasopharynx
Oropharynx
Hypopharynx
11
Q
The pharynx extends from the
A
Base of the skull to the cricoid cartilage
12
Q
The Nasopharynx is at level
A
C1
Skull base superior
Soft palate inferior
13
Q
The Oropharynx is at level
A
C2-3
Soft palate superior
Epiglottis is inferior
14
Q
The Hypopharynx is at level
A
C5-6
Epiglottis superior
Cricoid cartilage inferior
15
Q
The pharynx is innervated by
A
Superior Laryngeal Nerve (SLN)
Recurrent Laryngeal nerve (RLN)
16
Q
The Internal Branch of the Superior Laryngeal Nerve provides
A
Sensory input to the hypopharynx above vocal cords
17
Q
The External Branch of the Superior Laryngeal Nerve provides
A
Motor input to cricothyroid muscle
18
Q
The recurrent laryngeal Nerve provides
A
Sensory innervation to subglottic area & trachea
19
Q
The RIGHT Recurrent Laryngeal nerve loops around the
A
Subclavian Artery
20
Q
The LEFT Recurrent Laryngeal nerve loops around
A
Aortic Arch
21
Q
Unilateral injury to the Recurrent Laryngeal Nerve will cause
A
Vocal Cord paralysis on one side
Not problematic
22
Q
Bilateral injury to the Recurrent Laryngeal nerve can casue
A
Unopposed adduction of the vocal cords, causing stridor & severe respiratory distress
23
Q
Is injury to the Superior Laryngeal nerve a concern?
A
No
Not associated with respiratory distress
24
Q
The larynx begins with the
A
Epiglottis & extends to the cricoid cartilage
25
What is the purpose of the larynx?
Phonation
Protects lower airway from aspiration
Provides gag & cough reflex
26
Blood supply to the larynx is provided by the
External carotid, which branches into the superior thyroid, then superior laryngeal artery (supraglottic) & inferior laryngeal artery (infraglottic)
27
The Larynx is composed of what 3 single cartilages?
Thyroid
Cricoid
Epiglottis
28
The larynx is composed of what 3 paired cartilages?
Arytenoid
Corniculate
Cuneiform
29
What comprises the larynx is all joined by
Ligaments, membranes & synovial joints that are suspended by the hyoid bone via the thyrohyoid ligaments & membrane
30
The cricoid cartilage is at the level of the
C6; anteriorly connected to the thyroid cartilage by the cricothyroid membrane
31
The cricoid cartilage is the only
Complete cartilaginous ring in the airway
32
The trachea begins at the level of the
Cricoid cartilage & extends to the carina; level T5
33
How many C-shaped rings?
16-20 rings, with trachealis muscle at the posterior side
34
In the adult, the RIGHT mainstem bronchus
Branches off at a more vertical angle than the left
Creates a likelihood of an ETT tube entering the right side
35
The diaphragm lies between the
Pleural & ABD cavities
36
Diaphragm is innverated by the
Phrenic nerve
37
Relaxation of the diaphragm causes
Exhalation
38
What assessment tools are used for the airway Exam?
Mallampati (assesses size of tongue relative to the oropharyngeal opening; airway visualization; class 1-4; PUSH; OSA)
TMD (from chin & thyroid cartilage; assess mandibular space)
ULBT
Dental
Neck ROM
39
The interincisor gap measurement refers to the
Distance between the upper & lower incisors when the mouth is open
40
An interincisor gap less than 3cm means
Difficult intubation
41
An interincisor gap greater than or equal to 6cm (3 finger-breadths) indicates
Good visualization
42
What is the 3-3-2 rule?
3 fingers between teeth
3 fingers from mandible to neck
2 fingers from hyoid to thyroid
43
The thyroidmental distance is measured from the
Thyroid notch to the lower border of the mentum at the tip of chin; identifies potential submandibular space
44
What is the Mandibular-Hyoid Distance (MHD)?
Used to evaluate the position of the larynx in relation to the base of the tongue
45
The MHD is measured from the
Junction of the mandible & neck to the tip of the thyroid notch
46
A MHD that is more than 2 finger breadths may indicate
A larynx that is too far down the neck
Difficult intubation
47
A MHD that is less than 2 finger breadths can indicate
A larynx that is tucked under the base of the tongue
Anterior position of the larynx
Challenging intubation
48
The Atlantooccipital joint mobility tests
Neck ROM
49
Pre-oxygenation is
Denitrogenation; filling lungs up with air
Allows for safe apneic time (up to 8 min)
take in good tidal volume for 3-5 min
50
What is the goal of fraction of expired O2?
Above 70%
51
What is the gold standard that ensures a good bag/mask ventilation?
Chest Rise
Fog
ETCO2
52
Where is the placement of a straight blade, like the MILLER?
Placed behind the epiglottis & gentle force is applied to lift it DIRECTLY
53
What is the placement when using a Miller blade?
Tip is placed in the VALLECULA & lifts the epiglottis indirectly
54
What is BURP glottic Manipulation?
Applying backward, upward, rightward pressure on the larynx to enhance vocal cord visualization
55
Most ETT are high_____ & low_____
High Volume
Low Pressure
56
When are cuffless ETTs often used?
Neonates & infants
57
Cuff pressure should be no more than
25cm H20
Should be monitored, especially when nitrous oxide (N2O) is used
58
ETT is sized based on
Internal diameter
59
The size of an ETT will affect
Airway resistance
WOB
Potential for Mucosal trauma
60
What is the typical ETT size for a male? Female?
Male: 7.0-7.5
Female: 6.5-7
61
The use of a smaller ETT will increase
Resistance
62
Larger ETT will risk
Trauma & sore throat
63
Armored tubes are used to
Prevent kinking (reinforced)
64
Sniffing helps align
LA, OA & PA
65
Cormack & Lehane grading system Grade 1?
Full view of glottic opening, including anterior commissure & posterior laryngeal cartilages
66
Cormack & Lehane grading system Grade 2a?
Partial view of the vocal cords (anterior commissure not seen) & full view of posterior laryngeal cartilages
67
Cormack & Lehane grading system Grade 2b?
Only posterior portion of the glottic opening can be seen (posterior laryngeal cartilages)
68
Cormack & Lehane grading system Grade 3?
Only epiglottis can be seen; No portion of the glottic opening can be seen
69
Cormack & Lehane grading system Grade 4?
Epiglottis cannot be seen; can only see soft palate
70
What can minimize bleeding during nasotracheal intubation?
Applying a vasoconstrictor like phenylephrine or oxymetazoline
71
Which way should the bevel of a nasal tube point?
facing away from the midline
72
When inserting a nasotracheal tube, traction should be applied
Cephalad (upper)
73
A difficult airway is one where a trained anesthetist struggles with
Facemask ventilation
Laryngoscopy
Intubation
74
For an awake intubation, you need
Sedation
Block
Topicalization
75
Benzocaine & Cetacaine are
Rapid & have a short duration
76
What is a serious complication associated with Benzocaine?
Methemoglobinemia
77
With a Glossopharyngeal block, where should the needle be placed?
0.25 to 0.5 cm where gutter meets the base of the palatoglossal arch
78
In a Glossopharyngeal block, what should happen before injection?
Aspirate!
Air?-needle is too deep
Blood?- reposition needle more medially to avoid carotid artery
79
How much anesthetic should be injected during a Glossopharyngeal block?
1-2mL of 2% lidocaine & repeat on opposite side
80
The placement of a Glossopharyngeal block targets
Lingual branches of the glossopharyngeal nerve, providing sensory anesthesia to the posterior third of the tongue, upper larynx & inner surface of the tympanic membrane
81
When placing a Superior Laryngeal block, what should be located & displaced?
Locate Hyoid bone & displace it toward injection side
82
With a Superior Laryngeal block, where should the needle be inserted & advanced?
Insert perpendicular of skin & advance to the inferior border of the greater cornu
Walk needle off the caudal edge of hyoid bone until it contacts thyrohyoid membrane (will feel a bounce)
83
When placing a Superior Laryngeal block, aspiration of blood may indicate
Intravascular placement
84
How much & where should the anesthetic be placed when placing a Superior Laryngeal block?
1mL of 2% lidocaine above the thyrohyoid membrane, then advance needle 2-3 mm through membrane & inject additional 2mL of lidocaine
85
The Superior Laryngeal block provides a
Dense block of the Supraglottic region by targeting the superior laryngeal nerve
86
When placing a transtracheal block, what should be located?
The cricoid membrane by palpating the cricothyroid membrane with index & middle to identify
87
How much anesthetic is needed with a transtracheal block?
3-5mL of 2% lidocaine
88
Where should the needle be placed with a Transtracheal block?
Midline through the cricothyroid membrane in a caudal direction with continuously aspirating
When you see bubbles, the tip is in the tracheal lumen
Patient may cough
89
What should happen with injection when performing a transtracheal block?
Ask patient to take a deep breath
Inspiration-inject into tracheal lumen (will cough & distribute anesthetic to VC)
90
The transtracheal block provides local anesthetic directly to the
Trachea & VC
91
Cricoid pressure is also known as
The Sellick maneuver
92
The cricoid pressure involves applying pressure
To cricoid cartilage to prevent aspiration during the induction of general anesthesia
Occludes esophagus the prevent aspiration (RSI)
93
How much force is applied with Cricoid Pressure?
10-20 Newtons before loss of consciousness & increase to 30-40 after loss of consciousness
94
What position should the patient be in when performing Cricoid pressure?
20 degree angle
95
What are the complications of Cricoid pressure?
Excessive force can cause discomfort & laryngeal injury
Vomiting
Cervical spine injury
Hinder visualization or intubation
96
What is the primary use of an LMA
Can replace bag-mask ventilation during general anesthesia & is used in many surgical procedures
97
An LMA can serve as a _________ for endotracheal intubation
Conduit
98
Second generation LMAs provide
Aspiration prevention
Reinforced tips
Improved Cuff design (allows for more pressures)
Increased rigidity
99
LMA cuff pressure should not exceed
60cm H2O
100
What are the complications of placing an LMA
Overinflation (opens esophageal sphincter or cricoarytenoid muscle fatigue)
No seal
Laryngospasm
Aspiration
101
The LMA ProSeal is the only LMA that can
Exceed 20mm water pressure for effective ventilation
102
When can a Bougie be used?
When The glottic opening is hard to see
103
How far should the Bougie be advanced?
Until the 25cm marking at the lip
104
What should happen is you meet resistance when placing ETT?
Rotate 90 degrees to the left
105
How is a person ventilated when using an airway exchange catheter
Jet ventilation; using jet insufflation with an airway exchange catheter may require muscle relaxation to prevent glottic closure
Oral airway can keep airway open
106
Flexible intubating scopes (FIS0 use a
camera at the distal end to transmit images to an external screen
107
How should a Glidescope be inserted?
Midline & into the vallecula
108
The anesthesia machine uses what system?
Semi-closed circle system
Recycles a portion of the patient's exhaled gas, presenting unique engineering challenges
109
The Maquet Volume Reflector uses a system that
Uses a pneumatic pressure system to deliver ventilation
110
What is the purpose & function of the Adjustable Pressure Limiting (APL) valve (pop off)
An adjustable relief valve used to manage the pressure within the anesthesia breathing circuit
vents Excess gas to the scavenging system & controls circuit pressure during spontaneous & manual ventilation modes
111
What are advantages of deep extubation?
Reduced risk of gagging, coughing, & discomfort
112
What are the disadvantages of deep exubation?
Respiratory depression
Delayed awakening
Difficult assessing airway reflexes
113
What are the advantages of an awake extubation?
Patient can protect airway & breathe spontaneously
Useful when there is a history of difficult intubation or high aspiration risks
114
What are the disadvantages of an awake extubation?
Increased CV stimulation & discomfort
Coughing & straining
115
What are complication of Extubation?
Airway Obstruction (swelling, bleeding)
Respiratory depression/failure
Laryngospasm
Aspiration
CV instability
116
What is a good extubation position for a patient at high risk for pulmonary aspiration?
Lateral Decubitus Position
117
What is the purpose of applying positive pressure immediately before cuff deflation
Expels secretions collected above the cuff
118
Upper airway obstruction after extubation can be due to
A weakened pharyngeal muscle, which can increase the risk of obstruction
119
Response to hypoxia
Can be diminished
120
What is a laryngospasm?
An involuntary reflex resulting in the contraction of laryngeal muscle, which can significantly affect airway management & patient safety
121
Laryngospasm can cause
Bradycardia
Pulmonary edema
Pulmonary Aspiration
Desaturation/Hypoxemia
122
What causes a laryngospasm?
Sensory stimulation of the vagus nerve (SLN is stimulated)
Muscle contraction (cricothyroid muscle tenses the VC- SLN while the thyroarytenoid & lateral cricothyroid muscle-RLN causes ADDUCTION of cords)
123
What can overcome a laryngospasm?
Avoid stimualtion
Provide Positive Pressure
Jaw Thrust/Chin left
Give Lidocaine or Muscle relaxant
124
What processes are involved with breathing
Neuropathways
Pressure Gradient
Chemoreceptors
Phrenic nerve
Need a pH balance
Kreb cycle
125
Activation of the sympathetic system is due to
Superior Cervical Ganglion
Will cause vasoconstriction
125
Activation of the parasympathetic system is caused by
CN 7 (facial) & pterygopalatine ganglion
Will cause vasodilation
126
Mallampati acronym is
PUSH
127
Roughly, how long does it take to wake up from propofol?
8 min
127
The larynx is also called the
Adams Apple
128
Which assessment tool gathers the most information?
The 3:3:2 interincisor Gap
129
What makes bag mask ventilation difficult?
Beard
Obstruction/Obese/Old/OSA
No teeth
130
Sequence of Induction?
Pre-oxygenate
Induction medication
Bag mask
NMB
DL/VL
131
What is FRC?
Functional Residual Capacity
132
What are the 3 distinct laryngoscopy procedures?
DL
VL
Tracheal intubation
133
The BURP technique helps enchance
Vocal cord visualization
134
Standard ETT are usually ______volume & _______pressure
High volume
Low Pressure
135
What size is the universal adapter?
15mm
136
Cuff pressure should be less than
25cmH2O
137
Roughly, how many cc of air can go in the ETT cuff?
8-12cc
138
What are the 3 benefits to an awake intubation?
Preserves Spontaneous Breathing
Improves Pharyngeal Anatomy
Increases Safety
139
What are the 4 advances when using a Second Generation LMA?
Aspiration Prevention
Reinforced Tip
Improved Cuff design
increased Rigidity
