Airway (Exam II) Flashcards
(96 cards)
1
Q
How many turbinates are there?
What is another name for turbinates?
A
Three (also known as meatus)
- Inferior
- Middle
- Superior
2
Q
Which turbinate does the endotracheal tube pass through during a nasal intubation?
A
Inferior turbinate
3
Q
What is necessary for bleeding reduction during nasal intubation?
A
Vasoconstrictors (ex. oxymetazoline-afrin, neosynephrine)
4
Q
What area is considered the pharynx?
A
Base of skull to lower border of cricoid cartilage.
5
Q
What area is indicated by 1 on the figure below?
A
Nasopharynx
6
Q
What area is indicated by 2 on the figure below?
A
Oropharynx
7
Q
What area is indicated by 3 on the figure below?
A
Hypopharynx
8
Q
What structure divides the oropharynx and the hypopharynx?
A
Epiglottis
9
Q
Loss of pharyngeal muscle tone results in _________ _________.
A
Airway obstruction
10
Q
Fill in the structures that compose the picture of the larynx below.
A
11
Q
What structure is indicated by 1 on the figure below?
A
- Median glossoepiglottic fold
12
Q
What structure is indicated by 2 on the figure below?
A
- Lateral glossoepiglottic fold
13
Q
What structure is indicated by 3 on the figure below?
A
Aryepiglottic fold
14
Q
What structure is indicated by 4 on the figure below?
A
- Ventricular fold
15
Q
What structure is indicated by 5 on the figure below?
A
- Vocal fold
16
Q
What structure is indicated by 6 on the figure below?
A
- Trachea
17
Q
What structure is indicated by 7 on the figure below?
A
- Corniculate Cartilage
18
Q
What structure is indicated by 8 on the figure below?
A
- Cuneiform Cartilage
19
Q
What structure is indicated by 9 on the figure below?
A
Piriform Recess
20
Q
What structure is indicated by 10 on the figure below?
A
- Tubercle of Epiglottis
21
Q
What structure is indicated by 11 on the figure below?
A
- Epiglottis
22
Q
What structure is indicated by 12 on the figure below?
A
- Vallecula
23
Q
What vertebrae corresponds with the very bottom of the larynx?
A
6th vertebrae
24
Q
What is the purpose of the larynx?
A
- Inlet to trachea
- Phonation
- Airway protection
25
Which laryngeal cartilages are unpaired?
- Thyroid (largest, supports soft tissue)
- Cricoid
- Epiglottis
26
Which laryngeal cartilages are paired?
- Arytenoid
- Corniculate
- Cuneiform
27
What do the vocal cords attach to?
- Arytenoid muscles & cartilage
- Thyroid at thyroid notch
28
How far does the trachea span?
What supports it anteriorly and posteriorly?
- From the inferior cricoid membrane to the carina (10 - 15 cm).
- Posterior: longitudinal trachealis muscle
- Anterior: Tracheal rings (c-shaped, bougie intubation)
29
Is airway history or assessment more valuable?
Airway history
30
What portions of patient history can be a cause for airway concern? Which is most important?
- **Past difficult airway**
- Report of sore throat
- Report of cut lip or broken tooth
- Recent hoarseness
- Hx of OSA
31
What is a better indication of airway difficulty than BMI?
Thick neck greater than 43cm
32
What factors that are assessed visually would give one concern for a potentially difficult airway?
- Facial deformities
- Head & neck cancers
- Burns
- Goiter
- Short/Thick neck
- Receding mandible
- Large beard
- C-collar
33
What inter-incisor distance is best?
> 6cm (3 finger breadths)
34
What is the sniffing position?
Why does it make intubation easier?
- Cervical flexion and antlanto-occipital extension
- Aligns oral, pharyngeal, and laryngeal axes.
35
What technique is depicted below?
Why is it used?
Ramping: used for positioning larger patients.
| Ear to sternal notch
36
What is the sternomental distance?
What is an indicator of a potentially difficult airway?
- Distance between sternal notch and chin with head fully extended and mouth closed.
- Less than < 12.5 cm
37
What is thyromental distance measuring?
What would be preferred?
- Submandibular compliance (tip of chin to thyroid notch)
- > 6.5cm preferred
38
How is prognathic ability measured?
Upper lip bite test (assesses how much lower incisors can extend beyond upper incisors)
39
What structures should be visible in a Mallampati class I?
- Fauces
- Tonsillar pillars
- Entire uvula
- Soft palate
| comparing tongue to oropharyngeal space
40
What should be visible in a Mallampati class II?
- Fauces
- Portion of uvula
- Soft palate
41
What should be visible in a Mallampati class III?
- Base of uvula
- Soft palate
42
What should be visible in a Mallampati class IV?
Only the hard palate
43
What is BURP?
Backward, Upward, and Rightward Pressure on larynx to facilitate intubation
44
What is Optimal External Laryngeal Manipulation (OELM) ?
Moving someone else's hand over external neck until a proper view is seen
45
What Cormack-Lehane view is depicted below? What is visible with this view?
- CL - 1
- Entire glottis is visible
46
What Cormack-Lehane view is depicted below? What is visible with this view?
- CL - 2
- Posterior of glottis is visible
47
What Cormack-Lehane view is depicted below? What is visible with this view?
- CL - 3
- Only the epiglottis is visible
48
What Cormack-Lehane view is depicted below? What is visible with this view?
- CL - 4
- Epiglottis can't be visualized.
49
What forms the medial wall of each nasal passage (fossae)?
Nasal Septum
50
What forms the hard palate of the mouth?
Part of maxilla and palantine bone
| 2/3 of anterior roof of mouth
51
What's one manuevar you can do to prevent pharyngeal muscle airway collapse?
Chin lift with mouth closure
52
What area is considered the larynx?
Epiglottis to lower end of cricoid cartilage
| inlet to trachea
53
How do you assess mandibular prognathism?
Have pt slide mandible anteriorly
54
What is edentulousness?
Having no teeth
| Difficult mask ventilation
55
What teeth are most likely to get injured?
Anterior maxillary center and lateral incisors
56
Why are teeth more frequently knocked out on the left?
The blade
57
Position for laryngoscopy
ear to sternal notch
| suction ready
58
Class I
59
Class II
60
Class III
61
Class IV
62
What is Cromack-Lehane classification?
Classification of laryngeal view
63
Criterial associated w/difficult mask ventilation
O: Obesity
B: Beard
E: Edentulous
S: Snorer, OSA
E: Elderly, male
& Mallampati 3/4
64
What does BOOTS stand for?
B: Beard
O: Obesity
O: Older
T: Toothless
S: Sounds - snoring, stridor
Indicators of difficult airway
65
What does LEMONS stand for?
L: Look (abnormal face, trauma, unusual anatomy)
E: Evaluate 3-3-2 rule
M: Mallampati score
O: Obstruction/Obesity
N: Neck mobility
66
All criteria associated with difficult airway
Large upper incisiors
Strong overbite
Inability to protrude mandible
Small inter-incisor distance (<6 cm)
Mallampati 3/4
Large tongue
Narrow or high-arched palate
Short thyromental distance (<6.5 cm)
Excessive mandibular soft tissue
Short, thick neck
Decreased cervical range of motionap
67
How is adequate mask ventilation assessed?
CO2
68
What are 5 things you will consider when deciding on awake intubation or intubation after induction?
- Suspected difficult laryngoscopy
- Suspected difficult ventilation
- Significant increased risk of aspiration
- Increased risk of desaturation
- Suspected difficult emergency invasive airway
| If yes to any of the above = awake intubation
69
If you fail at an attempted awake intubation what do you do?
Consider other options
70
If you fail an attempted awake intubation and fail at "other options" what do you do?
Postpone case
71
What is your first step after failed intubation attempt following induction?
Consider calling for help
Limit attempts
72
After failed intubation following induction you are not able to adequately mask ventilate, what do you do now?
Consider supraglottic airway
73
What is one thing you do with both awake and induced intubation?
Optomize oxygenation throughout
74
You have induced, failed to intubate, failed to bag, but successfully placed a supraglottic airway. Now what do you do?
Limit attempts, consider waking patient and consider other options
| Non-emergent pathway
75
You induced, failed to intubate, failed to bag, failed to place a supraglottic airway... now what do you do?
- Call for help
- Limit attempts & beware of time
- Consider invasive access
| Emergency pathway because you suck at anesthesia
76
3 B's of dynamic airways
Bullets
Bites
Burns
77
# RSI or Awake
Known easy airway
Normal anatomy
RSI
78
# RSI or Awake
Upper GI bleed
RSI
79
# RSI or Awake
Bowel obstruction
RSI
| aspiration
80
# RSI or Awake
Stable GI bleed requiring endo and slow progressive neuromuscular weakness requiring transfer
Awake
81
# RSI or Awake
Flixed flexion deformity of the neck, cannot open mouth
Awake
82
If you fail to intubate what should you do?
Change something, don't try again without adjusting
83
Where is the black line on the bougie?
25 cm
84
Which patients can't you use SUX on?
Rhabdo
Hyperkalemia
ALS, MS
Stroke/spinal injury > 72hrs old
Burns > 72hrs old
Tetanus, botulism, severe infection
Immobilization
MH
Bradycardia
Fasciculation
Masseter spasm
85
Contraindications to ROC
- Allergy
- Longer DOA
- Suggamadex not avalible
86
DOA SUX
5-10 min
87
DOA ROC
30-90 min
88
Intubation is not a cause of death but what physiologic killers surounding intubation are?
Hypotension
Hypoxia
Metabolic acidosis
| Resuscitate before you intubate!
89
Induction agent of choice in shock patients & dose
Ketamine
1-2 mg/kg
reduce to 0.5 mg/kg in shock pts
90
Paralytic agent of choice in shock patients & dose
ROC
1.6 mg/kg
| longer safe apnea time
91
Push dose pressor of choice
Epinephrine
| Alpha & Beta
92
Intervention 1 (hypoxia)
NC 15 LPM
BVM 15 LPM
PEEP 5-15 cmH2O
93
Intervention 2 (hypoxia)
- DSI (delayed sequence intubation)
- procedural sedation for preoxygenation
ketamine 1mg/kg -> preoxygenate -> paralyze -> apneic oxygenation -> intubate
94
Intervention 3 (hypoxia)
BUHE (back up head elevated) intubation
95
Intervention 1 (acidosis)
Bicarb
| make sure you're ventilating well
96
Intervention 2 (acidosis)
VAPOX - ventilator assisted pre-oxygenation
