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Anesthesia Concepts > Airway Intro > Flashcards

Airway Intro Flashcards

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1
Q

Nasal passages include 3

A

Septum, turbinates, adenoids

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2
Q

Nasal passages function: 4

A

2/3 of upper airway resistance, humidify, filter, warm

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3
Q

Nasal passage innervation

A

Branches of CN V trigeminal

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4
Q

Oral cavity include 4

A

Teeth, tongue, hard palate, soft palate

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5
Q

What is predominate cause of airway resistance in oral cavity

A

Tongue

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6
Q

Oral cavity innervation

A

Trigeminal nerve: hard palate, soft palate, ant 2/3 of tongue
Glossopharyneal: posterior 1/3 tongue, soft palate, oropharynx

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7
Q

What connects nasal and oral cavities to larynx and esophagus

A

Pharynx

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8
Q

Pharynx divided into: ____, border of soft palate. ___ border is epiglottis, includes tonsils and uvula. Also ___/___

A

Nasopharynx
Oropharynx
Hypopharynx/laryngopharynx

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9
Q

Innervation of pharynx

A

CN 9 and 10

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10
Q

Larynx
Located where in adult
Functions 3

A

C4-C6

Airway protection, respiration, phonation

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11
Q

Larynx composed of ___ ___ and ___ __ which is fissure between

A

Vocal cords and glottic opening

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12
Q

Vocal cords: formed by ___ ligament, attached anteriorly to ___ cartilage and posteriorly to ___ cartilages

A

Thyroartyenoid
Thyroid
Artyenoid

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13
Q

What is the triangular fissure between vocal cords

A

Glottic opening

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14
Q

What is narrowest part of adult airway

A

Glottic opening

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15
Q

Paired cartilages larynx

A

Arytenoid, corniculate, cuneiform

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16
Q

Unpaired cartilage in larynx

A

Thyroid, cricoid, epiglottis

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17
Q

Arytenoid: ___ attachment for vocal cords. Falsely identified in an __ __

A

Posterior, anterior airway

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18
Q

Corniculate: ___ portion of the ___ fold

A

Posterior, aryepiglottic

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19
Q

Cuneiform: in the ___ fold but not always ___. Lateral to ___

A

Aryepiglottic, present

Corniculates

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20
Q

Which cartilage is large, most prominent, and anterior attachment for vocal cords

A

Thyroid

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21
Q

Epiglottis: covers opening to ___ during swallowing

A

Larynx

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22
Q

Only complete signet shaped ring, narrowest part of peds airway

A

Cricoid cartilage

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23
Q

Which muscles control length and tension of vocal cords, and size of glottic opening

A

Intrinsic laryngeal muscles

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24
Q

Cricothyroid muscle innervated by the ___ branch of the __ __ nerve and a branch of the __ nerve

A

External
Superior laryngeal
Vagus

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25
All intrinsic laryngeal muscles except for ___ innervated by __ __ nerve, branch of __ nerve
Cricothyroid Recurrent laryngeal Vagus
26
Which muscles adduct vocal cords
Lateral cricoarytenoid, oblique and transverse arytenoids
27
Which is only vocal cord abductor
Posterior cricoarytenoid
28
Cricothyroid action
Tenses and elongates vocal cords
29
Thyroarytenoid action
Relaxes and shortens vocal cords
30
Vocalis action
Relaxes and shortens vocal cords
31
Action of extrinsic laryngeal muscles
As a whole move larynx cephalad or caudad
32
Suprahyoid group 4 Action
Stylohyoid, mylohyoid, geniohyoid, digastric Raises larynx cephalad
33
Infrahyoid group 4 Action
Sternothyroid, sternohyoid, thyrohyoid, omohyoid | Moves larynx caudad
34
Functions of branches of trigemincal nerve Ophthalmic Maxillary Mandibular
Sensory to nares and anterior nasal septum Sensory to turbinates and posterior nasal septum Sensory to ant 2/3 tongue, motor to mastication muscles
35
Glossopharyngeal nerve | Sensory and motor to what
Sensory to soft palate, oropharynx, post 1/3 tongue, tonsils, vallecula, topside of epiglottis Motor to stylopharyngeus
36
Vagus nerve Superior laryngeal nerve External branch innervates what Internal branch innervates what
Motor to cricothyroid, sensory to ant subglottic mucosa Sensory of posterior epiglottis to VC, thyroepiglottic joint, and cricothyroid joint
37
Vagus nerve Recurrent laryngeal nerve Innervates what
Motor to all intrinsic laryngeal muscles except cricothyroid Sensory below VC, trachea
38
Injury to external branch of superior laryngeal nerve: Action through what leads to what
Tensing vocal cords through cricothyroid Thyroidectomy Hoarseness
39
Injury to recurrent laryngeal nerve Controls what About chronic unilateral injury
All other intrinsic muscles like posterior cricoarytenoids | Generally well tolerated
40
Injury to recurrent laryngeal nerve | Acute bilateral injury leads to what
Bilateral paralysis of VC abductors (post cricoarytenoids), unopposed tensing of cricothyroid, strider and respiratory distress
41
Recurrent laryngeal nerve | Unilateral injury leads to what
Paralysis of ipsilateral vocal cord abductors, no airway emergency
42
Parts of lower airway
Trachea, carina, bronchi, bronchioles, terminal bronchioles, respiratory bronchioles, alveoli
43
Trachea __-__ __ length ___ __ diameter in adult
10-20 | 22
44
Trachea How many u shaped cartilages Posterior side lacks what Bifurcated where
16-20 Cartilage T4
45
Right bronchi is __ __ long with angle of __ | Left bronchi is __ __ long with angle of __
2.5 cm, 25 degrees | 5 cm, 45 degrees
46
What creates a difficult airway
Not 1 factor, combination of factors
47
Questions to consider when evaluating airway 9
``` Radiation or burn to head or neck C spine pain of LROM TMJ pain Rheumatoid arthritis Ankylosing spondylitis Abscess or tumor Prior intubation or trach Snoring or sleep apnea Dysphagia or stridor ```
48
Mallampati score Correlates __ space with ease of direct laryngoscopes and intubation How to test
Oropharyngeal | Have pt sit up with neutral head and open mouth, stick tongue out, no aah
49
Mallampati Class I Class II
Faucial pillars, entire uvula, soft and hard palates Uvula tip masked by tongue, soft and hard palates
50
Mallampati III IV
Soft and hard palates, uvula base only | Hard palate only
51
Score of laryngoscopic view of the glottis
Cormack and Lehane
52
Cormack and lehane score Grade I Grade II
I- most of glottis visible | II- only posterior portion of glottis visible
53
Cormack and lehane score Grade III Grade IV
III- only epiglottis visible | IV- no airway structures visualized
54
Thyromental distance Distance from what to what with neck fully extended Normal: Difficult intubation if what
Lower border of mandible to thyroid notch 6-6.5 cm, 4 fingerbreadths <3 fingers, receding mandible, anterior airway
55
What you need to prepare for induction
``` Monitors on, appropriate settings Suction on and at HOB Machine checked, means of PPV Airway IV Drugs- emergency and case specific ```
56
Airway set up | What you need on top of msmaids
Appropriate sized face mask, tongue depressor, oral and nasal airways, laryngoscope handle, 2 different blades, 2 size ETTs, stylet, syringe, LMA, tape
57
3 things that can make a mask hard to fit
Beard, edentulous (no teeth), short mandible
58
Goal of pre oxygenation
To increase O2 in functional residual capacity by washing out nitrogen (79% in RA) with oxygen
59
FRC is what
Volume of air left in lung at end of passive expiration
60
Doing what will lead to 10 minutes of safe apnea time
3-5 min of tight mask fit during normal tidal breathing with 100% fio2 at >6LPM flow
61
What leads to 5 minutes of safe apnea time
4 vital capacity breaths within 30 seconds w 100% fio2 at > 6LPM
62
Common problem in induction is airway obstruction by tongue and epiglottis due to relaxation of what
Genioglossus muscle
63
Two types of oral airways
Berman BOA | Guedel
64
Adult sizes of BOA and Guedel. Small, medium, large
S- 80 mm BOA, guedel 3 Med- 90 mm BOA, guedel 4 L- 100 mm BOA, guedel 5
65
Measure oral airway how
Center of mouth to angle of the jaw | Or from corner of the mouth to the earlobe
66
Complications of oral airways 3
Laryngospasm (if not asleep before placement) Bleeding Soft tissue damage
67
Nasal airway Provides passage of nose to what 3 __ sizes: Length estimates distance from nares to what
Pharynx French 24, 26... 36 Meatus of eat
68
Nasal airway Important for what How to use, how its tolerated compared to oral
Used in series small to large, dilate prior if elective Lubricate Better
69
Nasal airway complications | If on anticoagulants
Epistaxis Nasal or basal skull fractures Adenoid hypertrophy Dont use
70
Mac (__-__) | Miller (__-__)
1-4 | 0-4
71
ETT Size for female Size for male Want what available
6.5-7 mm id 7.5-8 mm id 2 sizes
72
Ideal position ett Males approx ___ cm, females __ How to calculate depth
23, 21 | ID x 3
73
Optimal intubating position | Aligns what
Sniffing | Oral, pharyngeal, laryngeal axis
74
Sniffing position allows for what 2
Optimal visualization of vocal cords and most effective mask ventilation
75
How to get sniffing position normal adult
Pillow and tilt head back
76
How to get sniffing position if obese
Ramp up, bring chest cavity up by using pillows or blankets
77
LMA ___ airway device Used for __ and __ ___ management Can be used as conduit for what
Supra glottic Routine and difficult airway Ett placement
78
Appropriate sized lma based on what
Weight
79
``` Adult size lma 30-50 kg 50-70 kg 70-100 kg >100 kg ```
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Anesthesia Concepts (12 decks)

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