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Airway management 2 Flashcards

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1
Q

Which congenital conditions are associated with cervical spine anomalies? Select 2
a. Treacher collins
b. Klippel-Feil
c. Goldenhar
d. Pierre Robin

A

B. Klippel-Feil
C. Goldenhar

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2
Q

____________ is the chief concern in the patient with angioedema

A

Upper airway obstruction

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3
Q

Three key causes of angioedema include

A

anaphylaxis, ACE inhibitors, and C1 esterase deficiency

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4
Q

Angioedema caused by anaphylaxis is best treated with

A

epinephrine, antihistamines, & steroids

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5
Q

Angioedema caused by ACE inhibitors or C1 esterase deficiency is best treated with

A

icatibant
ecallantide
FFP
C1 esterase concentrate

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6
Q

______________ is a bacterial infection characterized by a rapidly progressing cellulitis in the floor of the mouth

A

Ludwig’s angina

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7
Q

The most significant concern with Ludwig’s angina is

A

posterior displacement of the tongue resulting in complete, supraglottic airway obstruction

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8
Q

In the patient with Ludwig’s angina, the best methods of securing the airway include

A

awake nasal intubation or awake tracheostomy

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9
Q

Congenital conditions that impact airway management include:

A

Pierre Robin
Treacher Collins
Trisomy 21
Klippel-Feil
Goldenhar
Beckwidth
Cri du Chat

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10
Q

What is the cause of ACE-I angioedema?

A

ACE inhibitors prevent bradykinin breakdown

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11
Q

What is the treatment for hereditary angioedema?

A

C1 esterase concentrate
FFP
ecallantide
icatibant
patients should receive prophylaxis for porceudres that stimulate the upper airway

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12
Q

_________ is contraindicated in patients with an infection above the level of the trachea

A

Retrograde intubation

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13
Q

Which conditions are characterized by a large tongue?

A

“Big Tongue”
Beckwith syndrome
Trisomy 21

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14
Q

Which conditions are characterized by a small/underdeveloped mandible?

A

“Please get that chin”
Pierre Robin
Goldenhar
Treacher collins
Cri du Chat

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15
Q

Which conditions are characterized by a cervical spine anomaly?

A

Kids Try Gold
Klippel-Feil
Trisomy 21
Goldenhar

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16
Q

Pierre robin is characterized by

A

small/underdeveloped mandible (micrognathia or mandibular hypoplasia)
a tongue that falls back and downwards (glossoptosis)
cleft palate
neonate often requires intubation

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17
Q

Treacher Collins is characterized by

A

small mouth
small/underdeveloped mandible
nasal airway blocked by tissue (choanal atresia)
ocular and auricular anomalies

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18
Q

Trisomy 21 is characterized by

A

small mouth
large tongue
atlantoaxial instability
small subglottic diameter (subglottic stenosis)

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19
Q

Klippel-Feil is characterized by

A

congenital fusion of cervical vertebrae–> neck rigidity

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20
Q

Goldenhar is characterized by

A

small/underdeveloped mandible
cervical spine abnormality

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21
Q

Beckwith syndrome is characterized by

A

large tongue

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22
Q

Cri du chat is characterized by

Study These Flashcards
A

small/underdeveloped mandible
laryngomalacia
stridor

23
Q

What is the optimal position for tracheal intubation?
a. cervical flexion only
b. atlanto-occipital joint extension only
c. cervical flexion and atlanto-occipital joint extension
d. cervical extension and atlanto-occipital joint flexion

Study These Flashcards
A

c. cervical flexion & atlanto-occipital joint extension

24
Q

The “sniffing position” consists of

Study These Flashcards
A

cervical flexion and atlanto-occipital extension

25
The sniffing positions aligns the
oral, pharyngeal, and laryngeal axes
26
What positioned should be used for morbidly obese patients?
HELP position (head elevated laryngoscopy position) when patient lies supine, excess adipose on the neck, shoulders, and back place the chest higher than the head
27
For the morbidly obese patient, putting the bed in __________ unloads the diaphragm and may prolong the time between apnea and desaturation
reverse Trendelenburg
28
How does lateral rotation of the head affect the ETT?
ETT tip moves away from carina (risk of extubation)
29
How does the nose away from chest position affect the ETT?
ETT tip moves away from the carina (risk of extubation)
30
How does the nose to chest position affect the ETT?
ETT tip moves towards the carina (risk of endobronchial intubation)
31
Optimal position for laryngoscopy of the obese patient is achieved when the
sternum and the external auditory meatus are in the same horizontal plane
32
What are nerve injuries related to airway management?
aggressive jaw thrust face mask strap is too tight endotracheal tube connector resting on the patient's face
33
An aggressive jaw thrust can cause injury to the
facial nerve
34
Presentation of injury to the facial nerve as a result of an aggressive jaw thrust includes
the affected side of the face may sag, the patient may drool, and chewing will be affected
35
A face mask strap that is too tight can compress the
buccal branch of the facial nerve (CN7)
36
Nerve injury as a result of a too tight face mask can present as
the patient will have difficulty opening and closing lips (orbiculares oris muscle function is impaired)
37
An endotracheal tube connector resting on the patient's face may cause
damage to the supraorbital nerve
38
Presentation of damage to the supraorbital nerve appears as
eye pain, forehead numbness, photophobia
39
What axes are aligned when the head is lying flat on the bed and extended?
laryngeal & pharyngeal
40
Contraindications to the use of a nasopharyngeal airway include: (select 2) a. dental trauma b. coagulopathy c. Pierre robin syndrome d. Le Fort 2 fracture
b. coagulopathy d. Le Fort 2 fracture
41
An oro or nasopharyngeal airway is used to
relieve upper airway obstruction opens the airway by displacing the tongue and epiglottis from the posterior wall of the pharynx
42
How should you size an OPA?
measure from the corner of the mouth to the earlobe or the angle of the mandible
43
How should you size a NPA?
measure from the nare to the earlobe or the angle of the mandible
44
Placing an oral airway into a lightly anesthetized patient can precipitate
vomiting or laryngospasm
45
A __________ is usually better tolerated in a lightly anesthetized patient
nasal airway
46
Contraindications for a NPA include
cribriform plate injury (LeFort 2 & 3 fracture), coagulopathy, nasal fracture, previous Caldwell-Luc procedure, previous transphenoidal hypophysectomy
47
A cribiform plate injury presents as
LeFort 2 or 3 fracture, basilar skull fracture, CSF rhinorrhea, racoon eyes, periorbital edema
48
What complications may arise from use of an OPA?
dental injury vomiting oropharyngeal trauma ischemia (compresses blood flow to affected areas)
49
An OPA that is ___________ can obstruct the airway by causing the tongue to kink against the roof of the mouth
too short
50
An OPA that is _________ can obstruct the patient's airway by displacing the epiglottis towards the glottis, It can also cause trauma
too long a too long NPA can also do the same
51
What are the types of oropharyngeal airways?
Guedel Berman WIlliams Ovassapian
52
Specific uses for the Ovassapian OPA is
fiberoptic intubation
53
Specific uses for the Williams OPA include
blind orotracheal intubation fiberoptic intubation
54
What is the cribiform plate?
a boney structure that separates the nasal cavity from the anterior cranial fossa; injury to this structure can allow an NPA or nasal ETT to enter the brain

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