Airway Mgmt - Quiz 2, Part 3

Question 1

4 steps to a good outcome for pediatric airway mgmt

Answer 1

1. thorough airway H&P
2. a plan for supraglottic ventilation
3. a plan for intubation and extub
4. an alternative plan for emergency

Question 2

How many cartilages in the larynx?

Answer 2

9

Question 3

What do the extrinsic muscles of the larynx do?

Answer 3

move the larynx as a whole

Question 4

What do the intrinsic muscles of the larynx do?

Answer 4

Move various cartilages in relation to ea/o

Question 5

What are the 2 branches of each vagus nerve?

Answer 5

Superior Laryngeal Nerve (SLN)

Recurrent Laryngeal Nerve (RLN)

Question 6

What is the fx of the SLN?

Answer 6

1. sensory innervation above cords

2. external branch - innervates cricrothyroideus; responsible for pitch

Question 7

What is the fx of the RLN?

Answer 7

1. Sensory innervation below cords

2. Innervates all other laryngeal musc

Question 8

Damage to which branch of the vagus nerve results in monotone voice?

Answer 8

SLN

Question 9

Damage to which branch of the vagus nerve results in hoarse voice?

Answer 9

RLN

Question 10

Unilateral damage to the RLN causes:

Answer 10

1. Horase Voice
2. Compromise of airway protection
3. Airway function itself is not impaired

Question 11

Bilateral damage to the RLN causes:

Answer 11

compromised airway fx

Question 12

At what spinal level does the carina lie in adults?

Answer 12

T5

Question 13

What suspends the trachea from the cricoid cartilage?

Answer 13

Cricotracheal ligament. duh.

Question 14

Which bronchi is larger in diameter

Answer 14

the Right

Question 15

True or False: A child’s larynx though smaller than an adult’s, is proportionately the same size as an adult’s larynx.

Answer 15

False.

An infant/child’s larynx is proportionately smaller than an adult’s.

Question 16

Spinal level of a child’s larynx

Answer 16

C 3, 4, 5

FYI: adult is C 4, 5, 6

Question 17

A child’s vocal folds are at an [anterior or posterior?] angle with respect to perpendicular axis of the larynx in an infant/child

Answer 17

anterior

Question 18

“Warning Signs” of a difficult intubation

Answer 18

1. Chipped tooth during previous surgery

2. Significant or prolonged sore throat after previous intubation

Question 19

What palate shape may indicate a difficult peds airway?

Answer 19

1. High
2. Arched
3. Narrow

Question 20

Thyromental distance of _____ may indicate a difficult peds airway

Answer 20

<5 cm

Question 21

Three aspects of ideal preoxygenation in a pediatric pt

Answer 21

1. 5 min
 of
2. 100% O2 
with
3. tight fitting mask

Question 22

Does intrathoracic pressure increase or decrease with onset of apnea?

Answer 22

decreases

Question 23

Mainstay in anesthesia delivery and pt resuscitation

Answer 23

Supraglottic ventilation - anesthesia face mask

Question 24

maximum pressure that should be required to inflate the lungs during mask ventilation in a pt w normal lung compliance

Answer 24

no more than 20-25 cmH2O

Question 25

A properly sized oral airway should extend from _______ to ________

Answer 25

Teeth

Angle of mandible

Question 26

Which airway carries a greater risk of laryngospasm, oral or nasal?

Answer 26

Nasal

Question 27

Tx of laryngospasm

Answer 27

1. Remove offending stimulus
2. Provide CPAP
3. Deepen anesthesia
4. Rapid acting NMB (may use sub-intubating doses)

Question 28

True or false: In the case of laryngospasm, SCh may be injected directly into the base of the tongue above the hyoid bone.

Answer 28

true.

Question 29

Which type of laryngoscopy blade is better for a small mouth with little room to pass the tube? (Straight vs curved blade)

Answer 29

Curved

Question 30

Which type of laryngoscopy blade is better for a small mandibular space, large incisors, or a large epiglottis?

Answer 30

Straight blade

Question 31

When inserting an uncuffed tube, where should the double line be in relation to the cords?

Answer 31

Double line should be below the cords

Question 32

True or false. The relative large size of an infant/child’s occiput may obviate the need for sniffing position for laryngoscopy

Answer 32

True

although shoulders may need to be elevated instead

Question 33

Does a child have a higher or lower incidence of endobronchial intub and extub with head movement?

Answer 33

higher

Question 34

Hyperextension of _________ during laryngoscopy may cause airway obstruction

Answer 34

A-O joint

D/t pliable cartilage of trachea

Question 35

What reliably improves intubating conditions and greatly minimizes the potentially fatal complication of laryngospasm during intubation?

Answer 35

Muscle Relaxation