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Flashcards in Basic Airway /Advanced Airway Deck (103)
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1

Problems that can occur in association with difficult airway

Dental damage
pulmonary aspiration
airway trauma
unanticipated trach
anoxic brain injury
cardiopulmonary arrest

2

The upper and lower airway is divided where?

cricord cartilage

3

5 parts of upper airway

Nose
mouth
pharynx
hypopharynx
larynx

4

6 parts of lower airway

Trachea
Bronchi
Bronchioles
terminal brinchioles
respiratory bronchioles
alveoli

5

Function of the nose

warm and humidify air
primary source of filtration

6

Anatomy of the mouth/oral cavity

Hard palate
soft palate
tongue
Uvula
tonsils

7

What structure of the mouth is at high risk for obstruction

tongue

8

Parts of the pharynx

Nasopharynx
oropharynx
hypopharynx

9

What are S/S of SLN injury, both unilateral and bilateral

Unilateral- minimal ( no real signs)
Bilateral- hoarseness

10

What are S/S of RLN injury, both unilateral and bilateral (acute and chronic)

Unilateral- Hoarseness
Bilateral-
---Acute-stridor, resp distress
-- Chronic- Aphonia

11

3 paired cartilages that make up the larynx

-2 arytenoids
-2 corniculate
-2 cuneiform

12

Vallecula

Space between the epiglottis and base of the tongue

13

2 types of muscles in the larynx

Intrinsic
extrinsic

14

What do the intrinsic muscles of the larynx do

control of vocal cords
opening and closing of the glottis

15

What do the extrinsic muscles of the larynx do

-connect larnyx with the hyoid bone and other structure
-adjust position of trachea for phonation, breathing, and swollowing

16

How long is the adult trachea

10-20 cm

17

What is the only cartilage with a complete ring in the trachea

Cricord ring

18

What is pertinent to airway assessment (questions to ask or look up; not physical)

-prior sx or hx of intubation/trach
-pror hx of diff intubation
-Hx of OSA
-Hx of oral, pharyngeal, esophageal disease
-trauma, burns, chemicals, radiation exposure to neck

19

S/S that indicate a pt has an increased risk for aspiration

-Loss of airway reflex
-LOC
-full stomach
-obese, pregnant, hiatial hernia
-GERD
-Decrease GI motility (DM, Trauma)
-volume > 25 ml (ph < 2.5)

20

Mendelson Syndrome

chemical pneuminitis due to the parenchymal inflammatory reaction caused by a large volume of gastric contents in lungs from aspiration ( independent of infection)

21

Ways to decrease risk of aspiration

-NPO
-Block histamine release (H2 blockers)
-increase gastric PH (antacids)
-Increase GI motility (reglan)
-use caution with sedationa and opiods
-ETT vs LMA
-RSI vs awake FOI
-Awake vs deep extubation

22

Liter flow rates and Fi02 delivered
Nasal cannula
Simple face mask
Non-rebreather

NC- 1-6 LPM / 24-44%
SFM- 5-12 LPM / 30-85%
NRB- 10-15 LPM / 60-85%

23

4 techniques to manipulate head, neck, and jaw for airway patency

-chin lift
-head tilt and chin lift
-Jaw thrust
-Hyperextension of Neck (head tilt)

24

3 axis to align for maximal exposure with intubation

-Oral axis
-pharyngeal axis
-laryngeal axis

25

3 main types of LMAs

Classic
Proseal
Fast track

26

What is unique about the proseal LMA

-drain tube

27

What is unique about the fast track LMA

Allows you to place an OETT
has an epiglottis flap

28

Tracheal intubation is recommended when?

-compromised airway
-long procedures
-procedures of head/neck/chest/abd
-Need for positive pressure ventilation
-inability to maintain mask ventilation
-disease of the airway
-risk of aspiration

29

What are indications for Awake FOI

-anticipated difficult airway
-unstable neck fx
-Halo
-small / limited oral opening
-critical care settings

30

What airway structures are most vulnerable to injury during intubation

arytenoids
posterior half of vocal cords
posterior tracheal wall

31

What can occur up to 3 hours post extubation

Croup

32

LMA size compared to weight and max inflation (only adult sizes)

LMA size Weight MAX inflate
#3 30-50kg 20 ml
#4 50-70kg 30 ml
#5 70-100kg 40 ml
#6 >100kg 50 ml
* how to remember the max inflate for test- minus 1 and add 0 to the size. ex #3 -1=2 add 0 = 20 ml

33

What muscle acts as a barrier to regurgitation in conscious Pts.

cricopharyngeos muscle

34

Extubation criteria

-adequate TV and rate
-open eyes to commands no diplopia
-sustained protrusion and purposeful movements of the tongue
-effective swollow
-head lift >5 sec
-effective cough
-sustained titanic response to 50 hrz for 5 sec's
-TOF > 90 ratio with NO fade

35

Whats the difference in airway resistance between the nasopharynx and oropharynx

the resistance to airflow through the nasopharynx is twice that of the oropharynx and accounts for about 2/3rds of the total airway resistance

36

Disadvantages of oropharyngeal airways

-cut lips, tongue, oral mucose
-Can cause a gag reflex
-obstruction of glottis (if to large)
-Push tongue posterior and cause obstruction (if too small)

37

Advantages of oropharyngeal airways

-air can pass around or through
-keeps teeth/lips open

38

Advantages of nasopharyngeal airways

-better tolerated in light planes
-prefered with pts with limited mouth openings or dental caries

39

Disadvantages of nasopharyngeal airway

nose bleeds
-contraindicated with coagupathies and basilar skull fx

40

LMA contraindications

-pharyngeal pathology
-pharyngeal obstruction
-full stomach
-decreased pulmonary compliance (RAD), that requires > 30 cmH20 pressure

41

What LMA is designed for anticipated difficult airways situations and CPR, b/c it can facilitate continuous ventilation during intubation

Fast track

42

Which LMA is a reusable airway that has a cuff made of softer material than the classic, it is designed to conform to the hypopharynyx, although it can be used with spont breathing pts, it is designed for PPV with or without muscle relaxants

proseal

43

How do you confirm appropriate tracheal intubation

MOST RELIABLE - end tidal CO2
PCO2 > 30 mmhg for 3-5 breaths

44

S/S ETT not olaced correctly

-no rise in CO2
-decrease O2 sat
-Unilateral breath sounds
-inability to palpate ETT cuff @ sternal notch
-Increased Peak Pressures
-Tachycardia

45

Afferent is _____ and carries nerve impulses _____?

Sensory
carries impulses to the CNS

46

Efferent is _____ and carries nerve impulses ________?

Motor
carries impulses away from CNS to periphery

47

Mallampatti I

Hard palate
Soft palate
tonsillar fauces
tonsilar pillars
uvula

48

Mallampatti II

Hard palate
Soft palate
tonsilar fauces
uvula

49

Mallampatti III

Hard palate
Soft palate
base of uvula

50

Mallampatti IV

Hard palate

51

Cormack and Lehane Gade I

Entire laryngeal aperature

52

Cormack and Lehane Gade II

posterior portion of laryngeal aperature only

53

Cormack and Lehane Gade III

epiglottis only

54

Cormack and Lehane Gade IV

soft palate only

55

Unilateral RLN injury causes what

hoarsness

56

NPO fasting guidelines

clear liquids -2hours
Breast milk- 4 hours
everything else @ least 6 hours

57

The antacid sodium citrate (bicitra) has what disadvantage

increased gastric volume

58

ASA Scores

I- Normal healthy adult
II- Pt with mild systemic disease
III- pt with severe systemic disease
IV- pt with severe systemic disease THAT IS A CONSTANT THREAT TO LIFE
V- morbid pt who is not suspected to live without Sx
VI- brain dead/ organ donor

59

Four Ds that make a difficult airway

dentation
distortion
disproportion
dysmobility

60

what mallampatti scores are good

I-II

61

3 single cartilages that make up the larynx

thyroid
cricoid
epiglottis

62

What does the external SLN innervate

motor fxn to cricothyroid muscle of larynx

63

What 2 things does the RLN innervate

-sensory innervation to the subglottic area and trachea
-motor to all muscles of larynyx EXCEPT cricothyroid

64

The SLN divides into what?

Internal and external SLN

65

What does the internal SLN innervate

sensory input above the cords

66

The vagus nerve branches into what in the pharynx

Superior laryngeal nerve (SLN)
Recurrent Laryngeal Nerve (RLN)

67

The MOTOR response of the pharynx that Results in a gag is what nerve

CN X- (Vagus nerve)

68

SENSORY response elicited when the posterior wall of pharynx is touched and stimulated are carried to the brain by what nerve

Glossopharyngeal (CN IX)

69

Difficult intubation is defined as what

3 or more attempts
more than 10 minutes

70

Difficult mask ventilation is defined as what

inability to maintain SPO2 > 90% or signs of inadequate ventilation

71

The nasopharynx is separated from the oropharynx by what

soft palate

72

The oropharynx is separated from the hypopharynx by what

epiglottis

73

The trachea begins and ends where

C6-T5 (the carina)

74

How many horseshoe shaped cartilages make up the trachea

16-20

75

What supplies the infraglottic region and comes off of the inferior thyroid artery

Inferior laryngeal artery

76

What supplies the supraglottic region of the larynx, comes from the superior thyroid artery

superior laryngeal artery

77

What part of the oral cavity remains stationary

hard palate

78

What part of the mouth covers the posterior 3rd to half of the oral cavity, rises during eating to prevent passage of contents into the nasal passage way

soft palate

79

What part of the mouth guards the passageway from the oral cavity to the oropharynx

uvula

80

What structure of the mouth is walnut shaped and sits on both sides of the posterior opening of the oral cavity

tonsils

81

Function of the larynx

-protect airway from aspiration
-provide airflow b/t hypopharynx and trachea
-cough and gag reflex
-phanation

82

5 intrinsic muscles of the larynx

posterior cricoarytenoid
lateral crioarytenoid
arytenoids
cricothyroid
thyroarytenoid

83

Common physical assessments for airway

interincisor gap
thyromental distance
head and neck extension
mallampatti
body weight

84

what is the best/ideal way to determine a difficult airway

there isn't one dummy!!!

85

Signs that may indicate a pt will be a difficult mask ventilation

elderly
endentulous
obese
snores/ OSA
bearded (RTFF)
stridor

86

Difficult airway adjuncts

blades
fiberopticscope
lightwand
bullard scope
LMA
stylet
retrograde intubation
bougie
TTJV
combitube

87

What do the intrinsic muscles of the larynx do

control the tension of the vocal cords and the opening and closing of the glottis

88

What is the ideal BVM positioning

aligning the external auditory meatus with the sternal notch

89

How do you break a laryngospasm

-positive pressure
-anesthestic gasses
-10-20 mg sux's
-lidocaine
-push on trigger point in sternocleido muscle

90

If not treated with positive pressure the laryngospasm can cause what

negative pressure pulmonary edema

91

Why would you never wake a pt is stage II anesthesia

will cause laryngospams

92

Per the literature what adjunctive tool is most superior for difficult airways

Awake-FOI

93

Per real life what adjunctive tool is most superior for difficult airways

the one you are most comfortable using

94

How do you prepare for a nasal intubation

-prep with astringent (afrin or neosynephrin)
-dialate nares with progressive lubricated nasal trumpets
-Introduce and advance the ETT

95

Steps for an Awake-FOI

-discuss steps with pt
-local anesthetic
-antisialogoue
-monitors, 02, sedation
-semi-fowlers or supine
-insert ETT
-advance Fiberoptic
-identify anatomy
-advance through cords
-go till you see the carina
-advance ETT over fiberoptic
-withdraw fiberoptic
-conform with ETCO2
- IV or inhalation induction

96

What is important about sedation during an awake-FOI

sedation should not obtund the protective reflexes of pt

97

Sedation choices for awake-FOI

midazolem
fentanyl
dexmetomodine

98

How should you extubate the difficult to intubate pt

awake and responsive
good grip/ head lift sustained
adequate reversal
NIF > 20mmhg (neg inspiratory force)
VC> 15 ml/kg (vital capacity)

99

Can't ventilate + can't intubate = what

sugical airway

100

What must you remember about TTJV

-MUST USE INTERMEDIATE PRESSURE 02 SUPPLY
-allow time for expiration (1:4)
-risk of barotrauma
-buys the anesthesia team time before surgical airway

101

Why do we use RSI

for pt'swho are at increased risk for aspiration requireing minimal time with an unrotected airway

102

Steps for RSI

-aspiration prophylaxis
-airway eqipment - suction
-optimize intubation conditions
-denitrogenate
-STP + Sux IV push
-proper cricord pressure
-no bag ventilation
- intubate
-on emergence- awake extubation

103

What 3 intrinsic muscles are responsible for laryngospasms

lateral cricoarytnoid
cricothyroid
thyroarytnoid

remember CAT