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Sim Lab 3 > ENT and Eye > Flashcards

ENT and Eye Flashcards

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1
Q

Basic part of the ear

3

A
  1. Inner
  2. Middle
  3. Outer
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2
Q

Basic Inner Ear anatomy

A

Cochlea
Cochlear nerve
Vestibular nerve
Eustachian tube

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3
Q

Basic Middle Ear anatomy

A

Semicircular canals
Eustachian tube
Stapes
Incus
Malleus
Tympanic membrane

SIM-> Proximal to distal

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4
Q

Basic Outer Ear anatomy

A

External acoustic meatus
Temperal bone

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5
Q

External ear surgeries

A

Reconstruction of ear or auditory canal

GA with LMA and local

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6
Q

Middle Ear procedures: OCR

A

Ossicular chain reconstruction (OCR) is a surgical method used to repair conductive hearing loss.

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7
Q

Middle Ear procedures: Myringotomy and Tube Insertion

Classic BMT

A

Helps drain middle ear because the eustachian tube isnt working

Facemask induction for shorter cases. LMA or ETT for longer ones

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8
Q

Middle Ear procedures: Cholesteatoma

A

Cholesteatoma is a skin-lined cyst that begins at the margin of the eardrum and invades the middle ear and mastoid

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9
Q

Middle Ear procedures: Stapedectomy

A

Stapedectomy is a surgical procedure to treat hearing loss caused by otosclerosis

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10
Q

Inner Ear Procedures: Neoplasm or chochlear implant

Meneirs Dx: common issues with Labyrinth/Semicurcular canals

A

Complex, GA with muscle relaxation
Increased PONV risk

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11
Q

A microscope is common in ear surgery. What things do we have an impact on while the doc is working under the scope?

A

Movement: Relaxation
Breathing: Spontaneous / Belly breathing

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12
Q

Ear surgery considerations

A

Avoid coughing
NO N2O
Increased PONV risk
Monitoring negates use of NMB’s

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13
Q

Basic Nasal Anatomy

A
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14
Q

Sinus Anatomy

A
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15
Q

4 types of nasal surgery

A
  1. External
  2. Nasal Cavity
  3. Nasal Sinus
  4. Nasal Bony Structures
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16
Q

LMA’s in Nasal surgery?

A

No, they get in the way. Use an ETT and tape it to the side

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17
Q

Nasal Surgery: Throat packs

A

Remove BEFORE wakeup
OG tubes sometimes used

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18
Q

Nasal Surgery: Nasal ETT or Nasal Airway

A

Do not use

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19
Q

Throat surgery: Pearls

A
  • Decadron for swelling, pain, PONV (0.05-0.15mg/kg)
  • Abx not indicated
  • NMB not indicated
  • NSAIDS (minus aspirin) are fine
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20
Q

Throat surgery: Complications

A
  • Post extubation laryngospasms
  • Bleeding Tonsils
  • Reintubation difficult (swelling and bleeding)
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21
Q

How can we decrease post extubation spasms?

LITIES

A
  • Lay on side, decrease secretions on vocal chords
  • IV Lido 1mg/kg
  • Topical Lido 4mg/kg
  • IV Magnesium (not really just in the book)
  • Ensure proper narc level
  • Small bolus of propofol
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22
Q

General info on bleeding tonsils

A

Venous in nature
bleeds more often in adult males (2-5%)
Usually in a 6 hour window
Blood loss is hard to measure since it is swallowed
Check H/H if low
Use smaller ETT if reintubating
OG Tube for blood in stomach

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23
Q

Vocal Cord surgeries

A

Pathology: Bx and resections
Injections: for RLN/Cord dysfunction (usually a filler)

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24
Q

Types of tubes: MLT

A

Micro Laryngeal Tube
Smaller in diameter, less in the way

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25
Types of tubes: Dual cuff laser
Yellow cuff: air Clear cuff: saline ## Footnote Sometimes add dye to saline to see if ruptured easier
26
Types of tubes: Armored
won't kink but can be compromised by compression
27
Types of tubes: Montandon
J shaped and inserted into a temp tracheostomy if larynx is to be removed.
28
Head and Neck considerations
* Usually for cancer resections * avoid jugular veins for central line * carotid sinus may be manipulated * risk for blood loss * neuromonitoring common * airway issues by manipulations, lesions, or radiation scarring * Remifent infusions are great for these
29
Tracheostomy steps ## Footnote 6
1. Dissection down to trachea 2. We advance ETT further to avoid puncture 3. Doc has us SLOWLY retract for visualization 4. Once our tube goes past they will introduce the trach device 5. Leave out tube just past the vocal cords for emergency 6. Disconnect circuit and pass to surgeon. Confirm EtCO2
30
Three parts to a trach tube
1. Outer cannula 2. Obturator 3. Inner cannula
31
*Cuffed* with **disposable** inner cannula
Used to obtain a closed circuit for ventilaiton
32
*Cuffed* with **resuable** inner cannula
Used to obtain a closed circuit for ventilaiton
33
*Cuffless* with **disposable** inner cannula
Used in pts with tracheal problems and pts ready for removal of trach tube
34
*Cuffless* with **resuable** inner canula
Used in pts with tracheal problems and pts ready for removal of trach tube
35
Fenestraded cuffed
Pts on the vent but are not able to tolerate a speaking valve
36
Fenestrated cuffless
Used for pts who have difficulty with a speaking valve
37
Which type of trach tube is in most patients?
Cuffless
38
Which type of trach tube is needed to PPV?
Cuffed, needed to make a seal
39
Why don't we replace a trach tube if it is still new?
Tissues inflammed and can create a flase passage May close before we can get a new one in
40
Info printed on trach tubes?
Manufacture (Shiley) Size (inner diamter i.e. 8) DCT: dual cannula tracheostomy I.D.: inner diameter (mm) O.D.: outer diameter (mm) Tube length: XLT Proximal or Distal
41
What the heck does an XLT Proximal indication on a trach tube mean?
Longer proximally because the pt has a thick neck
42
What the heck does an XLT Distal indication on a trach tube mean?
Longer distally to help bypass a stenotic trachea
43
OMFS?
Oral and Maxillofacial Surgery
44
OMFS surgeries
Cleft palate jaw deformity facial trauma oral cancer dental procedures
45
What is a LeFort fx?
facial fx, 3 types ## Footnote Don't need to know the 3 types
46
Cleft Palate / LeFort pearls
High risk for blood loss Usually young healthy pts: permisive hypotension Tons of Local used with high amounts of EPI Most often nasal RAE used Remi infusions good here
47
What does RAE stand for?
Ring Adair Elwyn
48
OMFS trauma
Usually a zygomatic arch or mandible fx
49
OMFS trauma management
Bleeding not always an issue massive exposure and plating nasal rae throat pack wired jaw
50
What do we make sure of before wiring the jaw shut?
Throat pack is removed and we have wire cutters ready to go
51
To Zanzibar By Motor Car ## Footnote Facial nerve branches
* Temporal * Zygomatic * Buccal * Mandibular * Cervical
52
Eye cranial nerves: CN 2
Optic Nerve neural signal from retina
53
Eye cranial nerves: CN 3
Oculomotor Nerve
54
Eye cranial nerves: CN 4
Trochlear Nerve
55
Eye cranial nerves: CN 5
Trigeminal touch and pain
56
Eye cranial nerves: CN 6
Abducens controls extrinsic eye muscles
57
IOP normal pressure?
10-20mmHg
58
Does blood flow increase or decrease with a reduction in IOP?
Increase
59
Oculocardiac Reflex
retraction on eye muscles causes profound bradycardia via the trigeminal to vagus route ## Footnote Medial Rectus muscle more profound, possible with injections
60
How do we overcome the oculocardiac reflex
Stop retracting 0.2mg Glyco
61
Acetazolamide
carbonic anhydrase inhbitor deceases IOP for glaucoma
62
Echothiphate
topical anticholinesterase treats glaucoma ## Footnote Chronic use will lead to prolonged succs effects
63
Pilocarpin and Acetylcholine
Cholinergic agonists constricts pupil ## Footnote Bradycardia and bronchospasm may occur with use
64
Timolol
BB for glaucoma Bronochospasm, bad for CHF and COPD
65
Cataract surgery
No blood loss, little pain, extreme anxiety as pt is awake HTN and T2D common in pt population Possible pulmonary issues when lying flat Coughing an issue OSA potential issue
66
Regonal Anesthesia for eye surgeries
Facial nerve block Retrobulbular block Posterior Peribublar Sub-Tenon block
67
Facial Nerve Blocks
van Lint O'Brien Nadbath-Rehman | prevents eye movement ## Footnote Just know these names
68
Retrobubular Blocks
Retrobubular hemorrhage may occur IOP can increase IV injection possible (small dose no worry for LAST) Intra-arterial injection possible (will cause transient seizure) | prevents movement and good analgesia
69
Posterior Peribubular Blocks
Modified retrobubular with lower hemorrhage risk two different injection sites longer onset potential for incomplete block of movement
70
Sub-Tenon Block
Sedation and topical anesthesia needed for this much longer onset but most profound
71
Sedation for blocks
Benzo's: Versed (low doses) or PO Alprazolam, Diazepam Fent: 12.5-50 mcg / Alfentanil: 50-100 mcg Prop: 30-50 mg
72
What needle is used for a retrobulbular block?
Atkinson Needle
73
Two types of anesthetic drops?
Tetracaine 0.5% Lidocaine 4%
74
Pros and Cons of LMA for eye surgery
Can get in the way of doc less secure more potential for spasms LMA spontaneous vent can cause rocking under the microscope **Spontaneous vent does not cause increase in IOP**
75
Pros and Cons of ETT for eye surgery
Can be bent out of the way for doc more secure airway protected against spasms PPV more stable under microscope **PPV can increase IOP**
76
N2O in eye surgery
Avoid completely
77
Two gases used for vitreous gas bubbles
Sulfur hexafluoride Perfluoropropane

Sim Lab 3 (6 decks)

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