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Flashcards in Respiratory Deck (40):
0

How do the blades work around the valeculla

Mac blade - slides into vallecula and will pull epiglottis forward.

Miller blade - actually picks up the epiglottis

1

Functions of the larynx

Phonation, respiration, airway protection

2

Where is the larynx located?

Cervical vertebrae 3-6

3

How do the vocal chords attach?

Angles of the thyroid (A) and the arytenoids (P)

4

Narrowest point of the airway in adult and child

Pediatric - cricoid cartilage
Adult - glottic opening

5

List the 9 cartilages of the larynx

2 arytenoid
2 cuneiform
2 corniculate
Thyroid
Cricoid
Epiglottis

6

Describe laryngeal intrinsic muscle innervation

Recurrent laryngeal nerve via CN X

Except for the cricothyroid muscle which is innervated by the external branch of the superior laryngeal nerve

7

Innervation of the tongue

Back 1/3 of tongue gets supply from CN IX (glossopharyngeal)

8

Innervation of the nasopharynx

CN V (trigeminal)

9

Muscles that open and close the glottis

Lateral cricoarytenoids - adduct
Arytenoids - adduct
Posterior cricoarytenoids - aBduct

10

Muscles that put tension on the vocal cords

Cricothyroid - elongates vocal cords
Vocalis - shortens vocal cords
Thyroarytenoid - shortens vocal cords

11

List extrinsic laryngeal muscles

Sternohyoid, omohyoid, thyrohyoid

The move the larynx as a whole

12

Level of the carina

5th cervical vertebrae.

13

Angles of trachea bifurcation

R side - 25 degrees
L side - 45 degrees

14

PMH to ask about pre-op

Radiation to head and neck
Burns to head or neck
C-spine problems
TMJ pain
RA
Abscess or tumors
Prior intubation or tracheotomy
Dysphasia or stridor
Snoring or OSA
Ankylosing spondylitis

15

Steps for mallampati evaluation

Sit upright
Neck neutral
Open mouth
Stick tongue out far
Don't say AH

16

What's a good thyromental distance

4 finger breadths or 6-6.5mm

17

what is the risk of using a head strap during intubation?

May cause facial nerve palsies with nerve compression

18

what does the sniffing position do?

aligns all all three axis: oral, pharyngeal, laryngeal

19

what is the goal of supplemental oxygen pre-intubation?

increased the FRC of Oxygen and decrease the nitrogen in FRC

20

during RSI, how can you pre-oxygenate?

4 vital capacity breaths in 30 seconds

21

How long should you give O2 in a normal pre-surgical intubation?

3-5 minutes of 100% O2 at >5L/min

22

what size tube can you place over an #4 LMA?

#6 OETT

23

what is a major complication of oral airways?

LARYNGOSPASM, bleeding, soft tissue damage

24

what are some contraindications to nasal airway insertion?

epistaxis, nasal trauma, basal skull fractures, anticoagulation, adenoid hypertrophy

25

How far down do you want your OETT to be?

4 cm above the carina, 2 cm below the vocal cords

about 23 cm in males and 21 cm in females

26

what are is the sensory innervation of the airway?

glossopharyngeal (back 1/3 of the tongue), recurrent laryngeal, internal branch of the superior laryngeal

27

What is the motor innervation of the airway?

external branch of the superior laryngeal nerve (above the cords), recurrent laryngeal nerve (below the cords)

28

what are some major complications of tracheal intubation?

trauma to airways, esophageal intubation, laryngospasm, sore throat, endobronchial intubation

29

what is the induction sequence for tracheal intubation?

pre-oxygenation, sniffing position, monitors, induction agent, test ventilation, paralytic drug, eyes taped, mask-bag ventilation until muscle movement stops, laryngoscopy, intubate, confirm ETT placement with bilateral breath sounds and ETCO2, ventilate with bag or machine, maintenance anesthetic, tape OETT

30

what is a major indication for an airway block?

an awake intubation and/or a suspected difficult airway

31

what are 2 major complications for airway blocks?

systemic toxicity and hematoma formation

32

what does a transtracheal block do?

blockes RLN

anesthesia below the vocal cords

through the cricothyroid membrane

33

What does a superior laryngeal block do?

blocks internal SLN and the supraglottic region

goes through the thyrohyoid membrane

34

What anatomical landmark are you looking for in a SLN block?

the cornu of the hyoid bone.

Then go 1/4 inch caudal and 1/4 inch medial

35

What spread transtracheal anesthesia?

coughing

36

what is one important feature of SLN blocks?

they need to be done bilaterally

37

When would you do a glossopharyngeal nerve block?

when local anesthetic on the back of the throat is not enough

38

what should you aspirate during a glossopharyngeal block?

nothing... if you get air, you're too deep
if you get blood, pull needle out and redirect medially

39

What is a common alternative to a glossopharyngeal block?

nebulized lidocaine