Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
130 Cards in this Set
- Front
- Back
|
What are the components of the Upper Airway
|
-Nose
-Mouth -Pharynx -Hypopharynx -Larynx |
|
|
What are the components of the Lower Airway
|
-Trachea
-Bronchi -Bronchioles -Terminal Bronchioles -Respiratory Bronchioles -Alveoli |
|
|
Which arteries supply the nose with blood
|
-Maxillary
-Opthalmic -Facial |
|
|
Which nerves supply the nasal mucosa?
|
-Opthalmic
-Maxillary |
|
|
The opthalmic and maxillary nerves are branches of what nerve?
|
Trigeminal
|
|
|
Parasympathetic innervation to the nose is from where?
|
7th Cranial nerve (Facial)
|
|
|
Sympathetic innervation to the nose is from where?
|
Superior cervical ganglia
|
|
|
When the nose is stimulated sypathetically what can happen?
|
vasoconstriction, shrinkage of the nasal tissue (opens airway for passage of O2)
|
|
|
When the nose is stimulated parasympathetically what happens?
|
engorgement of nasal tissue
|
|
|
What is the mouth separated from the nose by?
|
Hard and soft palates
|
|
|
Which palate raises during eating to prevent food and liquid from going into the nose-causing aspiration
|
soft
|
|
|
which organ is involved in tasting and ingestion
|
tongue
|
|
|
what gaurds the passage from the oral cavity into the oropharynx?
|
uvula (helps to simulate gag reflex)
|
|
|
What three things make up the pharynx?
|
-oropharynx
-nasopharynx -hypopharynx |
|
|
where is the nasopharynx located?
|
Anterior to C1 (top of cervical chain)
|
|
|
where is the oropharynx located?
|
C2 and C3
|
|
|
What is the hypopharynx?
|
the inferior portion of the pharynx between the epiglottis and the larynx at the C5-C6 level
|
|
|
What innervates the hypopharynx?
|
The Vagus nerve
|
|
|
What are the two branches of the vagus nerve?
|
Superior Laryngeal Nerve (SLN)
Recurrent Laryngeal Nerve (RLN) |
|
|
The SLN has two branches. What are they and what do they do?
|
Internal Branch- provides sensory input above the vocal cords
External Branch- provides motor to the cicothyroid (belwo vocal cords) |
|
|
What does the RLN do?
|
-Provides sensory below vocal cords (larynx and trachea)
-Provides motor to all of the muscles of the larynx except cricothyroid muscle |
|
|
What does the glossopharyngeal nerve provide?
|
taste plus general sensation via lingual branches to the tongue
|
|
|
What does the Facial nerve provide to the tongue?
|
taste via chorda tympani
|
|
|
What is the action of the posterior cricoarytenoid?
|
separates the vocal cords (abducts) and opens the glottis
|
|
|
What is the action of the lateral cricoaryetnoid?
|
closes the glottis (adducts)
|
|
|
What closes the glottis posteriorly?
|
The arytenoids
|
|
|
What produces tension, elongating the vocal cords?
|
Cricothyroid
|
|
|
What shortens, relaxing the vocal cords?
|
Thyroarytenoid
|
|
|
The larynx is made up of what?
|
3 single cartilages, 3 paired cartilages=9 total cartilages
|
|
|
Where does the larynx begin and end?
|
Begins between the 3rd and 4th cervical vertebrae and ends at the 6th (cricothyroid muscle)
|
|
|
What are the single cartilages?
|
Thyroid, Cricoid and Epiglottic
|
|
|
What are the paired cartilages?
|
Arytenoid, Corniculate and Cuneiform
|
|
|
What is the single cartilage that sits above the glottic opening?
|
epiglottis
|
|
|
The epiglottis opens or closes during swallowing?
|
closes
|
|
|
what is the space between the epiglottis and the base of the tongue called?
|
superior vallecula
|
|
|
Where is the inferior vallecula located?
|
between the inferior edge of the epiglottis and the true vocal cords
|
|
|
If you apply upward force on the superior vallecula what will happen?
|
the epiglottis will lift, pulling it way from the glottic opening
|
|
|
What artery supplies blood to the supraglottic region of the larynx?
|
the superior laryngeal artery (branch of the external carotid)
|
|
|
What artery supplies blood to the infraglottic region of the larynx?
|
the inferior laryngeal artery (branch of the inferior thyroid artery)
|
|
|
The superior laryngeal nerve can be damaged in two ways. What are these ways?
|
Unilateral and Bilateral
|
|
|
If the SLN is damaged unilaterally what happens?
|
Minimal Effects
|
|
|
If the SLN is damaged bilaterally what happens?
|
Hoarseness and tiring of voice
|
|
|
Is it more serious if the SLN is damaged or the RLN and why?
|
The RLN because the SLN has two branches meaning you aren't damaging the whole airway if it is damaged.
|
|
|
If you have unilateral RLN damage what symptoms do you exhibit?
|
Hoarseness
|
|
|
Bilateral damage to the RLN can be acute or chronic, what are the effects of each of these?
|
Acute: stridor, respiratory distress, death
Chronic: Aphonia |
|
|
When the Vagus nerve is damaged unilaterally what symptoms are present?
|
hoarseness
|
|
|
when the vagus nerve is damaged bilaterally what symptoms are present?
|
aphonia
|
|
|
Where does the trachea originate?
|
inferior border of the cricoid cartilage and extends to the carina (biforcation to the left and right)
|
|
|
How long is the adult trachea?
|
10-20 cm
|
|
|
Which cartilage of the trachea is the only complete ring?
|
Cricoid cartilage
|
|
|
How many C shaped cartilaginous rings are there on the trachea
|
16-20
|
|
|
What is the job of the bronchi?
|
Provide humidification and warming of the air as it passes to the alveoli
|
|
|
At what angle does the right mainstem bronchus sit?
|
25-30 Degrees
|
|
|
Birfurcation to the right upper lobe is apporximately _____ cm from the carina.
|
2.5cm
|
|
|
What is the angle of the left mainstem bronchus?
|
45 degrees
|
|
|
The left mainstem bronchus is approximately ____ cm long before is bifurcates into the left superior and inferior lobe bronchi
|
5cm
|
|
|
Which side are you most likely to have an aspiration?
|
Right mainstem
|
|
|
The tracheobronchial tree is innervated by the?
|
Sympathetic-1st through 5th thoracic gangila
Parasympathetic- branches of the vagus nerve |
|
|
The carina is (richly/poorly) innervated which makes it (sensitive/nonsensitive) to sensory stimulation
|
Richly
Sensitive |
|
|
What are the structures you can see on a Class I Mallampati?
|
-Soft Palate
-Fauces -Uvula -Pillars (Tonsils) |
|
|
What are the structures you can see on a Class II Mallampati?
|
-Soft Pallate
-Fauces -Uvula |
|
|
What are the structures you can see on a Class III Mallampati?
|
-Soft Palate
-Base of the Uvula |
|
|
What are the structures you can see on a Class IV Mallampati?
|
-The soft palate is not visible at all
|
|
|
What are the 5 difficult airway predictors?
|
Obese
Bearded Elderly Snores Endentulous |
|
|
What three axes that need to be aligned for best intubation site?
|
-Oral Axis (OA)
-Pharyngeal Axis (PA) -Laryngeal Axis (LA) |
|
|
By placing the head on a pad which axes are you aligning?
|
PA and LA
|
|
|
How should the patient be positioned to align all axes?
|
Head resting on a pad and in the sniffing position
|
|
|
What is the leading cause of long term morbidity and mortality in closed claimed analysis?
|
Inability to successfully establish an airway
|
|
|
What is the leading cause of inability to establish an airway?
|
unrecognized esophageal intubation
|
|
|
What is the airway manager's worst nightmare?
|
CANNOT INTUBATE, CANNOT VENTILATE
-nothing else matters but establishing an airway even if it is only temporary (cric) |
|
|
What are the three most important things to know when managing an airway?
|
-Recognize those who are likely to be difficult
-How to salvage an airway for those that are unexpectedly difficult (4-5 backup plans) -Recognize when the airway is successfully managed and when it is not |
|
|
Pre existing difficult anatomy include?
|
-Small Mouth
-Narrow receding mandible -Protuberant Maxilla (overbite) -Large tongue -<6 cm distance mandible to thyroid prominence -inability to place pt in sniffing position -short/full/bulk neck -Neck Mass >18cm -Body weight -Head and Neck movement -jaw movement -buck teeth |
|
|
Difficult airway recognition with trauma patients...
|
-Direct airway trauma (facial fractures, wounds)
-edema -distortion/loss of normal structures -blood -impingement of vital structures |
|
|
Any disease or congenital anomalies that cause ____ will predict a difficult airway.
|
Stiffness of neck/surround structures
|
|
|
How many fingers do you want to be able to fit in between the upper and lower incisors?
|
3 fingers
|
|
|
If the patient has a (high/low) arch of their palate, this is considered difficult?
|
high
|
|
|
What is a normal thyromental (chin to thyroid) distance
|
3 fingers or greater
|
|
|
What is the assessment tool for difficult airway prediction?
|
LEMON
|
|
|
What does the L stand for in LEMON?
|
Look externally-looking for teeth, obesity, face or neck pathology
|
|
|
What does the E stand for in LEMON?
|
Evaluate the 3-3-2 rule
-mouth opening >3 fingers -Thyroid chin distance >3 fingers -Thyroid to mouth floor >2 fingers |
|
|
What does the M stand for in LEMON?
|
Mallampati Score-want a class I or II
|
|
|
What does the O stand for in LEMON?
|
Obstruction-looking for abscess anywhere along the airway
|
|
|
What does the N stand for in LEMON?
|
Neck Mobility- looking for any limited ROM
|
|
|
What is the mandibular protrusion test?
|
the ability to stick your bottom teeth in front of your top teeth
|
|
|
Class A/1 in the mandibular protrusion test means?
|
lower teeth extend over bottom teeth=good
|
|
|
Class B/2 in the mandibular protrusion test means?
|
lower teeth brought inline with upper teeth
|
|
|
Class C/3 in the mandibular protrusion test means?
|
cannot even bring bottom teeth to upper teeth=bad
|
|
|
Why do we preoxygenate for 5 minutes with 100% O2?
|
de-nitrogenation
|
|
|
about how many minutes do you have or sustained apenic saturation in healthy lungs?
|
about 5 minutes
|
|
|
What is one of the most important skills to have when managing an airway?
|
Mask Ventilation
|
|
|
Which hand usually hold the mask?
|
Left
|
|
|
Your _____ and ____ hold the mask in place while the other fingers remain on the mandible
|
thumb and first finger
|
|
|
When are you at risk for gastric inflation?
|
airway pressure > 15cm H2O
-Large tidal volumes -high RR -rapid delivery of volume |
|
|
What are some signs of inadequate make ventilation?
|
-Absent or inadequate measures of exhaled gases
-hemodynamic changes associated with hypoxia or hypercarbia -Gastric dilation |
|
|
What can cause an orophorynx airway obstruction?
|
relaxation of jaw and base of tongue
|
|
|
How do you remedy an airway obstruction?
|
Chin lift, jaw thrust, oral airway or nasal trumpet
|
|
|
What are the supraglottic airways?
|
-LMA
-Cobra -Combitube -King |
|
|
What are the subglottic airways?
|
-transtracheal jet ventilation
-cricothyroidotmy |
|
|
How are LMAs sized
|
by weight
|
|
|
LMAs are a (shot/long) term solution and should not be used in a (full/empty) stomach.
|
short term, full stomach
|
|
|
Do LMAs provide protection against aspiration?
|
no because there is not full closure of the esophagus
|
|
|
When are three times you cannot use an LMA?
|
-Pharyngeal or laryngeal pathology-hard to get tight seal
-High pressure ventilation -when the pt is lightly anesthetized-placed in a very stimulating part of airway |
|
|
Laryngoscopy causes are release of what?
|
Catecholamine release-monitor hemodynamics closely
|
|
|
What are the 8 questions to ask yourself before intubating?
|
1. how easy to intubate?
2.how east to ventilate? 3. how much pulmonary reserve? 4. is the patient a full stomach? 5. what is the hemodynamic status? 6. what is the volume status? 7. how much cardiac reserve? 8. are there any other issues, c-spine, ICP |
|
|
It is hard to kill a spontaneously breathing patient-with that in mind, what is sometimes a safer alternative?
|
Awake intubation
|
|
|
What is the most obstructive structure in the upper airway?
|
the tongue
|
|
|
Which blade is best to move the tongue out of the way?
Which blade is best to move a large epiglottis out of the way? |
-mac
-miller (UPPP) |
|
|
Where does the mac blade go?
|
into the vallecula, indirectly lifting the epiglottis
|
|
|
where does the miller blade go?
|
under the epiglottis, directly lifting the epiglottis
|
|
|
Getting the mouth to open wide to put the laryngoscope in is a ______?
|
time saving factor
|
|
|
sweep from ____ to ____ to move the tongue out of the way
|
right to left
|
|
|
If you don't see the epiglottis, what should you do?
|
Pull back, you are probably in too far
|
|
|
if the patient desaturates, _________?
|
ventilate!
|
|
|
how many additional people may you need for intubation
|
1-3
-stabilization for C-spine injury -one person to hold cricoid pressure -one person to push drugs and backup |
|
|
What are some confirmations of intubation
|
-ETCO2= gold standard
-auscultation- midaxillary and stomach -condensation -chest excursion -O2 sat -visualization -radiography |
|
|
At how many cm is the tube when properly intubating a women?
|
about 21cm
|
|
|
At how many cm is the tube when properly intubating a man?
|
about 22 cm
|
|
|
If you are right mainstem, about how far should you pull the tube back?
|
2-3 cm
|
|
|
Why does videolaryngoscopy make visualization easier?
|
Takes away much of the OA and LA angle
|
|
|
Is the glidescope inserted midline or R to L?
|
midline
|
|
|
What are things to know about your environment?
|
-who is there to help
-what equipment do i have on hand |
|
|
what are things to know about your patient?
|
-elective or emergent surgery
-hx of difficult airway -physical exam |
|
|
What is the narrowest part of the pediatric airway?
|
circoid
|
|
|
What is the narrowest part of the adult airway
|
cords
|
|
|
Children have ____ tongues and ____ mouths
|
larger and smaller
|
|
|
What is a way to determine ETT size in kids?
|
Age/4 +4 =ETT
|
|
|
Children have narrow, long, angulated and floppy epiglottis, which blade is best?
|
miller
|
|
|
Do you use a cuff or uncuffed ETT in kids?
|
Uncuffed
|
|
|
At what age does a peds airway become an adult airway?
|
8 y/o
|
|
|
What happens in a laryngospasm and how do you treat it?
|
the cords shut-force open with PPV or succs
|
