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73 Cards in this Set
- Front
- Back
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anesthesia of the nasal mucosa and nasopharynx (nasal intubation)
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spenopalantine ganglion and ethmoid nerve
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anesthesia of the mouth, oropharynx and base of tongue
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glossopharyngeal nerve block, SLN block
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anesthesia of the hypopharynx, larynx, and trachea
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RLN block, transtracheal block
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which nerve is blocked for nasal intubation
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CN V
indicated for nasal intubations or procedures |
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which nerve is blocked for oropharyngeal
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glossopharyngeal (CN IX) indicated for manipulations involving areas ABOVE the epiglottis, pharynx, and posterior 1/3 of tongue, laryngoscopy
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what blocks laryngeal cavity and trachea?
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branches of the Vagus nerve (CN X) ... indicated for blocking of structures more distal in airway to the epiglottis.
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which nerve is blocked to produce complete anesthesia of the airway
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THERE IS NO SINGLE NERVE BLOCK THAT CAN DO THIS
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drugs for nasal intubation
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lido 4% with epi (or cocaine 4% -max 200mg in adult) or mixture of lido 3% and phenylepherine 0.25%
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another name for sphenopalatine ganglion
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mechel's or ....
pterygopalatinum ganglion (whew!) |
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drugs for mouth/oropharynx to abolish gag reflex or hemodynamic response to laryngoscopy
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cetacaine(benzocaine 14% & tetracaine 2%), lidocaine spray 10%, lido gel 2-5%, tetracaine 0.5 soln, lido 4% soln....
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max dose of cetacaine spray
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benzocaine 100mg and tetracaine 100mg in adult. toxicity has been reported at 40 mg
max 2 second spray |
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what is the treatment for methemoglobinemia?
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methylene blue
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SLN block
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abolish gag reflex or hemodynamic response
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drug used for SLN block
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2-4ml of 1% lido with or without epi
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is the hyoid bone displaced away from or toward the side being blocked on a SLN block
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displaced toward the side being blocked
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pathology of methemogloinemia
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ferrous molecule in hemoglobin is changed to its ferric state
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which blocks are used for the RLN?
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transtracheal or translaryngeal block
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which nerve does transtracheal/translaryngeal blocks affect- RLN or SLN?
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BOTH. injection is below the cords, and the patient coughs the drug onto the SLN structures
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which patients should not receive a transtracheal block
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any process in which coughing would be contraindicated - ICP, unstable neck, etc.
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where is the needle inserted for a transtracheal block
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in the cricothyroid membrane
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should you spray the LA on inhalation or exhalation in a transtracheal block?
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end exhalation, (or inspiration)...inspiration will cause a cough and THUS spray lido onto SLN
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transtracheal block - when should you remove the needle? when should you remove the catheter?
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remove the needle immediately. remove the catheter after intubation to prevent likelihood of sq emphysema
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minimum mouth opening needed for a bullard
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6mm
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upsherscope requires what size mouth opening
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15mm
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minimum mouth opening for wuscope
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20mm
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a bullard cannnot be used for nasal intubation - true or false
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false
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how long will the LED light illuminate for in the airtraq
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90 minutes
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airtraq - what happens if the LED light is not left on for 30 seconds before use
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lens will fog
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what abducts the vocal cords
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Posterior CricoArytenoids =
pulls cords apart |
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epiglottis is innervated by....
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SLN internal
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name the cartilages in order superior to inferior
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epiglottis, thyroid, cuneiform, corniculate, arytenoid, cricoid
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how many cartilages are there in the larynx and which are single?, which are paired?
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9 cartilages....
epiglottis, thyroid, cricoid are single. cuneiform, corniculate, arytenoid are paired |
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what happens if there is damage to the external branch of the SLN?
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weakness and huskiness of the voice, vocal cords cannot be tensed. cricothyroid muscle is paralyzed
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most common injury after subtotal thyroidectomy?
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right RLN. characterized by hoarseness
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bilateral RLN requires intubation? T/F
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true.
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hoarseness after subtotal thyroidectomy can be caused by unilateral RLN or SLN
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both. RLN is common, SLN is rare
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LEMON
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L = look externally
E = evaluate 3-3-2 rule M = mallampati O = obstruction N = neck mobility |
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OBESE - for difficult mask
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O = overweight
B = beard E = elderly S = snoring E = edentulous |
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MOANS - difficult mask
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M = mask seal
O = obesity or obstruction A = age > 55 N = no teeth S = stiff |
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E = Evaluate the 3-3-2 rule.
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normal mouth opening is three (of the patient's) fingerbreadths; mandible dimension will allow three fingerbreadths between the mentum and the hyoid bone; and the notch of the thyroid cartilage should be two fingerbreadths below the hyoid bone
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is the pediatric larynx (therefore epiglottis) more anterior or posterior than adults?
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more anterior
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which blade (miller, mac) is best in an infant
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miller
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stimulation to the epiglottis will cause:
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epiglottis is stimulated by the vagus nerve - therefore bradycardia might ensue. this is why a mac might be better
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where is LMA in difficult airway algorithm
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precedes cricothyroidotomy - nag/zag
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should cricoid pressure be held when inserting combitube?
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no
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TTJV -
20g needle delivers 16g needle delivers 14g needle delivers |
20g = 400ml/s
16g = 500ml/s 14g = 1600ml/s |
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for TTJV - use non-compliant tubing, or corregated tubing
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non-compliant. corregated tubing decreases minute volume delivered
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complications TTJV
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barotrauma, tissue emphysema, exhalation difficulties
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what can facilitate exhalation in TTJV?
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bilateral nasal airways, oral airway
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how long before FOB should you administer atropine or glyco?
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5 - 20 minutes
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what pathologies is FOB contraindicated in?
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epiglotitis, laryngeotracheitis, bacterial tracheitis. caution in radiated patients with glyco et al as mucus already dried. also caution in burn pts
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TTJV cephalad/caudad?
retrograde cephalad/caudad? |
TTJV = caudad
retrograde = cephalad |
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peak serum concentrations of lidocaine in how long
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30 minutes
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another difficult mask memory tool?
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santa with no teeth
obese elderly beard snoring edentulous |
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larynx - intrinsic muscles do what
extrinsic muscles do what |
intrinsic - tension; open/close glottis
extrinsic - connect larynx to hyoid |
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larynx anatomy
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starts epiglottis C3,C4; ends at cricoid C6
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would you want to extubate an RSI while deep?
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NO! no pt with chance of aspiration should be extubated while deep
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extubation criteria
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head lift > 5 seconds
airway reflexes present/adequate Vt > 5.cc cc/kg + muscle strength all extremities opens eyes and follows commands |
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ventilatory extubation criteria
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vital capacity 15ml/kg,
inspiratory force 25-30 cm H2O sustained tetanic response to 50Hz for 5 seconds TOF > .90 with no fade no fae to double burst stimulation |
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which tooth is most often damaged in intubation
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#9
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endotracheal tube obstruction can lead to what?
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NPPE... negative pulmonary pressure edema.
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What is the treatment for NPPE?
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possibly diuretics and PPV
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afferent stimulus of pharynx via which nerve?
efferent response returns via which nerve? |
afferent CN IX
efferent CN X |
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what two "phases" does laryngospasm consist of?
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shutter - partial obstruction
ball valve - complete obstruction |
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tx for laryngospasm
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gentle PPV 10-20 cm
then possible 0.1mg/kg IV sux tx of ball valve spasm may require 1-2mg/kg sux IV or 4mg/kg IM |
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what is croup
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postintubation edema around glottic/subglottic regions
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when does croup occur
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within 3 hours after extubation
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symptoms of croup
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respiratory stridor and a barking cough
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tx croup
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reducing swelling:
inhalation cool, moist oxygen dexamethasone 0.1 - 0.5mg/kg inhalation racemic epi (0.5 of 2.25% soln in 2.5 NS) |
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how much is O2 consumption increased in gravid patient?
during active labor |
20%
another 23% take home message - along with the lowered FRC, pregnant patients desat QUICKLY |
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should you lightly ventilate a pregnant pt while performing RSI?
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according to nag/zag pt 422, YES! #3 " there is no evidence that smooth, controlled light ventilation increases the incidence of aspiration. prolonged periods of apnea should be abandoned."
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pathologic reasons for difficult intubation
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epiglottitis
abscess sarcoidosis diabetes hypothyroidism thyromegaly obesity |
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physiologic/congenital reasons for difficult airway management
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downs - trisomy 21
goldenhar trreacher collins klippen-feil turner's pierre robin |
