Airway Exam Ii

Front 1

Result of failed airway management

Back 1

Dental damage
Pulmonary aspiration
airway trauma
unanticipated tracheostomy
anoxic brain injury
cardiopulmonary arrest
Death

Front 2

Definition of difficult mask ventilation

Back 2

An inability of a trained anesthetist to maintain oxygen sat > 90% using a face mask for ventilation and 100% inspired oxygen , provided the pre ventilation o2 sat level was within normal range.

Front 3

Upper airway

Back 3

Nose, mouth, pharynx, hypopharynx, and larynx

Front 4

Lower airway

Back 4

Trachea, bronchi, bronchioles, terminal bronchioles, resp bronchioles, and alveoli

Front 5

primary passage by which air enters the lungs

Back 5

nose, resistance is twice that through the mouth

Front 6

blood supply to the nasal mucosa

Back 6

maxillary (sphenopalatine)
opthalmic and facial (septal)

Front 7

competence in airway management requires

Back 7

1. knowledge of the A&P of the airaway.
2. ability to assess a difficulty airway.
3. skills with devices for airway management
4. application of ASA algorithm for difficult airway

Front 8

innervation of the nasal mucosa

Back 8

cranial nerve V, as the anterior ethmoidal, nasopalatine, and sphenopalatine nerves.

Front 9

glossopharyngeal nerve(IX)

Back 9

innervates the posterior third of the tongue, soft palate, and the oropharynx.

Front 10

Obstruction by the tongue is increased by the relaxation of the ............. muscle during anesthesia

Back 10

genioglossus

Front 11

Obstruction by the tongue is inc. by relaxation of the ............ muscle during anesthesia

Back 11

Genioglossus

Front 12

Glossopharyngeal nerve (IX)

Back 12

innervates the posterior third of the tongue (gag reflex), soft palate, and oropharynx. Sensory for vallaculla

Front 13

Two branches of the Vagus nerve, that innervate the hypopharynx

Back 13

SLN and RLN

Front 14

the internal SLN

Back 14

provides sensory input to the hypopharynx, above the vocal cords.

Front 15

the external SLN

Back 15

provides motor function to the cricothyroid muscle of the larynx. (adduct VC)

Front 16

The RLN provides

Back 16

sensory innervation to the subglottic area and the trachea.

Front 17

the motor component of the RLN provides motor function to all the muscles of the larynx except.......

Back 17

cricothyroid muscle (abducts VC)

Front 18

unilaterl injury to the RLN result in

Back 18

hoarseness, without resp status compromise. VC shift midline towards uninjured side.

Front 19

acute bilateral injury of RLN

Back 19

result in unopposed tension and adduction of the VC result in stridor > severe resp distress>death

Front 20

Larynx level

Back 20

C-5 in adult
C-3 in newborn

Front 21

Cartilages of the Larynx

Back 21

Thyroid, cricoid, epiglottic, arytenoid(p), corniculate(p), and cuneiform(p)

Front 22

The intrinsic muscles of the larynx

Back 22

posterior cricoarytenoid(abducts and open the glottis)
lateral cricoarytenoid(adduct the glottis)
arytenoids (closes the glottis)
cricothyroid (elongates the VC)
Thyroarytenoid (shortens & relaxes the VC)

Front 23

The extrinsic muscles of the larynx

Back 23

Sternohyoid (draws hyoid bone inferiorly)
Sternothyroid (draws thyroid cartilage caudad)
thyrohyoid (pulls hyoid bone inferiorly)
omohyoid (pulls hyoid bone caudad)

Front 24

larynx is the gatekeeper of what two areas?

Back 24

Aryepiglottis folds and the false and true VC.

Front 25

vascular supply to the larynx

Back 25

external carotid > superior thyroid artery >superor laryngeal artery. (supplies the supraglottic region of the larynx)
ITA> ILA (supplies the infraglottic region)
STV> SLV
ITV>ILV

Front 26

Conditions that predispose to difficult airway

Back 26

infections(epiglottis, croup, bronchitis, pneumonia) trauma(maxillofacial trauma, cervical spine injury, laryngeal injury) endocrine, foreign body , inflammatory conditions (ankylosing spondylitis, RA)
tumors, congenital problems, physiological conditions (pregnancy, edema morbid obesity)

Front 27

4 D's that suggest difficult intubation

Back 27

dentition, distortion, disproportion, dysmobility

Front 28

LEMON

Back 28

Look externally
Evaluate the 3-3-2 rule
Mallampati
Obstruction
Neck mobility

Front 29

Mallampati

Back 29

Class I : SPUF
Class II: SUF
Class III: SU
Class IV: hard palate

Front 30

Laryngoscopic view (cormack and Lehane score)

Back 30

Grade I: Most of the glottis is visible
Grade II: posterior commissure
Grade III: tip of epiglottis
Grade IV: no glottic structure

Front 31

indicators of difficult to intubates.

Back 31

long incisors, poor TMJ function, mallampati 3&4, small jaw, narrow palate, thyromental distance < 6cm
rigid submadibular space

Front 32

Difficult masking (OBESE)

Back 32

Elderly
Endentulous
Obese
Snores(OSA)
Bearded
Obstruction

Front 33

Risk of aspiration

Back 33

loss of airway reflexes, altered LOC, full stomach, obesity, pregnancy, hiatal hernia, GERD, decreased GI motility (DM, trauma), inc risk if pH< 2.5 and vol. >25ml

Front 34

Reducing risk of aspiration

Back 34

NPO orders
inc. gastric pH
inc. gastric motility
caution with sedation and opiods
ETI vs. LMA
RSI vs awake intubation
aspiration of gastric contents after intubation and prior to extubation
awake vs deep extubation

Front 35

Difficulty airway

Back 35

any intubation that takes a skilled anesthetist more than three attempts or greater than 10 mins.

Front 36

Pros of LMA

Back 36

-Avoids tracheal intubation and mask ventilation
-used in pts with potentially difficult airway or in airway emergence
-use as a conduit for other instrument
-avoid use of NMB
use in short procedure, in which pts may spontaneously breath
- insertion does not cause change in hemodynamics, ICP, IOP

Front 37

Cons of LMA

Back 37

not effective > 20cm H2O, air leak and gastric distension may occur
-no protection from aspiration
-cannot use in prone cases
-use of N2O may distend cuff> to pharymgeal ischemia
-may not be safe in pts with GERD, hiatal hernia, gastric neuropathy, or full stomach.

Front 38

types of LMA

Back 38

proseal: allow oral gastric tube insertion. allows higher airway pressure.
Fastrach: facilitate blind ETI (accomodate upto 8mm)

Front 39

LMA use

Back 39

inspection
preparation
insertion
fixation
maintenance
emergence

Front 40

Combitube

Back 40

disposable emergent airway device
-indicated for supraglottic obstruction or when need for immediate airway (cannot ventilate & cannot intubate)

Front 41

Cons of Combitube

Back 41

Gastric distention/inflation
-esophageal rapture
-transient cranial nerve IX & XII dysfunction
-sore throat & hoarseness
-only 2 adult size available
->cost

Front 42

Cricord pressure

Back 42

BURP (backward, upward rightward pressure = 30N

Front 43

classic LMA

Back 43

size: 1 weight <5kg vol. 4ml
1.5: 5-10: 7
2: 10:20: 10
2.5: 20-30: 14
3: 30-50: 20
4: 50-70: 30
5: 70-100: 40
6: >100: 50