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35 Cards in this Set

  • Front
  • Back
Which cranial nerve innervates the nasal mucosa?
"CN V. It splits into the anterior ethmoidal, nasopalatine & sphenopalatine nerves."
Which oral surfaces are innervated by CN IX?
"Posterior third of the tongue, the soft palate and the oropharynx."
Which protective mechanism can be problematic in the larynx?
"The separation of the trachea from the esophagus when swallowing. When exaggerated, this movement becomes laryngospasm."
What is the narrowest portion of the adult airway?
The vocal cords.
What is the Mallampati classification?
A system that helps evaluate oropharyngeal anatomy to determine how difficult intubation and laryngoscopy are likely to be. Airways are termed Class I – IV depending on their structure.
Describe a Class I airway.
"Soft palate, fauces, uvula and tonsilar pillars are visible."
D Describe a Class II airway.
"Soft palate, fauces & uvula are visible."
Describe a Class III airway.
The soft palate and the base of the uvula are visible.
Describe a Class IV airway.
The soft palate is visible.
Which congenital syndromes are associated with difficult ET intubation?
"Trisomy 21 (Lg tongue, am mouth; frequent laryngospasm); Goldenhar (Sm jaw and C-spine abnormality); Klippel-Feil (Cervical vertebral fusion); Pierre Robin (Sm mouth, Lg tongue, mandibular anomaly); Treacher Collins (difficult laryngoscopy); Turner (Difficult to intubate)."
What is the Cormack and Lehane score?
A score that classifies laryngoscopic views accoriding to the airway structures visualized. The scores range from Grade I to grade IV.
Describe a Grade I airway.
Most of the glottis is visible.
Describe a Grade II airway.
Only posterior portion of glottis is visible.
Describe a Grade III airway.
"The epiglottis, but no part of the glottis is visible."
Describe a Grade IV airway.
No airway structures are visible.
Name two conditions that might make it difficult to intubate a patient.
"C-spine injury, because spinal manipulation may injure the cord."
"Acromegaly, due to lg tongue & bony overgrowths."
Airway tumors or abscesses may block the airway.
Why would you want to avoid nasal intubation on a patient with a basilar skull fracture?
"You might end up with intracranial intubation, which is not very helpful!"
Which head position provides optimal alignment for intubation?
"The elevated sniffing position aligns the laryngeal axis, the pharyngeal axis and the oral axes; the elevated sniffing position may not be possible if the patient has a c-spine injury or abnormality."
What variables might predict difficult facemask ventilation?
"Age >55; BMI >26 kg/m3; beard, lack of teeth, history of snoring."
What is Selleck’s maneuver? Why would you use it?
Cricoid pressure applied by an assistant as you are intubating a patient. It compresses the espophagus and may help prevent spillage of GI contents into the pharynx before a tube is placed.
Why would you want to use a low volume of air in the balloon on an ET tube?
"Because that reduces the likelihood of ischemic damage to the trachea; however, ciliary denudation can occur under the cuff site after just two hours of pressure at less than 25 mmHg."
What is the most reliable confirmation of ETT placement?
Capnography – end-tidal PCO2 >30 mmHg for three to five consecutive breaths.
What is the general depth pf placement of the ETT in the adult male and female?
23 cm at the teeth or gums for the male; 21 cm at teeth or gums for the female.
What is an absolute contraindication to fiberoptic endotracheal intubation?
"Lack of time. If immediate airway management is needed, another technique should be used."
Name some relative contraindications to fiberoptic intubation.
"Anything that impinges on airway size will make it more difficult to use the fiberoptic system; also, conditions that might cause soiling of the fiberoptic bronchoscope like bleeding will make this a difficult technique to use."
What is the formula for determining the size of the ET tube for an infant or child?
(Age + 16)/4 = ET tube size.
What is the difference between a Miller and a Macintosh laryngoscope blade?
The Macintosh blade is curved; the Miller blade is straight (may have a slight curve just at the tip).
What are some physiologic responses to endotracheal intubation?
Hypertension and tachycardia. Cardiac dysrhythmias (particularly vent. bigeminy) can indicate light anesthesia.
What is the earliest manifestation of bronchial intubation?
"An increase in Peak Inspiratory Pressure. Some other clues include unilateral breath sounds, unexpected hypoxia (although this isn’t reliable at high FIO2) or inability to palpate the cuff in the sternal notch during inflation."
Why should you reposition the tube if you can palpate the cuff above the level of the cricoid cartilage?
Because prolonged intralaryngeal location may result in post-op hoarseness and increases risk of accidental extubation.
Why might you avoid extubating the pt during a light plane of anesthesia?
There is an increased risk of laryngospasm. Any reaction to suctioning usually indicates a light plane of anesthesia.
When would you want to avoid extubating an awake patient?
"When coughing or “bucking” and the associated increased heart rate, BP, CVP, intracranial pressure, intraocular pressure or intrabdominal pressure might be problematic; i.e., large abdominal surgical sites, pt’s with head trauma."