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57 Cards in this Set

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  • Back
posterior cricoarytenoid
What is it and action?
Muscle of the larynx
seperates vocal cords (abducts) and opens the glottis
lateral cricoarytenoid
What is it and action?
Muscle of the larynx
closes the glottis (adducts)
Name 5 intrinsic muscles of the larynx
cricoarytenoids (posterior and lateral)
arytenoids
cricothyroid
thyroarytenoid
Name 4 extrinsic muscles of the larynx?
sterohyoid, sternothyroid, thyrohyoid, omohyoid
What is the function of the intrinsic and extrinsic muscles of the larynx?
Intrinsic- control tension of the vocal cords and opening and closing of the glottis
Extrinsic- connect larynx with hyoid, adjust position during phonation, breathing, swallowing
Name 3 areas where the larynx can close to prevent aspiration?
true and false vocal cords and arye epiglottic fold
Name the level of the Larynx in relation to the vertebra in adults and children
C-5 in adults
C-3 in newborns
Name the 3 paired and 3 unpaired cartilage of the larynx
Unpaired- thyroid, cricoid, epiglottis
Paired- arytenoids, corniculates, cuniform
Which cranial nerve innervates the superior laryngeal nerve and the recurrent laryngeal nerve?
Vagus
What is the sensory and motor function of the the internal and external aspect of the Superior Laryngeal nerve (SNL)?
Internal- sensory above the cords to the hypopharynx
External- motor cricothyroid muscle and adducts the cords
What is the motor and sensory function of the recurrent laryngeal nerve?
Sensory- subglottic area and trachea.
motor function- to all of larynx except cricothyroid.
**abducts cords
Why do we not give muscle relaxants during thyroid surgery?
to ensure the laryngeal nerves are not damaged
Especially the Recurrent Laryngeal Nerve and Superior Laryngeal nerve
How can you treat laryngeospasm?
positive pressure ventilation, protrude the mandible with index fingers at the temporalmandibular joint, succ 0.1mg/kg or an anesthetic agent
How do you treat postextubation croup/stridor in children?
humidified o2, racemic epi, steroids, reintubation
Physiological responses to intubation?
Tachycardia, HTN, myocardial ischemia, reflex bradycardia, broncospasum (turn up agent to decrease pressure), ICP, intraocular HTN or extrusion of vitreous humor (Propofol or narcotic)
4 D’s that suggest a difficult airway
Dentition- prominent upper incisors, receding chin
Distortion (edema, blood vomit, tumor, infection
Disproportion (short chin to larynx distance, bull neck, large tongue, small mouth
Dysmobility- TMJ, and cervical spine, ROM
Signs of difficult mask-vent?
 Elderly, edentulous, obese, snores/apnea, bearded, airway obstruction (stridor), lack of teeth, neck radiation, mallimpati III or IV, inability to protrude tongue\
Signs of increased risk of aspiration?
 Loss of airway reflexes
Altered LOC, hernia, obesity, PG, GERD, DM, trauma (assume full stomach)
Risk PH < 2.5 and volume > 25ml
What is the max Peep that can be given with a LMA?
Can not give peep above 20cm h2o, or gastric distention may occur
What is the standard LMA size that connects to the circit? (in mm)
15mm
This LMA has 2 channels at the top, allows for oral gastric tube in order to decompress the stomach and a bite block device (typically larger, prevents aspiration)
Proseal
This Special LMA has a metal portion, allows to intubate with the use of an LMA, allows blind intubation only allows an 8.0 ett. Can use a fiberoptic glidoscope inside it. Low incidence of esophageal intubation (5%)
Fast Track LMA
(can not use for C-spine injuries)
This Type of blade is curved with less risk of damaging teeth, more room in mouth.
Macintosh-
This straight blade, goes under epiglottis and lift up, can potentially have a better view due to lifting. Used more with infants and children. However due to straight can damage teeth or have less room for tube.
Miller blade
Common ETT sizes for M & F, and what is the formula for a childs ETT?
female 7-7.5
men 8-8.5
Child 4 + age/4
T or F. Children under the age of 8 usually have a cuffed ETT?
False! The area is so narrow that if the correct size ett is inserted it prevents aspiration.
What is the narrowest portion of an adult and infants airway?
Narrowest portion of an infact is the cricoid cartilage and adult vocal cords
How do you check if an infant has the correct size ett tube (uncuffed)?
Correct size of a tube is one that allows an air leak when Apply 20-25 cm h2o of positive pressure is applied
S/S of CROUP?
nasal flairing, retrations, increased rr, stridor, decreased o2.
For what type of surgery should the cuff be filled with dye?
Laser Surgery
What 3 axis need to be lined up in order to visualize the vocal cords?
Oral, Pharyngeal and laryngeal axis! (sniffing position)
How do you look up an EKG on portal?
GE MUSE
Name extubation criteria
-Muscle relaxant fully reversed
-Airway reflexes recovered
-Patient follows commands
-Adequate tidal volume, rate, adequate vital capacity at least 15ml/kg
-Can they lift their head for 5 seconds
-Inspired force of at least 25-30 cm h20 neg pressure
T/F When extubating a patient positive pressure must be applied?
True
Ciliary damage often occurs over the tracheal rings and cuff site after ____ hours of intubation?
2 hours of intubation
For confirmation of ETT placement, End tital co2 of greater than ____mmhg for 3-5 consecutive breaths is needed.
30mm Hg
T/F  In addults the Epiglottis is larger and more firm, and most importantly more posterior blocking direct view of the vocal cords
False, this is true in children/infants
While sleeping/anesthesia, the _______can fall against the nasal passage blocking the airway causing sleep apnea.
soft palate
This part of the pharynx is found between the epiglottis and the cricoid with the upper esophageal sphincter at its lower edge
hypopharynx (C5-C6)
The ________has the following funcion:Protects from aspiration, airflow between hypopharynx and trachea, cough/gag reflex, & phonation
Larynx
this structure originates at the inferior border of the cricoid cartilage and extends to the carina
Trachea (10-20cm long in adults)
The bronchial tree receive sympathetic innervation from ___ through ____ thoracic ganglia?
1-5th throacic ganglia
The most prominent factors predicting a difficult airway are: (5)
obesity, decreased head/neck movement, decrease jaw movement, receding mandible, and buck teeth
The thyromental distance is measured from the ___ to the ___ and should be at least __cm
thyoid notch to the inner border of the mandible and hsould be 6cm (3 finger breadths)
Describe the 3-3-2 rule for airway assessment
3 fingers between incisors
3 fingers between tip of chin and hyoid
2 fingers between hyoid and thyroid notch
ASA Difficult airway algorithm has 4 end-points:
-intubation awake or asleep
-intubation emergent/ nonemergent
-approch subglottic or supraglottic
-airway access surgical or nonsurgical
Without preoxygenation the oxygen reserve in the FRC will last approximately____min in a can't venilate/intubate situation?
2.5 min (good pre-oxygenation can last up to 12 min) (FGF of 5L for 3-5 min with tight mask fit is needed for preoxygenation or 4 Vital Capacity breaths in 30 sec)
What occures during cricoid pressure and when should this be utilized?
decreases risk of aspiration..DM, full stomach, trauma

Cricoid pressure posterior displacement of the cricoid cartilage against the cervical vertebra occluding the esophagus
Describe BURP for proper cricoid pressure?
Backward
upward
rightward
pressure

Rightward because 75% of patients esophagus is to the right side of the airway.
This nerve innervates the roof of the pharynx, tonsils and undersurface of the soft palate,
glossopharyngeal nerve (VII)
The vagus (X) nerve innervates what 3 nerves?
superior laryngeal nerve
internal laryngeal nerve
recurrent laryngeal nerve
(SIR)
These two muscles abduct and aduct the vocal cords
Posterior cricoarytenoid- abduct
lateral cricoarytenoids- aduct
damage to this nerve can cause respiratory distress and inability to open vocal cords
Recurrent Laryngeal Nerve
Difficult masking s/s
Obesity, old, bearded, edentulous, snores/apnea, airway obstruction (stridor), neck radiation, suncken cheeks
Where should the LMA be positioned?
LMA sits on the laryngeal inlet in the hypopharynx
Where anatomically should the macintosh blade be placed for intubation?
The macintosh blade sits on the vallecula of the epiglottis to expose the glottis.
Where anatomically should the miller blade be placed for intubation?
The miller blade goes under the epiglottis and lifts it up