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57 Cards in this Set
- Front
- Back
posterior cricoarytenoid
What is it and action? |
Muscle of the larynx
seperates vocal cords (abducts) and opens the glottis |
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lateral cricoarytenoid
What is it and action? |
Muscle of the larynx
closes the glottis (adducts) |
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Name 5 intrinsic muscles of the larynx
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cricoarytenoids (posterior and lateral)
arytenoids cricothyroid thyroarytenoid |
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Name 4 extrinsic muscles of the larynx?
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sterohyoid, sternothyroid, thyrohyoid, omohyoid
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What is the function of the intrinsic and extrinsic muscles of the larynx?
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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 |
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Name 3 areas where the larynx can close to prevent aspiration?
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true and false vocal cords and arye epiglottic fold
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Name the level of the Larynx in relation to the vertebra in adults and children
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C-5 in adults
C-3 in newborns |
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Name the 3 paired and 3 unpaired cartilage of the larynx
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Unpaired- thyroid, cricoid, epiglottis
Paired- arytenoids, corniculates, cuniform |
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Which cranial nerve innervates the superior laryngeal nerve and the recurrent laryngeal nerve?
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Vagus
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What is the sensory and motor function of the the internal and external aspect of the Superior Laryngeal nerve (SNL)?
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Internal- sensory above the cords to the hypopharynx
External- motor cricothyroid muscle and adducts the cords |
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What is the motor and sensory function of the recurrent laryngeal nerve?
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Sensory- subglottic area and trachea.
motor function- to all of larynx except cricothyroid. **abducts cords |
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Why do we not give muscle relaxants during thyroid surgery?
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to ensure the laryngeal nerves are not damaged
Especially the Recurrent Laryngeal Nerve and Superior Laryngeal nerve |
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How can you treat laryngeospasm?
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positive pressure ventilation, protrude the mandible with index fingers at the temporalmandibular joint, succ 0.1mg/kg or an anesthetic agent
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How do you treat postextubation croup/stridor in children?
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humidified o2, racemic epi, steroids, reintubation
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Physiological responses to intubation?
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Tachycardia, HTN, myocardial ischemia, reflex bradycardia, broncospasum (turn up agent to decrease pressure), ICP, intraocular HTN or extrusion of vitreous humor (Propofol or narcotic)
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4 D’s that suggest a difficult airway
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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 |
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Signs of difficult mask-vent?
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Elderly, edentulous, obese, snores/apnea, bearded, airway obstruction (stridor), lack of teeth, neck radiation, mallimpati III or IV, inability to protrude tongue\
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Signs of increased risk of aspiration?
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Loss of airway reflexes
Altered LOC, hernia, obesity, PG, GERD, DM, trauma (assume full stomach) Risk PH < 2.5 and volume > 25ml |
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What is the max Peep that can be given with a LMA?
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Can not give peep above 20cm h2o, or gastric distention may occur
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What is the standard LMA size that connects to the circit? (in mm)
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15mm
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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)
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Proseal
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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%)
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Fast Track LMA
(can not use for C-spine injuries) |
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This Type of blade is curved with less risk of damaging teeth, more room in mouth.
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Macintosh-
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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.
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Miller blade
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Common ETT sizes for M & F, and what is the formula for a childs ETT?
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female 7-7.5
men 8-8.5 Child 4 + age/4 |
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T or F. Children under the age of 8 usually have a cuffed ETT?
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False! The area is so narrow that if the correct size ett is inserted it prevents aspiration.
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What is the narrowest portion of an adult and infants airway?
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Narrowest portion of an infact is the cricoid cartilage and adult vocal cords
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How do you check if an infant has the correct size ett tube (uncuffed)?
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Correct size of a tube is one that allows an air leak when Apply 20-25 cm h2o of positive pressure is applied
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S/S of CROUP?
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nasal flairing, retrations, increased rr, stridor, decreased o2.
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For what type of surgery should the cuff be filled with dye?
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Laser Surgery
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What 3 axis need to be lined up in order to visualize the vocal cords?
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Oral, Pharyngeal and laryngeal axis! (sniffing position)
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How do you look up an EKG on portal?
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GE MUSE
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Name extubation criteria
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-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 |
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T/F When extubating a patient positive pressure must be applied?
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True
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Ciliary damage often occurs over the tracheal rings and cuff site after ____ hours of intubation?
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2 hours of intubation
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For confirmation of ETT placement, End tital co2 of greater than ____mmhg for 3-5 consecutive breaths is needed.
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30mm Hg
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T/F In addults the Epiglottis is larger and more firm, and most importantly more posterior blocking direct view of the vocal cords
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False, this is true in children/infants
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While sleeping/anesthesia, the _______can fall against the nasal passage blocking the airway causing sleep apnea.
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soft palate
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This part of the pharynx is found between the epiglottis and the cricoid with the upper esophageal sphincter at its lower edge
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hypopharynx (C5-C6)
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The ________has the following funcion:Protects from aspiration, airflow between hypopharynx and trachea, cough/gag reflex, & phonation
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Larynx
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this structure originates at the inferior border of the cricoid cartilage and extends to the carina
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Trachea (10-20cm long in adults)
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The bronchial tree receive sympathetic innervation from ___ through ____ thoracic ganglia?
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1-5th throacic ganglia
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The most prominent factors predicting a difficult airway are: (5)
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obesity, decreased head/neck movement, decrease jaw movement, receding mandible, and buck teeth
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The thyromental distance is measured from the ___ to the ___ and should be at least __cm
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thyoid notch to the inner border of the mandible and hsould be 6cm (3 finger breadths)
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Describe the 3-3-2 rule for airway assessment
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3 fingers between incisors
3 fingers between tip of chin and hyoid 2 fingers between hyoid and thyroid notch |
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ASA Difficult airway algorithm has 4 end-points:
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-intubation awake or asleep
-intubation emergent/ nonemergent -approch subglottic or supraglottic -airway access surgical or nonsurgical |
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Without preoxygenation the oxygen reserve in the FRC will last approximately____min in a can't venilate/intubate situation?
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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)
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What occures during cricoid pressure and when should this be utilized?
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decreases risk of aspiration..DM, full stomach, trauma
Cricoid pressure posterior displacement of the cricoid cartilage against the cervical vertebra occluding the esophagus |
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Describe BURP for proper cricoid pressure?
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Backward
upward rightward pressure Rightward because 75% of patients esophagus is to the right side of the airway. |
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This nerve innervates the roof of the pharynx, tonsils and undersurface of the soft palate,
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glossopharyngeal nerve (VII)
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The vagus (X) nerve innervates what 3 nerves?
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superior laryngeal nerve
internal laryngeal nerve recurrent laryngeal nerve (SIR) |
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These two muscles abduct and aduct the vocal cords
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Posterior cricoarytenoid- abduct
lateral cricoarytenoids- aduct |
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damage to this nerve can cause respiratory distress and inability to open vocal cords
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Recurrent Laryngeal Nerve
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Difficult masking s/s
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Obesity, old, bearded, edentulous, snores/apnea, airway obstruction (stridor), neck radiation, suncken cheeks
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Where should the LMA be positioned?
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LMA sits on the laryngeal inlet in the hypopharynx
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Where anatomically should the macintosh blade be placed for intubation?
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The macintosh blade sits on the vallecula of the epiglottis to expose the glottis.
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Where anatomically should the miller blade be placed for intubation?
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The miller blade goes under the epiglottis and lifts it up
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