Fiu 6091 Airway Management

Front 1

what separates the nasal and oral pharynx?

Back 1

soft palate

Front 2

what separates the oropharynx from the hypopharynx?

Back 2

epiglottis

Front 3

Which 2 cranial nerves innervates the pharynx?

Back 3

9 and 10. Glossophyrngeal and Vagus.

Front 4

what innervates the soft palate?

Back 4

glossopharyngeal

Front 5

What branches of the vagus nerve provide sensation to the hypopharynx?

Back 5

internal branches of the superior laryngeal nerve

Front 6

How can you approximate where the larynx is on an adult?

Back 6

between the 3rd to 6th cervical vertabrae

Front 7

What 6 cartilageous structures make up the larynx?

Back 7

1- thyroid
2- cricoid
3- arytenoids
4- corniculates
5- epiglottis
6- cuneiform

Front 8

What is the narrowest portion of the adult airway?

Back 8

vocal cords

Front 9

At what level of cervical vertabrea does the trachea begin?

Back 9

6th

Front 10

when you do the mallampati score, should the patient make a sound?

Back 10

NO

Front 11

what do you see with a class 1 mallampati?

Back 11

soft palate, uvula, tonsillar pillars, and hard palate

Front 12

what is a mallampati class 2?

Back 12

soft palate, uvuala, hard palate

Front 13

what is mallampati class 3?

Back 13

soft palate, hard palate, and base of uvula may be visible

Front 14

what is mallampati class 4?

Back 14

hard palate only

Front 15

What is a grade 1 laryngoscopic view (Cormack and Lehane)?

Back 15

entire laryngeal aperature

Front 16

What is a grade 2 laryngoscopic view(Cormack and Lehane)?

Back 16

posterior portion of laryngeal aperature

Front 17

What is a grade 3 laryngoscopic view(Cormack and Lehane)?

Back 17

only the epiglottis

Front 18

What is a grade 4 laryngoscopic view (Cormack and Lehane)?

Back 18

just the soft palate

Front 19

What are 5 predictors of difficult mask ventilaiton?

Back 19

1-age over 55 years
2-BMI >26
3-beard
4- lack of teeth
5- history of snoring

Front 20

when mask ventilating, what can happen if too much pressure is applied to the patients submandibular soft tissue by the SRNA's fingers?

Back 20

airway obstruction

Front 21

what 2 things should be done to align the oral, pharyngeal, and laryngeal axes for easier intubations?

Back 21

1- elevate patients head 8-10 cm with pads under occiput
2- extension of head at the atlanto-occiptal joint into the sniffing position

Front 22

which type of blade is advanced into the space between the base of the tongue and the pharyngeal surface of the epiglottis (vallecula)?

Back 22

Curved or Macintosh

Front 23

what are the standard size blades for intubating adults?

Back 23

Miller 2 or 3
Macintosh 3 or 4

Front 24

How far should you advance the ett?

Back 24

Until the proximal end of the cuff is 1-2 cm past the vocal cords

Front 25

When securing the ett, what CM marking should be at the teeth or gum?

Back 25

women- 21 cm
men- 23 cm

Front 26

What is the most reliable way to confirm ett placement?

Back 26

Immediate and sustained presence of CO2 on the capnograhy. ET CO2 of at >30 for 3-5 breaths

Front 27

what are some ways to confirm ett placement?

Back 27

bilateral chest wall movement, ausculation of bilateral breath sounds, condensation in the tube, ETCO2, "feel" of reservoir bag, expiratory refilling of bag

Front 28

what intubation technique is recommended for patients with unstable cervical spines?

Back 28

fiberoptic

Front 29

what is the absolute contraindication for fiberoptic intubation?

Back 29

lack of time

Front 30

with is the Fastrach LMA used for?

Back 30

It is an intubating LMA

Front 31

why should the patient not be extubated during a light level of anesthesia?

Back 31

they are at risk for laryngospasm

Front 32

If you had a difficult intubation, when would you extubate them?

Back 32

when they are fully awake

Front 33

what are some complications of direct larygoscopy?

Back 33

dental or oral tissue trauma, systemic HTN and tachycardia, dysrhythmias, myocaridal ischemia, aspiration

Front 34

What are some complications that occur while patient is intubated?

Back 34

tube obstruction, endobronchial intubation, esopageal intubation,cuff leak, barotrauma, GI distension,tracheal mucosa ischemia, accidental extubation

Front 35

Complications from extubation?

Back 35

laryngospasm, aspiration, pharyngitis, laryngitis, larngeal edema, laryngeal ulceration, traceitis, tracheal stenosis, vocal cord paralysis, arytenoid cartilage dislocation

Front 36

by what age has a childs airway taken on the characteristics of an adults?

Back 36

usually by 10 years of age

Front 37

what is the narrowest part of a childs airway?

Back 37

the cricoid ring

Front 38

Afferent or sensory stimuli from the posterior wall of the pharynx is carried to the medulla by what nerve?

Back 38

glossopharyngeal

Front 39

What nerve causes the gag reflex?

Back 39

Vagus and glossopharyngeal

Front 40

What are the names of the 2 branches of the superior laryngeal nerve?

Back 40

Internal and external

Front 41

What does the internal branch of the superior laryngeal nerve do?

Back 41

It provides sensory input to the hypopharynx above the vocal cords

Front 42

What does the external branch of the superior laryngeal nerve do?

Back 42

motor function to the criothyroid muscle of the larynx

Front 43

which nerve provides sensory innervation to the subglottic area and to the trachea?

Back 43

the recurrent laryngeal nerve

Front 44

Which muscle does the recurrent laryngeal nerve not affect?

Back 44

cricothyroid muscle. It provides motor function to all others

Front 45

what is the name for the space in between the base of the tongue and the epiglottis?

Back 45

superior vallecula

Front 46

branches from what artery supply blood to the larynx?

Back 46

Carotid and superior thyroid artery

Front 47

what is the name of the tracheal cartilage that is the only complete ring?

Back 47

cricoid

Front 48

what is the angle of bifucation of the right mainstem bronchus?

Back 48

25-30 degrees

Front 49

what is the angle of bifurcation of the left mainstem bronchus?

Back 49

45 degrees

Front 50

namne 4 congenital syndromes associated with difficult airways?

Back 50

Pierre Robin, Treacher collins, Downs, choanal atresia

Front 51

Name some physical characteristics that can lead to a difficult airway?

Back 51

large and protruding teeth, thick neck, spinal malformations like humpback and scoliosis, large tongue, mirognathia, overbite

Front 52

Name some traumatic injuries that can lead to difficult airways?

Back 52

oral and airway burns, facial trauma, head and neck injuries, mandibular fractures, TMJ dislocation

Front 53

Name some chronic diseases that can lead to difficult airways?

Back 53

rheumatoid arthritis, diabetes, obesity, supraglottic tumors, acromegaly

Front 54

name some acute disorders that can lead to difficult airways?

Back 54

peritonsillar or retropharyngeal abscess, epiglottitis, postop airway bleeding, Ludwigs angina

Front 55

In the patient with a known difficult airway, why is it important to preoxygenate?

Back 55

1- delay arterial desaturation during intubation
2- increases oxygen and eliminates much of the nitrogen from the FRC.

Front 56

What are some situations where an awake intubation would be considered?

Back 56

anticipated difficult airways, unstable neck fractures, halo devices, small or limited oral openings

Front 57

What are the 3 nerve blocks that can be done for an awake intubation

Back 57

1- Superior laryngeal
2- transtracheal
3- glossopharyngeal

Front 58

when is using cricoid pressure the standard of care in anesthesia?

Back 58

when the patient has a full stomach

Front 59

in the patient with a full stomach, should cricoid pressure be applied before or after the patient is asleep?

Back 59

Before

Front 60

how much pressure should be applied to an awake patient during cricoid pressure?

Back 60

2 kg

Front 61

how much pressure should be applied during cricoid pressure if the patient is unconscious?

Back 61

4 kg

Front 62

What adjunct for airway management can be used instead of mask ventilation?

Back 62

LMA

Front 63

Does the LMA prevent stomach inflation, aspiration, or regurgitation?

Back 63

NO

Front 64

which type of LMA has been used in the can't intubate and can't ventilate scenario?

Back 64

Fastrach

Front 65

Which type of airway adjunct is a double lumen tube that is blindly inseterted into the hypopharynx?

Back 65

combitube

Front 66

with both cuffs of the combitube inflated, is there protection against aspiration?

Back 66

there may be some protection.

nz 417

Front 67

what can be done to provide oxygen in the can't intubate, can't ventilate scenario when the patient is becoming hypoxic?

Back 67

Transtracheal jet ventilation

Front 68

what are some complications of transtracheal jet ventilation?

Back 68

barotrauma, tissue emphysema, and exhalation difficulties

Front 69

what can be done to assist the patient undergoing transtracheal jet ventilation with exhaltation?

Back 69

placement of oral or nasal airways

Front 70

Is doing a retrograde intubation an emergent process?

Back 70

No. It takes at least 5-7 minutes

Front 71

what type of intubation is characterized by placing an IV catheter through the cricothyroid membrane. A wire or sutures is passed through the catheter into the oropharynx. An ETT is then passed blindly over the wire/suture.

Back 71

retrograde intubation

Front 72

what are some extubation criteria?

Back 72

adequate tidal volumes, good RR, purposeful movement of the tongue, ability to swallow, head or leg lift for 5 seconds, presence of effective cough,NIF of 25-30 cm H2O

Front 73

what are some s/s of esophogeal intubation?

Back 73

absence of lung breath sounds, gurgling over the epigastrum, abdominal distension, lack of sustained ETCO2, late sign would be hypoxia

Front 74

what are signs of endobronchial intubation?

Back 74

increased peak inspiratory pressures, uneven chest excursion, decreased breath sounds on one side, ETCO2 decreases, tachycardia, hypoxemia.

Front 75

what are some causes of ett obstruction?

Back 75

biting, kinking, foreign materials

Front 76

what is the most common postop anesthesia complaint?

Back 76

sore throat

Front 77

Which nerves cause laryngospasm?

Back 77

Sensory from superior laryngeal nerve and afferent responses from the recurrent laryngeal nerve

Front 78

what causes laryngospasm?

Back 78

secretions or stimulation of the larynx while the patient is in a light plane of anesthesia

Front 79

How do you treat laryngospasm?

Back 79

1-gentle positive pressure ventilation with 100% O2
2-if it continues succynocholine at 0.1 mg/kg IV
3- full laryngospasm may need aan intubating dose of succynochline 1-2 mg/kg IV

Front 80

which patients should you avoid using nasal airways?

Back 80

anticoagulated, patients with or suspected of having a basilar skull fracture, children with prominent adenoids

Front 81

in lightly anesthetized patients which type of airways oral or nasal is better tolerated?

Back 81

nasal

Front 82

can oral airways trigger laryngospasm in awake or lightly anesthetized patients?

Back 82

yes

Front 83

how do you measure for a nasal airway?

Back 83

from the nares to the meatus of the ear

Front 84

positive pressure ventilation in a non-intubated patient should be limited to how many cm of H2O?

Back 84

20. Greater than that will cause stomach inflation

Front 85

after insertion of an LMA, you suspect there is an obstruction of the airway. What would cause this?

Back 85

downfolding of the epiglottis

Front 86

what are some contraindications of an LMA?

Back 86

pharyngeal pathologies like an abscess, pharyngeal obstruction, full stomachs inmcluding pregnancy and hiatal hernia, low pulmonary compliance like COPD

Front 87

what contributes to resistance to airflow in the ETT?

Back 87

mainly tube diameter, but also tube length and curvature

Front 88

What size ett for a women?

Back 88

7-7.5

Front 89

what size ett for a man?

Back 89

7.5-9

Front 90

is feeling the pilot balloon on the ETT a reliable way to judge adequacy of cuff pressure?

Back 90

NO

Front 91

What is the earlies manifestation of bronchial intubation?

Back 91

increase in peak inspiratory pressures

Front 92

When doing a nasotracheal intubation, which way should the bevel of the tube be faced?

Back 92

laterally away from the turbinates

Front 93

what are some complications of extubating an awake patient?

Back 93

increased hr, coughing, increased CVP, Inc SBP, Inc ICP, inc intraoccular pressure, wound dehiscence and bleeding

Front 94

does and ETT or LMA have less hemodynamic consequences?

Back 94

LMA

Front 95

what medications can be give to attenuate the hemodynamic responses of laryngoscopy and intubation?

Back 95

lidocaine, remifentanil, alfentanil, or femtanyl 4-5 min before.

Front 96

what is the most commonb arrythmia noted during laryngoscopy and intubation? and what causes it?

Back 96

ventricular bigeminy. Caused by light sedation