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89 Cards in this Set
- Front
- Back
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Closed claim study results
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Closed claim study results
87 of 266 claims involved larynx VC paralysis,artenoid dislocation,hematoma 80% associated with routine intubation |
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Airway injury adverse outcomes [4]
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death
nerve injury brain injury airway injury |
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upper airway consists of?
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Nose
Mouth Pharynx Hypophayrnx Larynx |
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lower airway consists of?
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Trachea
Bronchi Bronchioles Terminal Bronchioles Respiratory Bronchioles Alveoli |
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functions of nose?
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Humidification of air
1 liter of moisture added Fossa provides large surface area for warming Filtration Secretions have bactericidal properties Rationale for using HME in circuit |
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Nose Blood supply?
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Branches of 3 main arteries;
Maxillary (shpenopalatine), Opthalmic Facial(Septal) |
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nose nerve supply?
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Nasopalatine & ethmoid branches of facial nerve (also supply nasopharynx, septum, & palate).
Sensory is supplied from ophthalmic and maxillary division of trigeminal |
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nasal sensory nerve?
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ophthalmic and maxillary division of trigeminal
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nasal sympathetic innervation?
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Superior cervical ganglion
Results in vasoconstriction and shrinkage of nasal tissue. General anesthesia may cause engorgement of tissue increasing likelihood of bleeding |
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nasal parasympathetic innervation?
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Parasympathetic innervation
7th cranial nerve Pterygopalatine ganglion |
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what separates the mouth from the nasal passages?
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hard and soft palate
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what fills most of the oral cavity?
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tongue
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what structure 'guards' the oropharynx?
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uvula
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what structure[s] are in the soft tissue at the base of the tongue?
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tonsils
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what may obstruct the airway in an obtunded patient?
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tongue
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3 parts of pharynx?
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nasopharynx
oropharynx hypophyarynx |
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nasopharynx mucosa sensory innervation?
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maxillary nerve
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Bound superiorly by base of skull & inferiorly by soft palate?
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nasopharynx
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what straucture is anterior to C1?
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nasopharynx
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What lies at C2 to C3
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oropharynx
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what is bound superiorly by soft palate & inferiorly by epiglottis?
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oropharynx
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what opens into mouth anteriorly, through anterior and posterior tonsillar pillars?
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oropharynx
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what can occasionally impede ETT if infected?
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oropharynx
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what lies posterior to the larynx?
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hypopharynx
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what is bound by the superior border of epiglottis & inferior border of cricoid cartilage at C5-C6 level?
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hypopharynx
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the upper esophageal sphincter lies at lower edge; arises from cricopharyngeous muscle?
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hypopharynx
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what is the common pathway for food and respiratory gases?
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pharynx
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Patency is vital to patency of airway and gas exchange?
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pharynx
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Allows only air and prevents secretions and food from entering trachea?
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larynx
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Organ of phonation?
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larynx
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Begins with epiglottis and extends to cricoid cartilage?
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larynx
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Composed of cartilages; 3 paired--arytenoid, corniculate, & cuniform; 3 unpaired– thyroid, cricoid, & epiglottis?
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larynx
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Begins C3 & C4 and ends at cricothyroid muscle (C6)?
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larynx
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3 paired cartilages?
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3 paired--
arytenoid corniculate cuniform |
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3 unpaired cartilages?
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3 unpaired–
thyroid cricoid epiglottis |
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Anterior and lateral larynx formed by?
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thyroid cartilage
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Posterior border of larynx formed by?
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cricoid cartilage
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Internal to the larynx are? [3]
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articulating cartilages
arytenoids epiglottis |
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where are the Vocal cords?
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larynx
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what is the triangular opening between VC?
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Rima glottidis
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what sits above glottic opening, closes during swallowing?
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epiglottis
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Single cartilage leaf or tear shaped?
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epiglottis
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pouchlike area between median and lateral folds?
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valleculae
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Space between epiglottis and base of tongue is?
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superior vallecula
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Tip of properly placed Mac blade rests here?
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superior vallecula
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Narrowest part of Adult airway?
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glottic opening
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Narrowest part of child's airway?
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Narrowest at cricoid level
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larynx facts
Children under 10 years. [4] |
Narrowest at cricoid level
Lies anterior C3-C5 VC more angled Epiglottis less rigid |
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Intrinsic muscles of the larynx control?
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Intrinsic muscles control tension of vocal cords and open/closure glottis
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Extrinsic muscles connect larynx with ________ and adjust position of _______ during phonation, breathing and swallowing
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hyoid bone
trachea |
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what forms the true VC?
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Thickened inner edges of the cricothyroid ligament (vocal ligament)
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what connects the cricoid, thyroid, & arytenoid cartilage?
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Cricothyroid ligament (true cords)
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The False cords are?
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Fibroelastic membrane beneath laryngeal mucosa
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The lower free border of the vestibular ligament forms?
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vestibular folds or False Cords
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motor and sensory innervation of the larynx?
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vagus
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sensation above cords, what nerve?
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Superior laryngeal nerves
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sensation below cords, what nerve?
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Recurrent laryngeal nerves
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innervation of the Posterior 1/3 tongue, uvula, soft palate, pharynx?
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Glossopharyngeal Nerve
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innervation of the laryngeal epiglottis, vallecula, vestibule, aryepiglottic fold, posterior rima glottidis?
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Superior Laryngeal Nerve
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Laryngeal Spasm is a?
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Polysynaptic involuntary reflex
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Stimulation of superior laryngeal nerve in supraglottic region can induce?
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protective closure of glottis
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nerve endings in the larynx are sensitive to? [3]
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touch
heat chemical stimuli |
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“Went down the wrong tube” reflex?
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Polysynaptic involuntary reflex
glottic closure |
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Begins at inferior border of cricoid and extends to carina
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trachea
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Trachea [5]
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Begins at inferior border of cricoid and extends to carina
10-20 cm long in adult Cricoid cartilage is only complete ring Remaining 16-20 cartilaginous rings are C shaped to allow swallowing Cartilaginous rings continue in bronchi until bronchioles |
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Bronchi
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Right and Left division of trachea
Right bronchi bifurcation is 25-30 degrees; lobe 2.5 cm from carina ETT, suction catheter, foreign bodies more readily enter Left bronchi bifurcation is 45 degrees; approx 5 cm before branches. Carina is RICHLY innervated, and sensitive to stimulation |
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Right bronchi bifurcation is _____ degrees?
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25-30
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Left bronchi bifurcation is _____ degrees?
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45
approx 5 cm before branches. |
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Carina is _____ innervated, and _______ to stimulation
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richly
sensitive |
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Right and Left division of trachea?
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bronchi
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the most important factor in good mask ventilation is?
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a good fit
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what causes AW obstruction in muscle relaxation?
treat with? |
Tongue falls back
Chin lift |
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Laryngospasm
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Closure of vocal cords
Partial – high pitched phonation Total – no sound, tracheal retraction, nostril flaring |
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tracheal intubation recommended for?
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Compromise/ inaccessibility of patient airway
Long surgical procedure Surgical procedures involving head, neck, abdomen, or chest Need for positive pressureInability to maintain airway with mask or other airway device Risk of aspiration Pregnancy Disease process involving airway |
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can both orotracheal and nasotracheal inubatiopn be accomplished awake or asleep, with direct, fiber optic or blind?
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YES
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Tracheal Intubation
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Elevate patient head - “Sniffing Position”
OR table position head at your xiphoid Adequate muscle relaxation Open mouth – scissor technique Insert laryngoscope right, sweep left Miller vs MAC ??? And correct size “BURP”- backward, upward, rightward pressure |
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Tip advanced beneath epiglottis, which blade?
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miller
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Tip advanced into vallecula and lifted, which blade?
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mac
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indication for nasotracheal intubation?
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oral procedures
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NRAE tube & Placement [3]
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Preparation of nares!!!
Magills forceps Direction of tube altered by Rt/Lt rotation |
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Nasotracheal Contraindications [4]
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Intranasal abnormalities
extensive facial fx. basilar skull fx. coagulopathy |
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what do muscle relaxants do to your AW?
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Remove protective ability of airway
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Confirmation of ETT placement [6]
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Visualize tube pass through cords
Equal, bilateral breath sounds Observation of chest rise/fall Water condensation in tube Movement of reservoir bag End-tidal CO2 |
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side effects of ETT? [3]
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Hypertension and Tachycardia
Increased intracranial pressure Increased intraocular pressure |
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Why do an RSI?[3]
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Crash induction
Secure airway quickly Reduce risk of aspiration |
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Cricoid Pressure AKA?
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Sellicks Maneuver
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Cricoid Pressure [4]
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Controversial whether effective
Use during RSI as long as doesn’t impede airway management Apply before loss of consciousness, do not release until ETT placement confirmed Only trained individual should apply |
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Cricoid Pressure, extras
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Pre-oxygenate x 5 minutes
Four deep breaths – 30 seconds Three VC breaths with 100% O2 If concerned about ability to ventilate, ventilate gently with cricoid pressure Release cricoid if active vomiting |
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Laryngeal Mask Airway [7]
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Can be used in place of mask
Inserted blindly into posterior pharynx Sits in hypopharynx above epiglottis after insertion Seals airway over larynx after inflation If over inflated can open esophageal sphincter Does not protect against aspiration Do not use positive pressure >25 torr! |
