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89 Cards in this Set

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Closed claim study results
Closed claim study results

87 of 266 claims involved larynx
VC paralysis,artenoid dislocation,hematoma

80% associated with routine intubation
Airway injury adverse outcomes [4]
death
nerve injury
brain injury
airway injury
upper airway consists of?
Nose
Mouth
Pharynx
Hypophayrnx
Larynx
lower airway consists of?
Trachea
Bronchi
Bronchioles
Terminal Bronchioles Respiratory Bronchioles Alveoli
functions of nose?
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
Nose Blood supply?
Branches of 3 main arteries;

Maxillary (shpenopalatine), Opthalmic
Facial(Septal)
nose nerve supply?
Nasopalatine & ethmoid branches of facial nerve (also supply nasopharynx, septum, & palate).
Sensory is supplied from ophthalmic and maxillary division of trigeminal
nasal sensory nerve?
ophthalmic and maxillary division of trigeminal
nasal sympathetic innervation?
Superior cervical ganglion
Results in vasoconstriction and shrinkage of nasal tissue.
General anesthesia may cause engorgement of tissue increasing likelihood of bleeding
nasal parasympathetic innervation?
Parasympathetic innervation
7th cranial nerve
Pterygopalatine ganglion
what separates the mouth from the nasal passages?
hard and soft palate
what fills most of the oral cavity?
tongue
what structure 'guards' the oropharynx?
uvula
what structure[s] are in the soft tissue at the base of the tongue?
tonsils
what may obstruct the airway in an obtunded patient?
tongue
3 parts of pharynx?
nasopharynx
oropharynx
hypophyarynx
nasopharynx mucosa sensory innervation?
maxillary nerve
Bound superiorly by base of skull & inferiorly by soft palate?
nasopharynx
what straucture is anterior to C1?
nasopharynx
What lies at C2 to C3
oropharynx
what is bound superiorly by soft palate & inferiorly by epiglottis?
oropharynx
what opens into mouth anteriorly, through anterior and posterior tonsillar pillars?
oropharynx
what can occasionally impede ETT if infected?
oropharynx
what lies posterior to the larynx?
hypopharynx
what is bound by the superior border of epiglottis & inferior border of cricoid cartilage at C5-C6 level?
hypopharynx
the upper esophageal sphincter lies at lower edge; arises from cricopharyngeous muscle?
hypopharynx
what is the common pathway for food and respiratory gases?
pharynx
Patency is vital to patency of airway and gas exchange?
pharynx
Allows only air and prevents secretions and food from entering trachea?
larynx
Organ of phonation?
larynx
Begins with epiglottis and extends to cricoid cartilage?
larynx
Composed of cartilages; 3 paired--arytenoid, corniculate, & cuniform; 3 unpaired– thyroid, cricoid, & epiglottis?
larynx
Begins C3 & C4 and ends at cricothyroid muscle (C6)?
larynx
3 paired cartilages?
3 paired--

arytenoid
corniculate
cuniform
3 unpaired cartilages?
3 unpaired–

thyroid
cricoid
epiglottis
Anterior and lateral larynx formed by?
thyroid cartilage
Posterior border of larynx formed by?
cricoid cartilage
Internal to the larynx are? [3]
articulating cartilages
arytenoids
epiglottis
where are the Vocal cords?
larynx
what is the triangular opening between VC?
Rima glottidis
what sits above glottic opening, closes during swallowing?
epiglottis
Single cartilage leaf or tear shaped?
epiglottis
pouchlike area between median and lateral folds?
valleculae
Space between epiglottis and base of tongue is?
superior vallecula
Tip of properly placed Mac blade rests here?
superior vallecula
Narrowest part of Adult airway?
glottic opening
Narrowest part of child's airway?
Narrowest at cricoid level
larynx facts
Children under 10 years. [4]
Narrowest at cricoid level
Lies anterior C3-C5
VC more angled
Epiglottis less rigid
Intrinsic muscles of the larynx control?
Intrinsic muscles control tension of vocal cords and open/closure glottis
Extrinsic muscles connect larynx with ________ and adjust position of _______ during phonation, breathing and swallowing
hyoid bone

trachea
what forms the true VC?
Thickened inner edges of the cricothyroid ligament (vocal ligament)
what connects the cricoid, thyroid, & arytenoid cartilage?
Cricothyroid ligament (true cords)
The False cords are?
Fibroelastic membrane beneath laryngeal mucosa
The lower free border of the vestibular ligament forms?
vestibular folds or False Cords
motor and sensory innervation of the larynx?
vagus
sensation above cords, what nerve?
Superior laryngeal nerves
sensation below cords, what nerve?
Recurrent laryngeal nerves
innervation of the Posterior 1/3 tongue, uvula, soft palate, pharynx?
Glossopharyngeal Nerve
innervation of the laryngeal epiglottis, vallecula, vestibule, aryepiglottic fold, posterior rima glottidis?
Superior Laryngeal Nerve
Laryngeal Spasm is a?
Polysynaptic involuntary reflex
Stimulation of superior laryngeal nerve in supraglottic region can induce?
protective closure of glottis
nerve endings in the larynx are sensitive to? [3]
touch
heat
chemical stimuli
“Went down the wrong tube” reflex?
Polysynaptic involuntary reflex

glottic closure
Begins at inferior border of cricoid and extends to carina
trachea
Trachea [5]
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
Bronchi
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
Right bronchi bifurcation is _____ degrees?
25-30
Left bronchi bifurcation is _____ degrees?
45

approx 5 cm before branches.
Carina is _____ innervated, and _______ to stimulation
richly

sensitive
Right and Left division of trachea?
bronchi
the most important factor in good mask ventilation is?
a good fit
what causes AW obstruction in muscle relaxation?

treat with?
Tongue falls back


Chin lift
Laryngospasm
Closure of vocal cords
Partial – high pitched phonation
Total – no sound, tracheal retraction, nostril flaring
tracheal intubation recommended for?
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
can both orotracheal and nasotracheal inubatiopn be accomplished awake or asleep, with direct, fiber optic or blind?
YES
Tracheal Intubation
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
Tip advanced beneath epiglottis, which blade?
miller
Tip advanced into vallecula and lifted, which blade?
mac
indication for nasotracheal intubation?
oral procedures
NRAE tube & Placement [3]
Preparation of nares!!!
Magills forceps
Direction of tube altered by Rt/Lt rotation
Nasotracheal Contraindications [4]
Intranasal abnormalities
extensive facial fx.
basilar skull fx.
coagulopathy
what do muscle relaxants do to your AW?
Remove protective ability of airway
Confirmation of ETT placement [6]
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
side effects of ETT? [3]
Hypertension and Tachycardia

Increased intracranial pressure

Increased intraocular pressure
Why do an RSI?[3]
Crash induction
Secure airway quickly
Reduce risk of aspiration
Cricoid Pressure AKA?
Sellicks Maneuver
Cricoid Pressure [4]
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
Cricoid Pressure, extras
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
Laryngeal Mask Airway [7]
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!