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Flashcards in Respiratory Deck (40)
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0
Q

Functions of the larynx

A

Phonation, respiration, airway protection

1
Q

How do the blades work around the valeculla

A

Mac blade - slides into vallecula and will pull epiglottis forward.

Miller blade - actually picks up the epiglottis

2
Q

Where is the larynx located?

A

Cervical vertebrae 3-6

3
Q

How do the vocal chords attach?

A

Angles of the thyroid (A) and the arytenoids (P)

4
Q

Narrowest point of the airway in adult and child

A

Pediatric - cricoid cartilage

Adult - glottic opening

5
Q

List the 9 cartilages of the larynx

A
2 arytenoid
2 cuneiform
2 corniculate 
Thyroid
Cricoid
Epiglottis
6
Q

Describe laryngeal intrinsic muscle innervation

A

Recurrent laryngeal nerve via CN X

Except for the cricothyroid muscle which is innervated by the external branch of the superior laryngeal nerve

7
Q

Innervation of the tongue

A

Back 1/3 of tongue gets supply from CN IX (glossopharyngeal)

8
Q

Innervation of the nasopharynx

A

CN V (trigeminal)

9
Q

Muscles that open and close the glottis

A

Lateral cricoarytenoids - adduct
Arytenoids - adduct
Posterior cricoarytenoids - aBduct

10
Q

Muscles that put tension on the vocal cords

A

Cricothyroid - elongates vocal cords
Vocalis - shortens vocal cords
Thyroarytenoid - shortens vocal cords

11
Q

List extrinsic laryngeal muscles

A

Sternohyoid, omohyoid, thyrohyoid

The move the larynx as a whole

12
Q

Level of the carina

A

5th cervical vertebrae.

13
Q

Angles of trachea bifurcation

A

R side - 25 degrees

L side - 45 degrees

14
Q

PMH to ask about pre-op

A
Radiation to head and neck
Burns to head or neck
C-spine problems 
TMJ pain
RA
Abscess or tumors
Prior intubation or tracheotomy
Dysphasia or stridor
Snoring or OSA
Ankylosing spondylitis
15
Q

Steps for mallampati evaluation

A
Sit upright
Neck neutral
Open mouth
Stick tongue out far
Don't say AH
16
Q

What’s a good thyromental distance

A

4 finger breadths or 6-6.5mm

17
Q

what is the risk of using a head strap during intubation?

A

May cause facial nerve palsies with nerve compression

18
Q

what does the sniffing position do?

A

aligns all all three axis: oral, pharyngeal, laryngeal

19
Q

what is the goal of supplemental oxygen pre-intubation?

A

increased the FRC of Oxygen and decrease the nitrogen in FRC

20
Q

during RSI, how can you pre-oxygenate?

A

4 vital capacity breaths in 30 seconds

21
Q

How long should you give O2 in a normal pre-surgical intubation?

A

3-5 minutes of 100% O2 at >5L/min

22
Q

what size tube can you place over an #4 LMA?

A

6 OETT

23
Q

what is a major complication of oral airways?

A

LARYNGOSPASM, bleeding, soft tissue damage

24
Q

what are some contraindications to nasal airway insertion?

A

epistaxis, nasal trauma, basal skull fractures, anticoagulation, adenoid hypertrophy

25
Q

How far down do you want your OETT to be?

A

4 cm above the carina, 2 cm below the vocal cords

about 23 cm in males and 21 cm in females

26
Q

what are is the sensory innervation of the airway?

A

glossopharyngeal (back 1/3 of the tongue), recurrent laryngeal, internal branch of the superior laryngeal

27
Q

What is the motor innervation of the airway?

A

external branch of the superior laryngeal nerve (above the cords), recurrent laryngeal nerve (below the cords)

28
Q

what are some major complications of tracheal intubation?

A

trauma to airways, esophageal intubation, laryngospasm, sore throat, endobronchial intubation

29
Q

what is the induction sequence for tracheal intubation?

A

pre-oxygenation, sniffing position, monitors, induction agent, test ventilation, paralytic drug, eyes taped, mask-bag ventilation until muscle movement stops, laryngoscopy, intubate, confirm ETT placement with bilateral breath sounds and ETCO2, ventilate with bag or machine, maintenance anesthetic, tape OETT

30
Q

what is a major indication for an airway block?

A

an awake intubation and/or a suspected difficult airway

31
Q

what are 2 major complications for airway blocks?

A

systemic toxicity and hematoma formation

32
Q

what does a transtracheal block do?

A

blockes RLN

anesthesia below the vocal cords

through the cricothyroid membrane

33
Q

What does a superior laryngeal block do?

A

blocks internal SLN and the supraglottic region

goes through the thyrohyoid membrane

34
Q

What anatomical landmark are you looking for in a SLN block?

A

the cornu of the hyoid bone.

Then go 1/4 inch caudal and 1/4 inch medial

35
Q

What spread transtracheal anesthesia?

A

coughing

36
Q

what is one important feature of SLN blocks?

A

they need to be done bilaterally

37
Q

When would you do a glossopharyngeal nerve block?

A

when local anesthetic on the back of the throat is not enough

38
Q

what should you aspirate during a glossopharyngeal block?

A

nothing… if you get air, you’re too deep

if you get blood, pull needle out and redirect medially

39
Q

What is a common alternative to a glossopharyngeal block?

A

nebulized lidocaine