Term
| What mneumonic helps you remember a person may be difficult to bag mask |
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Definition
BOOTS
B: Beard
O: OBESE
O: Old
T: Toothless
S: Snoring |
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Term
| what kind of trick can you do with a person with a beard who needs to be bag masked |
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Definition
| Place jelly over beard or place tegaderms. |
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Term
| What does STOP-BANG used for and how many have to be present for a positive correlation? |
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Definition
SLEEP APNEA - Stop - Bang --> Need three or more for positive indicator.
S: Snoring
T: Tired all the time
O: OBserved periods of apnea
P: Pressure is HIGH
B: BMI >35
A: Age > 50
N: Neck Circumference >40
G: Gender - Male |
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Term
| What anatomical structures surround the epiglottis |
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Definition
1. Anterior to the epiglottis is the hyoid bone
2. Superior to the epiglottis is the vulecuela and pharynx
3. Inferior to the epiglottis is the vocal cords
4. posterior to the epiglottis is the spinal cord. |
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Term
| The esophagus is anterior or posterior to the trachea? |
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Definition
| Posterior to trachea!!! Hence why you can apply cricoid pressure to prevent aspiration. The posterior portion of the this ring cartilage is larger than the anterior portion and flat (lamina) which makes for a great flat plate to compress the esophagus directly behind it. |
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Term
| Describe the anatomy of the cricoid cartilage and why it is different than tracheal cartilage and how that helps with RSI |
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Definition
| Tracheal cartilage rings are U shape and the back of the trachea is soft and a longitudinal muscle. Versus the cricoid cartilage is hard all the way around. Since the back is hard too it can stay formed and compress the esophagus to help with cricoid pressure. |
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Term
| Describe the anatomy of the cricothyroid and why it makes a good location for a crash airway |
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Definition
| The cricothyroid is not big only 0.9/3.0 cm in size for adults. It is a soft point with good land marks and no major blood vessels where you can perform a crash airway. |
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Term
| the cricoid cartilage sits around what cervical vertebrae? |
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Definition
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Term
| The vocal cords sit above or below the cricothryoid membrane |
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Definition
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Term
| Right main Bronchus is __ CM long and angles at ___ degrees |
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Definition
| right main is 2.5 cm long, and angles at 25 degrees |
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Term
| Left main is __ cm long and angles at ___ degrees |
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Definition
| left main is 5 cm long and angles at 45 degrees |
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Term
| describe the nerves that innervate the vocal cords and area of the pharynx, larynx and trachea. |
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Definition
| Trigemminal nerve does nasal, naso-pharynx and upper palate, Glossopharyngeal does oral, oropharynx and tongue, Vagus does inferior to epiglottis. |
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Term
| Describe branches of the vagus nerve in your airway |
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Definition
| Vagus branches into the superior laryngeal nerve and recurrent laryngeal nerve. The recurrent laryngeal nerve is responsible for opening your vocal cords. The superior laryngeal branches into the internal and external laryngeal branches. The internal Laryngela branches supply sensory while the external supplies muscle control to the cricothyroid muscle to close vocal cords |
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Term
| Bilateral damage to the superior laryngeal nerves increases risk for? |
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Definition
| Bilateral damage to the superior laryngeal nerves reduces the ability for the vocal cords to close increasing the risk of aspiration. |
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Term
| What muscle opens the vocal cords? What nerve innervates this muscle? |
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Definition
| The recurrent laryngeal nerves supply the other muscles of the vocal cords, including the posterior cricoarytenoid muscle which is the only muscle which opens the vocal cords. |
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Term
| Bilateral damage to the recurrent laryngeal nerves will cause? |
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Definition
| Bilateral damage to the recurrent laryngeal nerves can comprimise the airway as the posterior criocoarytenoids cannot open them. Now the superior layrngeal nerves are unopposed causing the vocal cords to stay closed = stridor! Airway emergency. |
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Term
| what is the larynx made up of |
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Definition
| larynx is made up of multple cartilages, muscles and the vocal cords. It is situated between the hyoid bone and trachea. It is made up of 9 cartilages, 3 paired and 3 unpaired. 3x paired are the artyenoid cartilages, corniculate cartilages, cuneiform cartilages, 3 unpaired are the cricoid cartilage, thyroid cartilage, and epiglottis, larynx also includes the intrinsic and extrinsic muscles and vocal cords. |
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Term
| a partially open larynx allows for what to occur |
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Definition
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Term
| a completely closed larynx is important for? |
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Definition
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Term
| adam's apple also known as ? |
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Definition
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Term
| what are the two different ways the cricoid cartilage connects with the thyroid cartilage |
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Definition
1. via the cricothyroid membrane (anterior)
2. via the articulate between the thyroid cartilage inferior horn and the cricoid cartilage (posterior) |
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Term
| how do you remember which way the thyroid cartilage moves to either open or close larynx? |
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Definition
| Well when you eat you have to swallow. When you swallow the larynx is raised towards the incoming food to allow for the epiglottis to flap over the vocal cords and protect it. When you have a person tripoding and working really hard to breath they use accessory muscles such as the thyrosternal muscles which pull down the thyroid cartilage to open the airway as large as posible. |
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Term
| is the thryoid or cricoid cartilage a complete ring? IS the anteiror or posterior part larger in height? |
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Definition
| The Cricoid cartilage is a complete ring. The posterior portion is large in height and is what compresses the esophagus when you apply pressure to the front of the cricoid cartilage ring. |
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Term
| LEMON is for evaluating? What does it stand for? |
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Definition
LEMON mnemonic for difficult airway.
L: Look - anatomy? Obstructions?
E: Evaluate- 3:3:2 rule
M: Mallampati
O: Obstruction
N: Neck |
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Term
| The distance between teeth is important for airway assessment because? |
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Definition
| A mouth that can open 3 finger breadths has good temporomandibular joint mobility and will allow for easier visual field and insertion of instruments. |
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Term
| what does the thyroidmental distance represent when examining an airway? What is normal? If its not normal than what does that indicate? |
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Definition
| Thyromental distance is measured from the submentus to the supraprocess of your thyroid cartilage. It should be 4 finger breadths. If its less < 4x finger breadths than patient will likely have an anterior airway. |
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Term
| a class IV mallampati correlates with a ___% failed intubation rate |
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Definition
| 10% failed intubation rate |
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Term
| all obese people have a decrease in what lung volumes? |
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Definition
| Obese people have a decrease in functional residual capacity |
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Term
| Part of LEMON.. How do you assess N? |
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Definition
| N: Neck Mobility. Assess by asking patient to flex neck by placing chin on sternum. Then have them hyper-extend |
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Term
| what two pre-existing conditions put patients at greater risks for subluxution injuries with neck manuevers? |
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Definition
1. dwarves
2. rheumatoid arthritis |
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Term
| what are the three axis's of the airway? |
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Definition
1. Oral axis
2. larynx axis
3. pharyngeal axis |
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Term
| the larynx is perfectly aligned when you level the ___ with the ___ |
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Definition
| tragus leveled with the anterior sternal border will perfectly align the larynx axis for optimal views. This would be a "sniffing" positioning. |
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Term
| What is the mnemonic for identifying patients who are not appropriate to receive a laryngeal airways |
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Definition
RODS
R: restrictive mouth opening. Not good for LMA
O:Obstruction (epiglotitis, goieters, trauma penetrating object)
D: Distortion (edema, abnormal anatomy)
S: Stiff lungs (COPD, Asthma, Edema) |
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Term
| What mnemonic is for assessing feasibility of a cricothyrotomy |
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Definition
SHORT
S: surgery hx (scars,anatomy altered)
H: Hematoma present
O: Obesity
R: Radiation
T: Tumors (obstruct and vascular = bleed) |
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Term
| what are the airway connection diameters |
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Definition
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Term
| The epiglottic vallecula is? |
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Definition
| The epiglottic vallecula is a depression (vallecula) just behind the root of the tongue between the folds in the throat. |
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Term
| what's the difference in how you use the MAC blade compared to the Miller blade when performing a laryngoscopy? |
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Definition
| The MAC blade tip is placed into the vallecula and by lifting here the epiglotis follows. The Miller blade is longer and used to directly sweep under the epiglottis and lift the entire superior structure up and away for direct visualizaiton of the cords. |
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Term
| which blade Miller or MAC is better for a suspected anterior airway? |
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Definition
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Term
| Which blade is better with children; MAC or Miller? Why? |
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Definition
| Miller. Children have larger epiglottis so the blade is better choice to reach behind it and lift it up and out. |
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Term
| BURP for airway manipulation stand for? |
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Definition
BURP
B: Back: Push cricoid back
U: Up: Push cricoid UP and Back
R: Right: Push cricoid up towards the back and to the right
P: Pressure: maintain pressure thorugh first three steps. |
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Term
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Definition
| 5 years or older, disposable blade, screen directly on scope. |
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Term
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Definition
| 60 degree angle with videa on a seperate screen infront of you |
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Term
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Definition
| A old school mirror scope to see larynx. SINGLE USE. Side channel to advance airway. Place tip of this device into vallecuela |
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Term
| How do you determine ETT size for children |
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Definition
Uncuff tubes: 4 + (Age / 4)
Cuffed tubes: {4 + (Age / 4)} - 1 |
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Term
| what special design feature is at the end of the ETT to prevent obstructions while its inside a patient from either hitting the wall or mucus pluggin? |
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Definition
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Term
| contraindications for a LMA |
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Definition
| Pharyngeal pathology like abscesses, epiglottis, obstructions, full stomach, hiatal hernia pts, prego patients, poor pulmonary compliance. |
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Term
| when placing a combitube how do you know proper depth? |
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Definition
| Teeth should be between lines |
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Term
| Which end of the combitube is suppose to go into the trachea? |
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Definition
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Term
| what are some contraindications for using a LMA |
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Definition
| Pharyngeal pathology like abscesses, epiglottis, obstructions, full stomach, hiatal hernia pts, prego patients, poor pulmonary compliance. |
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