366433.csv

"TYPE•Elastic cartilageGENERAL SHAPE•LeafARTICULATIONS•NoneATTACHMENTS•Hyoepigloticligament•ThyroepiglotticligamentFUNCTIONSProtects against food entering the larynx"

"STRUCTURE -OTHER•Superior cornu (horns) –suspend thyroid cartilage from hyoid bone•Inferior cornu (horns) –suspend cricoid cartilage from thyroid cartilageARTICULATIONS•Inferior cornu & cricoid cartilageATTACHMENTS•Thyrohyoid membrane cephalad•Cricothyroid membrane caudad•Vocal cords –midline

"STRUCTURE –PHYSICAL EXAM•Midline

"The nasopharynx

"The oropharynx extends inferiorly from the soft palate to the superior border of the epiglottis"

SLN)RLN DamageParalysisContraction"

"Know names "

"Numbering"

"•Anterior 2/3 –lingual nerve•Taste Fibers-Facial nerve (VII)•Posterior third –Glossopharyngeal nerve (IX)•Motor supply –Hypoglossal nerve (XII)•Superior Laryngeal nerve-minimal"

cricoid

"Rimaglottidisis the space b/w true vocal cords and arytenoidcartilages

"is the rimaglottidis

"•(PA) alveolar pressure•(Pa) arterial pressure•(Pv) venous pressure–Zone 1 –upper = PA>Pa>Pv–Zone 2 –middle = Pa>PA>Pv–Zone 3 –lower = Pa>Pv>PA"

"•PaO2 estimate

"•Normal O2 consumption is 250ml/minute•Normal O2 extraction is 25%•A decrease in DO2 typically causes cellular hypoxia leading to anaerobic metabolism which causes a lactic acidosis13"

"Trachea and Mainstem BronchiShorter and narrowerRight mainstem has less acute angleDiameter of larynx affected more by edema"

"The larynx is the organ that connects the lower part of the pharynx with the tracheaIt serves as a:–Valve to guard the air passagesespecially during swallowing–Maintenance of a patent airway–Vocalization"

"–1stbifurcation at carina -> R & L lung–R main bronchus less angled than L--------Easier to R mainstem intubation–RUL of lung only 2.5cm from carina–Walls contain smooth muscle

"•The most common reason for mechanism for hypoxemia is an increased A-a gradient"

"–R = 3 lobes

"–Double layer surrounding the lungs-------Visceral pleura –lung-------Parietal pleura –lines thoracic cavity–Interpleural space-------Small amount of lubricating fluid"

"–Clavicle to 8thrib anteriorly–10thrib laterally–T12 posteriorly"

"–Size is a function of both gravity and lung volume–Average diameter ~0.05-0.33mm–Largest alveoli at apex & smallest at base when upright–Gas exchange on thin side (~0.4μm thick)–Thick side provides support (1-2 μm)–50-100m2surface area for gas exchange"

"–Type I pneumocytes•--Flat

"•Pulmonary response to low PAO2•Can improve gas exchange by redirecting BF away from poorly ventilated areas

"–Lung volume at end of a normal exhalation–Measured by nitrogen wash-out

"•Forced Vital Capacity (FVC) (effort dependent)–--Measuring vital capacity as an exhalation that is hard and as rapid as possible•Forced Expiratory Volume (FEV1) (effort dependent)–--Forced volume in 1 second (can go to 2 or 3s)•Ratio of FEV1/FVC ≥80% in normal adults is proportional to degree of airway obstruction–--COPDers have a lower FEV1than normal"

"Memorize"

"Beard Facial scars Facial injuries/dressings Edentulous Any airway obstruction (e.g. after multiple DL's)"

"–For 1stL/M of O2 = 3%

"•What happens to the airway during an anesthetic?–--Unconscious patient –attempting to spontaneously breath but airway obstructed•---Management–----------O2–----------Airway support»------------->Physical maneuver –jaw thrust maneuver»------------->Instrumentation for physical support -OAW

"•A-a gradients depend on 3 things

"–Physical maneuver•--Jaw thrust maneuver•--Chin lift maneuver–Adjuncts for physical support•--Oral airway (OAW)•--Nasal airway (NAW)"

"•Malleable

"–Airway maintenance in the sedated and unconscious patient–Protects an endotracheal tube (ETT) from being bitten and occluded–Facilitates airway suctioning"

"–Berman OAW•----Body–------Central I beam–------Side air channels•----Flange–Guedel•----Body–------Central lumen•----Flange"

"–Oral airway too long•-----Obstructs larynx by forcing down epiglottis–Oral airway too short•-----Pushes tongue into airway–Vomiting and laryngospasm in the awake patient"

"•Adult–-Large: 8-9 mm Internal Diameter (I.D.)

"1.Esophageal intubation (if too long)2.Laryngospasm3.Vomiting (less likely than with OAW)4.Nasal mucosa injury and secondary blood aspiration"

"The distance from the thyroid cartilage to the mentum (tip of the chin) should be >6.5-7cm.Measurement: RulerNormal: > or equal to 6.5 cmSignificance: FOM space may be decreased

can be summarized in the word “OBESE”"

"(Mandibular angle –mental symphasis distance)Measurement: RulerNormal: > or equal to 9 cmSignificance: Limited space for soft-tissue displacement during DL

"(Prayer sign)Measurement: ObservationCause: glycosylation of tissue proteins –occurs in chronic hyperglycemiaSignificance: Joint mobility limitation also may exist with TMJ

"1. Mouth must open (at least a little).2. Three axes (tracheal

"Class IV: no uvula or soft palateYes

"•In most patients Direct Laryngoscopy results in a clear view of the larynx. The laryngeal view has been classified by Cormack and Lehane as follows: •Grade 1: Full view of the glottis•Grade 2: Only the posterior commissure is visible•Grade 3: Only the epiglottis is seen•Grade 4: No epiglottis or glottis structure visible"

"•Most surgery of head face or neck•Emergency Surgery•Muscle paralysis•Lengthy surgery•Thoracic surgery•Failure of mask anesthesia•Abnormal positions (prone)•Limited access"

"–Ability to open mouth 3 to 4 cm or two –three finger-breadths–Mallampati Class I–At least 6.5cm –three finger breadths from tip of mandible to thyroid notch w/neck extended"

examination

"BeardFacial scarsFacial injuries/dressingsEdentulousAny airway obstruction (e.g. after multiple DL's)"

"–Oral airway too long•---Obstructs larynx by forcing down epiglottis–Oral airway too short•---Pushes tongue into airway–Vomiting and laryngospasmin the awake patient"

"1.) particle related complication---particles must be cleared from the airway–Patient may develop acute airway obstruction–Severe hypoxemia2.) Acid Related Complication–Two phases:•---1.) immediate tissue injury•---2.) a later inflammatory reponse3.) Bacterial-related complications–Gastric and pharyngeal contents usually don’t contain bacteria–Antibiotics not usually used for preventative measures"

"–Ph 2.5–Volume 0.4 mL/kg (25 mL)"

"–1.) asymmetrical movement of chest wall–2.) increase in peak inspiratorypressures (PIP)–3.) CO2 waveform–4.) auscultation of chest"

"–Non-fasted patients–Risks of aspiration (GERD

"–May be used as a rescue airway and fiberoptic conduit when intubation is difficult

"–Use tidal volumes of approximately 8 ml/kg–Maintain peak inspiratorypressures within the maximum airway seal pressure

high airway pressures can cause the mask to leakSo reduce the airway pressure by: (4)"

"–Open sores–Abrasions–Scars–Chapped skin"

"•Finucane6.1•Ventilatorysupport (assisted or mechanical)•Protection of the airway•Ensuring airway patency•Anesthesia and surgery•Suctioning•Finucanetable 6.1 page 163"

"1.Flex the cervical spine (sniffing position)2.Extend the atlanto-occipital joint3.Open the mouth-----1.Scissor technique-----2.Pinky technique-----3.Natural opening4.Insert laryngoscope-----Right to left5.Displace the tongue-----•Right to left6.Elevate the epiglottis------Forward and upward motion7.Expose the vocal cords8.Guide the endotracheal tube through the vocal cords under direct vision –aka –your eyes see it pass through the vocal cords------Never take your eyes of the prize!upon positioning"

"–Performed using1.Direct vision –most common•---YOU seethe cords2.Indirect•---YOU see the cords through something else-----»Ex –--------Monitor

"–Introduce the blade right side of mouth–Blade remains lateral to the tongue–Elevate the epiglottis–Confirmation of endotrachealtube in trachea"

but the capnogramsuggests that tube is in esophagus –False/Negatives (5)"

"1.Poor or no chest movements2.Cyanosis developing within 10 minutes3.Failure to oxygenate4.Anomalous tube length"

"Partial Pressure oxygen (PIO2)PIO2=(PB-PH2O(water vapor))x FIO2PIO2= (760-47) x .21=149.7 mmHgPAO2 estimate = PIO2-(PaCO2/RQ)PAO2 estimate= FIO2 X 6"

"The total content of O2 in the blood (CaO2) is the sum of that in solution plus whatever is being carried by hemoglobinCaO2 content is (1.31 x Hbx SaO2) + (PaO2 x .003)Oxygen delivery (DO2) = Cardiac output X CaO2

"•Difference between capnographyand capnometry•Transpulmonarypressure = PIP -Plateau"

"–Inability to advance the mandible (prognathism)–Body weight greater than 110kg–Positive history of difficult intubation"

"Absolute Indication1) isolation of one lung----a) unilateral infection----b) Massive hemorrhage2) Control of the distribution of ventilation----a) Bronchopleural fistula----b) Bronchopleural cutaneous fistula----c) Giant lung cyst3) Unilateral bronchopulmonary lavage"

"Relative Indications1) Surgical exposure2) Upper lobectomy3) Aortic aneurysm resection"

"– Delivers a minimum set respiratory rate(RR)

"– Delivers a only a set rate (RR)

"– Ventilator augments each breath by a preset amount of pressure– No set TV

"– Applies preset pressure to the ETT during inspiration– TV varies with the mechanics of the respiratory system– Flow is provided until a preset pressure is reached

"– Standard I:E ratio is 1:2 or 1:3– IRV changes this to 1:1

""

if at all w/ regards to airway compliance  "

"Ch 49 MM"