IHS Test 2 Flashcards

Question	Answer
Three Regions of the Pharynx	Nasopharynx Oropharynx Larynx
Name the sensory innervation of the Nasopharynx	Cranial Nerve V
Name the Parasympathetic Innervation for the Nasopharynx	Cranial Nerve VII
Name the sensory innervation to the oropharynx	CN IX (glossopharyngeal)
What is the landmark for placement of an emergency airway?	Cricothyroid membrane
Name the major visual landmarks in intubation	Epiglottis, Arytenoids, and Vocal Cords
What cartilage is the smallest diameter of the pediatric larynx?	Cricoid cartilage
Name the only complete cartilage in the airway	Cricoid cartilage
Name the 9 cartilages in the larynx	3 paired cartilages 2 arytenoids 2 corniculates 2 cuneiforms
What does a Mac blade fit into?	The vallecula
Name the muscle of the larynx that pulls the cords apart	Posterior Cricoarytenoids (these are the abductors)
What are the principal adductors of the vocal cords?	Lateral Cricoarytenoids
What are the two branches of the vagus nerve that innervate the larynx?	Recurrent laryngeal nerve (RLN) Superior laryngeal nerve (SLN)
Name the major motor innervation of the larynx	RLN
Name the major sensory innervation of the larynx	Internal SLN
Name the four major cranial nerves involved with the upper airway	V-trigeminal VII - facial IX - glossopharyngeal X - Vagus
Name the injury that causes complete unilateral recurrent laryngeal nerve injury	Cords compensate by shifting the midline toward uninjured side
What are the average distances from incisors to vocal cords? From vocal cords to carina?	13 centimeters
What is the sensory innervation of the trachea?	RLN
All of the bronchi make up what?	The conducting airways
Name from the trachea the pathways of the lungs	Trachea - right and left main bronchi - divide into lobes - segmental bronchi - terminal bronchioles
Which side of the lungs do foreign bodies more easily lodge?	The Right mainstem bronchus
How do you know a person's anatomical deadspace?	Know their weight in pounds
What is alveolar deadspace?	Volume of air that reaches the alveoli but still is not perfused by blood
How much alveolar headspace will a healthy adult have?	Virtually zero
What part of the tracheobronchial tree is very sensitive to sensory stimulation?	Carina
Name some of the chief concerns regarding pediatric airways versus adults	Larger relative tongue size Small airway diameter Higher metabolic rate Poorly developed muscles Small lung volumes More compliant chest wall Immature sympathetic nerves (Vagal)
A pediatric larynx is shaped like what?	A funnel
Define BONES	Beard Obesity No teeth Elderly (older than 55) Snores These make a person hard to bag.
Define LEMON	Look at head and neck Evaluate 3-3-2 Mallampati Obstruction Neck mobility (This is for difficulty to intubate)
Define RODS	Restricted mouth opening Obstruction at or below larynx Disrupted or distorted airway Stiffness - lungs or cervical spine This is a difficult extraglottic device
Define SHORT	Surgery-disrupted airway Hematoma Obese/Access Problems Radiation Tumor (difficult cricothyrotomy)
Name three conditions that will give you trouble with airway management	Micrognathia Macroglossia Acromegaly
What are two absolute contraindications to nasal intubation?	1. CSF rhinorrhea 2. Signs of basilar skull fracture
Mallampati Class I	Ease of intubation, Grade I 99 to 100 percent of the time; can visualize soft palate, fauces, uvula, anterior & posterior pillars; easy to intubate
Mallampati Class II	Soft palate, fauces, and uvula; possibly difficult to intubate
Mallampati Class III	Soft palate, base of uvula; probably difficult to intubate
Mallampati Class IV	Soft palate not visible; very difficult to intubate
What is TMD?	Thyromental distance, three fingers under the jaw
What is the ideal position for laryngoscopy?	Sniffing position
Name the three axes for intubation	Oral Axis: axis of the cavity of the mouth Pharyngeal axis: axis of the pharynx Laryngeal Axis: axis of cavity of the larynx
What Is Sellick's Maneuver?	Applying cricoid pressure; the posterior displacement cricoid cartilage against cervical vertebra; used to prevent aspiration of stomach contents
What does BURP stand for? When is it used?	Backward Upward Rightward Pressure Used for cricoid pressure
What's another term for pre-oxygenation	De-nitrogenation
What two things are necessary for effective face mask ventilation?	1. Gas-tight mask fit 2. Patent airway
Name some complications associated with face mask ventilation	Eye pressure - blindness, corneal abrasions Excessive mandible pressure, can damage facial nerve Pressure on mental nerves, can cause lower lip numbness Gastric distention
Name the five branches of the facial nerve	Temporal Zygomatic, Buccal, Mandibular, Cervical The Zebra Bit My Cat
Who shouldn't have bag mask ventilation?	1. Non-fasted patient 2. Morbidly obese 3. Intestinal obstruction 4. patient in trendelenburg position 5. Presence of tracheoesophageal fistula 6. Massive oropharyngeal bleeding
What is the problem with improper oral pharyngeal airway?	Can worsen obstruction by forcing tongue backwards
Why isn't an LMA a replacement for an ETT?	It can't protect against aspirating gastric contents
What is the maximum pressure inside an LMA cuff?	60 cm H20
Name side effects associated with LMA	sore throat overinflated cuff vascular compression nerve compression (lingual and trigeminal) Aspiration
What's the drug of choice when inserting an LMA?	Propofol
When should you deflate the cuff in an LMA?	After the patient is awake (and awake enough for removal -- coughing isn't enough); patient should open mouth on command
Name some examples of non-ionizing radiation	• Visible light • Infrared radiation • Microwaves • Radio waves • Ultrasound • Magnetic resonance imaging (MRI)
Name examples of ionizing radiation	Particulate: a and b particles Electromagnetic: y (gamma) and X-rays
What is the difference between y and X rays?	Their origin. Y (gamma) rays are emitted from nucleus during radioactive decay. X rays are artificially produced in X-ray machines.
What is the inverse square law?	The law that says the beam intensity is inversely proportional to square of its distance from source -- applies to X-rays
What is the predominant source of radiation exposure to anesthesia providers?	X-rays
What is an early or deterministic dose?	A substantial dose needed to produce responses in few hours to months. Severity of symptoms related to dose. Examples of damage include cataracts and skin injury.
What is a late effect of radiation exposure?	An effect from repeated low doses over long periods. Also called stochastic exposure.
What is the maximum yearly occupational exposure for providers?	No more than 5 REM per year
What is the lifetime effective dose for radiation exposure?	No more than 10 times the medical worker's age in years
What does ALARA stand for?	as low as reasonably achievable
What are some ways you can reduce radiation exposure?	Time (keep time source to minimum) Distance (physical separation) Shielding (wearing a lead apron)
What is the recommended distance from a patient during a procedure?	Three feet
What does LASER stand for?	Light Amplification by Stimulated Emission of Radiation
Name three ways laser light differs from visible light	Monochromatic (one wavelength) Coherent (oscillates in same phase) Collimated (narrow, parallel beam)
What color glasses do you wear for CO2 lasers?	Clear
What colored glasses do you wear for ND:YAG lasers?	Green
What colored glasses do you wear for KTP lasers?	Orange-red
What colored glasses to wear for argon laser?	Orange
What is the formula for converting Celsius to Kelvin?	C + 273 = K
What is the formula for converting Fahrenheit to Celsius?	5/9(F-32) = Celsius
What is the formula for converting Celsius to Fahrenheit?	(9/5 X C) + 32 = Fahrenheit
How do you calculate Ideal Body Weight for Men? For women?	Men: 106 + 6 pounds for every inch over five feet Women: 105 + 5 pounds for every inch over five feet
How do you calculate mean arterial pressure (MAP)?	(2XDiastolic + Systolic) / 2 = Mean arterial pressure
What is the formula to calculate amount?	Amount = concentration x volume
How often should you record BP and heart rate?	Every five minutes
What lead is sensitive to inferior wall ischemia?	Lead II; Lead II is also good at recognizing dysrhythmias
What lead views the anterior and lateral portions of the ventricle?	Lead V5 - 70 percent of ischemic events can be detected in a 5-lead system
What three leads increase sensitivity to ischemia to 96 percent?	Leads II, V5, and V4
What are the leads detected for Inferior, Lateral, and Anterior issues?	Inferior - II, III, and aVF Lateral - I, aVL, V5, and V6 Anterior - V1 - V4
Name some indications for invasive arterial B/P monitoring	– Hypotensive anesthetic technique – Anticipated wide fluctuations in B/P – End‐organ disease necessitating precise beat‐to‐ beat B/P regulation – Need for multiple blood/ABG samples
What are some contraindications Arterial BP monitoring?	Poor collateral blood flow (Allen’s Test) – Preexisting vascular insufficiency (Raynaud’s Phenomenon)
What is the most common site for arterial BP?	Radial artery -- use Allen's test for collateral flow first.
When should you use the femoral artery? What is a risk for femoral artery?	Low-flow states (Low bp's); local and retroperitoneal bleed and infection; Also risk for aseptic necrosis of femoral head in children
Name some indications for inserting central line/CVP monitoring?	– Monitoring of fluid status/fluid shifts (CVP) – Need for hyperalimentation – Venous air embolism (VAE) aspiration – Pacing – Lack of peripheral IV access – Vasopressor drug administration – Expected large blood loss (Trauma Line)
What are some contraindications for CVP monitoring?	Contraindications – Renal cell tumor extension into right atrium – Fungating tricuspid valve vegetations – Anticoagulation therapy, bleeding disorders – Ipsilateral carotid endarterectomy
Is CVP a good indicator of LV functiON?	No. And it also shows increased readings with right ventricular infarction and tricuspid valve disease
What is the most common site for IV cannulation?	Right internal jugular vein. Left IJ is usually smaller in 1/3 of the population.
What are some possible complications of of central line insertion?	• Infection • Accidentalcannulationofcarotidartery • Nervedamage • Airembolus • Hematoma • Pneumothorax,hemothorax • Chylothorax • Cardiacperforation • Cardiactamponade
What does the A-wave represent in a CVP waveform?	Atrial contraction; it's absent in a-fib
When does the C-wave occur on a CVP waveform?	cwavesoccurwhenthe ventricles begin to contract – Caused partly by slight backflow of blood into the atria at the onset of ventricular contraction, but mainly by bulging of the tricuspid valve backward toward the atria because of increasing pressure in the RV
What do giant V waves mean on a CVP?	Tricuspid regurgitation
What do cannon A waves mean on a CVP?	AV dissociation - right atrium contracting against closed tricuspid valve
What system determines the overall level of CNS activity, including wakefulness and sleep?	Reticular Activating System
Most of our sleep is what wave sleep?	It's slow-wave sleep, which is also known as delta-wave sleep.
What is desynchronized sleep, and what waves are characterized by it?	Desynchronized sleep, which is known by beta waves on the EEG. These are similar to those that occur during wakefulness.
What type of waves disappear during sleep?	Alpha waves, they are typical of an awake, resting state
What are theta waves?	They occur in healthy children during sleep and in general anesthesia.
What are delta waves?	These waves occur in deep sleep, during general anesthesia, or in the presence of organic brain disease; this suggests the cerebral cortex is released from the RAS-activation.
Do opioids alter BIS number?	No. And BIS doesn't monitor muscle relaxation, but a lack of can alter your reading.
What do you know about BIS clinical endpoints?	Light to moderate sedation = 80 to 100 Deep sedation = 70 General Anesthesia = 40 to 60 Deep Hypnotic State = less than 40 0 = Flat line So, lower the number, less brain activity
What could cause a sudden BIS drop?	Decrease in surgical stimulation Increase in agent administration Receiving NMBA Hypothermia Drop in BP/Ischemia
What can cause a sudden increase in BIS?	patient shivering, tightening or twitching NMBA wearing off Patient has pacemaker EMG and high-frequency artifacts increasing stimulation affected IV lines/vaporizers
Where is temperature best monitored?	External auditory meatus, which is close to the hypothalamus
What are some harmful effect of hypothermia?	Deleteriouseffectsofhypothermia – Cardiac arrhythmias and ischemia – Increased peripheral vascular resistance – Left shift of the hemoglobin‐oxygen saturation curve – Reversible coagulopathy (platelet dysfunction) – Postoperative protein catabolism and stress response – Altered mental status – Impaired renal function – Decreased drug metabolism – Poor wound healing → increased incidence of wound infection
What are some ways you can make the temperature warmer?	– Forced‐air warming blankets – Warm‐water blankets – Heated humidification of inspired gases – Warming intravenous fluids – Raising ambient operating room temperature – Low gas flows
What is the standard of care for monitoring oxygenation?	Pulse oximetry
What law is used to measure pulse oximetry?	Beer-Lambert Law
What do you know about the Beer-Lambert Law?	2 wavelengths of light are emitted by the pulse oximeter (spectrophotometric analysis) • 660 nm (red) • 940 nm (infrared) – Ratio of absorption of red/infrared light correlated to hemoglobin saturation – measures the difference between absorbed light by oxyhemoglobin relative to deoxyhemoglobin in a pulsatile (therefore arterial) bed – ratio of the two is analyzed by a microprocessor and oxygen saturation is displayed on a monitor
What factors influence accuracy of pulse oximeter?	– Low flow conditions • Hypotension – Motion artifact – Nail polish – Ambient light interference – Dysfunctional hemoglobin • Fetal hemoglobin • Hemoglobin S – Carboxyhemoglobinemia Methemoglobinemia – Methylene blue, indigo carmine
What are three ways you verify intubation?	Auscultation Chest excursion Confirmation of CO2 in expired gases
What are two potentially fatal conditions that may be indicated by capnographic changes?	Pulmonary Embolism (CO2) Malignant Hyperthermia (CO2)
What does the alpha angle indicate?	V/Q status of the lung
What does the beta angle indicate?	Extent of re-breathing
What are some possible reasons for No ETCO2?	DecreasedCO2 production/delivery – Hypothermia Decreased pulmonary perfusion – Hypovolemia – Hypotension – Pulmonary embolism – Decreased cardiac output (arrest) Altered alveolar ventilation – Hyperventilation – Apnea (accidental extubation/circuit disconnect) – Partial/total airway obstruction – Increase in dead space ventilation (V/Q mismatch) • Technical errors/Machine faults – Sampling line leak – Ventilator malfunction – Esophageal intubation • Certain clinical scenarios may warrant obtaining an ABG to compare ETCO2 with arterial CO2 to distinguish cause
What are the reasons for elevated ETCO2?	• Increase CO2 production/delivery (hypermetabolic states) – Fever – Sepsis – Hyperthyroid storm – Malignant hyperthermia – Shivering – Sodium bicarbonate administration – Tourniquet release – Laparoscopic surgeries • Venous CO2 embolism – Right‐to‐left shunts • Increased pulmonary perfusion – Increased cardiac output – Increased blood pressure Altered alveolar ventilation – Hypoventilation(inadequate ventilator settings) – Bronchialintubation – Mechanical/partialairway obstruction • Technical errors/machine faults – CO2 rebreathing • Exhausted CO2 absorber • Faulty unidirectional valve • Inadequate fresh gas flows – Leaksinthebreathingsystem – Machine/ventilator malfunction
What causes small breaths (curare clefts) in the ETCO2 waveform?	Causes include: – improperventilatorsettings – inadequate muscle paralysis – severehypoxia – patientwakingup – *pressure on the patient’s chest or ventilator malfunction
What does an elevated ETCO2 baseline indicate?	Indicates CO2 rebreathing – Abnormal with circle breathing systems – Suggests either exhausted CO2 absorbent or incompetent valves – Sudden elevation is contamination of the CO2
What is the relationship of alveolar ETCO2 to PaCO2?	End-tidal is less than arterial concentration (usually between 2 and 5 mmHg less)
What nerves are most frequently monitored in the peripheral nerve monitoring?	– The facial nerve – The ulnar nerve
What is the best nerve to monitor for onset of block?	Facial nerve - best monitors the response of the diaphragm (go to sleep closing your eyes)
What is the best nerve to monitor for recovery?	Ulnar nerve - more sensitive to relaxants than the diaphragm, (wake up, thumbs up)

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