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135 Cards in this Set
- Front
- Back
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What is a major skill CRNA need to hone?
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mask ventilation
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what population is particularly prone to difficult airways and GA is avoided in these patients for this reason
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obstetric population
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what type of intubation is impossible with blood in the airway?
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fiberoptic
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This fracture is the least problematic for airway and is around the level of the maxilla
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Le Forte I
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This fracture is not an airway emergency and forms a pyramid fracture around the nasal bone
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Le Forte II
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This type of fracture changes the way we accomplish the airway and is a total dissociation of the forehead from the rest of the head down.
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Le Forte III
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This is an area below the ear lobes were pressure is exerted in order to break a laryngospasm
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mastoid process
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Is is important to position the head how?
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"sniffing postion" head higher than chest and thorax
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What are pediatric problems relating to skull structures and the airway
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they have large heads in relationship to their body
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What is the most common cause of obstruction in the airway?
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tounge
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what arteries are potential sources of bleeding in the nose
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sphenopalatine artery, superior labial and lateral nasal arteries and anterior and posterior ethmoid arteries
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what separates the nasal bone from the brain?
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cribiform plate
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If a patient has a head injury or facial trauma you should assume there is damage to what structure?
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cribiform plate
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what two things are never done if there is an interruption in the cribiform plate?
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no nasal intubation and no NG tube
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how long should a nasal airway be?
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measure from tip of the nares to the earlobe
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u shaped bone btwn mandible and larynx
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hyoid bone
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base of the tongue attaches to what
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hyoid bone
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blood supply to the tonsils
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tonsillar branch of the facial artery
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where is the vallecula?
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oropharynx
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the depression between the median and lateral glossoepiglottic folds
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vallecula
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when using a mac blade where is the blade tip placed?
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vallecula
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will you see the epiglottis when you intubate using at mac blade?
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yes
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what is the narrowest part of the adults larynx?
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glottis (level of the vocal cords)
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the adult larynx is located where?
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3rd-6th cervical vertebrae
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Where is the narrowest part of the larynx in a pediatric patient?
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cricoid cartilage
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If a tube passes through the vocal cords with ease on an adult does that alone mean the tube is the right size?
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no, because the narrowest part of their larynx is the cricoid cartilage
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what lies anterior to the larynx?
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epiglottis
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what lies posterior to the larynx
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arytenoid cartilages
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what lies lateral to the larynx
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aryepiglottic folds
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leaf like single cartilage that hangs over the airway
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epiglottis
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this sits proximal to the cricoid cartilage
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thyroid
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what are the 3 paired cartilages?
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arytenoid, cuneiform, and corniculate
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what are the 3 single cartilages
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thyroid, cricoid, and epiglottis
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This cartilage is shaped like a signet ring and lies inferior to the thyroid cartilage
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cricoid cartilage
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what is the only complete cartilaginous ring in the upper airway?
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cricoid cartilage
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what is a potential source for edema and post op complications in the pediatric population?
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cricoid cartilage because it is the smallest part of the airway and it is the only complete cartilaginous ring.
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This connects the cricoid cartilage to the thyroid cartilage
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cricothyroid membrane
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what is the epiglottis made of?
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elastic tissue rather than hyaline tissue
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does the epiglottis ever ossifie?
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no, because it is is made of elastic
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what are the hallmark signs of epiglotitis?
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resp. distress and drooling
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the three paired (arytenoid, corniculate, and cuneiform) cartilages lie where in regards to the airway?
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posterior (up from them is the airway)
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what is the mine difference between the esophagus and the vocal cords?
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vocal cords have cartilages around them there is no cartilages around the esophagus
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small, pyramid shaped cartilages
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arytenoid cartilages
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What muscles ABDUCT vocal cords?
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posterior cricoarytenoid muscles
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What muscles adduct vocal cords
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lateral cricoarytenoid muscles
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you always want function of what muscles of the larynx
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posterior cricoarytenoid muscles because the abduct the vocal cords
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what do the posterior cricoarytenoid muscles do
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abduct the vocal cords
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what do the lateral cricoarytenoid muscles do
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adduct vocal cords
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what happens if you loose function of your posterior cricoarytenoid muscles?
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asphyxiation
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the glossopharyngeal nerve (CNIX) provides what?
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sensation to the posterior 1/3 of the tongue
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what does the lingual nerve do
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provides sensation to the anterior 2/3 of the tongue
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what does the facial nerve do? (CNVII)
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taste
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what does the hypoglossal nerve do?
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intervates all of the muscles of the oral cavity except the palatoglossus muscle
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what never intervates the palatoglossus muscle?
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vegas (X)
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what CN is the glossopharyngeal nerve?
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IX
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what CN is the facial nerve?
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VII
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what CN is the hypoglossal nerve?
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VII
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what bone is important to the oral cavity because several nerves transverse this bone making it important to airway intervation.
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hyoid bone
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the nerve supply to the larynx is from where?
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recurrent laryngeal nerve and the superior laryngeal nerves
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the superior laryngeal nerve and the recurrent laryngeal nerve are derived from what nerve?
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vegas
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what are the two branches to the superior laryngeal nerve?
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internal and external branch
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which branch of the superior laryngeal nerve is responsible for motor?
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external branch
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what does the external branch of the superior laryngeal nerve innervate?
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cricothyroid muscle
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the internal branch of the superior laryngeal nerve allows for what?
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sensory to posteror aspet of tongue base to vocal cords
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sensory below the vocal cords is supplied by the
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recurrent laryngeal nerve
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what is very noxious for the superior laryngeal nerve
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blood...could lead to laryngospasm
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the noise heard prior to a laryngospasm occurs because of what?
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irritation of the SLN (external branch) which changes the integrity of phonation
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stimulation of the ____ in the supraglottic region can cause involuntary closure of the vocal cords leading to a laryngospasm
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SLN (internal side senses, external side cause motor response)
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Innervation of the cricothyroid muscle by the external branch of the SLN allows for what
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phonation
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how do you break a laryngospasm
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100% O2, then positive pressure (continuous pressure on the bag) with a good mask seal. Also you can do a jaw thrust with pressure on the mastoid process
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if all fails when trying to break a laryngospasm what do you do?
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give succ .25/mg/kg
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the internal superior laryngeal nerve must be blocked when doing away things to the airway...what landmark is here (the interal branch is lateral and inferior)
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hyoid bone
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where is air warmed and humidified during normal breathings?
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Nares
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this connects the nasal and oral cavities to the esophagus an larynx
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pharynx
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this area functions in the modulation of sound and separates the trachea from the esophagus during swallowing
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larynx
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what mallampati score would be given to a patient where tonsillar pillars uvula and soft palate are seen?
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1
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what mallampati score would be given to a patient whose soft palate and fauces and uvula are visible?
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2
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what mallampati score would be given to a patient with base of the uvula visible and the soft palate
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3
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what mallampati score would be given to a patient with no soft palate visible?
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4
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what classification system is used to correlate the oropharyngeal space with the ease of direct laryngoscopy?
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mallampati
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what classification system is used to grade the laryngoscopic view?
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cormack and lehane score
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what does a grade 1 view look like?
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most of the glottis is visible
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in a grade 2 view what can be seen?
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posterior portion of the glottis
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in a grade 3 view what can be seen ?
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the epiglottis but not part of the glottis
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what is seen in a grade 4 view
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no airway structures
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interincisor gap (mouth opening) should be how large?
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3 finger breaths
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extension of the head on what joint is important for aligning the oral and pharyngeal axes to obtain direct line or vision during direct laryngoscopy
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atlanto-occipital joint
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what is the normal atlanto-occipital extension?
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35-45 degrees
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what is the normal thyromental distance?
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6cm or 4 fingerbreadths
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what is the area into which the soft tissues of the pharynx must be displaced to obtain a line of vision during direct laryngoscopy
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submandibular compliance
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how do you find the cricothyroid membrane?
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find the thyroid and move down the membrane should lie just below
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having a beard or no teeth make mask ventilation difficult because of ??
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inability to develop adequate positive pressure
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what will help mask ventilation in a patient with a beard or no teeth?
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oral airway
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where should the bottom of the facemask fit?
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between the lower lip and the chin
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prior to induction of anesthesia what should be done?
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pre-oxygeation to allow for prolonged duration of apnea without desaturation
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what it the goal of preoxygenation?
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end tidal O2> 90%, 3 minutes of tidal volume breathing
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a patient who is not obese and has no pulmonary dysfunction can maintain a SAO2 >90% for how long?
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8.5 min
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when providing face mask ventilation it is important to prevent pressure where?
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submandibular soft tissue because it can lead to airway obstruction
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it is important to do what with your left hand fingers when providing mask ventilation
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lift mandible into the mask (chin lift jaw thrust)
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which fingers apply counter pressure on the facemask
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thumb and index finger
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ventilating pressures should be less than what to avoid insuffflation of the stomach
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20 cm H2O
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if your assistant to mask ventilation is not trained in airway management how can they help>
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squeeze the bag while you mirror left hand with right on the mask
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would you provide an oral airway for a patient who is awake or lightly anesthtized?
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no, will cause gag reflex or laryngospasm
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when are nasal airways contraindicated
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in patients with coag or platelet abnomalities or those with basilar skull fractures
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the height of the operating table should be adjusted so that the patients face is near the level of the standing anesthesia providers _____
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xiphoid cartilage
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how might a provider help to facilitate exposure of the glottic opening?
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BURP backward, upward, right pressure
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what are the standard intubating blade sizes for an adult?
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mac 3-4 or miller 2-3
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what is an absolute contraindication for fiberoptic endotracheal intubation?
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lack of time
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why is fiberoptic endotracheal intubation so helpful
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because you can do it without general anesthesia
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what do you give to vasoconstrict the nasal mucosa
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3% lidocaine with .25% phenylephrine
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what patients can not be given the vasoconstrictors required for nasal intubation?
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pregnant women and some patients with heart disease
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what drug can cause methemoglobinemia?
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benzocaine
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what is the preferred topical local anesthetic ?
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lidocaine
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what is so different about the hyoid bone?
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it does not articulate with any other bone
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what do you inject the local anesthetic solution when doing a superior laryngeal nerve block
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between the hyoid bone and the thyroid cartilage...in the vicinity of the SLN
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what is the most used example of supraglottic airway device
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Laryngeal mask airway (LMA)
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what is the most frequent type of damage related to Direct laryngoscopy?
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dental trauma
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in an adult where can you tape the tube and assume it is in int he midtrachea?
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21-23cm
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what are the two most serious potential immediate complications after tracheal extubation?
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laryngospasm and inhalation of gastric contents
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who is at most risk for a laryngospasm
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patients who are extubated and still lightly anesthetized because their laryngeal reflexes are neither adequately suppressed nor recovered
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at about what age has a child's airway taken more adult airway characteristics
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10
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the narrowest portion of a child's airway
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cricoid cartilage
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what CN innervates the nasal cavity?
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trigeminal nerve V
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what two nerve branches from the trigeminal nerve CNV innervate the nasal cavity
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ophthalmic and maxillary...opthalmaic branches into the anterior ethmodial and maxillary branches into the sphenopalatine
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these nerves branch from the sphenopalatine ganglion to innervate the hard and soft palate
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palatine nerves
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what are the five functions of the nose
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respiration, humidification, olfaction, filtration, phonation
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blockage of what nerve needs to be completed before nasal intubation
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V1 (ophthalmic)
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what is the kiesselbachs plexus
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place in the nasal cavity where four arteries come together and from anastomosis. Place where 90% of nose bleeds occur
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what ligament attaches the pharynx to the base of the skull
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stylohyoid ligament
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functions of the pharynx
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passageway for air and food
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if there is a problem with this muscle choking will occur
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palatoglossus
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children with enlarged tonsils and adenoids are noted to be what kind of breathers
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mouth
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the palatine tonsils are located where?
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lateral walls of the oropharynx
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where are the pharyngeal tonsils located
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(adenoids) located in the nasopharynx just about and behind the uvula
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what is the source for post op bleeds from tonsillectomy
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pharyngeal venous plexus
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