Principles- Airway Mega Quiz

The glossopharyngeal block involves moving the patient's tongue to the side and injecting Lidocaine on either side of the tongue to produce a block. This block is used to provide anesthesia to the tongue and throat region during certain medical procedures. It is not to be confused with the other options listed, which involve different nerve blocks or procedures.

The correct answer is the Interior Superior Layngeal nerve. This nerve innervates the area pictured in blue.

The criteria for extubating a patient who was very difficult to intubate include the patient being fully awake and having their protective reflexes intact. This is important to ensure that the patient is able to maintain their own airway and protect against aspiration. It is also recommended to use a jet stylet or fiberoptic scope during the extubation process. This allows for better visualization and control during the procedure. Deep extubation is recommended to prevent the patient from bucking and potentially biting the tube.

The proper technique for BMV'ing a patient with a normal airway involves holding the mask with the left hand using a C formation grip with the thumb and index finger. The other fingers should grasp the mandible and extend the atlantooccipital joint. This technique ensures proper placement and stability of the mask while allowing the patient to spontaneously ventilate.

TTJV stands for Transtracheal Jet Ventilation, which is a technique used to provide oxygenation via a high-pressure delivery system. It involves the insertion of a large bore IV through the cricothyroid membrane, allowing for direct delivery of oxygen into the trachea. This technique is often used in emergency situations where traditional methods of oxygenation are not effective or feasible.

The correct answer is Glossopharangeal (IX). The glossopharyngeal nerve is responsible for the sensory, afferent limb of the gag reflex. This nerve carries sensory information from the back of the throat and the base of the tongue to the brain. When the back of the throat is stimulated, such as by touching the uvula or the back of the tongue, the glossopharyngeal nerve sends signals to the brain, triggering the gag reflex.

Administering a higher amount of sevoflurane is not an appropriate intervention for a patient experiencing a laryngospasm. Sevoflurane is a volatile anesthetic that can induce or worsen laryngospasm. Increasing the concentration of sevoflurane would not help in relieving the laryngospasm and may even exacerbate the condition.

The diagram above is asking to identify what A represents. Looking at the options given, "Tongue" is the correct answer. The diagram does not provide any additional context or information, but based on general knowledge, the tongue is a muscular organ in the mouth that helps with speech, swallowing, and taste. Therefore, A in the diagram represents the tongue.

Mallampati class 2 refers to a moderate degree of airway obstruction. In this class, the soft palate, uvula, and tonsillar pillars are visible, but the base of the uvula is not visible. This indicates that the patient may have some difficulty in achieving a clear airway during intubation.

A wide palate would not put a patient at risk for a difficult airway because it refers to the width of the roof of the mouth, which does not directly affect the airway. Pregnancy, wearing a Halo device, and thyromental distance can all potentially contribute to a difficult airway.

Based on the information provided, the correct answer is Size 4. The size of the LMA chosen for a patient depends on their weight and height. Ms. Bowser weighs 52 kg, which falls within the range for a Size 4 LMA. Additionally, her height of 5'4" does not indicate a need for a smaller or larger size. Therefore, Size 4 is the appropriate choice for Ms. Bowser's minor foot surgery.

Retrograde intubation involves inserting a large gauge needle through the cricothyroid membrane and threading a wire cephalad to guide the endotracheal tube (ETT) into the trachea. This technique is used when traditional intubation methods are difficult or impossible, such as in cases of airway obstruction or limited mouth opening. By inserting the wire from below the vocal cords and then pulling it out through the mouth, the ETT can be guided into the trachea in a reverse direction. This allows for successful intubation even in challenging situations.

The correct answer is Uvula. The uvula is a small, fleshy, cone-shaped structure that hangs down from the soft palate in the back of the throat. It is composed of muscle and connective tissue and is covered by mucous membrane. The uvula helps to prevent food and liquid from entering the nasal cavity by closing off the nasopharynx during swallowing. It also plays a role in speech and the production of certain sounds.

Since the previous attempts at intubation and bag-mask ventilation (BMV) have failed, the next step should be to attempt inserting a FastTrach LMA or Combitube to assure an airway. These devices are alternative airway management tools that can be used when intubation and BMV are not successful. They provide a secure airway and can be inserted quickly and easily, making them suitable options in this situation. The other options mentioned, such as repositioning, using cricoid pressure, giving more muscle relaxant, using a straight blade and neck hyperflexion, or waking the patient up and canceling the case, may not be appropriate or effective in this scenario.

if cuff is ruptured by laser, methylene blue will alert you to problem.

The function of the exterior superior laryngeal nerve is to control the motor movement of the cricothyroid muscle, which is responsible for adducting (closing) the vocal cords.

Keeping the patient NPO (nothing by mouth) for 6 hours is not a way to reduce the risk of aspiration. While it is important for the patient to have an empty stomach before surgery to reduce the risk of regurgitation and aspiration, simply relying on NPO status for 6 hours may not be sufficient. Other measures such as cricoid pressure during intubation, administration of H2 blockers (to reduce gastric acid secretion), administration of a prokinetic (to promote gastric emptying), and rapid sequence intubation (to minimize the time the patient is at risk for aspiration) are commonly used to further reduce the risk of aspiration during emergency surgeries.

Mallampati class 1 refers to a patient with a fully visible soft palate, uvula, tonsillar pillars, and the base of the uvula. This indicates that the patient has a good airway and is likely to have easy intubation.

The correct size LMA to use on a 9-year-old boy who weighs 46 kg is Size 3. The size of the LMA is determined by the weight and age of the patient. In this case, the 9-year-old boy's weight falls within the range for Size 3, making it the appropriate choice.

The correct answer suggests that the next step should be to use a straight blade and neck hyperflexion. This technique can help improve the view of the vocal cords during intubation. Additionally, considering the use of a specialized laryngoscope, such as a fiberoptic scope, can further aid in visualizing the airway and increasing the chances of successful intubation.

The correct answer is Esophagus. The diagram is likely showing a cross-section of the throat or upper respiratory system. The esophagus is the tube that connects the throat to the stomach and is responsible for carrying food and liquids from the mouth to the stomach. The other options, such as the epiglottis, arytenoids, and trachea, are also structures in the throat, but they have different functions and are not directly related to the transportation of food.

The internal superior laryngeal nerve is responsible for providing sensory innervation between the epiglottis and the vocal cords. It carries sensory information from this area back to the brain. It does not have any motor function and does not innervate any muscles.

The answer "Attempt an awake intubation, in anticipation of a difficult airway" is the most appropriate plan for intubating this patient. The patient has a history of a shooting accident resulting in a small lower jaw, limited mobility, and multiple scars. These factors suggest that intubation may be challenging due to potential airway difficulties. An awake intubation allows for better control and assessment of the airway, ensuring patient safety during the procedure.

Mallampati class 3 refers to a specific classification system used to assess the difficulty of intubation in patients. Class 3 indicates that the soft palate and the base of the uvula are visible, while the tonsillar pillars and the pharyngeal walls are not. This suggests that intubation may be moderately difficult in these patients.

The correct answer is 2.5. In pediatric anesthesia, the size of the laryngeal mask airway (LMA) is determined based on the weight of the child. The commonly used formula is weight in kilograms divided by 4 plus 1. Therefore, for a 4-year-old girl weighing 22 kg, the appropriate LMA size would be 5.5 (22/4 + 1). However, since LMA sizes are available in whole numbers, the closest size that can be used is 2.5.

The correct answer is 18 cm. When inserting an endotracheal tube (ETT) in a 12-year-old girl, it is important to consider her age and size. The recommended depth for ETT insertion in children is generally estimated by the formula "age/2 + 12". In this case, half of the girl's age (12/2 = 6) is added to 12, resulting in an estimated depth of 18 cm. This depth ensures proper placement of the ETT in the trachea, allowing for effective ventilation and oxygenation.

The TrachLite uses transillumination of the neck to accomplish intubation. Transillumination is a technique where a light source is used to shine through the tissues, allowing the healthcare provider to visualize the structures underneath. In the case of the TrachLite, it is used to visualize the trachea and guide the placement of the endotracheal tube during intubation. This technique can be particularly useful in difficult intubation cases where traditional methods may be challenging or unsuccessful.

The correct answer is Trigeminal Block. During an awake intubation, various nerve blocks are performed to numb specific areas and prevent pain. The Trigeminal nerve block is not one of these nerve blocks. The Trigeminal nerve is responsible for sensation in the face and is not directly involved in the intubation process. Therefore, it is not necessary to perform a Trigeminal nerve block during an awake intubation.

Prior to extubation, it is expected to see the child attempting to swallow and cough, the ability to squeeze hand upon request, and the eyes closed with a train of four 3/4 strong twitches. However, it is not expected to see the child bringing their knees to their chest. This movement suggests discomfort or respiratory distress, which would not be ideal prior to extubation.

Deep extubation refers to the removal of an endotracheal tube while the patient is still under anesthesia and unconscious. This technique is not effective in decreasing the risk for aspiration because it does not address the factors that contribute to aspiration, such as gastric pH or motility. In fact, deep extubation may increase the risk for aspiration as it can lead to inadequate airway protection and the potential for regurgitation of gastric contents. Therefore, deep extubation is the exception among the given options as an effective way to decrease the risk for aspiration.

All of the LMA's mentioned in the question have a 15 mm connector.

The use of a LMA (Laryngeal Mask Airway) is contraindicated in certain situations, but a MAC (Monitored Anesthesia Care) case requiring no neuro-muscular blockade is not one of them. A LMA can be used in this case because it does not require the use of muscle relaxants. In contrast, the other options listed can be contraindications for using a LMA. The lithotomy position may cause airway obstruction, a trauma case requiring fast intubation may require a secure airway with an endotracheal tube, and a patient at 26 weeks gestation may have a higher risk of aspiration, making a LMA unsuitable.

Based on the given information, Mr. Matisse is obese (weighs 173 kg) and has a history of GERD. These factors can increase the risk of aspiration during the procedure. Therefore, it is recommended to use an endotracheal tube (ETT) instead of a laryngeal mask airway (LMA) for this patient. The correct answer suggests using an ETT, which is the appropriate choice in this case to ensure proper airway management and reduce the risk of complications.

The 6.5 mm size ETT would be chosen for a 10-year-old child. The size of the endotracheal tube (ETT) is determined based on the age, weight, and height of the patient. In this case, a 6.5 mm ETT is appropriate for a 10-year-old child. The ETT should be of an appropriate size to ensure proper ventilation and oxygenation during intubation and to minimize the risk of complications.

The "sniff position" in intubation involves aligning the oral, pharyngeal, and laryngeal axis as close to each other as possible. This positioning helps to optimize the visualization of the vocal cords and facilitate the passage of the endotracheal tube into the trachea. By aligning these axes, the airway is straightened, allowing for easier insertion of the tube and reducing the risk of complications during intubation.

Succinycholine is a medication that is commonly used to induce muscle relaxation during certain medical procedures. In the case of laryngospasm, where the vocal cords involuntarily close, the administration of succinycholine can help to relax the muscles in the throat and open up the airway. This can alleviate the symptoms of laryngospasm and allow for normal breathing to resume. It is important to note that this medication should only be administered by trained medical professionals.

The correct answer is Superior Laryngeal nerve block. This nerve block involves depositing anesthetic above and below the thyrohyoid membrane, providing a dense block of the supraglottic region. The other options, such as Trigeminal Block, Transtracheal block, and Glossopharyngeal block, do not specifically target the supraglottic region or involve depositing anesthetic above and below the thyrohyoid membrane.

A 5-month-old child who weighs 8 kg would typically require a size 1.5 LMA (Laryngeal Mask Airway). The size of the LMA is determined based on the weight and age of the child to ensure a proper fit and effective airway management during procedures. The size 1.5 LMA is suitable for infants and young children weighing between 5-10 kg, making it the appropriate choice for this specific case.

Inadequate ventilation is the most common cause of adverse respiratory events in closed claims reviewed by the ASA. This means that the failure to provide sufficient oxygen or remove carbon dioxide during anesthesia can lead to complications and adverse outcomes. It is important for anesthesiologists to closely monitor and adjust ventilation to ensure proper respiratory function during procedures.

Prevents passive reflux of gastric contents

After a failed intubation attempt, the next step should be to reposition the patient, apply cricoid pressure, and consider administering more muscle relaxant. Repositioning the patient may help to improve the laryngeal view and increase the chances of a successful intubation. Cricoid pressure can help to prevent regurgitation and aspiration during intubation. Administering more muscle relaxant can aid in achieving better muscle relaxation and improving intubation conditions. This approach allows for further attempts at intubation while ensuring patient safety.

The statement "Measure from patient’s lip to ear lobe" is NOT true about Nasopharyngeal airways. Nasopharyngeal airways are measured from the patient's nostril to the earlobe to determine the appropriate size.

The proper tube location can be reconfirmed by palpating the cuff in the sternal notch. This means that by feeling the tube cuff at the sternal notch, one can ensure that the tube is correctly positioned. The sternal notch is a prominent, easily identifiable landmark on the sternum, making it a reliable location for confirming tube placement.

The correct answer is Epiglottis. The diagram is likely showing the anatomy of the throat, with various structures labeled. The epiglottis is a flap of tissue located at the base of the tongue that prevents food and liquid from entering the windpipe during swallowing. It acts as a protective mechanism to ensure that only food and liquid go down the esophagus and into the stomach, while keeping the airway clear.

Based on the patient's height and weight, a size 6 LMA should be chosen. The size of the LMA is determined by the patient's weight and height, and in this case, a size 6 is appropriate for a patient who is 6'2" and weighs 105 kg.

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Based on Mrs. Wong's height and weight, a size 5 LMA would be the most appropriate choice. The size of the LMA is determined by the patient's weight and height, and a size 5 LMA is typically recommended for patients weighing around 75 kg. Since this is a short procedure and neuromuscular blockade is not required, using a size 5 LMA would provide adequate airway management for Mrs. Wong.

If the patient cannot be bag mask ventilated despite being in an optimal position, the next step would be to insert an LMA (Laryngeal Mask Airway) Combitube. If this is not possible, the next step would be to attempt TTJV (Trans-tracheal Jet Ventilation). These interventions are alternative methods of maintaining ventilation when intubation has failed or is not possible.

A 3.5 mm endotracheal tube (ETT) would be the appropriate size for a 3-month-old child. ETTs are used to secure and maintain an open airway during anesthesia or respiratory distress. The size of the ETT is determined by the age and size of the patient. In this case, a 3.5 mm ETT is recommended as it is suitable for a 3-month-old child. This size ensures proper ventilation and minimizes the risk of complications such as airway obstruction or injury.

The next course of action would be to perform a surgical airway. This is necessary because the patient is difficult to intubate and cannot be effectively bag-mask ventilated even after repositioning the head. A surgical airway provides a direct and secure route for oxygenation and ventilation when other methods have failed. Blind insertion of an LMA or inserting a nasal airway would not be sufficient in this situation.

C is the correct answer because the diagram shows the location of the tonsils and adenoids. The tonsils are located at the back of the throat, on either side of the uvula. The adenoids are located higher up, behind the nose and roof of the mouth. Both the tonsils and adenoids are part of the immune system and help to fight off infections.

The earliest manifestation of bronchial intubation is an increase in peak inspiratory pressure. When the endotracheal tube is incorrectly placed in the bronchus instead of the trachea, it can cause air to be delivered to only one lung, leading to an increase in pressure required to inflate that lung. This can be detected by monitoring the peak inspiratory pressure during mechanical ventilation. Decreased Sa02 and increased CO2 levels may occur later as a result of inadequate ventilation, while unequal chest rise may be observed during physical examination but is not as specific as the increase in peak inspiratory pressure.

Answer B- difficult to mask but not to intubate

The correct answer is "High, at least 4L/min". This suggests that a high flow rate of at least 4 liters per minute should be used with an LMA airway. This is important for maintaining an adequate supply of fresh gas flow and ensuring sufficient ventilation during the procedure. A higher flow rate helps to prevent rebreathing of exhaled gases and maintain a clear airway.

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The maximum allowable pressure we can bag-ventilate a patient with RSI is not 20cm H2O. The correct answer is False, indicating that the statement is incorrect. The actual maximum allowable pressure for bag-ventilation may vary depending on the specific patient and their condition, but it is generally recommended to keep the pressure below 20cm H2O to avoid potential complications.

Osteoarthritic patients are not at a higher risk for neck injury during intubation because osteoarthritis primarily affects the joints, particularly the cartilage, rather than the neck itself. Intubation involves the insertion of a breathing tube through the mouth or nose, which does not directly impact the neck. Therefore, osteoarthritic patients do not have an increased susceptibility to neck injury during this procedure.

The correct answer is 4.0 - 4.5 mm. This size of endotracheal tube (ETT) is appropriate for a 10-month-old baby. ETTs are used to maintain a clear airway during medical procedures or in cases where a patient is unable to breathe on their own. Choosing the correct size is crucial to ensure proper ventilation and prevent complications. The 4.0 - 4.5 mm size is suitable for a baby of this age, considering their anatomical characteristics and airway requirements.

The superior(internal) laryngeal nerve is responsible for causing the paroxysmal coughing and choking consistent with laryngospasm during extubation. Laryngospasm is a protective reflex that occurs when the vocal cords close tightly, obstructing the airway. The superior(internal) laryngeal nerve provides sensory innervation to the larynx and plays a role in the cough reflex. Stimulation of this nerve can trigger a laryngospasm response, leading to coughing and choking. The other nerves listed do not have a direct role in causing laryngospasm.