APEX Anesthesia: Unit 1 Respiratory 78
complete solutions.
APEX Anesthesia: Unit 1 Respiratory 78
complete solutions.
Which muscles tense and relax the vocal cords? - ANSWER Which muscles tense and relax the vocal
cords?
- CricoThyroid "Cords Tense"
- ThyroaRytenoid "They Relax"
Which muscles abduct and adduct the vocal cords? - ANSWER Which muscles abduct and adduct the
vocal cords?
- Posterior CricoArytenoid "Please Come Apart"
- Lateral CricoArytenoid "Let's Close Airway"
Describe the sensory innervation of the upper airway.
*4 nerves - ANSWER Trigeminal n.
- V1 (ophthalmic): Nares and anterior 1/3 septum
- V2 (maxillary): Turbinates and septum
- V3 (mandibular): Anterior 2/3 tongue
Glossopharyngeal n.
- Posterior 1/3 tongue
- Soft palate
- Oropharynx
- Vallecula
- Anterior epiglottis
SLN
- Internal branch: posterior epiglottis → vocal cords
,APEX Anesthesia: Unit 1 Respiratory 78
complete solutions.
- External branch: Ø sensory fx! (only motor innervation to cricothyroid muscle)
RLN
- below vocal cords → trachea
How does bilateral and unilateral RLN injury affect airway integrity? - ANSWER Bilateral RLN injury
- Acute: respiratory distress (unopposed action of cricothyroid m.)
- Chronic: no respiratory distress
Unilateral RLN injury
- No respiratory distress
How does bilateral and unilateral SLN injury affect airway integrity? - ANSWER Bilateral SLN injury
- hoarseness
- no respiratory distress
Unilateral SLN injury
- No respiratory distress
Airway block landmarks
- Glossopharyngeal n. block
- SLN block
- Transtracheal n. block - ANSWER Airway block landmarks
- Glossopharyngeal n. block: palatoglossal arch at anterior tonsillar pillars
- SLN block: greater cornu of hyoid
,APEX Anesthesia: Unit 1 Respiratory 78
complete solutions.
- Transtracheal n. block: cricothyroid membrane
3 paired cartilages of larynx
3 unpaired cartilages of larynx - ANSWER Paired cartilages of larynx
- Corniculate
- Arytenoid
- Cuneiform
Unpaired cartilages of larynx
- Epiglottis
- Thyroid
- Cricoid
*Adult larynx extends from C3-C6 consisting of bone, ligaments, and 9 cartilages.
7 Laryngospasm treatments - ANSWER Laryngospasm tx
- 100% FiO2
- Remove noxious stimuli
- Deepen anesthesia
- CPAP 15-20cmH2O
- Open airway (head extension, chin lift)
- Larson's maneuver
- Sux**
**Infants/small kids should also get 0.02 mg/kg atropine with sux! If Sux is not possible, roc is the only
other NMBD that can be given IM.
**If no IV, submental sux will produce fastest onset!
, APEX Anesthesia: Unit 1 Respiratory 78
complete solutions.
Contraction of the inspiratory muscles reduces thoracic pressure and increases thoracic volume.
What law is this? - ANSWER Contraction of the inspiratory muscles reduces thoracic pressure and
increases thoracic volume. This is an example of Boyle's Law.
Describe how the respiratory muscles function during breathing cycle. - ANSWER Inspiration
- diaphragm and external intercostals contract (tidal breathing)
- diaphragm increases the superior-inferior dimension of the chest
- external intercostals increase the anterior-posterior diameter
- accessory muscles include the sternocleidomastoid and scalene muscles
Expiration
- exhalation usually is passive; driven by recoil of the chest wall
- active exhalation is carried out by the abdominal musculature (rectus abdominis, transverse
abdominis, internal obliques, external obliques)
- internal intercostals serve a secondary role in active exhalation
- exhalation becomes an active process when Vm increases or in patients w/ lung dz (ex. COPD)
- forced exhalation is required to cough and clear airway of secretions
Difference b/t minute ventilation (Vm) and alveolar ventilation (VA). - ANSWER Vm: amount of air in a
single breath x #breaths per minute
⇨ Vm = Vt x RR
VA: only measures the fraction of Vm that is available for gas exchange. It removes the anatomic dead
space gas from Vm formula.
⇨ VA = (Vt - Anatomic dead space) x RR
*VA is directly proportional to CO2 production; indirectly proportional to PaCO2.
What are the 4 types of dead space?
complete solutions.
APEX Anesthesia: Unit 1 Respiratory 78
complete solutions.
Which muscles tense and relax the vocal cords? - ANSWER Which muscles tense and relax the vocal
cords?
- CricoThyroid "Cords Tense"
- ThyroaRytenoid "They Relax"
Which muscles abduct and adduct the vocal cords? - ANSWER Which muscles abduct and adduct the
vocal cords?
- Posterior CricoArytenoid "Please Come Apart"
- Lateral CricoArytenoid "Let's Close Airway"
Describe the sensory innervation of the upper airway.
*4 nerves - ANSWER Trigeminal n.
- V1 (ophthalmic): Nares and anterior 1/3 septum
- V2 (maxillary): Turbinates and septum
- V3 (mandibular): Anterior 2/3 tongue
Glossopharyngeal n.
- Posterior 1/3 tongue
- Soft palate
- Oropharynx
- Vallecula
- Anterior epiglottis
SLN
- Internal branch: posterior epiglottis → vocal cords
,APEX Anesthesia: Unit 1 Respiratory 78
complete solutions.
- External branch: Ø sensory fx! (only motor innervation to cricothyroid muscle)
RLN
- below vocal cords → trachea
How does bilateral and unilateral RLN injury affect airway integrity? - ANSWER Bilateral RLN injury
- Acute: respiratory distress (unopposed action of cricothyroid m.)
- Chronic: no respiratory distress
Unilateral RLN injury
- No respiratory distress
How does bilateral and unilateral SLN injury affect airway integrity? - ANSWER Bilateral SLN injury
- hoarseness
- no respiratory distress
Unilateral SLN injury
- No respiratory distress
Airway block landmarks
- Glossopharyngeal n. block
- SLN block
- Transtracheal n. block - ANSWER Airway block landmarks
- Glossopharyngeal n. block: palatoglossal arch at anterior tonsillar pillars
- SLN block: greater cornu of hyoid
,APEX Anesthesia: Unit 1 Respiratory 78
complete solutions.
- Transtracheal n. block: cricothyroid membrane
3 paired cartilages of larynx
3 unpaired cartilages of larynx - ANSWER Paired cartilages of larynx
- Corniculate
- Arytenoid
- Cuneiform
Unpaired cartilages of larynx
- Epiglottis
- Thyroid
- Cricoid
*Adult larynx extends from C3-C6 consisting of bone, ligaments, and 9 cartilages.
7 Laryngospasm treatments - ANSWER Laryngospasm tx
- 100% FiO2
- Remove noxious stimuli
- Deepen anesthesia
- CPAP 15-20cmH2O
- Open airway (head extension, chin lift)
- Larson's maneuver
- Sux**
**Infants/small kids should also get 0.02 mg/kg atropine with sux! If Sux is not possible, roc is the only
other NMBD that can be given IM.
**If no IV, submental sux will produce fastest onset!
, APEX Anesthesia: Unit 1 Respiratory 78
complete solutions.
Contraction of the inspiratory muscles reduces thoracic pressure and increases thoracic volume.
What law is this? - ANSWER Contraction of the inspiratory muscles reduces thoracic pressure and
increases thoracic volume. This is an example of Boyle's Law.
Describe how the respiratory muscles function during breathing cycle. - ANSWER Inspiration
- diaphragm and external intercostals contract (tidal breathing)
- diaphragm increases the superior-inferior dimension of the chest
- external intercostals increase the anterior-posterior diameter
- accessory muscles include the sternocleidomastoid and scalene muscles
Expiration
- exhalation usually is passive; driven by recoil of the chest wall
- active exhalation is carried out by the abdominal musculature (rectus abdominis, transverse
abdominis, internal obliques, external obliques)
- internal intercostals serve a secondary role in active exhalation
- exhalation becomes an active process when Vm increases or in patients w/ lung dz (ex. COPD)
- forced exhalation is required to cough and clear airway of secretions
Difference b/t minute ventilation (Vm) and alveolar ventilation (VA). - ANSWER Vm: amount of air in a
single breath x #breaths per minute
⇨ Vm = Vt x RR
VA: only measures the fraction of Vm that is available for gas exchange. It removes the anatomic dead
space gas from Vm formula.
⇨ VA = (Vt - Anatomic dead space) x RR
*VA is directly proportional to CO2 production; indirectly proportional to PaCO2.
What are the 4 types of dead space?
