Term
| in what operating position is the patient most at risk for a optic nerve injury |
|
Definition
| prone position with a head rest. Directly related to ocular pressure. |
|
|
Term
| Ocular pressure and damage to the optic nerve can be result in what problems 3x |
|
Definition
1. increased intraocular pressure
2. retinal artery occlusion
3. stimulation of the oculocardiac reflex |
|
|
Term
| ipsilateral cord adduction is the result of damage to what nerve |
|
Definition
| recurrent laryngeal nerve damage during surgery. Effects the same side (Ipsilateral) |
|
|
Term
| what nerve is damaged from shoulder blocks when the patient is placed in a trendelenberg position |
|
Definition
| brachial plexus. Most often C5 and C6 |
|
|
Term
| if you over abduct the arm with hyperextension, and external rotation and (make this worse with also contralateral rotation of the head) you can suffer injury to what nerves and what Sx will you see |
|
Definition
| lower C8 and T1 = paralysis of small muscles of the hands and wrist. (claw hand) |
|
|
Term
| saturday night palsy is associated with injury to what nerve..what Sx is associated with it |
|
Definition
| Radial nerve injury resulting in wrist drop. saturday night palsy refers to a common way this injury happens which is falling asleep on a sofa chair watching tv. |
|
|
Term
| most common injury to the upper extremity nerves is? |
|
Definition
|
|
Term
pressure to the
1. outer aspect of the arm may result in what nerve injury?
2. medial aspect of arm may result in what nerve injury |
|
Definition
1. outer aspect of arm is radial nerve damage
2. medial aspect of arm is ulnar nerve damage |
|
|
Term
| claw hand is associated with what injury |
|
Definition
1. ulnar nerve
or
2. C8, T1 |
|
|
Term
| Trauma to the antecubital IV insertion may damage what nerve? |
|
Definition
|
|
Term
| ape hand paresis is a result of damage to what nerve and during what procedure |
|
Definition
| IV insertion to AC. Damages median nerve. |
|
|
Term
| what nerves are at risk when the patient is in the lithotomy |
|
Definition
1. obturator nerve
2. saphenous nerve
3. femoral nerve
4. common peroneal nerve |
|
|
Term
most common:
1. upper nerve damaged
2. lower nerve damaged |
|
Definition
1. upper nerve = ulnar nerve
2. lower nerve = common peroneal |
|
|
Term
| what positioning can cause damage to common peroneal nerve |
|
Definition
1. lithotomy
2. lateral decubitus stirups |
|
|
Term
| foot drop may indicate damage to what nerve |
|
Definition
|
|
Term
| crossed feet may result in damage to what nerve |
|
Definition
| sural nerve and deep peroneal nerve |
|
|
Term
| lower back from being supine for long periods results in damage where |
|
Definition
| to lumbosacral nerves due to flattening of a normal lumbar convex joints. |
|
|
Term
| Name the 6x structures in the respiratory system that compose dead space |
|
Definition
1. nasal cavities
2. oral cavity
3. pharynx
4. larynx
5. trachea
6. bronchial tree |
|
|
Term
| what word describes any area of bi-directional flow that does not participate in gas exchange |
|
Definition
|
|
Term
| where anatomically does dead space end? AKA where is the first off branching of alveoli |
|
Definition
| Level of the terminal bronchioles |
|
|
Term
| name in order as air enters the respiratory tract which cells does it pass and where |
|
Definition
| Air starts and enters the front of the nose and oral cavity and meets non-ciliated stratified epithelium... then it enters the back of the nose, nasopharynx and laryngeal mucosa above the cords and meets ciliated pseudostratified squamos epithelium...then below the cords it passes ciliated pseudostratified columnar epithelium until it reaches respiratory bronchioles and terminals where the rest of the cells are nonciliated cuboidal epithelium. |
|
|
Term
| name the four paranasal sinuses |
|
Definition
1. maxillary
2. frontal
3. sphenoid
4. ethmoid |
|
|
Term
| …a musculomembranous tube extending from the undersurface of the skull to the level of C6 and lower border of the cricoid cartilage where it is continuous with the esophagus.... |
|
Definition
|
|
Term
| cervical ______ is the lower border of the cricoid cartilage in a adult |
|
Definition
|
|
Term
| pharynx gets sensory input via______ and motor innervation via ______ |
|
Definition
1. Sensory via glossopharyngeal IX
2. Motor via Vagus X |
|
|
Term
| where does the nasopharynx begin? |
|
Definition
| behind the posterior nares and goes to just above the soft palate |
|
|
Term
| where is the location of the oropharynx |
|
Definition
| from the soft palate to the base of the tongue |
|
|
Term
| name for babies born with obstructed nasal passages |
|
Definition
|
|
Term
| location of the laryngopharynx |
|
Definition
| from base of the tongue to the opening of hte esophagus |
|
|
Term
| the epiglottis, aryepiglottic folds and arytenoid cartilages are all found in what compartment of the respiratory tract |
|
Definition
|
|
Term
| when you place a MAC blade into the valecula and lift up you are exerting pressure on what anatomical structure |
|
Definition
| median glosso-epiglottic fold which results in lifture of the epiglottis |
|
|
Term
| false cords are also called |
|
Definition
|
|
Term
| the upper esophageal sphincter is also known as |
|
Definition
| the cricopharyngeus muscle |
|
|
Term
| is the UES voluntary or involuntary |
|
Definition
|
|
Term
| what nerve innervates the cricopharyngeal muscle |
|
Definition
| reccurrent laryngeal nerve |
|
|
Term
| the lower esophageal sphincter may be open with how much pressure |
|
Definition
| 18 cm H20.. so over bagging a patient can cause this to open. |
|
|
Term
| what in the upper GI tract protects against regurgitation into the airway |
|
Definition
| upper esophageal sphincter aka the cricopharyngeus muscle. |
|
|
Term
the adult larynx sits at what Cervical vertebrae?
The child larynx sits at what cervical vertebrae |
|
Definition
|
|
Term
| trace the arterial supply to the larynx |
|
Definition
| subclavian artery -> inferior thyroid artery -> inferior laryngeal artery |
|
|
Term
| trace the venous return from larynx |
|
Definition
| Inferior laryngeal vein to brachiocephalic vein to SVC |
|
|
Term
| Name all 9 cartilages of the larynx. Identify which are paried and which are sinuglar |
|
Definition
Singular
1. thyroid cartilage
2. cricoid cartilage
3. epiglottis cartilage
Paired:
1. Artenoids 2x
2. corniculates 2x
3. Cuneiforms 2x |
|
|
Term
| the largest cartilage of the larynx is |
|
Definition
|
|
Term
| The thyroid cartilage is held in place by what membranes |
|
Definition
| thryohyroid membrane up top and the cricothyroid down below |
|
|
Term
| what is the narrowest portion of the pediatric airway |
|
Definition
|
|
Term
| only complete ring in the larynx is |
|
Definition
|
|
Term
| cricoid cartilage AKA.... |
|
Definition
|
|
Term
| childs larynx is ___ in shape |
|
Definition
|
|
Term
| first cartilage of the larynx encountered during laryngoscopy is |
|
Definition
|
|
Term
| describe the shape of the artenoid cartilages |
|
Definition
|
|
Term
| what three things attach to the arytenoid cartilages |
|
Definition
1. posterior cricoartenoid muscle
2. lateral cricoartenoid muscle
3. vocal cords |
|
|
Term
| is the cuneate or corniculate cone shape |
|
Definition
| CO = COrniculate is cone shaped |
|
|
Term
| narrowest portion of the adult airway is? |
|
Definition
|
|
Term
| glottis is also called the |
|
Definition
1. rima glottis
2. rima
3. rimaglotidisc |
|
|
Term
| what muscle opens the vocal cords ( widens the rima) |
|
Definition
| posterior cricoarytenoids (2x) |
|
|
Term
| When you open the vocal cords you abduct or adduct? |
|
Definition
|
|
Term
| What muscles close the vocal cords |
|
Definition
| Lateral cricoartenoids (2x) |
|
|
Term
| what hypercloses the vocal cords |
|
Definition
| transverse arytenoids (1x) |
|
|
Term
| deeper voice is a result of what muscle |
|
Definition
thyroarytenoids (2)
thyROOOOOOO (deep) id |
|
|
Term
| Sharp voice is the result of what muscle |
|
Definition
|
|
Term
| sensory above the cricoid supplied by |
|
Definition
|
|
Term
| what nerve is stimulated that precipitates laryngospasms |
|
Definition
| what nerve is stimulated that precipitates laryngospasms it is the SUPERIOR laryngeal nerve INTERNAL Branch |
|
|
Term
| the superior laryngeal nerve has two branches..name them and their function |
|
Definition
1. internal branch = sensory above vocal cords
2. external branch = motor innervation to cricothryoid muscles = Tenses and elongates
Sharp Voice |
|
|
Term
| the recurrent laryngeal muscle supplies motor innervation to all laryngeal muscles except for the |
|
Definition
|
|
Term
| what nerve supplies sensory below the cords and which above |
|
Definition
above = internal superior laryngeal nerve
Below = recurrent larygenal nerve |
|
|
Term
If this damage then this Sign to recurrent laryngeal nerve
1. hoarseness from?
2. complete airway obstruction from?
3. flaccid vocal cords |
|
Definition
1. hoarseness = one sided transection
2. obstruction = ischemia to bilateral nerves
3. flaccid vocal cords = bilat transection |
|
|
Term
| print out laryngeal nerve picture |
|
Definition
|
|
Term
| carina is around what landmark |
|
Definition
|
|
Term
| incisor to carina in male and female adults is |
|
Definition
female: 24-26 cm
male: 26-28 |
|
|
Term
| mercedes sign describes the right main stem or left main stem |
|
Definition
|
|
Term
angle of the
1. right main stem
2. left main stem |
|
Definition
1. right mainstem = 25 degree
2. left mainstem 40-60 degree |
|
|
Term
| From carina name components of the airway |
|
Definition
| carina -> segmental bronchi -> small bronchi -> bronchioles -> terminal bronchioles -> respiratory bronchioles |
|
|
Term
does ETT add or take away dead space to:
1. child
2. adult |
|
Definition
1. child: adds dead space
2. adult: decreases |
|
|
Term
| equation for dead space in adult is? |
|
Definition
| 1 cc/lb in adults and children |
|
|
Term
| what is the dead space for a 40 lb child |
|
Definition
|
|
Term
| what is the deadspace for a 202 lb adult |
|
Definition
|
|
Term
| thickest muscle to airway ratio is in what part of the lung |
|
Definition
|
|
Term
| greatest effect of bronchospasms on airway is at the |
|
Definition
| respiratory bronchioles due to its largest muscle to airway ratio |
|
|
Term
| muscle in the airway stops after |
|
Definition
| stops after the respiratory bronchioles |
|
|
Term
| fetus starts secreting surfactant at week ____ and has enough surfactant at what week__ |
|
Definition
| starts at 26 weeks but not sufficent till week 35-36 |
|
|
Term
| at what subdivision do respiratory bronchioles begin |
|
Definition
|
|
Term
| how many subdivisions of the lung are there |
|
Definition
|
|
Term
| generation of airway chart on test=print |
|
Definition
|
|
Term
| picture on slide 48 on test |
|
Definition
|
|
Term
|
Definition
|
|
Term
| each lung has a concave or convex base |
|
Definition
|
|
Term
| right or left apex rises slightly higher than the clavicle..why |
|
Definition
| right due to liver pushing up on lung |
|
|
Term
| perfusion without aeration is called |
|
Definition
|
|
Term
| aeration without perfusion is called |
|
Definition
|
|
Term
| is dead space or shunt an area of bi-directional air flow |
|
Definition
|
|
Term
| name all 7 accessory muscles of inspiration |
|
Definition
1. sternocleidomastoid
2. pectoralis major
3. pectoralis minor
4. serratus anterior
5. serratus posterior superior
6. upper iliocostalis
7. scalenes |
|
|
Term
| name all 6 accessory muscles of expiration |
|
Definition
1. external oblique
2. internal oblique
3. rectus abdominus
4. lower iliocostalis
5. lower longissimus
6. serratus posterior inferior |
|
|
Term
| brachial plexus composed of what roots |
|
Definition
|
|
Term
| mneumonic for remembering divisions of brachial plexus |
|
Definition
Real Teenagers Drink Cold Beer
Roots Trunks Divisions Cords Branches |
|
|
Term
| sub divisions of each main division of brachial plexus are |
|
Definition
Roots: C5-T1
Trunks: Tree trunk upper, middle, lower
Divisions: Front line or rear line (posterior or anterior)
Cords: Spinal cord has nerves that run posterior, medial and lateral.
Branches: |
|
|
Term
| what branches arise off the lateral cords of the brachial plexus |
|
Definition
| 1. musculocutaneous 2. median |
|
|
Term
| what branches arise off the posterior cords |
|
Definition
|
|
Term
| what branches arise off the medial cord of the brachial plexus |
|
Definition
|
|
Term
| Name the four approaches for a brachial plexus block and their biggest risk |
|
Definition
1. interscalene - intravascular injection
2. Supraclavicular-pneumo
3. Infraclavicular-pneumo,hemo
4. Axillary - incomplete block missed the musculocutaenous nerve |
|
|
Term
| which brachial plexus block is at high risk for an incomplete block missing what nerve? |
|
Definition
| axillary block, may miss the msuculocutaneous nerve. |
|
|
Term
| lumbar plexus involves what nerve roots |
|
Definition
|
|
Term
| sciatic nerve comes from what roots |
|
Definition
|
|
Term
| sciatic nerve come from what branches |
|
Definition
| comes from tibial and common peroneal nerve |
|
|
Term
| what drains into the superior vena cava |
|
Definition
| the right and left brachiocephalic vein (Aka the innominate vein) |
|
|
Term
| where does the thoracic duct enter central venous circulation? What risks does this impose during an intervention |
|
Definition
| Thoracic duct enters central circulation at the left subclavian where it meets the left brachiocephalic vein. This in just above the left clavicle. Cannulation of the internal jugular is a high risk for hitting this. IF so will see milky yellow fluid. |
|
|
Term
| First, second, third branch of the right brachiocephalic trunk |
|
Definition
1. 1st is common carotid
2. 2nd is vertebral artery
3. 3rd is the right subclavian artery |
|
|
Term
| what are the three main branches off the aortic arch in order from heart |
|
Definition
1st = right brachiocephalic
2nd = left common carotid artery
3rd = left subclavian artery |
|
|
Term
| the the left vertebral artery come off the aortic arch, subclavian or common carotid |
|
Definition
|
|
Term
| most common nerve injury at the AC? Second most common injury? |
|
Definition
1st = median nerve
2nd = brachial artery |
|
|
Term
| cerebral perfusion pressure =? |
|
Definition
| MAP - ICP or whichever is higher |
|
|
Term
What is the CPP for a patient who's
ICP = 15
MAP = 80
CVP=10 |
|
Definition
Since ICP > CVP use that.
CPP = MAP - ICP
CPP = 65 |
|
|
Term
| total CSF volume at any given time is? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what structure is the CSF reabsorbed |
|
Definition
|
|
Term
| Trace the flow of CSF from start to finish |
|
Definition
1. created at choroid plexus
2. lateral ventricles
-Thru foramen of monroe
3. 3rd ventricle
-through adequate of sylvius
4. 4th ventricle
-thru foramina of luschka
-thru foramina of magendie
5. Subarachnoid space
6. reabsorbed via the arachnoid villi. |
|
|
Term
| max amount of csf drained in one hour |
|
Definition
|
|
Term
| largest interspace in vertebral column to access spinal cord is? Another name for this? |
|
Definition
|
|
Term
| when we check the line across some one's hips this imaginary line is called |
|
Definition
|
|
Term
| tuffier's line on adult is approximately what interspace? |
|
Definition
|
|
Term
| will obese people have a tuffier's line that is lower or higher than normal |
|
Definition
| lower. Because they're fat and compression of the vertebrae pulls cord down. |
|
|
Term
| how many arteries supply the spinal cord? Which are front and which are back |
|
Definition
3x arteries.
1x anterior
2x posterior. |
|
|
Term
| which spinal arteries supply the most amount of blood to spinal cord |
|
Definition
| anterior spinal artery (1x) supplies 2/3 of blood. Comes from the vertebral artery |
|
|
Term
| where do the spinal cord arteries arise from |
|
Definition
Anterior (1x) spinal artery arises from the vetebral artery.
Posterior Spinal Arteries (2x) arise from the cerebellar artery |
|
|
Term
| another name for the artery of adamkiewicz 2x |
|
Definition
AKA
1. great ventral radicular artery
2. arteria radicularis magna |
|
|
Term
| substantia gelatinosa is found where |
|
Definition
| dorsal horn of the spinal cord |
|
|
Term
| substantia gelatinosa is also know as |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| facial nerve TOF illicits motor response from what |
|
Definition
1. orbicularis oculi
2. corrugator supercilli (eyebrow over nose) |
|
|
Term
| TOF goal for patient's readiness to extubate is |
|
Definition
| 4th twitch is at least 90% in strength to 1st twitch |
|
|
Term
for periheral nerve stimulation..which site is best for evaluating if..
1. pt ready to intubate
2. pt ready to extubate/reversal |
|
Definition
1. intubate - check facial nerve
2. extubate/reversal check adductor pollicis/ulnar nerve |
|
|
Term
| putting an a line into the brachial artery has what risk |
|
Definition
| nerve damage to median nerve |
|
|
Term
| which artery is good to cannulate in low flow states |
|
Definition
|
|
Term
| a pedal arterial line will have falsely high or lower BPs |
|
Definition
|
|
Term
| two mechanisms for nerve injury in the or patient |
|
Definition
1. compression
2. pressure
both resulting in ischemia |
|
|
Term
| are more male or female patient suffer from upper extremity nerve injuries |
|
Definition
| MALE. They are bigger and more muscle ect so more compression/pressure per area. 70-90% get this |
|
|
Term
| #1 cofactor for nerve injuries related to lithotomy position is |
|
Definition
|
|
Term
| opening a chest predisposes patient to what nerve injury |
|
Definition
|
|
Term
| If a patient is in prone position what position will predispose them to brachial plexus injury |
|
Definition
| IF shoulders prolapse too far forward |
|
|
Term
| femoral nerve more commonly injuried from what types of surgery? or movement of thigh in what way |
|
Definition
| deep, lower abdominal retraction or prounced ABDUCTION of thigh |
|
|
Term
| legs crossed does what to the upper leg over the lower leg. |
|
Definition
upper leg: sural nerve
lower leg: peroneal nerve
Sural SUPERIOR (upper leg)
Peroneal POSTERIOR (lower leg) |
|
|
Term
| what sign indicates billowing chemosis of pt eyes |
|
Definition
| Increase ICP 3x from baseline |
|
|
Term
what is the patients intraocular pressure
MAP 70
ICP 14
CVP 10 |
|
Definition
intraocular pressure = MAP - ICP
70-14 = 54 |
|
|
Term
| retinal artery occlusion is possible in what position |
|
Definition
| prone due to pressure. Its even more likely if you over hydrate patient. |
|
|
Term
| Major risk factors for retinal artery occlusion and possible blindness intra op for prone cases |
|
Definition
1. excess crystalloid
2. prolong periods of hypotension
3. direct pressure to orbits
4. EBL >2.5 L
5. prlonged surgery |
|
|
Term
| Is FRC decreased in prone position |
|
Definition
| NO. UN LESS intra abdominal pressure present.!!But normally no loss in FRC in prone. |
|
|
Term
| #1 complication from sitting position for surgery is |
|
Definition
|
|
Term
| MAP for your CPP is how many points lower than your MAP at the NIBP |
|
Definition
|
|
Term
| Pt lays on left lateral side for case. Which side has a shunt and which has dead space |
|
Definition
1. Right side = dead space (side up)
2. Left side = shunt (dependent side) |
|
|
Term
| where do you place the pulse oximeter for a lateral position case |
|
Definition
|
|
