The Upper Airways

breathing

process of moving air in and out of the body (inhaling/exhaling)

respiration

gas exchange at the cellular level

ventilation

mechanical movement of air in and out of the body

structures of the upper airway

nose, nasal cavity, oral cavity, and pharynx

functions of the nasal cavity

warm, humidify, and filter incoming air

aid in speech and provide sensory receptors for smell

vibrissae

hair inside nostrils that capture large particles

cilia

hairlike structures in respiratory tract that propel foreign materials towards the mouth to be swallowed or expectorated

nasal conchae (turbinates) function

structures that help increase surface area allowing an increased ability to warm, filter, and humidify

inferior conchae

closest to external nares - largest

directs airflow, filters and humidifies

middle conchae

protective structure for sinuses

superior conchae

smallest

protects olfactory nerves

epithelium in nasal cavity with location

first 1/3: stratified squamous epithelium

remaining 2/3: pseudostratified columnar ciliated epithelium; contains Goblet cells

goblet cells

produce mucus

sol/gel layers

upper gel layer: sticky protective barrier to trap dust/bacteria

lower sol layer: has cilia to push out particles and debris

function of olfactory nerve tissue

allows the ability to smell (approx. 6 million olfactory receptors)

anosmia

loss of the ability to smell

transient or permanent

due to damaged olfactory pathways from aging, disease, or trauma

hyposmia

decreased or reduced ability to smell

due to allergies, polyps, or infection

hyperosmia

increased ability to smell

associated with pregnancy, migraines, autoimmune disease, and lyme disease

paranasal sinuses location

frontal - forehead

sphenoid - side of head

ethmoid - between eyes and nose

maxillary - cheekbones

paranasal sinuses function

drain into nasal cavity

resonance space for speech

produce mucus that lubricates the nose

nasal congestion

"stuffy nose" occurs when mucous layer inside the nose is overabundant

feeling of fullness in nose or face and possibly having fluid drip out of nose or down back of throat

rhinitis

inflammation of the mucous membranes of the nasal cavity

can be allergic, nonallergic, or related to infection

sinusitis

inflammation of one or more of the sinus cavities

caused by bacterial, fungal, or viral infection

can be acute or chronic

epistaxis with causes

nosebleeds - most often in children 2-10 and adults 50-80

causes: trauma, drying of the nose, medications, and disease

nasal flaring with significance

nostrils widening when breathing

may occur because of asthma, nasal obstruction, respiratory diseases of the newborn (most often used), or pneumonia

alar collapse with treatment

the visible closing of the nostrils during breathing

treatment: continuous positive airway pressure (CPAP) or surgical procedures

structures of the oral cavity

hard palate, soft palate, palatoglossal arch, palatine tonsil, palatopharyngeal arch, uvula, and oropharynx

ankyloglossia with causes & treatment

"tongue-tied" condition where lingual frenulum is unusually short or thick

causes difficulty speaking, breastfeeding, and swallowing

treatment: surgical procedure to release tongue

cold-stimulus headaches

"ice cream headaches" sharp, stabbing pain in forehead following exposure to sudden extreme cold

oral candidiasis with causes & treatment

thrash. infection caused by Candida albicans producing white lesions inside the mouth

due to weakened immune system, diabetes, certain medications (corticosteroids or antibiotics)

treatment focuses on improved oral hygiene and antifungal medications

nasopharynx

provides passage from back of the nasal cavity to the soft palate

pharyngeal tonsils (adenoids) in upper rear portion

linked with eustachian tubes

oropharynx

proceeds from the soft palate to the superior border of the epiglottis

two palatine tonsils, lingual tonsils, and vallecula

laryngopharynx

passage extends from superior border of epiglottis to inferior border of cricoid cartilage where it becomes continuous with the esophagus

crucial role in preventing aspiration

vallecula with importance

small grove or indentation posterior to the root of the tongue between the median and lateral glossoepiglottic folds

important landmark used when placing a breathing tube into the trachea

larynx function

provides protection for the airways during swallowing, assissts in airway patency and supports vocalization "voice box"

thyroid cartilage

single. adam's apple - largest in the larynx

cricoid cartilage

single. below thyroid cartilage. only laryngeal cartilage to completely encircle the airway

epiglottic cartilage

single. thin, flat, spoon-shaped that moves downward to divert food away from the glottis and into esophagus

landmark for insertion of ETT

arytenoid cartilage

paired. pyramid shaped

vocal ligaments and intrinsic muscles that coordinate movement of the vocal folds attach to these processes

corniculate cartilage

paired. small conical (cartilage of Santorini)

aid in the opening and closing of the glottis and sound production

cuneiform cartilage

paired. rod-shaped.

provides support of the vocal folds and the lateral aspects of the epiglottis

role of epiglottis

prevents aspiration during swallowing. diverts food/liquid away from the glottis and into the esophagus

true vs. false vocal cords

true: lower pair that aids in speech

false: upper pair that does not play a role in speech

rima glottidis

the opening between the vocal cords

airway edema with causes

swelling in the respiratory tract

causes: allergic response, trauma, infection, toxic gas inhalation, hereditary conditions

upper airway edema can be life-threatening

croup with causes and symptoms

infection of the vocal cords, trachea, and/or bronchial tubes

children 6 mos. - 2 yrs at highest risk due to airway diameter

viral or bacterial often caused by HPIVs

coldlike symptoms with barking cough

dysphagia

difficulty swallowing

due to physical obstructions, diseases of muscles, or conditions that can alter swallowing processes

causes patients to be susceptible to aspiration pneumonia

epiglottitis

inflammation of epiglottis

life-threatening due to swelling

caused by trauma or infection (seasonally with strep or in children with Hib)

otitis media with symptoms and treatment

infection of the middle ear

pain, fever, bulging of tympanic membrane, middle ear effusion

treatment: antibiotic therapy and symptom relief for pain

valsalva maneuver

forcibly exhaling air against a closed airway to normalize middle ear pressure

can be used for cardiac ramifications to initiate changes in heart rate and/or blood pressure

bronchoscopy

procedure where a fiberoptic scope with a camera and light are used to visualize the upper airways and lungs

may be used to help with intubation

why use artificial airways

to prevent or relieve obstructions, allow access for suctioning or removal of mucus to prevent aspiration, or to provide a route for mechanical ventilatory support

nasopharyngeal airway

nasal trumpet

relieves upper airway obstruction

available in variety of sizes from pediatric to adult

oropharyngeal airway

curved plastic device with a flange that rests against the teeth when inserted

maintains airway to prevent tongue obstruction

guedel vs berman

oropharyngeal airways

guedel - single closed channel

berman - two open channels

supraglottic airway

used to deliver manual ventilation using a resuscitation bag when intubation or bag-valve-mask ventilation has failed

not long-term, typically done by EMS or for day surgery

endotracheal tube

inserted through the nose or mouth and passed through the vocal cords and extended into the trachea

intubation to facilitate mechanical ventilation or to prevent aspiration

firm yet flexible curved tube

tracheostomy tube

inserted through a surgical incision into the trachea to facilitate ventilation or clear secretions

opening in trachea is visible on the neck and is known as the stoma

can be plastic or metal - shorter than ETT

laryngoscope

used to visualize the larynx and insert ETT via the mouth

parts and blades of laryngoscope

a light source, a handle, and a blade

macintosh blade - curved

miller blade - straight