29.3 Airway

Question 1

What must be administered to all trauma patients?

Answer 1

Supplemental oxygen

Question 2

Primary involuntary respiratory center

Answer 2

Medulla

Question 3

What is connected to the respiratory muscles by the Vagus nerve?

Answer 3

The pons

Question 4

What factors can change respirations

Answer 4

a)Body temperature increases respiration.
b)Emotion increases respiration.
c)Pain increases respiration.
d)Hypoxia increases respiration.
e)Acidosis increases respiration.
f)Stimulant drugs increase respiration.
g)Depressant drugs, sleeping agents decrease respiration.
h)Drugs like Morphine will decrease respirations.

Question 5

What is the term for when there is no oxygen available at all?

Answer 5

Anoxia

Question 6

Literally means “deficient in oxygen”, that is an abnormally low oxygen availability to the body or an individual tissue or organ

Answer 6

Hypoxia

Question 7

Insufficient oxygenation; that is decreased partial pressure of oxygen in blood.

Answer 7

Hypoxemia

Question 8

Indications for O2 therapy are

Answer 8

(1) Cardiac and respiratory arrest
(2) Hypoxemia (pO2 < 58.5 mmHg, Sat < 90%)
(3) Hypotension (Systolic BP < 100 mmHg)
(4) Low Cardiac Output and Metabolic Acidosis (serum bicarbonate < 19 mmol/l)
(5) Respiratory distress (RR > 24/min)

Question 9

What is the rate of oxygen supplied from a nasal cannula

Answer 9

Oxygen is supplied at rates of 1-6 liters/min resulting in inspired concentration of approximately 25-30%.

Question 10

Which type of oxygen delivery device is used for the following:

1)Physical trauma
2)Chronic airway limitation/chronic obstructive pulmonary diseases
3)Cluster headache
4)Smoke inhalation
5)Carbon monoxide poisoning

Answer 10

Non-rebreather mask

Question 11

Which type of oxygen delivery device is used for the following:

a)Decompression illness (the “bends”)
(b)Carbon monoxide poisoning
(c)Radiation necrosis
(d)Reconstructive surgery
(e)Some infection, wounds

Answer 11

Hyperbaric Oxygen

Question 12

Steps for Manual Clearing of the Airway

Answer 12

1)The first step in airway management is a quick visual inspection of the oropharyngeal cavity.
2)Foreign material (e.g., pieces of food) or broken teeth and blood may be found in the mouth of a trauma casualty.
3)These are swept out of the mouth using a gloved finger or, in the case of blood or vomitus, may be suctioned away.
4)Prolonged suctioning should be avoided to eliminate the potential for hypoxemia, while administration of oxygen prior to suctioning may also prevent hypoxemia due to suctioning.

Question 13

What is the most common cause of airway obstructions

Answer 13

Tongue

Question 14

What manuever is used during BVM ventilation and aids in preventing aspiration

Answer 14

Sellick Maneuver

Question 15

What is the BURP maneuver

Answer 15

• Backward, upward, and rightward pressure on the larynx.
• The maneuver improves the visualization of the larynx structures and eases the intubation.

Question 16

What is the most frequently used artificial airway device

Answer 16

Oropharyngeal Airway (OPA).

Question 17

Indications for OPA

Answer 17

1)Casualty who are unable to maintain their airway.
2)Casualty whose tongue continues to fall into the back of pharynx causingairway obstruction.
3)To assist in improving ventilation in patient’s that are being ventilated with a BVM.
4)It also prevents an intubated casualty from biting an ET tube.

Question 18

Contraindications for OPA

Answer 18

Casualty who is conscious or semiconscious.

Question 19

Contraindication for NPA

Answer 19

Basilar skull fracture

Question 20

What is the preferred supraglottic airway because it makes it simpler to useand avoids the need for cuff inflation and monitoring

Answer 20

I-gel

Question 21

Sizes for I-gel

Answer 21

Size 4 is the correct size for the typical adult.
Size 5 is used for adults larger than 200 pounds.

Question 22

Indications for ET Tube

Answer 22

(a)Casualty who is unable to protect their airway.
(b)Casualty with significant oxygenation problem, requiring administration of high concentrations of oxygen.
(c)Casualty with significant impairment in ventilation requiring assisted ventilation.
(d)Cardiac arrest.
(e)Severe hemorrhagic shock.

Question 23

The following conditions require caution before attempting to intubate:

Answer 23

1)Ingestion of caustic substances
2)Mandibular fractures
3)Laryngeal edema
4)Thermal or chemical burns

Question 24

Complications with ET Tube

Answer 24

(a)Hypoxemia from prolonged intubation attempts.
(b)Trauma to the airway with resultant hemorrhage.
(c)Right mainstem bronchus intubation.
(d)Esophageal intubation.
(e)Vomiting leading to aspiration.
(f)Loose or broken teeth.
(g)Injury to vocal cords.
(h)Conversion of a cervical spine injury without neurologic deficit to one with neurologic deficit.

Question 25

ET tube sizes

Answer 25

• 7.5 mm is the “Universally Accepted” size for an unknown victim
• Men are usually larger, therefore an 8.0 mm tube may be appropriate
• Females are usually smaller, therefore a 7.0 mm tube may be appropriate

Question 26

Describe the sniffing position

Answer 26

Head is extended and the neck is flexed

Question 27

How long should you oxygenate a patient for prior to ET tube?

Answer 27

1 minute with 100% FIO2

Question 28

How far should the ET tube cuff advance after it passes the vocal cords

Answer 28

1/2 to 1 inch for proper placement

Question 29

Sizes of combitube

Answer 29

• 37 Fr (for patients to 6 ft. or 122 to 183 cm tall)
• 41 Fr (for patients more than 5 ft. or 152 cm tall).

Question 30

Indications for Combitube

Answer 30

(a)Ventilation in normal and abnormal airways.
(b)Failed intubation.
(c)Airway management in trapped patients.

Question 31

Complications with Combitube

Answer 31

(a)Combitube™ includes an increased incidence of sore throat, dysphagia andupper airway hematoma when compared to endotracheal intubation and LMA.
(b)Esophageal rupture is a rare complication but has been described.
(c)These complications may be partially preventable by avoiding over-inflation of the distal and proximal cuffs.

Question 32

Contraindications of Combitube

Answer 32

(a)Patients with intact gag reflexes.
(b)Patients with known esophageal pathology.
(c)Used in patients under 5 feet with standard Combitube™, under 4 feet with Combitube™ SA (small adult).

Question 33

Does LMA provide a definitive airway?

Answer 33

No

Question 34

Indication of LMA

Answer 34

When unable to perform endotracheal intubation and the casualty cannot be ventilated using a BVM device.

Question 35

Contraindications for LMA

Answer 35

1)When endotracheal intubation can be performed.
2)Insufficient training.

Question 36

Complications for LMA

Answer 36

(a)Aspiration, because LMA does not completely prevent regurgitation and protect the trachea.
(b)Laryngospasm.
(c)Sore throat.

Question 37

What is the optimal head position for LMA insertion

Answer 37

Neutral position

Question 38

Is LTA a definitive airway

Answer 38

The LTA is not a definitive airway device and plans to provide a definitive airwayare necessary

Question 39

Complications of LTA

Answer 39

(a)The laryngeal tube may be displaced during repositioning the patient’s head and neck for operation.
(b)Aspiration
(c)Poor seal with inability to ventilate.

Question 40

This a technique of “last resort” in prehospital airway management

Answer 40

Cricothyroid membrane

Question 41

Indications for cricothyroidotomy

Answer 41

(1) Massive midface trauma precluding the use of BVM device.
(2) Inability to control the airway using less invasive maneuvers.
(3) Ongoing tracheobronchial hemorrhage.

Question 42

Contraindications for cricothyroidotomy

Answer 42

(1) Any casualty who can be safely intubated, either orally or nasally.
(2) Casualties with laryngotracheal injuries
(3) Children under 10 years of age.
(4) Casualties with acute laryngeal disease of traumatic or infectious origin.
(5) Insufficient training

Question 43

How long can a cricothyroidotomy be left in place

Answer 43

24 hours