4th July [26th-1st]

Question 1

What does RSI stand for in terms of intubation?

Answer 1

Rapid Sequence induction

Question 2

Steps in RSI

Answer 2

1. Pre-oxygenation
2. Drugs [relaxing the airway]
3. Cricoid compression
4. Suction
5. Laryngoscope
6. Endotracheal tube insertion

Question 3

What happens before RSI?

Answer 3

• see if patient conscious
• call for help/anaesthetist
• open airway and examine with head tilt

Question 4

What to do if can’t head tilt patient [due to e.g. neck brace]?

Answer 4

• chin thrust

Question 5

What happens during the pre-oxygenation stage of intubation?

Answer 5

1. Try smaller gadelle [oropharygeal airway] or nasopharyngeal airway
2. Or try a IGEL [supraglottic airway]
3. Can keep these in place, then put on mask with the squeezable bag [bag mask ventilator]

Question 6

How to check the size of oro/nasopharyngeal airway?

Answer 6

Soft on soft: soft palate follow round to corner of mandible to see correct size
Hard on hard: hard palate follow round top of teeth incisor to bottom corner jaw

Question 7

How do you hold the ventilator?

Answer 7

C and E formed with hand, hold close to patient mouth

Question 8

Drugs given to patient in RSI

Answer 8

Muscle relaxants -> like propafol and rockiuranium or something?

RSI traditionally involves preoxygenating the lungs with a tightly fitting oxygen mask, followed by the sequential administration of an intravenous sleep-inducing agent and a rapidly acting neuromuscular-blocking drug, such as rocuronium, succinylcholine, or cisatracurium besilate, before intubation of the trachea.

Question 9

Pneumonic for difficult to access airways?

Answer 9

LEMON

Question 10

LEMON stand for?

Answer 10

Look externally 
Evaluate 332
Mallampati
Obstruction scores
Neck mobility

Question 11

What’s a mallampati score?

Answer 11

Predict difficult patients for intubation -> over 2-4 difficult

Question 12

Signs that the endotracheal tube is in place correctly

Answer 12

1. CO2 levels?
2. O2 saturation
3. Vision: see if it went in correctly
4. Chest rising equally on both sides
5. hm

Question 13

GCS of someone with a decreased level of consciousness classed to be in a stupor/coma

Answer 13

GCS of 8

Question 14

Indications for intubation

Answer 14

1. Depressed level of consciousness
2. Hypoxemia
3. Airway obstruction
4. Manipulation of airway [e.g. bronchoscopy]
5. Newborn

Question 15

What may be used to help insert intubation equipment into the right place?

Answer 15

A stylet: malleable long wire

Question 16

When are cricothyromoties indicated?

Answer 16

A cricothyrotomy is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive facial trauma.[53] A cricothyrotomy is nearly always performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine and is associated with fewer complications.

Question 17

When are tracheostomies indicated?

Answer 17

In the acute setting, indications for tracheotomy are similar to those for cricothyrotomy. In the chronic setting, indications for tracheotomy include the need for long-term mechanical ventilation and removal of tracheal secretions (e.g., comatose patients, or extensive surgery involving the head and neck)

Question 18

Risks of tracheostomy

Answer 18

In the acute setting, indications for tracheotomy are similar to those for cricothyrotomy. In the chronic setting, indications for tracheotomy include the need for long-term mechanical ventilation and removal of tracheal secretions (e.g., comatose patients, or extensive surgery involving the head and neck).

Question 19

Gold standard for confirmation of tube placement

Answer 19

Waveform capnography has emerged as the gold standard for the confirmation of tube placement within the trachea.

Question 20

List examples of predicting difficulty for intubation

Answer 20

the range of motion of the cervical spine: the subject should be able to tilt the head back and then forward so that the chin touches the chest.
the range of motion of the jaw (the temporomandibular joint): three of the subject’s fingers should be able to fit between the upper and lower incisors.
the size and shape of the upper jaw and lower jaw, looking especially for problems such as maxillary hypoplasia (an underdeveloped upper jaw), micrognathia (an abnormally small jaw), or retrognathia (misalignment of the upper and lower jaw).
the thyromental distance: three of the subject’s fingers should be able to fit between the Adam’s apple and the chin.
the size and shape of the tongue and palate relative to the size of the mouth.
the teeth, especially noting the presence of prominent maxillary incisors, any loose or damaged teeth, or crowns.