Advanced Airway Management

Question 1

Discuss the difference between rapid sequence inducton and delayed sequence inducton.

Answer 1

RAPID SEQUENCE INDUCTION (RSI)

• Near simultaneous administraton of anaesthetc and paralytic
• Intended to mnimise risk of aspiraton
• 9 steps to ensure preparaton

DELAYED SEQUENCE INDUCTON (DSI)

• Useful for patients fightng pre-oxygenaton, or preventing pre-intubaton checklist
• Procedural sedaton for pre-oxygenation
• Ketamine 1mg/kg, then pre-oxygenate

Question 2

Identify when RSI or DSI would be appropriate

Answer 2

RSI

Induces and paralyses simultaneously to prevent aspiraton of gastric contents

eg:

• patients who have an intact gag reflex and may be inadequately starved
• hx of gastric reflux
• impending obstructon (airway burn, penetrating neck injury)
• humane reasons (multple trauma/burns)
• hypoventilation
• neuroprotection (targeting PaCO2 35-40 mmHg)

DSI

Patients fighting pre-oxygenaton, or preventing pre-intubaton checklist
- essentially procedural sedaton for preoxygenaton

eg: hypoxic, starvaton

Question 3

Identify risk factors for a dfficult airway using

LEMON

Answer 3

• *Look**
• External markers of difficult intubation
  eg. obesty, collars, short neck, trauma, audible sounds, face shape, loose teeth
• *Evaluate**
• Can the pt fit 3 fingers between incisors
• Upper lip bite (class 1, 2 and 3)

Mallampati
How wide can pt open their mouth, glottis vew, tongue size

• Class 1 and 2 predict adequate oral access
• Class 3 predicts moderate difficulty
• Class 4 predicts a high degree of difficulty
• *Obstruction/Obesity**
• Upper airway obstruction?
• mass, infection, burns, oedema, foreign body, trauma
• obese with redundant tissue
• *Neck Mobility**
• Can the pt extend their neck or even be moved into a sniffing position?
• Cervical collar, trauma, arthritis

*can compromise laryngoscopy, passage of ETT, BVM or all 3

Question 4

How to prepare:

• Bougie
• Fibre optic scope
• Cricothyroidotomy sets

Answer 4

Youtube it

Question 5

Difficult airway management

• Discuss indications and nursing consterations for cricothyrodotomy

Answer 5

Incision made into the cricoid membrane at the front of the neck, an ETT or trachyostomy tube is inserted directly into the trachea

• *Indications**
• Final step n the emergency airway algorithm
• Can’t intubate, can’t oxygenate

Question 6

Difficult airway management

• Discuss indications and nursing consterations for needle cricothyrodotomy

Answer 6

A needle is inserted directly into the cricoid membrane, ventlation is managed via the cannula

• *Indications**
• Can’t ventilate, can’t oxygenate

Nursing considerations
Watch for:
- Pneumothorax
- Subcut and mediastinal emphysema
- bleeding
- Andoesophageal puncture
- Resp acidosis will worsen due to hypoventilation

Question 7

Difficult airway management

• Discuss indications and nursing consterations for retrograde intubaton

Answer 7

A needle is inserted directly into the cricoid membrane, catheter is aimed towards the mouth, wire is inserted through the catheter, advanced up the catheter and out of the mouth.
ET tube placed over the guide wire and advanced down the trachea to secure the airway

Question 8

What are the 9 P’s of Rapd Sequence Induction?

Answer 8

Plan/Prepare

Protect the c-spine

Pre-oxygenate

Positoning

Pre-treatment

cricoid Pressure

Paralysis wth induction

Placement with proof

Post-intubation management

Question 9

REVIEW INDUCTION AND PARALYTIC DRUGS FROM LAST SEMESTER

Answer 9

REVIEW INDUCTION AND PARALYTIC DRUGS FROM LAST SEMESTER