Advanced Airway Management

Question 2

Indications for an intubation

Answer 2

AOCC

• failure to protect own airway in cases of aspiration, decreased LoC or severe trauma to airway
• failed oxygenation or issue with adequate ventilation
• predicted clinical deterioation
• hypoxic driven cardiac arrest

Question 3

difficult airways for BVMs

Answer 3

MOANS

M - mask seal issue
O - obstruction or obesity
A - advanced age
N - no teeth or loose orals
S - stiff lungs

Question 3

why will advanced age affect bag mask ventilation

Answer 3

reduced skin turgor and poor muscle tone

Question 5

difficult airway predictors for intubation

Answer 5

LEMON

L - look externally
E - evaluate the 3 3 2 rule
M - Mallapati
O - obstruction
N - neck mobility limited

Question 6

airway predictor for surgical airway

Answer 6

SHORT

S - surgery
H - hematoma
O - obesity
R - radiation therapy in hx
T - tumor

Question 7

airway predictor for supraglottics

Answer 7

R - restricted mouth opening
O - obstruction
D - distorted away
S - stiff neck

Question 8

7 Ps of rapid intubation

Answer 8

1. prep
2. pre-O2
3. positioning and pre-rx
4. pharmacology and paralysis
5. placement
6. proof of placement
7. post-care

Question 9

how to prepare for induction?

Answer 9

> self, pt, team and equipment
SOAP-ME

Question 10

how should pre-O2 be done?

Answer 10

TIme: 3-5 mins
Mode: FiO2 or mask, but shorter period

Question 11

why is pre-O2 done?

Answer 11

increased conc in lungs and alveoli recruitment if NIPPV

Question 12

what position is best?

Answer 12

aligned to airway axis

Question 13

when is pre-Rx done?

Answer 13

in cases of high risk for intubation response, mostly in Paeds

Question 14

what drugs are given?

Answer 14

Induction –> paralytics ( see pic )

Question 15

measures of successful placement?

Answer 15

• inflate cuff
• check measurement at lips

> check there is a sustained capnograph
chest rise and fall
normal auscultatory findings

• secure tube

Question 16

Monitoring required in post-intubation care?

Answer 16

> 3 lead ECG
Sats
Capno
ABGs
BPs
CXR
drug monitoring of analgesia and sedation

Question 17

what may cause a delayed response in the pulse oximeter ?

Answer 17

• nail polish
• high ambient light
• CO2 poisoning
• cardiac arrest
• hypotension
• hypothermia

Question 18

why might SPO2 drop?

Answer 18

DOPES

• displaced ETT
• obstructed circuit
• pneumothorax
• equipment failure
• stomach full of air

Question 19

complications of ETT?

Answer 19

TILORT
- trauma
- infection
- largyngospasm
- oesophagus placement
- right main bronchus placement
- tension pneumothorax