- ADVANCED AIRWAY MANAGEMENT -

Question 1

Define delayed sequence induction and identify when this technique is appropriate

Answer 1

Delayed Sequence Induction is essentially sedation for effective pre-oxygenation. Indications:

• non-compliant with pre-O2, confused,ETOH,drugs, mental illness (good lungs bad brains)
• hypoxic: COPD, pneumonia, ARDS (bad lungs)

Question 2

Identify risk factors for a difficult airway

Answer 2

LEMON (look, evaluate, mallampati, obesity/obstruction, neck mobility)
L - obesity, collars, trauma, audible sounds,shape of the pts face)
E - size of the mandible, how wide can pt open their mouth, glottis visability
M - mallampati score (high score - more difficult)
O - obstruction, infection, swelling, facial trauma, obesity, previous surgery
N - collar, mobility, sniffing position achievable? arthritis, ankylosing spondylitis

Question 3

Demonstrate the ability to prepare difficult airway equipment including:

• Bougie
• Fibre optic scope
• Cricothyroidotomy sets

Answer 3

• scalpel
• bougie
• 6.0 ETT
• 10ml Syringe for inflation
• ETCO2 and BVM connections
• fibre optic scope
• anti-fogging agent

Question 4

Discuss the indications and nursing considerations for a

Cricothyroidotomy

Answer 4

Indications: can’t intubate, can’t ventilate (CICV) scenario)

Considerations: indications, contraindications, environment, preparation, signs of pneumothorax, trauma to the area, XR, family education

Question 5

Discuss the indications and nursing considerations for a Retrograde intubation

Answer 5

• Indications:
  ETT intubation is difficult, contraindicated or fialed (e.g. maxillofacial trauma)
• Considerations:
  Indications, contraindications, environment, preparation

Question 6

Define rapid sequence induction and identify when this technique is appropriate

Answer 6

Rapid sequence intubation (RSI) is an airway management technique that involves inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway

• RSI is particularly useful in the patient with an intact gag reflex, a “full” stomach, and a life threatening injury or illness requiring immediate airway control