Advanced Airway Management

Question 1

Why we fail at airway management

Answer 1

Lack of protocol
lack of planning or preparation
Lack of plan A, B, and C
Intubation failure
lack of equipment availability, use, or training
Approach
Communication failures

Question 2

Indications for airway management

Answer 2

Unable to swallow
Patient can't ventilate/oxygenate
FBAO
Apnea
Respiratory failure indicated by ABG
Expected clinical course of illness

Question 3

PAT

Answer 3

Appearance
WOB
CIrculation

Question 4

HEAVEN Criteria

Answer 4

Hypoxemia: SPO2 <93
Extremes of size
Anatomic challenges
Vomit/blood/fluid
Exsanguination/anemia:  
       potential accelerated desaturations
Neck mobility issues

Question 5

Failed airway algorithm

Answer 5

Patient requires secured airway- can’t intubate - can’t ventilate- can’t oxygenate >90% - Cric

Question 6

What should the ETT tube cuff be inflated to prevent mucosal tissue damage?

Answer 6

20 - 30 mmHg; 25 mmhg is the standard; truly only enough to make a seal

Question 7

How do you confirm tube placement with X-ray?

Answer 7

Distal tip of tuble should be 2-3 cm above carina, or 1 inch above carina, or at the level of T2 or T3

Question 8

Analgesic dose for Fentanyl

Answer 8

1 mcg/kg

Question 9

What is the onset of Fentanyl

Answer 9

3-5 minutes, 30-60 minute duration

Question 10

RSI dose for Etomidate

Answer 10

0.4 mg/kg

Question 11

Contraindications for Etomidate

Answer 11

Adrenal suppression: Avoid in Septic Shock or Addison’s Disease; Avoid in COPD and Asthmatic patients

Question 12

RSI dose for Ketamine

Answer 12

1-2 mg/kg

Question 13

Pain dose for Ketamine

Answer 13

0.1 - 0.2 mg/kg

Question 14

Combative dose for Ketamine

Answer 14

5 mg/kg IM

Question 15

Why is Ketamine preferred induction medication for Asthmatic patients?

Answer 15

it is a potent bronchodilator (beta 2)

Question 16

When should Fentanyl be avoided?

Answer 16

In patients with: increased ICP, hypoventilations (can cause chest wall rigidity), hypotension and bradycardia

Question 17

What is the reversal agent for Versed?

Answer 17

Flumazenil (Romazicon)

Question 18

What is the onset of Ketamine?

Answer 18

40-60 seconds; 10-20 minute duration

Question 19

RSI dose for Succinylcholine

Answer 19

1-2 mg/kg

Question 20

Contraindications for Succinylcholine

Answer 20

Crush injuries; eye injuries; narrow angle glaucoma; malignant Hyperthermia, burns > 24 hrs; any nervous system disorder (ie. Guillain-Barre, Myasthenia Gravis)

Question 21

A class/grade of airway view where all of the structures of the airway are visible; i.e. soft palate, uvula, anterior/posterior tonsillar pillars. Often associated with tall, thin necks.

Answer 21

Grade/Class 1 view (aka Mallampati 1) No difficulty

Question 22

A class/grade of airway view where tonsillar pillars are hidden by the tongue

Answer 22

Grade/Class 2 view (aka Mallampati 2) No difficulty

Question 23

A class/grade of airway view where only the base of the tongue can be seen.

Answer 23

Grade/Class 3 view (aka Mallampati 3) moderate difficulty

Question 24

A class/grade of airway view where the uvula cannot be seen and is typically associated with short, fat or muscular necks. No airway structures visible.

Answer 24

Grade/Class 4 view (aka Mallampati 4) difficult airway

Question 25

Respiratory Failure as indicated on ABG

Answer 25

pH <7.2, CO2 >55, PaO2 <60

Question 26

How are Mac blades designed to be used?

Answer 26

Lift the epiglottis via vallecula

Question 27

How are the Miller blades designed to be used?

Answer 27

Direct displacement of the epiglottis

Question 28

At what age should you attempt needle cric verses a surgical cricothyrotomy airway?

Answer 28

< 12 years of age