Airway

Question 1

Who do you contact for an emergency trachea?

Answer 1

ENT

Question 2

What are the different airway management techniques?

Answer 2

Chin lift
Jaw thrust
Oropharyngeal airway
Nasopharyngeal airway
Extra glottic and supraglittic devices
Endotracheal intubation

Question 3

What are the clinical signs of an obstructed airway?

Answer 3

Agitation or obtuned or abusive (think hypoxia)
Retractions and use of accessory muscles
Abnormal sounds
Deviated trachea

Question 4

What are the clinical signs of a fracture to the larynx?

Answer 4

Hoarseness, subcutaneous emphysema and palpable fracture

Question 5

If a patient has a sever airway obstruction what might they require?

Answer 5

An emergency surgical airway - make sure that the difficult airway equipment is available

Question 6

How might patient with neck trauma present?

Answer 6

They may initially be able to maintain the patency of their own airway but are at high risk of developing obstruction: plan for early intubation!

Question 7

What does trauma to the face require?

Answer 7

Aggressive and careful management of the airway

Question 8

What can penetrating injury to the neck cause?

Answer 8

Vascular injury with associated expanding haematoma which can result in displacement and obstruction of the airway

Question 9

Why should you be aware of a patient with facial fractures refusing to lie flat?

Answer 9

They may lack the ability to manage their own secretions

Question 10

What can fractures and dislocations to the mid face cause?

Answer 10

Compromise to the nasopharynx and oropharynx due to associated haemorrhage, increased secretions and dislodged teeth

Question 11

What is the best way to assess an airway?

Answer 11

Look - for any obvious obstruction
Listen - noisy?quiet?silent?
Feel - air coming in and out

Question 12

If you hear an inspiratory strider, what would you suspect?

Answer 12

Obstruction at the laryngeal level or above

Question 13

If you hear an expiratory strider, what would you suspect?

Answer 13

Obstruction of the lower airways, which tend to collapse and obstruct during expiration

Question 14

If you hear gurgling, what would you suspect?

Answer 14

Presence of liquid or semisolid foreign material in the upper airways

Question 15

If you hear snoring, what would you suspect?

Answer 15

The pharynx is partially occluded by the tongue or palate

Question 16

If you hear a silent airway, what would you suspect?

Answer 16

Complete obstruction

Question 17

When should a surgical airway be considered?

Answer 17

When an obstruction of the airway means that an ETT cannot be placed down the trachea to provide adequate oxygenation

Question 18

What is the preferred surgical airway?

Answer 18

Surgical cricothyroidotomy

Question 19

What does a needle cricothyroidotomy involve?

Answer 19

The insertion of a needle through the cricothyroid membrane into the trachea below the level of the obstruction to provide temporary, supplemental oxygenation on a short term basis until a definitive airway can be placed. Connect to oxygen at 15 L/min with a Y connector or a side hole in some 02 tubing with intermittent insufflation. Can adequately oxygenate for 30-45 mins

Question 20

With the jet insufflation technique, what large-calibre cannula should be used in adults and children?

Answer 20

12-14 gauge for adults and
16-18 gauge for children

Question 21

How is a surgical cricothyroidotomy performed?

Answer 21

Place patient in supine position
Making an incision that extends through the cricothyroid membrane. A bougie is then inserted into the trachea and a small ETT over the bougie
Ventilate lungs with self inflating bag attached to high flow
Confirm with auscultation and capnography

Question 22

Is a surgical cricothyroidotomy
recommended in children under the age of 12 years old?

Answer 22

No

Question 23

Why is a tracheostomy contraindicated in an emergency?

Answer 23

Time consuming
Hazardous
Requires considerable surgical skill and equipment
Substantial bleeding can occur

Question 24

How do you do a chin lift?

Answer 24

Place one hand on patients forehead and tilt the head back gently
Place the fingertips of the other hand under the point of the patients chin and gently lift

Question 25

When would you do a jaw thrust?

Answer 25

Suspected spinal injuries

Question 26

How do you do a jaw thrust?

Answer 26

Identify the angle of the mandible, and then apply steady upward and forward pressure to lift the mandible
Using the thumbs, slightly open the mouth by downward displacement of the chin

Question 27

How do you size a guedel airway?

Answer 27

Measure from the patients incisors to the angle of the jaw

Question 28

How do you insert a guedel airway?

Answer 28

Open patients mouth and ensure no foreign material that can be pushed down
Insert in the upside down position as far as the junction between the soft and hard palate then rotate 180 degrees
Advance airway until it lies within the pharynx

Question 29

When would you not use a NP airway?

Answer 29

Patient has suspected base of skull fracture

Question 30

How do you insert a NP airway?

Answer 30

Insert bevel end first, vertically along the floor of the nose with a slight twisting action
The curve of the airway should direct it towards the patients feet

Question 31

What are epistats and mouth props used for?

Answer 31

Facial trauma

Question 32

What is the preferable emergency airway for children under 12 years old?

Answer 32

Needle cricothyroidotomy

Question 33

What equipment is needed for a needle cricothyroidotomy?

Answer 33

Wide bore non kinking cannula
High pressure oxygen source

Question 34

How does heliox work?

Answer 34

It has low density which acts by lowering the resistance to gas flow within the airways and permitting an increase in ventilation

Question 35

Where do you find Heliox in the department?

Answer 35

Contact the porters who will get it

Question 36

What conditions can be treated with Heliox?

Answer 36

Upper airway obstruction croup
Post extinction strider asthma
COPD

Question 37

What suspected injury would we use mouth props for?

Answer 37

Lafort fracture (facial fracture affecting bridge of nose and face)