Airway

Question 1

List the causes of upper airway obstruction

Answer 1

Infection- epiglottitis
Foreign body
Trauma- penetrating/ blunt
Anatomical- Tracheomalacia / supraglottic stenosis
Immunology- anaphylaxis/ angioemdema
CNS- head injury/ ICH/
Toxicology- drugs
Neoplasia- base of tongue/ larynx/ trachea

Question 2

Predictor of difficult BVM
And Difficult LMAs

Answer 2

BVM- fit- beard/ dentures/ jaw
Obesity
Obstruction
Age >55
No teeth
Stiffness- c spine

LMA - restricted mouth opening
Obesity and obstruction
Distorted anatomy
Stiffness lung wall and chest wall.

Question 3

Predictors of difficult intubation

Answer 3

L- look- size tongue and jaw
E- evaluate 3/3/2 rule 3cm between incisors 3 cm thyomental distabce and 2cm hyoid to thyroid distance
M- maladaptive score
O- obesity and obstruction
N neck mobility
T TMJ distinction/ trauma or tumour
E xperience

Question 4

Predictor of difficult surgical airways

Answer 4

S- surgery prior to area
M ass- abscess or tumour to area
A access and anatomy
Radiation prior
T trauma or tumour

Question 5

What is Malampati score

Answer 5

Score system to determine how much on view of upper airway.
Grade 1- soft palate/ faucial pillars and uvula
Grade 2 soft palate/ faucial pillars and masked base uvula
Grade 3 only soft palate
Grade 4- hard palate only
Increasing grade increasing difficulty

Question 6

What is ASA score

Answer 6

1- healthy- non smoker no etoh
2- mild systemic disease- etoh/ smoker BMI>30/DM/HTN
3- severe not incapacitating- minor functional limitation
4- Severe consistent life threat- cVA/ sepsis/ MI
5- moribund- massive trauma ruptured AAA
6- brain dead- organ donation

Question 7

Why is Cormack- Lehane- direct laringoscopy

Answer 7

Grading system
Grade1 - full view glottis 68% pop
Grade 2a- partial view Glottis - 24% pop
Grade 2b- only posterior glottis - 6.5%
Grade 3- only epiglottis -1.2%
Grade 4 - neither glottis or epiglottis rate

Question 8

Indications to intubate in DEM

Answer 8

1-obtunded - GCS<8/ no gag/ can’t manage secretions
2- TCA overdose- hyperventilate
3- hypoxia to increase O2 delivery
4- increased WOB- take over ventilation
5- head injury- agitation/ hyperventilate
6- protect airway- burns/ anaphylaxis
7- volatile hydrocarbon ingestion
8- life threatening huperthermia- tube and muscle relaxant
9- bleeding- upper GI/ epistaxis
10- facial or neck burns

Question 9

Contraindications for intubation

Answer 9

1- increased aspiration risk
2- suspect or known difficult tube
3- inabilaity to perform a surgical airway
4- upper airway obstruction- foreign body ro cancer
5- haemodynamically unstable

Question 10

Size of blade for intubation and ETT size

Answer 10

Size 4 blade- adult average
Peadiatrics < 1=0 1=1 >2=2 >10=3 - use straight blade due to floppy eppiglottis

ETT
Adult female 7.5 and Male 8
Peadiatric age/4 + 4
Adult 20-23 cm teeth and peads 3xETT size

Question 11

Complications after intubation

Answer 11

1- hypotension- anaphylaxis to anaesthetics? Tension pneumothorax/ AMI/ induction drugs
2- hypoxia- dislodged ETT/ obstruction/ pneumothorax/ equipment fail- vent/ tube/ ICC/ breath stacking or bronchospasm/ mucous plugging
3- cuff perforated/ cuff leak
4- trauma
5- endobronchial tube
6- fail to tube- surgical
7- aspiration
8- patient aware

Question 12

Causes laringospasm

Answer 12

Ketamine induction
Irritation vocal cords by ETT
Incomplete paralysis
Aspiration
Foreign body
Hypo Ca2+

Question 13

Post intubation steps

Answer 13

1- BP/HR/ECG
2- rpt VbG or ABG o2
3- check ventilator settings
4- insert NGT decompress
5- IDC/ art line
6- analgesia and sedation-
Morphine- 50mg/50ml saline run 1-20mghr
Propofol- neat 1000mg/100ml- 10-100mghr
Fentanyl- 10-200mcg/hr 1-20ml/hr
Midazolam 1-20mg/hr
Look features anaphylaxis and malignant hyperthermia
CXR- check tube and NGT
Disposition- ICU