Airway

Question 1

What are the elements of evaluating for a difficult airway?

Answer 1

L: look
E: Evaluate  3-3-2 rule
M: Mallampati
O: obstruction/obesity
N: neck mobility

Question 2

What are the elements of evaluating for difficulty with BVM

Answer 2

MOANS
M: mask seal
O: obseity 
A: aged
N: no teeth
S: stiff lungs

Question 3

List conditions with increased resistance to ventilation

Answer 3

COPD
asthma
pulmonary edema
restrictive lung disease
term pregnancy

Question 4

What are predictors of difficult LMA

Answer 4

R: restricted mouth opening
O: obstruction at/below chords
D: displacement/distorion/disruption of airway
S: stiff chest wall or lungs

Question 5

List predictors of diffucult crichothyrotomy

Answer 5

SHORT
S: surgery
H: hematoma
O: obesity
R: radiation
T: tumor

Question 6

List methods to confirm ET tube placement

Answer 6

1. EtCO2 capnography or colorimetric detection
2. flexible bronchoscopy
3. aspiration with turkey baster
4. bilateral breath sounds
5. CXR
6. condensation in ET tube
   oxymetry

Question 7

List potential complications of using succinylcholine:

Answer 7

• Fasciculations àhyperkalemia (very high with myopathic disease – includes MS)
• masseter spasm (esp peds)
• Increased IOP (not clinically significant, Ron Walls airway manual à if open globe, select paralytic as with any patient)
• Increased ICP
• Bradycardia
• Hyperkalemia
  MH

Question 8

What conditions are associated with hyperkalemia after succinylcholine administration

Answer 8

Burns >10% BSA

Crush injury

Denervation (stroke, spinal cord injury)

Neuromuscular disease (ALS, MS)

Intra-abdominal sepsis

Pre-existing hyperkalemia

Hx MH

Question 9

Outline an approach to post intubation hypoxia

Answer 9

DOPE T”
o Dislodged tube: check position, ETCO2
o Obstructed tube: suction
o Pneumothorax: listen, U/S, CXR
o Equipment failure: check O2 tank, vent
o Tense patient!!! If inadequately sedated, fight vent à sedate, paralyze

Question 10

What medications and doses are good for post intubation maintenance of sedation?

Answer 10

Midazolam 0.1 mg/kg then then 0.02-0.1mg/kg/hr or 2-8mg/hr

• Fentanyl 3mcg/kg
• Morphine 0.1mg/kg
• Propofol 0.2-0.5 mg/kg then 0-50mcg/kg/min

Question 11

List 6 ways you can manage hypoxia in the intubated patient:

Answer 11

1. incr FiO2
2. Incr PEEP
3. Recruitment maneuver
4. Increase sedation/paralysis
5. Incr IFR
6. Incr minute ventilation (change RR or Vt)

Question 12

List 8 causes of high-pressure alarms in ventilated pt

Answer 12

INCREASED RESISTANCE

1. Kinked tube
2. Blocked ET tube
3. Bronchospasm

DECREASED COMPLIANCE

4. Parenchymal dz
5. Tension PTX
6. ARDS
7. Excessive Vt
8. Mainstem intubation
9. AutoPEEP
10. Abdominal distention

Question 13

What 6 parameters need to be set initially in volume cycled ventilators?

Answer 13

1. Mode: CMV, A/C, IMV, SIMV
   
   2. FiO2
   3. Vt
   4. Rate
   5. I/E ratio
   6. PEEP