Airway And Breathing Management

Question 1

Learning Objectives

Answer 1

• Identify the clinical settings in which airway compromise is likely to occur.
• Recognize the signs and symptoms of airway obstruction.
• Describe the techniques to establish and maintain a patent airway.
• Discuss the importance of adequate oxygenation and ventilation in all phases of airway management.

Question 2

What is your first priority if you see a 34-year-old motorcyclist lost control and crashed into a fence?

Answer 2

• Obvious facial trauma
• No helmet
• Smells of alcohol
• Belligerent at scene; now not communicating
• Pulse oximeter 85%
• Check if their airways are open

Question 3

Airway Assessment
How do I know the airway is adequate?

Answer 3

• Patient is alert and oriented
• Patient is talking normally
• There is no evidence of injury to the head or neck
• You have assessed and reassessed for deterioration

Question 4

List the Signs and symptoms of airway compromise

Answer 4

• High index of suspicion
• Change in voice / sore throat
• Noisy breathing (snoring and stridor)
• Dyspnea and agitation
• Tachypnea
• Abnormal breathing pattern
• Low oxygen saturation

Question 5

When do you intervene when the airway is patent?

Answer 5

• Inability to protect the airway
• Impending airway compromise
• Need for ventilation

Question 6

How do you manage the airway or a trauma patient?

Answer 6

• Supplemental oxygen
• Basic techniques
• Basic adjuncts
• Definitive airway
• Cuffed tube in the trachea
• Difficult airway adjuncts
• Unexpected difficult airway
• Predicted difficult airway

Question 7

List one caution associated with airway management

Answer 7

Protect the cervical spine during airway management

Question 8

List one basic technique in airway management

Answer 8

Chin lift

Question 9

List some basic adjuncts in Airway management

Answer 9

• Oropharyngeal airway: Patients who can tolerate an oral airway will usually need intubation.
• Nasopharyngeal airway: Often well tolerated

Question 10

How do you predict a potentially difficult airway?

Answer 10

• If the following features are present
• Maxillofacial trauma and deformity
• Mouth opening
• Anatomy: Beard, Short, thick neck, Receding jaw, Protruding upper teeth

Question 11

List some easy definitive airways

Answer 11

• Oral intubation (medication assisted)
• Cricoid pressure, suction, back-up
• Maintain c-spine immobilization

Question 12

How would you plan for failure in these definitive airway management?

Answer 12

• Plan for failure:
• Gum elastic bougie
• LMA / LTA
• Needle cricothyroidotomy
• Surgical airway

Question 13

Describe some more easy definitive airways**

Answer 13

• Preoxygenate
• Cricoid pressure
• Sedate (midazolam)
• Paralytic (succinylcholine)
• Intubate
• Confirm (Auscultate, CO2)
• Release cricoid pressure and ventilate

Question 14

Describe difficult definitive airway methods

Answer 14

• Get help
• Be prepared
• Consider rapid sequence intubation vs. awake intubation
• Maintain c-spine immobilization

Question 15

What should you consider the use of in these difficult definitive airway methods

Answer 15

• Consider use of:
• Gum elastic bougie
• LMA / LTA
• Surgical airway
• Other advanced airway techniques, eg, fiberoptic intubation

Question 16

List other methods of definitive airways

Answer 16

• Surgical airway
• Cricothyroidotomy
• Use of needle or surgery

Question 17

What is a definitive airway?

Answer 17

A tube placed in the trachea with cuff inflated below the vocal cords

Question 18

How do you know if the tube is in the right place?

Answer 18

• Visualize it going through the cords
• Watch the chest
• Auscultation
• Pulse oximeter
• CO2 detector
• Radiology

Question 19

VD for the Airway Decision Scheme

Question 20

Summary

Answer 20

• Suspect airway compromise in all injured patients.
• Adjuncts for establishing a patent airway include:
• Chin-lift and jaw-thrust maneuvers
• Oropharyngeal and nasopharyngeal airways
• Laryngeal mask airway
• Multilumen esophageal airway
• Gum elastic bougie device

Question 21

Summary

Answer 21

• With all airway maneuvers, the cervical spine must be protected by inline immobilization.
• A surgical airway is indicated when an airway is needed and intubation is unsuccessful.
• The assessment of airway patency and adequacy of ventilation must be performed quickly and accurately.
• Pulse oximetry and end-tidal CO2 measurement are essential.

Question 22

Summary

Answer 22

• A definitive airway requires a tube placed in the trachea (inflated cuff, oxygen, assisted ventilation, airway secure).
• Oxygenated inspired air is best provided via a tight-fitting oxygen reservoir face mask with a flow rate of greater than 11 L/min.