Airway and ventilatory management

Question 1

Combativeness can be a sign of (4)

Answer 1

• airway compromise
• altered mental state eg post head injury
• pre-existing conditions eg alcohol
• hypoxia

Question 2

Define definitive airway

Answer 2

Tube placed in trachea with cuff inflated below the vocal cords, tube connected to a form of oxygen enriched assisted ventilation

Question 3

Signs of airway compromise on INSPECTION (5)

Answer 3

• head or neck injury
• dyspnoea, tachypnoea
• agitation (for hypoxia, obtundation for hypercarbia)
• abnormal breathing pattern (eg use of accessory muscles, rocking respiration)
• deviated trachea

Question 4

Signs of airway compromsie on LISTENING (3)

Answer 4

• change in voice
• noisy breathing (snoring, stridor)
• absent breath sounds on lung fields

Question 5

Signs of airway compromise on PALPATION (2)

Answer 5

• subcut emphysema on head, neck or chest
• head or neck injury

Question 6

Patients at high risk for compromised ventilation

Answer 6

• unconscious patients with head injuries
• obtunded patients (alcohol, drugs)
• thoracic injuries
• facial burns
• potential inhalation injuries

Question 7

Laryngeal fracture signs (3)

Answer 7

• hoarseness
• subcut emphysema
• palpable fracture

Question 8

Signs of inadequate ventilation (7)

Answer 8

• asymmetry
• tachypnoea
• tachycardia
• altered mental state
• accessory muscles + nasal flaring
• diminished breath sounds
• low saturations

Question 9

LEMON mneumonic for assessing airway

Answer 9

Look externally (body habitus, short neck, loose teeth, jaw abnormalities)

Evaluate 3-3-2 (3 fingers incisors, 3 fingers chin to hyoid, 2 fingers floor of mouth to thyroid notch)

Mallampati (visualisation of soft palate etc)

Obstruction or obesity (epiglottitis, quinsy, trauma)

Neck mobility (arthritis c spine, or c spine injury eg)

Question 10

Nasopharyngeal airway assessment for what obstructions (3)

Answer 10

Polyps
Fractures
Haemorrhage

Question 11

Indications for definitive airways

Answer 11

Airway - inability to maintain patent airway

Breathing - inability to maintain adequate oxygenation by facemask, or apnea

circulation - obtundation or combativeness resulting from cerebral hypoperfusion

Disability - obtundation indicating head injury + requiring ventilation; GCS <8; sustained seizure; need to protect lower airway from aspiration

Question 12

RSI indication

Answer 12

• need airway control, intact gag reflex
• head injury