Airway Equipment and Management

Question 1

Types of Airway Support

Answer 1

A) Spontaneous Ventilation
B) Mask ventilation (Bag)
C) Supraglottic Airways
D) Endotracheal Intubation
E) Tracheostomy

Question 2

Supraglottic airways (SGAs)

Answer 2

The LARYNGEAL MASK AIRWAY (LMA) is the best known and most widely-used SGA. Secondary generation have a gastric hole.
Sit on top of the glottis (vocal cords)
Patients can breathe spontaneously.
DO NOT offer reliable protection against aspiration
PRIMARY USE:
Suitable for short procedures in fasted patients who do not require intubation
SECONDARY USE:
Useful in emergencies as a backup/rescue airway when intubation or mask ventilation is not possible.

Question 3

Endotracheal Intubation Types

Answer 3

Protects Against Aspiration

1. Standard endotracheal tubes
2. The Reinforced (Armoured) ETT.
3. Pre-formed (bent) ETTs (RAE tubes)

Question 4

Standard endotracheal tubes

Answer 4

GOLD STANDARD TUBE
Made of polyvinyl chloride
Placed through the vocal cords using a laryngoscope.
Has inflatable/deflatable cuff
PROVIDE PROTECTION AGAINST ASPIRATION
BEST IN SUPINE POSITION (chest&abdomen)
Patient can be ventilated or breathe spontaneously .

Question 5

The (Reinforced) Armoured ETT

Answer 5

Metal wiring embedded in the wall=>more resistant to compression
Flexible; more difficult to insert use bougie.
PRIMARY USE
Used in non-standard positions (prone, lateral, beech-chair, neurosurgery, shoulder surgery)
SECONDARY USE
Used also for AWAKE NASAL FIBREOPTIC INTUBATION.

Question 6

Pre-formed (bent) ETTs (RAE tubes)= South-facing/ Oral RAE

Answer 6

Easy to insert, predetermined depth
Kinks easily
Used for surgery on the face, and eye surgery

Question 7

Pre-formed (bent) ETTs (RAE tubes)= North-facing/ Nasal RAE

Answer 7

Inserted through the nose
More difficult to insert
For surgery in the mouth/jaw/ dental

Question 8

Effective/Efficient Ventilation on Machine

Answer 8

All these in normal patient
Tidal Volume(exp)= 6-7ml/kg
RR= 12-20bpm
pCO2= 4.5-5.5kPa(%)
SATs= 100%
other: BP (must be 20% less than baseline)

Question 9

Laryngoscopes

Answer 9

Blades 3= females/ 4=males
Curved= Macintosh (placed in vallecula)
Straight= Miller (underneath epiglottis)

Question 10

Some indications for intubation (APA)

Answer 10

1. PROCEDURES REQUIRING IMMOBILISATION
Thoracic and abdominal surgery
Microsurgery (e.g. retinal / neurosurgery)
2. ARTIFICIAL  VENTILATION IS REQUIRED
Long complex surgeries
Respiratory failure
3. SECURING AIRWAY (N.GUR)
Shared airway
Risk for aspiration
GCS<8
Unfasted stomach
Non-supine positions

Question 11

The Airway Trolley EMAILS

Answer 11

Endotracheal tubes (different sizes)
Masks (different sizes), Magill's
Ambubag/ Airways (ORO/NAS)
Introducer (gum elastic bougie)
Laryngoscopes & LMAs
Suction/ Syringe/ Strapping

Question 12

Gum elastic bougie/introducer

Answer 12

Long, flexible device can be passed through glottis and the ETT advanced over it
Useful with difficult intubation.

Question 13

Suction/YANKAUER

Answer 13

Connected to suction tubing and collector which is connected to wall suction under negative pressure
Commonly used to suction oral / pharyngeal secretions

Question 14

Airways

Answer 14

Oropharyngeal airways (OPAs)
Nasopharyngeal Airways

Question 15

Oropharyngeal Airways

Answer 15

AKA Guedel airways
Assist in opening up the airway and relieving obstruction.
Prevents tongue from covering the epiglottis and back of pharynx
Awake patients will not tolerate an OPA (gag reflex)
USED
To assist spontaneously breathing patients, or to improve mask ventilation

Question 16

Nasopharyngeal Airways

Answer 16

Softer BUT Insert carefully with lubrication

Serve same function as OPAs but inserted through the nostril i.e prevent tongue from obstructing pharynx