Airway management

Question 1

Escalating airway support

Answer 1

Highest possible concentration of oxygen possible

Chin lift/jaw thrust
Suction
Airway adjuncts such as oropharyngeal airways
Laryngeal mask or endotracheal tube
Surgical airway

Question 2

Reasons for tracheostomy

Answer 2

Upper airway obstruction
Post laryngectomy/upper airway surgery
MSK disorders affecting ventilation
Assist weaning from ventilation on critical care
Incompetent swallow/impaired upper airway reflexes

Question 3

Types of tracheostomy

Answer 3

Cuffed
Uncuffed
Unfenestrated
Fenestrated - allow upper airway flow for phonation

Question 4

Trache management

Answer 4

Humidification and regular suction
Not changed within 3 days of surgery, and not within 7-10 days of a percutaneous procedure to ensure that tract formed properly
Single lumen tubes generally undesirable

Question 5

Common trache problems

Answer 5

Displacement
Obstruction
Haemorrhage

Question 6

Desaturation

Answer 6

Call for help
Recognise that patient has a patent upper airway
Breathing but suboptimal
Administer 100% O2
Remove inner cannula, apply suction, deflate cuff
Remove tracheostomy tube
Bag and mask ventilation
Perform intubation

Question 7

Haemorrhage

Answer 7

Erosion into blood vessels at site –> can be life threatening
Erosion into innominate artery or vein at superior end of sternum whilst rare, can be catastrophic
Call ants and ENT
100% O2, large bore IV access
Adrenaline with or without LA / soaked swabs
Gentle pressure to sternal notch and hyperinflation of trache cuff may alleviate situation
DO NOT deflate cuff
Check coags/gas if possible