Airway Management

Question 1

NPA:

Indications, Contradictions, Precautions

Answer 1

INDICATIONS:
- support airway patency in unconscious patient
- preferrable in patients with trismus, gag reflex or oral trauma

CONTRADICTIONS:
none

PRECAUTIONS:
- Facial fractures
- TBA / nTBI

Question 2

OPA:

Indications, Contradictions, Precautions

Answer 2

INDICATIONS:
- Support airway patency in unconscious patient
- Bite Block in intubated pt’s

CONTRADICTIONS;
- gag reflex
- trismus
- TBI / nTBI with adequate ventilation

PRECAUTIONS:
none
(pediatric pt’s = don’t turn 180 + laryngoscope)

Question 3

BVM (bag valve mask)

Indications, Contradictions, Precautions

Answer 3

INDICATIONS:
- Apnea
- Inadequate ventilation

CONTRADICTIONS:
None

PRECAUTIONS:
None

Question 4

Laryngoscopy

Indications, Contradictions, Precautions

Answer 4

INDICATIONS:
- Altered conscious state
- requiring inspection of airway

CONTRADICTIONS:
None

PRECAUTIONS:
None

Question 5

Magill’s Forceps

Indications, Contradictions, Precautions

Answer 5

INDICATIONS:
- foreign body airway obstructions + altered conscious state

CONTRADICTIONS:
None

PRECAUTIONS:
None

Question 6

SGA

Indications (4)
Contradictions (3)
Precuations (4)

Answer 6

INDICATIONS:
- unconscious pt (no gag reflex)
- BVM providing ineffective ventilatio
- Greater than 10 mins assisted ventilation required
- Unable to intubate

CONTRADICTIONS:
- Trismus
- Gag reflex
- Airway obstruction

PRECAUTIONS:
- can’t do sniffing position
- vomit
- Pt’s requiring high airway pressures
- Kids with enlarged tonsils

Question 7

BVM (bag Valve mask)

Procedure (6)

1, 2, 3, 4, 5(2), 6(3)

Answer 7

1. Sniffing position
2. Select mask size
3. Assemble BVM
4. Attach to oxygen source
5. APPLY MASK:
   - CE Grip
   - Pull face up INTO Mask
6. VENTILATE (3):
   - Squeeze bag at appropriate rate &volume
   - Confirm chest movement
   - Continually reassess mask seal, airway position, chest movement & spontaneous respiratory effort

Question 8

NPA

Procedure (6)

Answer 8

1. Sniffing and select size
2. Lubricate
3. Push tip of nose upwards
4. Insert NPA (2)
   - into widest nostril
   - 90 degree angle
5. REMOVE: if patient gags
6. OPTIONAL: Suction

Question 9

OPA

Procedure (5)

Answer 9

1. Sniffing and select size
   
   • middle of front teeth 2 jaw angle
2. Hold OPA by top and insert upside down until half way
3. ROTATE 180 whilst inserting
4. Insert until resting against lips
5. REMOVE if pt gags

Question 10

SGA (iGel)

Procedure (4,3,2)

Answer 10

PREPARATION:
1. Sniffing
2. Prepare equipment
3. select size
4. Lubricate

INSERTION:
5. DH: extend head back into sniffing
6. NDH: maintain gentle pressure on chin to lower jaw (ensure SP maintained)
7.Insert igel - aiming towards hard palate, gliding downwards until definitive resistance felt
- teeth should be in line with black marker

CONFIRM POSITION:
8. Confirm placement by observing chest
9. If unsuccessful - try reinserting

TROUBLE SHOOTING:
- clockwise/anticlockwise as inserting
- jaw thrust whilst inserting

Question 11

Laryngoscopy

Procedure (2,6,3)

Answer 11

PREPARATION:
1. Sniffing and select size
- bigendofblade = upperfrontteeth
- tip of blade = w/i 1 cm of jaw angle
2. Laryngoscope on left, suction equipment on right

INSERTION:
3: LH: grip laryngoscope
4. RH: Support & steady pt head
5. Open mouth
6. Insert to the right
7. Sweep tongue to the LEFT of mouth
8. Suction as required (to remove)

EXPOSE VOCAL CORDS:
1. Press down on tongue to visualise epiglottis
2. Position tip of blade INTO vallecula
3. Expose vocal cords by lifting
- mindful of angulation and teeth

Question 12

Magill’s Forceps

Procedure (6)

Answer 12

1. Inspect with laryngoscope
2. Prepare MF
3. Introduce forceps
   
   • ensure bend of forceps follows natural curve of blade
   • ensure tips are closed
4. Remove visualised impacted foreign body
5. CHECK (reinspect airway)
6. ASSESS
   - respiratory status
   - perform vital sign survey