Airway Management

Question 1

What are the respiratory rates of newborns through adults?

Answer 1

Newborn: 40-50
1 y/o:30-35
4 y/o: 20-25
8-adult:12-15

Question 2

Symptoms of respiratory failure

Answer 2

tachypnea, tachycardia, stridor (upper airways), tripod position, inability to speak

Question 3

Intubation indications

Answer 3

Failure of maintenance/protection/ventilation/oxygenation

Question 4

Basic Management of airway

Answer 4

Chin lift: extend head & lift chin; NEVER do this if c-spine fracture
Jaw thrust: move jaw forward → tongue moves fwd. Use in trauma b/c doesn’t move c-spine
Trumpet: lubricated tube, use “CE” technique w/ hands, lubricate the tube, rotate into position
Oropharyngeal Airway: curved tube; airway pointed to roof of mouth – rotate into position once past tongue

Question 5

Which pts are difficult to use the Bag-mask on?

Answer 5

MOANS;
Mask seal (face problems)
Obesity/Obstruction (includes 3rd trimester pregnancy)
Age > 55
No teeth to keep dentures in – difficult seal, mask caves in
Stiff lungs

Question 6

Preparation to intubate someone

Answer 6

1. Pre-oxygenate: get Pulse Ox as close to 100%

2. BURP maneuver (Backward, Upward, Rightward Pressure on cricoid cartilage

Question 7

Which pts will be difficult to Intubate?

Answer 7

Look Externally – foreign object, teeth (will make mask placement tough), neck mobility
Evaluate 3-3-2 using the PATIENT’s fingers:
3 fingers b/t front teeth w/ mouth open = good
3 fingers from chin tip to neck under mandible = good
2 fingers from hyoid to thyroid notch = good
Mallampati Score: visibility of posterior pharynx
1 = see tonsillar pillars (whole uvula visible)
4 = only palate (no uvula visible)
Obstruction
Neck Mobility: check flexion/extension

Question 8

Orotracheal intubation

Answer 8

DO NOT pass tube if you don’t see vocal cords

Question 9

Oxygen Desaturation times

Answer 9

100% - 90%
Healthy & pre-oxygenated 70kg adult: 8min
Obese: <3min
10kg child: <4min
Term pregnant woman: <3 min

90-0%
Healthy adult: <120s
Small adult: <45s

Question 10

Discuss Laryngoscope use

Answer 10

Miller= straight (use in child)
MacIntosh = curved
Grandview = Wide hybrid for thick tongues

Laryngoscope ALWAYS in L hand

Question 11

Validating Tube placement

Answer 11

PE: Listen to stomach (gurgling=bad), R & L lungs (must hear bilateral sounds)

Confirmation device: Esophageal Detector Devices, Exhaled CO2 detector

Must confirm by at least 2 seconds

Question 12

Surgical Airways

Answer 12

Non-emergent = Tracheostomy
Emergent = Cricothyroidotomy

Question 13

Which pts will be difficult to perform a Cricothyroidotomy on?

Answer 13

SHORT;
 Surgery Hx
Hematoma
Obesity
Radiation
Trauma