Airway Management

Question 1

Causes of inadequate airway

Answer 1

• impaired laryngeal reflexes
• obstruction
• mucosal inflammation and thickening
• acute respiratory failure

Question 2

Signs of inadequate airway

Answer 2

• voice alteration, hoarseness
• tachycardia, tachypnoea, sweating
• anxiety, confusion, lethargy
• gurgling
• drooling
• choking, gagging
• inspiratory stridor, crowing
• hypercarbia, hypoxaemia

Question 3

Methods of maintaining a clear airway

Answer 3

• positioning
• jaw position
• nebulised adrenaline
• suctioning
• oropharyngeal/nasopharyngeal airway
• endotracheal tube
• tracheostomy

Question 4

Positioning

Answer 4

• upright side lying
• chin lift manoeuvre
• jaw thrust (if suspected spinal injury)

Question 5

Oropharyngeal/Guedel’s airway

Answer 5

• short plastic tube to pharynx only
• keeps airway open
• facilitates suction
• insertion can cause patient to gag or vomit
• Care with loose teeth and bite reflex
• **If patient can tolerate it, they need it

Question 6

Nasopharyngeal airway

Answer 6

• soft silastic tube to pharynx
• inserted with lubricant
• changed several times per day

Question 7

Nasopharyngeal airway precautions

Answer 7

• nasal/facial fractures
• CSF leak
• torn dura
• coagulopathy
• anticoagulant therapy
• hypotension

Question 8

Intubation

Answer 8

• to just above carina
• inserted by medical staff
• only access to ventilation
• often requires sedation
• condition must be reversible

Question 9

Intubation indications

Answer 9

• airway obstruction
• inadequate oxygen
• inadequate ventilation
• elevated WOB
• airway protection
• facilitation of tracheobronchial suctioning
• facilitation of mechanical ventilation

Question 10

Intubation complications

Answer 10

• trauma
• malposition
• obstruction
• disordered physiology
  
  • increased secretions
  • decreased cilial activity
  • inability to cough
  • infection
  • inability to talk/swallow
  • lack of humidification (so need to humidify)

Question 11

Endotracheal tube

Answer 11

• larger
• less well tolerated
• tube occlusion by biting
• damage to patients’ teeth

Question 12

Nasotracheal tube

Answer 12

• oral hygiene easier
• easier to insert
• smaller –> easier to block with secretions
• can cause sinus infections and nose bleeds

Question 13

Cuffed ETT

Answer 13

• prevents aspiration of gastrointestinal contents
• provides good seal for ventilation
• prevents movement/holds tube in
• low pressure/high volume

Question 14

Cuffed ETT indications

Answer 14

• unconscious
• unable to swallow
• requires full mechanical ventilation
• can cause damage to vocal chords

Question 15

Uncuffed ETT

Answer 15

• awake or able to swallow
• paediatric use
• able to speak
• may cause increased secretions (irritation and movement)

Question 16

Tracheostomy

Answer 16

• short tube inserted cricoid cartilage
• reaches carina
• reduces anatomical dead space

Question 17

Tracheostomy indications

Answer 17

• long term intubation
• prevent laryngeal damage and oedema from ETT
• ETT not well tolerated if patient not sedated
• URT obstruction
• facilitation of suctioning
• permanent bypass obstruction or tumour

Question 18

Tracheostomy complications

Answer 18

• operative risks
• placement in pre-tracheal tissues
• haemorrhage of innominate artery
• tracheal stenosis
• tracheomalacia
• trachea-oesophageal fistula
• surgical emphysema
• blockage with secretions

Question 19

Surgical tracheostomies

Answer 19

• in OT
• actual dissection
• ± removal of cricoid cartilage
• for patients with “difficult airways” (thick, short necks)

Question 20

Percutaneous tracheostomies

Answer 20

• in ICU
• dilatation technique
• no scar
• avoid transport of critically ill patient

Question 21

Minitracheostomy

Answer 21

• inserted for secretion removal only
• maintain own airway, eat, talk
• no need for humidification
• may need NaCl 0.9% during suction
• size 8 or 10 FG catheter to suction

Question 22

Weaning from tracheostomy

Answer 22

• ACTs
• huffing
• smaller trachy
• spigotting
• swallow assesments
• fenestrated trachy tubes
• stomal button
• trachae teams
• one way valves (Passy Muir)

Question 23

Suctioning indications

Answer 23

• artificial airway
• unconscious
• inability to cough and effectively expectorate secretions

Question 24

Suctioning precautions

Answer 24

• pulmonary oedema
• haemoptysis
• respiratory burns
• head injuries
• high levels PEEP, FiO2
• severe infection

Question 25

Suctioning complications

Answer 25

• hypoxaemia
• cardiac arrhythmias
• haemodynamic alterations
• increased ICP
• gastric aspiration
• trauma
• distress
• atelectasis
• reflex bronchospasm
• infection

Question 26

Alternatives to suctioning

Answer 26

• increase FiO2 on ventilator
• manual hyperinflation
• efficient technique, reassurance
• closed suction systems

Question 27

Closed suction systems

Answer 27

• prevents disconnection from ventilator (prevents loss of FRC and O2)
• prevents pathogens sprayed into air
• not always effective if thick secretions