Airway management and ventilation

Question 1

What are the basic techniques for opening the airway?

Answer 1

head tilt
chin lift
jaw thrust

Question 2

How is a jaw thrust carried out?

Answer 2

Identify the angle of the mandible
With the index and other fingers behind the anlg, apply steady upwards pressure to lift the mandible
Using the thumbs slightly open the mouth by downward displacement of the chin

Question 3

If a clear airway cannot be achieved by manoeuvres what should be done?

Answer 3

Look for other causes
- remove any visible foreign body with forceps or suction
- remove broken or displaced dentures- leave well fitting dentures in place

Question 4

What are oropharyngeal and nasopharyngeal airways designed to do?

Answer 4

Overcome the soft palate obstruction and backward tongue displacement

Question 5

What is the downside of oropharyngeal and nasopharyngeal?

Answer 5

jaw thrust may also be required

Question 6

How do you size a guedel?

Answer 6

Length should correspond to length of patients incisors and angle of the jaw

Question 7

what is the technique for inserting a guedel?

Answer 7

Open the mouth and ensure no foreign material
insert into airway “upside down”as far as the junction between hard and soft palate then rotate 180, advance until it lies in the pharynx

Question 8

What is the benefit of a nasopharyngeal airway?

Answer 8

Better tolerated in patients who are not deeply unconscious
may be lifesaving in patients with clenched jaws, trismus or maxilofacial injuries

Question 9

Is a base of skull fracture an absolute contraindication of nasopharyngeal airway

Answer 9

No

Question 10

What size of nasopharyngeal airway should be used in adults?

Answer 10

6-7mm

Question 11

What can happen if a nasopharyngeal airway is too long?

Answer 11

Stimulate the laryngeal or glossopharyngeal reflexes to produce laryngospasm or vomitting

Question 12

What is the highest level of O2 a reservoir mask can provide?

Answer 12

85% at 10L min

Question 13

What oxygen concentration does rescue breathing provide?

Answer 13

16-18%

Question 14

What 02 percentage does a self-inflating bag not connected to an outlet provide?

Answer 14

21%

Question 15

If the self inflating bag is connected to 02 what is the max percentage?

Answer 15

85%

Question 16

If an airway isn’t patent when bagging what can happen?

Answer 16

Force air into the stomach causing vomiting and regurgitation

Question 17

What is the benefit of automatic resuscitators?

Answer 17

• In unintubated patients the rescuer has both hands free
• in intubated patients they free the rescuer for other tasks
• once set, they provide a constant tidal volume, respiratory rate and minute ventilation; thus, they may help to avoid excessive ventilation

Question 18

What size of igel will fit most adults?

Answer 18

4

Question 19

How do you insert an iGel?

Answer 19

1. select the size
2. lubricate the back and sides
3. grasp across the bite block and face the outlet towards the chin
4. ensure the patient is sniffing the morning air and gently press the chin down before inserting
5. insert the soft tip into the mouth in the direction of the hard palate
6. glide the device back and downwards along the hard palate with a gentle push until a definitive resistance is felt

Question 20

What should be done if there is early resistance during insertion

Answer 20

get a colleage to do a jaw thrust

Question 21

How do you assess clinically if a patient is adequately ventilated?

Answer 21

• observation of chest expansion bilaterally
• auscultation over the lungs bilaterally
• auscultation over the epigastrium (breath sounds should not be heard)
• condensation in the tube

secondary confirmation is with waveform capnography- this will not differentiate between a tube placed in a main bronchus and one placed in a trachea

Question 22

What indicates correct tube placement on a CO2 monitor?

Answer 22

persistence of exhaled C02 after six ventilations

Question 23

What are the two main types of C02 detectors?

Answer 23

1. end-tidal CO2 detectors
2. non-waveform electronic digital end-tidal CO2 detectors

Question 24

What should not be attempted if waveform capnography is not available?

Answer 24

intubation