Airway Management - Core Concepts

Question 1

Would you use an OPA or NPA on a conscious patient?

Answer 1

NPA.

Only use an OPA on an unconscious or intubated patient.

Question 2

Should you leave an OPA unsecured? Why?

Answer 2

Yes. It needs to be removed quickly if there is a problem.

Question 3

What is the most common problem with NPA use?

Answer 3

trauma to the mucosa.

Question 4

How would you measure an OPA? An NPA?

Answer 4

OPA: Angle of jaw to corner of the mouth.
NPA: Earlobe to the nostril

Question 5

If a child is less than 8, would you use a cuffed or uncuffed ETT?

Answer 5

Uncuffed. A child of < 8 will require an uncuffed tube, because the cricoid cartilage is narrow enough to seal the tube in the airway.

Question 6

What 2 classes of drugs will be required for an intubation?

Answer 6

A sedative and a NMBA (neuromuscular blocking agent)

sedatives can include “lams and pams”, such as midazolam, lorazepam, diazepam, alprazolam.

NMBA’s may include succinylcholine, vecuronium, and other -oniums.

Question 7

Which style (Mac/Miller) laryngoscope blade is preferred for neonates?

Answer 7

Miller. the design lifts the epiglottis directly and facilitates visualization of the neonates airway.

Question 8

How would you confirm ETT placement on the exam?

What is the first assessment of tube position?

What is the BEST way to confirm ETT placement?

Answer 8

Bilateral chest movement, auscultation, capnography/CO2 detection, x-ray.

The first assessment would be to look for bilateral chest rise.

X-Ray is the best way to confirm tube placement.

Question 9

Cuff pressure should always be lower than ___, because…

Answer 9

> 20 cmH2O. It will stop circulation to the compressed tissue.

Question 10

If a cuff pressure of >20 is required to seal the airway

If an uncuffed tube with a ventilating pressure of >20 is used and does not create a leak

If you cannot pass a suction catheter

If you cannot add air to the cuff (it is punctured)

What should you do?

Answer 10

Replace the tube.

If the cuff pressure necessary to create a good seal is >20, replace with a larger tube

If an uncuffed tube does not lead at PIP of >20, replace with a smaller tube.

Question 11

An uncuffed ETT will have a ___ ___ guide, which is a black line and visible on the tube. How do you use this guide?

Answer 11

An uncuffed ETT will have a “vocal cord” guide. You use it by advancing the ETT until the black line is at the position of the vocal cords. This is the correct placement for this airway.

Question 12

A preemie weighing less than 1000g or under 28 weeks of gestation will require what tube size, and what size miller blade?

2. 5 ETT and a Miller 00
3. 0 ETT and a Miller 0
4. 5 ETT and a Miller 0
5. 5-4.0 ETT and a Miller 1

Answer 12

2.5 ETT and a Miller 00

Question 13

A full term baby weighing over 3000g and over 38 weeks of gestational age will require what tube size, and what size Miller blade?

2. 5 ETT and a Miller 00
3. 0 ETT and a Miller 0
4. 5 ETT and a Miller 0
5. 5-4.0 ETT and a Miller 1

Answer 13

3.5-4.0 ETT and a Miller 1

Question 14

A full term baby weighing between 2500g-3100g and between 38-40 weeks of gestation will have an ETT placed at how many centimeters?

Answer 14

Full term babies will have an ETT placement of 8.5cm

Question 15

A premature baby weighing between 900g-1000g and between 27-29 weeks of gestation will have an ETT placed at how many centimeters?

Answer 15

A 27-29 week baby between 900g-1000g will have an ETT placement of 6.5cm

Question 16

Which is better:
High volume, low pressure cuff
HIgh pressure, low volume cuff

Answer 16

High volume, low pressure cuff

Question 17

A 4 year old will require a Miller ___ blade, a __mm ETT, and a ___ french suction catheter.

Answer 17

4 year olds:

Miller 2 blade
5.0 ETT
10 French suction catheter

*This will be asked on the exam

Question 18

At what age can you recommend either the Miller or Mac blades for a pediatric intubation?

Answer 18

8

Question 19

A 12 year old will require a ___ blade, a __mm ETT, and a ___ french suction catheter.

Answer 19

12 year olds:

Miller or Mac 3
7.0 ETT
12 French suction catheter

Question 20

How do you calculate ETT size on the exam?

Answer 20

Age + 16
_______
4

Question 21

There is a sudden deterioration of an intubated child. What mnemonic should you use to guide you through the problem?

Answer 21

DOPE

Displacement of tube
Obstruction of tube
Pneumothorax
Equipment failure (bag, vent, etc)

Question 22

On the exam, your question says “marked/severe” distress is noted post extubation. What do you do?

If it is described as “moderate” what do you do?

Answer 22

Re-intubate any post extubation assessment described as marked/severe.

Give cool aerosol and racemic epi for moderate distress. NOTE: there may be situations in which oxygen has not been given first. Remember it is ALWAYS the first drug given, so choose it if it has not been given and is offered as a choice.

Question 23

List 3 ways to minimize VAP risks (there are 8)

Answer 23

Hand washing
Oral care
Bed position (>30 degrees)
Minimize intubation time
Gentle suction to prevent cough
Vent circuit care (discard condensation, heated circuit)
MDI's instead of SVN
Remove secretions above the cuff (subglottic suction)

Question 24

How many attempts do you get to intubate?

Answer 24

3. If you fail all 3, you will need a physician for an emergency trach, cricothyrotomy, or retrograde intubation.

Question 25

How do you calculate the appropriate suction catheter size for an ETT?

Answer 25

ETT size divided by 2, then multiply by 3.

If the answer is odd, round down to the nearest even number.

For example: 6.0 ETT / 2 is 3. 3 x 3 is 9. 9 is odd, so round down to 8. A 6.0 ETT will need an 8 french suction catheter.

Question 26

Suction should be performed for no more than ___ seconds, and the catheter should be in the airway for no more than ___ seconds.

Answer 26

suction for < 5 seconds.

catheter should be out of the airway in < 10 seconds.