Airway Management I Flashcards
The upper airways or upper respiratory tract includes the nose and nasal passages, paranasal sinuses, the pharynx, and the portion of the larynx above the ___. The lower airways or lower respiratory tract includes the portion of the larynx below the _(same)_, trachea, bronchi and bronchioles.
- Vocal cords;
Note: The TCC Paramedic School curriculum emphasised the glottis as the division point between the upper and lower airways.
https://en.wikipedia.org/wiki/Respiratory_tract
Approximately ___% of the population has no gag reflex at baseline.
- 30;
Major Memory System: Male homos (30) engage in oral sex without exhibiting a gag reflex.
Manual of Emergency Airway Management, 3rd Ed.
___ refers to injuries caused by increased air or water pressure, such as during airplane flights or scuba diving.
- Barotrauma;
Note: Barotrauma of the inner ear is common. Generalized barotraumas, including decompression sickness, affect the entire body.
https://www.health.harvard.edu/a_to_z/barotrauma-a-to-z
What is the name of the air reservoir to which a syringe is connected in order to inflate an endotracheal tube cuff?
- Pilot balloon;
https://www.medscape.com/answers/865068-32798/what-is-the-role-of-the-pilot-balloon-on-a-cuffed-tracheostomy-tube
“There aren’t Mac or Miller paramedics, there are Mac or Miller ___.”
- Patients;
Missy, TCC Paramedic School Adjunct Professor
The ___ cartilage is a ring of _(cartilage type)_ cartilage located at the inferior aspect of the ___ and is the only complete ring of cartilage around the trachea.
- Cricoid;
- Hyaline;
- Larynx;
* https://emedicine.medscape.com/article/1949369-overview*
What does the acronym NO DESAT stand for?
NO DESAT
N - Nasal
O - Oxygen
D - During
E - Efforts
S - Securing a
T - Tube
https://epmonthly.com/article/no-desat/
The ___ is a small pointed eminence of the external ear, situated in front of the concha, and projecting backward over the meatus.
- Tragus;
https://en.wikipedia.org/wiki/Tragus_(ear)
Colorimetric capnometers turn from _(color)_ to _(color)_ when carbon dioxide is introduced.
- Purple;
- Yellow;
Note: Purple = Problem, Gold = Golden;
https://www.medtronic.com/covidien/en-us/products/intubation/nellcor-adult-pediatric-colorimetric-co2-detector.html
The ___ reflex is of no clinical value when assessing the need for intubation, and in fact may be dangerous to assess. Evaluation of spontaneous or volitional ___ is a better assessment of a patient’s ability to protect their airway.
- Gag;
- Swallowing;
* Manual of Emergency Airway Management, 5th Ed.*
The decision to intubate should be based on three fundamental clinical assessments:
- ___
- ___
- ___
- Is there a failure of airway maintenance or protection?
- Is there a failure of ventilation or oxygenation?
- What is the anticipated clinical course?
* Manual of Emergency Airway Management, 5th Ed.*
The presence of pooled ___ in a patient’s ___ should be considered to indicate a potential failure of airway protection.
- Secretions;
- Oropharynx;
* Manual of Emergency Airway Management, 3rd Ed.*
Unless ventilatory or oxygenation failure is due to a ___ cause, such as narcotic overdose, ___ is required.
- Reversible;
- Intubation;
* Manual of Emergency Airway Management, 3rd Ed.*
When evaluating a patient for emergency airway management, the first assessment should be of the ___ and ___ of the airway. In many cases, these can be superficially confirmed by simpy having the patient ___.
- Patency;
- Adequacy;
- Speak (Ask questions such as “What is your name?”);
* Manual of Emergency Airway Management, 3rd Ed.*
Intermittent expiratory moaning, often exhibited by patients in pain.
- Hysterical (or psychogenic) stridor;
Manual of Emergency Airway Management, 3rd Ed.
If spinal cord injury has impaired intercostal muscle functioning, ___ breathing may be present. In this form of breathing, there is little movement of the ___, and inspiration is evidenced by an apparent increase in ___ volume.
- Diaphragmatic;
- Chest wall;
- Abdominal;
* Manual of Emergency Airway Management, 3rd Ed.*
A medical term meaning “naturally accompanying or associated with.”
- Concomitant;
Google Dictionary
If doubt exists as to whether a patient requires intubation, err on the side of ___.
- Intubating the patient;
Manual of Emergency Airway Management, 3rd Ed.
The gag reflex is not involved in ___ closure or protection of the ___.
- Laryngeal;
- Airway;
* Manual of Emergency Airway Management, 3rd Ed.*
The ability of a patient to ___ with a ___, unobstructed voice is strong evidence of airway patency, protection, and ___ perfusion.
- Phonate;
- Clear;
- Cerebral;
* Manual of Emergency Airway Management, 5th Ed.*
Although an oropharyngeal or nasopharyngeal airway may restore airway patency in a severly ill or injured patient, they do not provide any protection against ___.
- Aspiration;
Manual of Emergency Airway Management, 5th Ed.
Patients who are unable to maintain their own airway are also unable to ___ it. Therefore, as a general rule, any patient who requires the establishment of a patent airway also requires ___ of that airway.
- Protect;
- Protection;
Note: The exception is when a patient has an immediately reversible cause of airway compromise.
Manual of Emergency Airway Management, 5th Ed.
The finding of pooled ___ in a patient’s ___ indicates a potential failure of airway protective mechanisms, and hence a failure of airway ___.
- Secretions;
- Posterior oropharynx;
- Protection;
* Manual of Emergency Airway Management, 5th Ed.*
If a patient is unable to ___ sufficiently, or if adequate ___ cannot be achieved despite the use of supplemental oxygen, then intubation is indicated.
- Ventilate;
- Oxygenation;
* Manual of Emergency Airway Management, 5th Ed.*
Unless ventilatory or oxygenation failure is resulting from a rapidly ___ cause, such as ___ overdose, or a condition known to be successfully managed with noninvasive ventilation (e.g., Bi-PAP for acute pulmonary edema), intubation is required.
- Reversible;
- Opioid;
* Manual of Emergency Airway Management, 5th Ed.*
In many cases, the adequacy of an airway is confirmed by simply having the patient ___. A ___ voice (as opposed to a muffled or distorted voice), the ability to ___ and ___ in the modulated manner required for speech, and the ability to comprehend the question and follow instruction are strong evidence of adequate ___ function.
- Speak;
- Normal;
- Inhale;
- Exhale;
- Upper airway;
* Manual of Emergency Airway Management, 5th Ed.*
When evaluating a patient for emergency airway management, after assessing verbal response to questions, conduct examinations of the _(five structures)_.
- Mouth;
- Oropharynx;
- Mandible;
- (Central) Face;
- (Anterior) Neck (including the larynx and trachea);
* Manual of Emergency Airway Management, 5th Ed.*
Name four key signs of upper airway obstruction.
- Muffled or “hot potato” voice (as though the patient is speaking with a mouthful of hot food);
- Inability to swallow secretions, because of either pain or obstruction;
- Stridor;
- Dyspnea;
* Manual of Emergency Airway Management, 5th Ed.*
When assessing a patient’s neck for emergency airway management, move the ___ from side to side, asessing for ___, indicating normal contact of the airway with the air-filled upper esophagus. Absence of this sign may be caused by ___ between the _(same as #1)_ and the upper esophagus.
- Larynx;
- Laryngeal crepitus;
- Edema;
* Manual of Emergency Airway Management, 5th Ed.*
The presence of ___ stridor, however slight, indicates some degree of upper airway obstruction. Lower airway obstruction, occurring beyond the level of the ___, more often produces ___ stridor.
- Inspiratory;
- Glottis;
- Expiratory;
* Manual of Emergency Airway Management, 5th Ed.*
When evaluating a patient for possible emergency airway management, note their respiratory pattern, observing the chest through ___ respiratory cycles, looking for normal, symmetrical, concordant chest movement. Ausculate the chest for adequacy of air ___. Decreased breath sounds indicate _(name two of four listed)_ or other disease pathology.
- Several;
- Exchange;
- Pneumothorax, hemothorax, pleural effusion, emphysema;
* Manual of Emergency Airway Management, 5th Ed.*
- What are the five general steps for evaluating the patency and adequacy of a patient’s airway when considering the necessity of emergency airway management?
- Assess verbal response to questions (and ability to swallow);
- Assess the upper airway (mouth, oropharynx, mandible, central face, anterior neck);
- Assess ventilation (chest wall movement, lung sounds, respiratory pattern);
- Assess oxygenation (SpO2, PetCO2, [CO]);
- Consider the anticipated clinical course;
* Manual of Emergency Airway Management, 5th Ed.*
___ stridor, when seen in ___, is particularly ominous and typically mandates intubation.
- Inspiratory;
- Adults;
* Manual of Emergency Airway Management, 5th Ed.*
Although there is no absolute cutoff for oxygen saturation or EtCO2 that dictates intubation, a saturation that cannot be sustained above ___%, a RR > ___ or a CO2 > ___ mm Hg has strong associations with intubation.
- 80;
- 30;
- 100;
Major Memory System: The Messiah (30) intubates Amy Quist with a bottle of hot sauce (100) that has a burning fuse (80) protruding from the top.
Manual of Emergency Airway Management, 5th Ed.
_(respiratory disease)_ and _(respiratory disease)_ are uncommon causes of ED intubation and can typically be managed with medical therapy and noninvasive postive airway pressure.
- COPD;
- Acute pulmonary edema;
* Manual of Emergency Airway Management, 5th Ed.*
One can benefit from thinking about airway difficulty in two categories; a(n) ___ difficult airway and a(n) ___ difficult airway.
- Anatomically;
- Physiologically;
* Manual of Emergency Airway Management, 5th Ed.*
Depending on the degree of predicted difficulty, one should not administer a ___ medication to a patient unless one has a measure of confidence that gas exchange can be maintained if laryngoscopy and intubation fail. Accordingly, if an anatomically difficult airway is identified, the ___ Algorithm should be used.
- Neuromuscular blocking (paralytic);
- Difficult Airway;
* Manual of Emergency Airway Management, 5th Ed.*
Difficult direct laryngoscopy, defined as a grade ___ or grade ___ ___ view, occurs in approximately ___% of all adult emergency intubations.
- III;
- IV;
- Laryngoscopic (Cormack-Lehane);
- 10;
Major Memory System: Amy (III) Quist lies naked on the operating room table with hairy (IV) nipples, looking hideous (10).
Manual of Emergency Airway Management, 5th Ed.
Based on large registry data of adult intubations, rescue surgical airways occur in ___-___% of all encounters.
- 0.3-0.5;
Major Memory System: A sumo (0.3) wrestler performs a cricothyrotomy on a weasel (0.5).
Manual of Emergency Airway Management, 5th Ed.
In clinical practice, the difficult airway has four dimensions:
- Difficult ___
- Difficult ___
- Difficult ___
- Difficult ___
- Laryngoscopy;
- BMV;
- EGD;
- Cricothyrotomy;
* Manual of Emergency Airway Management, 5th Ed.*