Airway Management II

Question 1

When pressure applied to edematious tissue leaves an indentation of 0–2 millimeters (mm) that rebounds immediately, the edema may be classified as Grade ___ pitting edema.

Answer 1

1. Grade 1 (The least severe type of pitting edema);

https://www.medicalnewstoday.com/articles/321773.php

Question 2

When pressure applied to edematious tissue leaves an indentation of 3-4 millimeters (mm) that rebounds in fewer than 15 seconds, the edema may be classified as Grade ___ pitting edema.

Answer 2

1. 2;

https://www.medicalnewstoday.com/articles/321773.php

Question 3

When pressure applied to edematious tissue leaves an indentation of 5-6 millimeters (mm) that takes up to 30 seconds to rebound, the edema may be classified as Grade ___ pitting edema.

Answer 3

1. 3;

https://www.medicalnewstoday.com/articles/321773.php

Question 4

When pressure applied to edematious tissue leaves an indentation of 8 millimeters (mm) or deeper that takes more than 20 seconds to rebound, the edema may be classified as Grade ___ pitting edema.

Answer 4

1. 4;

https://www.medicalnewstoday.com/articles/321773.php

Question 5

The most common cause of CHF.

Answer 5

1. Coronary Artery Disease (CHF);

FireRescue1 Academy: CHF Vs. COPD, As Presented in November 2019

Question 6

Rales may be present in the ___ stages of pulmonary edema. Rales represent fluid present in the _(relative size)_ airways. Rales will no longer be audible if these airways ___.

Answer 6

1. Early;
2. Small;
3. Become completely full of fluid;
   * FireRescue1 Academy: CHF Vs. COPD, As Presented in November 2019*

Question 7

Pedal edema is dependent edema of the _(body part)_.

Answer 7

1. Legs;

https://en.wikipedia.org/wiki/Edema

Question 8

Generally speaking, nasal intubation may be performed ___ or with ___ assistance.

Answer 8

1. Blind;
2. Fiberoptic;
   * https://litfl.com/nasal-intubation/*

Question 9

Nasal intubation should be considered when _(general condition)_. Give two (of three listed) examples).

Answer 9

1. Oral intubation is not feasible;
2. Swollen tongue (Glossitis; e.g., angioedema);
3. Mechanical obstructions to mouth opening (e.g., mandibular fixation and trismus);
4. Fixed neck contracture and limited mouth opening;
   * https://litfl.com/nasal-intubation/*

Note: “It is best in patients who are not critically hypoxic and in whom there is obvious oral pathology making intubation and ventilation through the mouth problematic.”

https://epmonthly.com/article/nasal-intubation/

Question 10

Dr. Rich Levitan describes his method of performing blind nasal intubation with these five words: ___.

Answer 10

1. Spray - Trumpet - Spray - Tube - Spray;

Note: Spray consists of 5-10 cc of 4% topical lidocaine with oxymetazoline.

https://litfl.com/nasal-intubation/

Question 11

Describe the seven general steps of the Berdan Method of Prehospital Blind Nasal Intubation.

Answer 11

1. Sedate patient with Ketamine (2 mg/kg IV/IO or 4 mg/kg IM) and support oxygenation with BVM;
2. Apply 2-3 sprays of Oxymetazoline into each naris;
3. Lubricate two nasal trumpets with 2% lidocaine jelly, insert, remove from target naris after one minute;
4. Place nasal cannula at 15 lpm in secondary naris (or mouth) for passive / apneic oxygenation;
5. Lubricate tracheal tube with 2% lidocaine jelly (as large as will fit into the naris and be tolerated, generally at least 7.0 mm ID), attach BAAM whistle and insert (keeping the proximal end of the tube directed toward the patient’s contralateral nipple) until loud breath sounds are audible (approximately 15 cm);
6. Pass tracheal tube through cords during inhalation, confirm placement and secure in place;
7. Administer Rocuronium (1 mg/kg IV/IO);
   * https://litfl.com/nasal-intubation/ (as adapted by Scott Berdan)*

Question 12

Singluar form of the word “nares.” This word translates to the layman’s term ___.

Answer 12

1. Naris;
2. Nostril;
   * https://www.medicinenet.com/script/main/art.asp?articlekey=25480*

Question 13

When passing a nasal trumpet or nasotracheal tube, ensure the _(tube feature)_ faces the _(body structure)_ laterally. Ensure the tube is advanced along both the _(body structure)_ medially and the ___ of the nasal cavity (which is _(geometrical term)_ to the plane of the face).

Answer 13

1. Bevel;
2. Turbinates;
3. Septum;
4. Floor;
5. Perpindicular;
   * https://litfl.com/nasal-intubation/*

Question 14

Tracheal tubes utilized for nasotracheal intubation should typically be placed ___ cm at the nose for women and ___ cm at the nose for men.

Answer 14

1. 26;
2. 28;
   * https://litfl.com/nasal-intubation/*

Question 15

Generally speaking (although not allowed by written order through the PCPs), with regard to ___ intubation, “topicalization is essential not only for patient comfort, but also to ensure proper placement. Without proper topicalization, the patient will gag, cough, and swallow the tube, preventing it from going into the trachea.”

Answer 15

1. Nasal;

https://epmonthly.com/article/nasal-intubation/

Question 16

According to Dr. Levitan, with regard to nasal intubation, “conscious sedation for intubation, using a combination of _(drug)_ and _(drug)_, may be appropriate and improve patient comfort, depending on the situation. In the patient is too agitated to permit the procedure, small aliquots of _(drug)_ (10 mg IV, repeated up to 40-50 mg total, although more can be given if needed) with _(drug)_ works magically well to facilitate the procedure.

Answer 16

1. Fentanyl;
2. Midazolam;
3. Ketamine;
4. Midazolam;
   * https://epmonthly.com/article/nasal-intubation/*

Question 17

What does BAAM stand for with regard to a BAAM whistle?

Answer 17

BAAM

B - Beck

A - Airflow

A - Airway

M - Monitor

https://epmonthly.com/article/nasal-intubation/

Question 18

Successful tracheal passage during nasotracheal intubation will induce laryngeal reflexes (e.g., coughing), loss of phonation, and air movement throught the tube. If not already done, it may be necessary to ___ because passage of the tube may elicit arm movement, head turning, and other efforts to remove the tube.

Answer 18

1. Restrain the patient’s arms;

https://epmonthly.com/article/nasal-intubation/

Question 19

The adult Ambu® SPUR II resuscitator (BVM) is intended for patients with a body weight > ___ lbs, the pediatric for patients with a body weight <= ___ lbs, and the infant for patients with a body weight <= ___ lb.

Answer 19

1. 66 lbs (30 kg);
2. 66 lbs (30 kg);
3. 22 lbs (10 kg);

Major Memory System: Cheech (66) drives a choo-choo (66) train over an onion (22).

Ambu® SPUR II Instructions for Use

Question 20

The volume deliverd by a one-handed squeeze of an adult Ambu® SPUR resuscitator (BVM) is ___ mL, while the pediatric version delivers ___ mL and the infant version delivers ___ mL.

Answer 20

1. 600;
2. 450;
3. 150;

Major Memory System: Jaws (60) jumps from the sea (0; 60 + 0 = 600) and rolls (450) in towels (150).

Ambu® SPUR II Instructions for Use

Question 21

The ___ on an Ambu® SPUR II resuscitator (BVM) provedes access to the inspiratory and expiratory gas flow, allowing connection of a syringe for drug delivery or to connect a gas sampling line for measuring sidestream EtCO₂.

Answer 21

1. M-Port;

Ambu® SPUR II Instructions for Use

Question 22

The pressure limiting valves on so-equipped Ambu® SPUR II resuscitators (BVMs) are set to open at _(pressure)_.

Answer 22

1. 40 cm H₂O;

Major Memory System: A rose (40) pokes out from the pressure limiting valve on an infant BVM.

Ambu® SPUR II Instructions for Use

Question 23

What type of grip is recommended during two-person bag mask ventilation in order to seal the mask to the patient’s face (i.e., without an advanced airway)?

Answer 23

1. Thenar eminence grip;

This grip is suggested in place of a two-handed CE grip, and was referred to as the “VE grip” during CPFR’s 2023 PAM course.

https://www.ems1.com/airway-management/articles/how-to-improve-your-bag-valve-mask-technique-Id6to8AxqaXnAs6v/

Question 24

What type of grip does the American Heart Association (AHA) recommend using during one-person bag mask ventilation in order to seal the mask to the patient’s face (i.e., without an advanced airway)?

Answer 24

1. CE Grip;

Hazinski, M. F. (Ed.). (2011). BLS for healthcare provider’s student manual. Dallas, TX: American Heart Association

Question 25

During BVM-assisted ventilation, rescuers must use caution to avoid generating high airway pressures. In general, inspiratory pressures greater than 1. _ cm H2O in the adult patient increases the risk of forcing air through the esophagus and into the stomach, a condition known as gastric insufflation.

Answer 25

1. 20;

https://www.ems1.com/airway-management/articles/how-to-improve-your-bag-valve-mask-technique-Id6to8AxqaXnAs6v/