Airway manoeuvres and devices

Question 1

What 3 areas make up the pharynx?

Answer 1

Nasopharynx
Laryngopharynx
Oropharynx

Question 2

Where does the upper respiratory tract transition into the lower?

Answer 2

At the vocal cords

Question 3

What is the cause of death in upper airway obstruction?

Answer 3

Hypoxia

Question 4

2 accessory muscles that are used in a patient suffering upper airway obstruction?

Answer 4

Sternocleidomastoid

Scalene

Question 5

What are some causes for upper airway obstruction? (there are lots)

Answer 5

Foreign body aspiration
CNS depression
Infection - laryngittis, epiglottitis, abscess,, haemorrhage, haematoma, laryngotracheobronchitis/croup
Laryngeal oedema - anaphylaxis, allergic, hereditory angioedema
PNS effects - Guillain Barre Syndrome, laryngospasm, obstructive sleep apnoea, right laryngeal nerve interruption
Neoplasm - pharyngeal, laryngeal, tracheobronchial carcinoma
Congenital - vascular rings, laryngeal web, laryngocele
Trauma
Burns

Question 6

Most common cause of upper respiratory obstruction in the unconscious patient?

Answer 6

Loss of muscle tone

Question 7

What is another name for the oropharyngeal airway adjunct and when can it be used?

Answer 7

Guidel

Used in unconscious or semi conscious as powerful gag reflex

Question 8

How do you measure the right size of Guidel?

Answer 8

Corner of the mouth to angle of the jaw

Question 9

What are the 3 colours of guidel and correlating sizes?

Answer 9

100mm = red
90mm = orange
80mm = green

Question 10

When is a nasopharyngeal airway adjunct preferred over an oropharyngeal?
How do you measure sizing?

Answer 10

Semi-conscious patient as can be used with in tact gag reflex
Measure sizes from tip of the nose to the tragus of the ear

Question 11

Contraindications to using the nasopharyngeal airway adjunct?

Answer 11

When there is a basal skull fracture
Any trauma
Active nose bleeds

Question 12

What is an LMA and what are the advantages to using one over a bag valve mask?

Answer 12

Laryngeal mask airway
Sits over vocal cords
Allows free hand ventilation and less gastric distension
Accessory device for management of difficult airways

Question 13

How do you calculate the volume required to inflate and LMA mask cuff?

Answer 13

Subtract 1 from the size and multiply by 10

Question 14

What is the difference between the LMA and iGel?

What situation is it ideal for?

Answer 14

iGel doesnt have an inflatory cuff but instead a thermoplastic elastomer that seals around the larynx and hypopharynx at body temperature
Ideal for cardiopulmonary resuss

Question 15

How does the iGel accomodate for gastric contents?

Answer 15

Small hole you can feed an NG tube down to drain gastric contents

Question 16

Contraindications to using LMAs?

Answer 16

GORD, not fasted, obese, pregnancy, lesions of oropharynx, decreased lung compliance,

Question 17

What sizes do iGel come in?

Answer 17

1-5

Question 18

How should the iGel be sitting once it is in position?

Answer 18

In the upper oesophageal opening and cuff located against the laryngeal framework in the hypopharynx
Incisors resting on the integral bite block

Question 19

What is an endotracheal tube?

Answer 19

Advanced airway protection that provides greater airway protection than the LMA or iGel

Question 20

Why is the endotracheal tube considered the only safe form of intubation?

Answer 20

It bypasses the nose, larynx and pharynx to sit in the trachea just above the carina
completely protects against gastric content aspiration unlike LMA and iGel
No gastric aspiration, inflation, ensures patent airway

Question 21

How do you know if you have accidentally caused oesophageal intubation with the endotracheal tube?

Answer 21

No capnography after a couple of breaths
Large air leak following cuff inflation
Hypoxia

Question 22

How can you tell if you have performed endobronchial intubation accidentally with the ET tube? What damage can occur?

Answer 22

Tube inserted past carina into a main bronchus
Hypoxia, bronchospasm, high airway inflation pressure
Damage to single lung as pressures are too high

Question 23

How is impaction combatted in ET tubes?

Answer 23

Murphy’s eye present on the tube allows air to escape even if impaction occurs
Impaction is when the tip of the tube abuts against the tracheal wall

Question 24

What are 5 complications that can occur due to ET tubes?

Answer 24

Oesophageal intubation, endobronchial intubation, impaction, herniation, stretching of the tracheal wall

Question 25

What is a bougie and what is it used for? What can you feel as you insert the bougie?

Answer 25

It is a long thin device used for difficult intubation
It is inserted so the ET tube can be fed over it
Acts as an introducer
Can feel tracheal clicks followed by a “hold up” sign

Question 26

What things can Magills forceps be used for?

Answer 26

Guide NG tube down, guide tracheal tube through vocal cords, remove foreign bodies

Question 27

What can suction equipment be used to remove?

Answer 27

Blood or secretions from pharynx

Stomach content via NG tube or orogastric tube