Ch. 1&2 Airway and Mechanical Ventilation

Question 1

What are the 3 essential criteria to consider when evaluating need for intubation?

Answer 1

1) Failure to maintain or protect the airway
2) Failure to oxygenate or ventilate adequately
3) Expected clinical course and likelihood of deterioration

Question 2

Explain a failure to maintain an airway when considering intubation.

Answer 2

Requiring a maneuver or device in order to maintain patency. Chin lift, jaw thrust, oral or nasal airway insertion.
In general, a patient requiring a device or maneuver and who easily tolerates this should likely be intubated unless presence of a rapidly reversible condition.

Question 3

Explain how to evaluate failure to protect the airway when considering intubation.

Answer 3

Protecting the airway is the ability to protect against aspiration of gastric contents.
Gag reflex is often used, but this is inadequate as up to 25% of normal people do not have a gag reflex.
Ability to swallow and handle own secretions is a more reliable assessment.

Question 4

Describe failure of ventilation/oxygenation in regard to intubation and the use of ABG’s.

Answer 4

Best assessed clinically including pulse O2 and breathing pattern as well as overall trend of patient condition. Capnography can be helpful, but is not needed. ABG’s can be misleading and are also not necessary. A tiring asthmatic may need intubation despite having mildly altered ABG.

Question 5

What are the 4 general means to manage an airway and provide ventilation?

Answer 5

Intubation
BMV
Extraglottic device
Cricothyrotomy

Question 6

Neuromuscular paralysis generally should be avoided in which patients being considered for intubation? Why?

Answer 6

Patients for whom a high degree of intubation difficulty is predicted
You don’t want to paralyze someone who has a high likelihood of failing intubation because you then have no way to ventilate them and they cannot breathe on their own.