Ch 1: The Decision to Intubate

Question 1

4 Indications for Intubation

Answer 1

1. Inability to protect and maintain airway.
2. Failed ventilation.
3. Failed oxygenation.
4. Anticipated failure trajectory. Angioedema.

Question 2

5 Keys to determine if airway is Patent AND Protected

Answer 2

1. Speaking clearly indicates a patent & protected airway.
2. Patency via OP/NP airway does not ensure Protection.
3. Most who need help w patency also require protection via cuffed ETT.
4. Swallowing & GCS are better than gag to predict protection.
5. Testing gag may induce vomitting and is no guarantee of the ability to protect the airway.

Question 3

3 patients who may crash

Answer 3

1. Intubate if current process may threaten airway soon. Anaphylaxis, angioedema or trauma.
2. Agitated patient who requires C spine immobilization.
3. Unstable pt. who must travel to XRay etc.

Question 4

4 signs of upper airway obstruction

Answer 4

1. Muffled Hot potato voice.
2. Inability to swallow secretions.
3. Stridor
4. Dyspnea

Examine mouth and oropharynx for bleeding or swelling

Examine mandible and central face.

Look at and palpate neck.

Question 5

Assessing respiration (4)

Answer 5

1. Inspiratory stridor is supraglottic.
2. Expiratory stridor is generally subglottic. Audible at bedside or subauditory w stethoscope.
3. Look for flail chest (asynchronous). Only diaphragmatic may indicate C spine injury.
4. Decreased sounds with PTX, HTX, Effusion or COPD.

Assessment of ventilation is clinical. DO NOT rely on ABG.