Chapter 2 - Airway and Ventilatory Management

Question 1

1. 1. What is the earliest sign of Airway compromise?

1. 2. What is the most important early assessment of the airway?

Answer 1

1. 1. Tachypnoea

1. 2. Talking to the patient to stimulate a verbal response

Question 2

Define a definitive airway.

Answer 2

A definitive airway is a tube placed in the trachea - cuff inflated - connected to a form of oxygen enriched assisted ventilation - secured in place

Question 3

1. 1. What is the clinical triad of laryngeal fractures?

1. 2. What would be the next appropriate intervention in diagnosing this injury?

Answer 3

1. 1. Hoarseness, subcutaneous emphysema, palpable fracture

1. 2. CT scan

Question 4

List objective signs of airway obstruction

Answer 4

1.1 Observstion
Agitated - suggesting hypoxia
Obtunded - suggesting hypercarbia
Cyanosis - late sign - hypoxaemia

1.2. Listen for abnormal sounds

Noisy breathing is obstructed breathing - snoring, gurgling, stridor suggests partial obstruction of pharynx and larynx

1.3. Behavior

Aggressive and abusive is not always intoxication

Question 5

List the factors indicating a difficult airway

Answer 5

C-spine injury
OA C-spine
Significant maxillofacial trauma
Limited mouth opening
Anatomical variations - receding chin, overbite, short muscular neck
Obese patients
Paediatric patients

Question 6

How would you assess for a difficult intubation?

Answer 6

LEMON

Look - small mouth or chin, large overbite, facial trauma

Evaluate 3-3-2 Rule -

Distance between incisors teeth should be 3 fingers
Distance between hyoid bone and chin - 3 fingers
Distance between thyroid notch an floor of mouth - 2 fingers

Mallampati score

Obstruction

Neck mobility - suspected C-spine injury will have restricted C-spine motion and therefore difficult intubation

Question 7

List equipment needed for successful intubation

Answer 7

Suction
Oxygen
NP and OP airwarys
BM ventilation
Laryngoscope
Gum elastic bougie
Endotracheeal tubes (various sizes)
Supraglottoc airways
Surgical cricothyroidotomy
Pulse oximetry
Capnography
Drugs

Question 8

Airway adjuncts - nasopharyngeal airway

1. 1. What are the sizing landmarks for an NPA
2. 2. Approximate size in adults and children

Answer 8

1. 1. Lateral edge of nostril - tragus of the ear

1. 2.

Question 9

Supraglottic airway devices include LMAs and Intubating LMAs

Appropriate sizes of LMA

Answer 9

Small adult - 3
Medium adult - 4
Large adult (90kg +) - 5

Infants to large pediatrics - 1 - 2.5