Chapter 2: Basic Airway Management

Question 1

What is the cornerstone of basic airway management?

Answer 1

Bag-mask ventilation

Question 2

Why is bag-mask ventilation most often needed?

Answer 2

Because of inadequate ventilation

Question 3

What are causes of inadequate ventilation?

Answer 3

1. Impaired respiratory effort

2. Airway obstruction

Question 4

Impaired respiratory effort can be caused by what?

Answer 4

1. Intrinsic factors: intracranial hemorrhage

2. Extrinsic factors: opioid overdose

Question 5

What are some causes of airway obstruction?

Answer 5

1. In an unconscious patient, the tongue may prolapse into the posterior pharynx
2. Loss of motor tone in the soft palate
3. Obstruction by foreign bodies
4. Injured tissue
5. Blood

Question 6

What maneuvers can fix an airway obstruction?

Answer 6

1. Head-tilt chin-thrust

2. Jaw-thrust with or without a head tilt

Question 7

What is the primary maneuver used in a patient in who. Cervical spinal injury is NOT a concern?

Answer 7

Head-tilt chin-lift

Question 8

Describe the head-tilt maneuver.

Answer 8

1. Use both hands to extend the patients neck and open an airway
2. While one hand applies pressure to the patients forehead, the tips of the index and middle finger of the second hand lift the mandible at the mentum.

This lifts the tongue from the posterior pharynx

Question 9

What maneuver is an effective airway technique in patients in whom a cervical spinal injury is a concern?

Answer 9

Jaw-thrust maneuver

Question 10

Describe the jaw-thrust maneuver.

Answer 10

1. By placing the heels of both hands on the parieto-occipital areas on each side of the patients head
2. Then grasping the angles of the mandible with the index and ring fingers
3. Displacing the jaw anteriorly

Question 11

What is the purpose of an airway adjunct?

Answer 11

1. To prevent the tongue from occlude for the airway

2. Provide an open conduit for air to pass.

Question 12

When do you use an oropharyngeal airway?

Answer 12

1. Should be placed whenever bag-mask ventilation is required.
2. Someone who is deeply unresponsive who is unable to maintain their airway.

Question 13

Does an oropharyngeal airway protect from aspiration of secretions or gastric contacts?

Answer 13

NO!

Question 14

When do you place an endotracheal tube?

Answer 14

Should be inserted as soon as possible in any patient who is unable to protect his or her airway.

Question 15

What does an oropharyngeal airway look like?

Answer 15

1. Curved
2. Firm
3. Hollow tube
4. Rectangular appetite that is used as a conduit between the mouth and the glottis to prevent obstruction by the tongue

Question 16

How do you determine the correct Oropharyngeal airway size?

Answer 16

1. Hold the airway beside the patients mandible, orienting it with the flange at the patients mouth and the tip directed toward the angle of the mandible
2. The tip SHOULD reach the angle of the patients mouth.

Question 17

What should the clinician avoid when inserting an oropharyngeal airway?

Answer 17

Avoid pushing the tongue into the posterior pharynx.

Question 18

How do you avoid pushing the tongue into the posterior pharynx when placing an oropharyngeal airway?

Answer 18

1. Start with the curve of the OPA INVERTED (pointing up toward you)
2. Then rotating it 180 degrees as its tip reaches the posterior pharynx

Question 19

Describe nasopharyngeal airway.

Answer 19

1. Soft rubber or plastic hollow tube

2. Passed through the nose into the posterior pharynx

Question 20

When is a nasopharyngeal airway used?

Answer 20

Used when an OPA is too difficult, such as when the jaw is clenched or the patient is semi-conscious

Question 21

What sizes of nasopharyngeal airways should be used for the following:

1. Large adult
2. Medium adult
3. Small adult

Answer 21

1. 8-9 cm
2. 7-8 cm
3. 6-7 cm

Question 22

How do you determine the correct nasopharyngeal airway size?

Answer 22

Hold the airway beside the patients mandible, orientation it with the flared end at the tip of the patients nose and the distal tip directed toward the angle of the mandible

The tip should just each the angle of the patients mandible

Question 23

What should be done prior to insertion of a nasopharyngeal airway?

Answer 23

The NPA should be coated with water-soluble lubricant or anesthetic jelly

Question 24

What does successful bag-mask ventilation depend on?

Answer 24

1. A patent airway
2. An adequate mask seal
3. Proper ventilation

Question 25

How is a patent airway obtained?

Answer 25

Using airway maneuvers and adjuncts

Question 26

Describe mask placement

Answer 26

• You should have a patent airway.
• The nasal portion of the mask should be spread slightly and placed on the bridge of the patients nose
• The body of the mask is place on the patients face overlying the patients nose and mouth

Question 27

What are the facial landmarks that must be covered by the mask?

Answer 27

1. The bridge of the nose
2. The two malar eminences
3. Mandibular alveolar ridge

Question 28

What is the best method to holding the mask in place?

Answer 28

Two-hand mask hold is most effective but you need a second person

Question 29

Describe single hand technique for bag-mask ventilation.

Answer 29

1. 1 hand is placed on the mask with the web space between the thumb and the index finger resting against the mask contour.
2. The other 3 fingers (middle, ring, little) are placed along the mandible and pull the mandible up into the mask in a chin-lift maneuver

Question 30

Describe the two hand technique for bag mask ventilation.

Answer 30

1. One providers sole responsibility is to use both hands to create a good mask seal and maintain an open airway.
2. Another provider squeezes the bag to ventilate the patient

Question 31

What are some causes of problems that might occur with bag-mask ventilation causing the chest not to rise?

Answer 31

1. Poor mask seal: false teeth should stay out; facial hair may need water applied to better seal; lower lip placement
2. Wrong mask size
3. Lack of airway adjuncts
4. Inexperienced personnel

Question 32

What are the clinical errors that should be avoided when ventilating a patient with a bag mask?

Answer 32

1. Giving excessive tidal volumes
2. Forcing air too quickly
3. Ventilating too rapidly