Chapter 3 - airway

Question 1

Laryngeal Mask Airway (LMA)
- where dose It sit
- sizes

Answer 1

Tube with an elliptical cuff fitted at the distal end that inflates around the hypopharynx around the posterior perimeter of the larynx.

• Sits against the laryngeal inlet.
• Can attach a bag value to the LMA for ventilation.

SIZES:
a. Size 5 – large adult
b. Size 4 – medium adult
c. Size 3 – small adult

Question 2

Endotracheal (ETT) Intubation
- time
-oxygen req
- hot / cold

Answer 2

ETT are inserted either orally or nasally through the larynx, should not take more than 20 seconds due to risk of Hypoxia, if exceeds more than 20 seconds – re-oxygenation should occur.

Ideally the unconscious patient is pre-oxygenated with 100% oxygen prior to an attempt.
- Consider leaving one pillow under the patient’s head; this can make visualisation easier in some cases.
- A patient in cardiac arrest will not require any drugs to sedate or paralyse them. This is called cold intubation.

Question 3

Endotracheal (ETT) Intubation - Monitoring

Answer 3

• Cardiac
• Oxygen saturation

Question 4

CRICOID PRESSURE
- why
- mark at gums
- how much inflate

Answer 4

ASSISTANT IN INTUBATION – CRICOID PRESSURE
1. Compress the oesophagus and helps to prevent pulmonary aspiration if the patient vomits.
2. Visualise the vocal cords.

CRICOID PRESSURE
The application of backwards pressure with the thumb and forefinger to the cricoid cartilage, which is located below the thyroid cartilage (the adams apple).
- Pressure is not released until the cuff of the ETT is inflated and the person intubating says so.
- Decreases the likelihood of aspiration

SIZING
Adult: 7.00 mm - 9.00 mm internal diameter

Placed @ 20-23cm mark at the gums.

Inflated using 5-8 mls of air.

Question 5

Correct placement of the ETT
(8)

Answer 5

There is a good chance it is in the right place if the intubate saw it pass through the cords.

HOW TO CONFIRM –
1. Listen with a stethoscope
2. Use End tidal carbon dioxide
3. Increasing Sp02
4. Bilateral rise and fall of the chest
5. Improved skin colour
6. The cricoid assistant felt the tube pass through the cricoid ring
7. Fogging of the ETT (condensation as the warm air cools inside the ETT)
8. Chest X-Ray

Question 6

combi tube

Answer 6

Double lumen airway with two inflatable balloon cuffs that is inserted blindly into the oesophagus or trachea.

• 1 x lumen contains ventilating side holes at the hypo pharyngeal level and is closed at the distal end.
• 1 x distal open end with a cuff similar to a tracheal tube

When inflated the balloon fills the space between the base of the tongue and the soft palate anchoring the combi tube into position and isolating the oesophagus or the trachea.

** can be used whether in oesophagus or trachea.

Question 7

Bag Valve Mask Ventilation
Flow rate

Answer 7

Connected to oxygen @ 15 L – giving 100% oxygen
** AIM: 6 to 10 breathes per minute.