Chapter 7 Airway managment and ventilation

Question 1

Name the likely location of airway obstruction if you heard the following:
Snoring
Gurgling
Inspiratory stridor
Expiratory strictor

Answer 1

Partial obstruction of pharynx by tongue of palate
Liquids in upper airways
Obstruction above laryngeal inlet
Obstruction below laryngeal inlet

Question 2

What is a head tilt chin lift?

Answer 2

Forehead tilted back, chin lifted up

Stretches anterior neck structures

Question 3

What is a head tilt chin lift?

Answer 3

Forehead tilted back, chin lifted up

Stretches anterior neck structures

Question 4

What maneuver can you add to a jaw thrust to make it move effective?

Answer 4

Head tilt

Question 5

You need to give bag-valve-mask ventilation, the patient has dentures. Do you leave them in or take them out?

Answer 5

If loose - remove them

If well fitting - keep them in

Question 6

Can you still do airway manouvers (head tilt, chin lift, jaw thust) with a naso/oropharyngeal airway in-situ?

Answer 6

Yes, they may still be needed and can help

Question 7

A patient is between sizes for an oropharyngleal airway. Do you choose size up or down?

Answer 7

Up. Slightly too large is better than slightly too small.

Question 8

Name 3 complications of an oropharyngeal airway

Answer 8

Displace tongue backwards
Lodge in the vallecula
Push epiglottis into lumen of airway

Question 9

What can happen if you try to insert on oropharyngeal airway into a conscious patient?

Answer 9

Stimulate vomiting or laryngospasm

Question 10

What is the risk of the nasopharyngeal tube is too long?

Answer 10

Stimulate vomiting, laryngospas

Question 11

What are the benefits of a fine-bore flexible suction catheter over a wide-bore rigid sucker (Yankauer)?

Answer 11

Useful in patients with limited mouth opening.

Can be used to suction through an orpharygneal or nasopharyngeal airway

Question 12

What increases the risk of gastric inflation?

Answer 12

Malignancy of head and neck, obstructed airway
Incompetent eosophageal sphincter (present in all cardiac arrest patients)
High inflation pressure/volumes

Question 13

When bagging a patient during CPR, over what time should be breath be given over?

Answer 13

1 second

If too slow, inspiratory time will be prolonged and time available to give good chest compressions is reduced

Question 14

If you hyperventilate a patient, this will lead to increased intrathoracic pressure. Why is this a problem during CPR?

Answer 14

Reduces coronary perfusion

Question 15

When a bag-valve-mark has oxygen attached, what oxygen levels are achieve 1)without an O2 reservoir bag, 2) with an O2 reservoir bag

Answer 15

1) 45%

2) 85% (same as non-rebreather)

Question 16

You are a single operator and are proving manual ventilating with a BVM but has a poor seal. To compensate you give excessive compression of the bag. What is the risk with this?

Answer 16

High peak pressures

Forces more air into the stomach

Question 17

What are some trouble-shooting techniques if insertion of an LMA is proving difficult?

Answer 17

Ensure head in sniffing position
Push tip of LMA posteriorly with fingers
Ask assistant to apply jaw thrust
Give a slight 45 degree twist

Question 18

You insert an LMA. There is good chest rise and fall but a small airleak. Is this acceptable or do you need to reposition?

Answer 18

Acceptable. Leave as is

Question 19

What is the seal pressure of an LMA?

Answer 19

Standard - 20mmHg
I-Gel 20 - 25mmHg
Beyond this air will leak out (mostly into mouth, some into stomach).

Question 20

What can happen if you apply cricoid pressure during active vomiting?

Answer 20

Eosophageal rupture

Question 21

While circoid pressure can help prevent gastric aspiration, there are complications that make its routine use not supported during CPR. What are they?

Answer 21

Impairs ventilation in many

Complete airway obstruction in up to 50%

Question 22

When applying cricoid pressure, how much pressure should be used? What are you trying to achieve?

Answer 22

3kg or 30N

Compresses eosophagus against vertebral column

Question 23

When using a bougie with very poor or blind technique, how do you know you are in the airway vs eosphagus?

Answer 23

Airway: feel for click of tracheal rings, bougie advancement will be stopped by smaller airways of bronchial tree
Eosophagus: no clicking of tracheal ring, can be inserted FULLY (passes into stomach)