Clinical Management Of Airways

Question 1

what is the upper respiratory tract?

Answer 1

parts of the respiratory tract above the vocal cords
includes nasal cavity, oral cavity, nasopharynx, oropharynx, part of the laryngopharnx until vocal cords

Question 2

what is the lower respiratory tract?

Answer 2

distal to the vocal cords: trachea, main bronchi, lobar bronchi, segmental bronchi, bronchioles, terminal bronchioles, alveoli

Question 3

what is the conducting zone?

Answer 3

up to and including terminal brocnhioles

Question 4

what epithelium lines the respiratory epithelium?

Answer 4

squamous epithelium for gas exchange

Question 5

what epithelium lines the conducting zone?

Answer 5

made up of respiratory epithelium - ciliated pseudostratefied columnar epithelium with goblet cells

Question 6

what makes up the respiratory zone?

Answer 6

respiratory bronchioles and alevoli

Question 7

Your patient has swallowed some amalgam, which lobe will it likely head towards?

Answer 7

right main bronchus because it has a straighter angle than the left main bronchus.

Question 8

what are the true and false vocal cords made of?

Answer 8

thryoarytenoid ligaments

Question 9

why are vocal cords/glottis longer in males?

Answer 9

adams apple is more prominent

Question 10

what are the causes of airway obstruction - within lumen?

Answer 10

within lumen - secretions, blood, foreign body, vomit

Question 11

what are the causes of airway obstruction - luminal wall?

Answer 11

anaphylaxis, infection (and angio-oedema, laryngospasm, tumour, trauma)

Question 12

what are the causes of airway obstruction - outside of the lumen?

Answer 12

oesophageal foreign body (and tumour, penetrating neck injury)

Question 13

difference between stridor or wheeze?

Answer 13

signs of partial airway obstruction
stridor is more deep

Question 14

what is the sign of complete airway obstruction?

Answer 14

no sounds

Question 15

algorithm for assessing airway?

Answer 15

look, listen, feel - 10 second process

Question 16

with severe airway obstruction you have an ineffective cough, how do you deal with this?

Answer 16

if unconscious start CPR
if conscious 5 black blows and 5 abdominal thrusts

Question 17

with mild airway obstruction you have an effect cough, how do you deal with this?

Answer 17

encourage a cough
continue to check for deterioration to ineffective cough or relief from obstruction

Question 18

advanced support ABCDE

Answer 18

airway, breathing, circulation, disability, exposure/everything else

Question 19

airway managment procedure

Answer 19

1. airway maneouvres
2. adjuncts
3. oxygenation/suction/ventilation
4. alternative airway devices
5. definitive airway
6. mechanical ventilation

Question 20

what are the airway maneouvres?

Answer 20

head tilt and lift - extension at the atlanto-occipital join and lifting of chin. simple effective and mobilises tongue from obstructing airway. not suitable for C-spine injuries.
jaw thrust - manual mandible protraction. pressure at angle of mandible. most successful when applied with head tilt.

Question 21

what are adjuncts to airway management - oral?

Answer 21

oropharyngeal airway/Guedel:
measure from incisors to angle of jaw
better to oversize than undersize
lifts tongue off posterior pharynx
inserted ‘upside down’ as far as possible along the hard and soft palate, then rotate 180 degrees. poorly tolerated in those with present gag reflect.

Question 22

what are adjuncts to airway management - nasal?

Answer 22

tolerated better than oropharyngeal airways. measured from tragus of ear to external nares. inserted bevelled end first towards septum. curvature pointing towards nasal floor.

Question 23

when might nasal adjuncts be needed over oral adjuncts?

Answer 23

in clenched jaws, trismus, maxfax injuries

Question 24

what is tracheal intubation?

Answer 24

optimal method. gives secure airway. trained individual airways only.

Question 25

considerations of tracheal intubation?

Answer 25

the Mallampati score: see soft palate or not see soft palate. releative ease of intubating.

Question 26

what are the 2 types of laryngoscope?

Answer 26

curved blade will sit in the vallecula at the roof of the tongue
straight blade will not

Question 27

what is a circothyroidotomy?

Answer 27

emergency airway through cricothyroid membrane

Question 28

why would cricothyroidotomy need to be used?

Answer 28

in the case that it is impossible to ventilate an apnoeic patient with a bag-mask, or pass an airway tube down. could be due to extensive facial trauma or significant laryngeal obstruction e.g., by anaphylaxis or foreign material.

Question 29

where do you insert for a cricothyroidotomy?

Answer 29

palpate the thyroid cartilage (adams apple). slide finger down to cricothyroid membrane. make incision.

Question 30

what is ludwigs angina?

Answer 30

life threatening cellulitis of the soft tissue of the floor of mouth and neck
occurs in the submandibular space

Question 31

what is the commonest tooth leading to ludwigs angina?

Answer 31

2nd or 3rd lower molar

Question 32

will lugwigs angina spread lingually or bucally and why?

Answer 32

lingual fashion
since bone on lingual aspect is thinner

Question 33

what comprises the submandibular space?

Answer 33

sublingual space and submylohyoid space

Question 34

why can infections of the submandibular space be dangerous - ludwigs angina?

Answer 34

rarely tooth caries can spread via direct communication to the parapharyngeal space, to retropharyngeal space, to the mediastinum and heart

Question 35

what attaches to the mylohyoid line?

Answer 35

mylohyoid muscle, superior pharyngeal constrictor, pterygomandibular raphe

Question 36

what is the dose of adrenaline in an IM pen?

Answer 36

1:1000 adrenaline
500 micrograms