Intubation (orotracheal & nasotracheal)

Question 1

Orotracheal and Nasotracheal Intubation
Indications

Answer 1

Need for ventilatory assistance or airway control
AND
Other airway management is ineffective

Question 2

LIDOCAINE SPRAY
Conditions
Other?

Answer 2

other: Orotracheal intubation

Question 3

LIDOCAINE SPRAY
Contraindications

Answer 3

1. Allery or sensitivity to lidocaine
2. Unresponsive patient

must be GCS ≥ 4 to receive Lidocaine spray

Question 4

LIDOCAINE SPRAY
Topical - hypopharynx
Dose?
Max. Dose?
Dosing Interval?
Max. # of Doses?

Answer 4

Dose: 10mg/spray
Max. Dose: 5mg/kg
Dosing Interval: N/A
Max. # of Doses:20

40kg patient will receive max dose (20 sprays = 200mg lidocaine)

Question 5

OROTRACHEAL INTUBATION
Conditions

Answer 5

ANYONE

Question 6

OROTRACHEAL INTUBATION
Contraindications

Answer 6

AGE < 50
AND
Current episode of asthma exacerbation
AND
Not IN or NEAR cardiac arrest

aka do not tube asthmatic unless theyre dead

Question 7

Xylometazoline (Otravin)
Conditions

Answer 7

Anyone

Question 8

Xylometazoline (Otravin)
Contraindications

Answer 8

Allergy or Sensitivity

Question 9

Xylometazoline (Otravin)
Route - Topical Nares
Dose?
Max. Single Dose?
Dosing Interval?
Max. # of Doses?

Answer 9

Dose: 2 sprays / nare
Max. Single Dose: 2 sprays / nare
Dosing interval: N/A
Max. # of doses: 1

Question 10

NASOTRACHEAL INTUBATION
Conditions
Age?
Other?

Answer 10

Age: ≥ 8 years
Other: Spontaneous Breathing

Question 11

NASOTRACHEAL INTUBATION
Contraindications

Answer 11

1. AGE < 50 and Current episode of asthma exacerbation and not in or near cardiac arrest
2. Suspected basal skull fracture or mid-face fracture
3. Uncontrolled Epistaxis
4. Anticoagulation Therapy(excluding ASA)
5. Bleeding Disorders

Question 12

Primary Confirmation method for Orotracheal / Nasotracheal Intubation?

Answer 12

ETCO2 with waveform capnography

Question 13

If waveform capnography unavailable how many secondary methods must be used to confirm placement? What are they?

Answer 13

3 secondary methods
1. ETCO2 NON-waveform
2. Visualization
3. Auscultation
4. Chest Rise
5. Esophageal detection device

Question 14

Maximum number or Orotracheal or Nasotracheal Intubation attempts?

Answer 14

Max Number of 2 attempts

Question 15

Formula for calculating uncuffed paediatric ETT?

Answer 15

(AGE/4) + 4

Question 16

Formula for calculating cuffed paediatric ETT?

Answer 16

(AGE/4) + 3.5

Use smaller syringe to inflate these cuffs

Question 17

Common ETT size for Adults?

Answer 17

6.5 - smaller adult
to
8.0 - large adult

choose what you think will pass the cords

Question 18

Macintosh blade features?

Answer 18

Curved Blade placed in vallecula to lift epiglottis

Question 19

Miller blade features?

Answer 19

Straight blade for scooping epiglottis up

more common in paediatrics - although preference of provider

Question 20

Orotracheal Intubation can stimulate what nerve? which can cause what to HR and SBP?

Answer 20

1. Vagus Nerve
2. Decrease HR and Decrease SBP

Question 21

L.E.M.O.N. score each stand for?

Answer 21

Look externally - external characteristics
Evaluate - 3-3-2 rule
Mallampati score
Obstructions?
Neck Mobility

3-3-2 rule = 3 fingers in mouth, 3 fingers from tip of chin to hyoid bone, 2 fingers between hyoid and thyroid notch
Mallampati - Class 1 to 4, 1 and 2 easier, 3 and 4 more difficult

Question 22

S.L.O.P.E.S. stand for?

Answer 22

S - Suction & Stylet
L - Laryngoscope, Lube
O - Oxygen, OPA
P - Position, Pillow
E - ETT size, ETCO2
S - Securing Device, Syringe, Stethoscope