Noninvasive Airway Management

Question 1

What is the first priority in airway control?

Answer 1

Ensuring airway patency for adequate oxygenation and ventilation.

Question 2

What is the function of Oropharyngeal airway (OPA)?

Answer 2

It is an S shaped device designed to hold the tongue away from the posterior pharyngeal wall, while providing an airway channel and suction conduit through the mouth

Question 3

Why is oropharyngeal airway is contraindicated in patients with gag or Cough reflex?

Answer 3

As it may stimulate vomiting or laryngospasm

Question 4

How is proper OPA size estimated?

Answer 4

It is by placing the OPAs flange at the corner of the mouth. The distal tip of the mouth should reach the angle of the mandible

Question 5

What is nasopharyngeal airway device?

Answer 5

It is a trumpet like tube made of rubber or plastic, it works as a airway conduit between the nares and pharynx

Question 6

Indications for nasopharyngeal airway?

Answer 6

Intoxicated or semi-concious patient who doesn’t tolerate an OPA.
When Trauma, trismus and other obstacles preclude the placement of an OPA

Question 7

How is NPA length determined?

Answer 7

It is estimated by measuring the length of the NPA from the tip of the nose to the tragus of the ear

Question 8

Who should receive supplemental oxygen?

Answer 8

All seriously sick or injured patients with cardiac diseases, respiratory distress, shock or trauma should receive supplemental oxygen even if their atrial PO2 is normal

Question 9

Why is caution recommend in Oxygen therapy for a COPD patient with hypoxia and chronic hypercarbia ?

Answer 9

Unmonitored treatment with high concentration of oxygen in these patients can result in respiratory depression due to loss of their hypoxic ventilatory drive

Question 10

What is the definition of adequate ventilation?

Answer 10

Sufficient oxygen delivery to the alveoli and sufficient carbon dioxide removal from the lungs.

Question 11

What is the sequence of intervention for the inadequate ventilation?

Answer 11

OPA insertion and bag mask ventilation as the bag mask can provide 100% oxygen as compared to the other O2 delivery techniques when attached to a high flow O2 source( 10-15L/min.

Question 12

What is the prerequisite for using paralytic agents to intubate a patient?

Answer 12

Substantial proficiency in BMV.

Question 13

The effectiveness of BMV is determined by ?

Answer 13

Observing the chest wall movements, feeling for resistance in the bag, and monitoring the oxygen saturation and end tidal CO2.

Question 14

What are the four fundamental reasons for definitive airway management or endotracheal intubation?

Answer 14

1) inability maintain or protect the airway
2) failure of ventilation or oxygenation
3) potential for deterioration based on the patients clinical presentation.
4) patient safety and protection

Question 15

What is the consequence of inability to voluntarily maintain or protect the airway?

Answer 15

Aspiration of gastric content into the lungs.

Question 16

If the supplemental oxygen therapy and clinical therapy do not reverse severe hypoxemia, what should be done? ,,

Answer 16

The patient has to be intubated to deliver high concentration of oxygen and positive pressure ventilation

Question 17

What are the common conditions that require anticipatory intubation Even if the patient is awake and talking?

Answer 17

Significant facial fractures, penetrating neck trauma, tracheal or laryngeal injuries, severe head injury, multiple trauma or sustained seizures.

Question 18

What should be the airway management in an agitated/ combative/ confused patient with multiple injuries or serious trauma?

Answer 18

Sedation and prophylactic intubation for the safety of the patient.

Question 19

What is Malampati classification?

Answer 19

It is a scale of I- IV used to predict the patient’s mouth’s feasibility to accommodate Laryngoscope and ETT

Question 20

What is 3-3-2 rule in airway management?

Answer 20

It describes the ideal dimension of the airway that facilitates direct visualization of the larynx.
Three fingers breadth of the mouth indicates adequate mouth opening, three fingers under the chin indicates that the patients mouth is large enough to accommodate the tongue.
2 fingers breadth from the hyoid bone to the thyroid cartilage indicates adequate neck length and laryngeal position

Question 21

What is LEMON Law in airway evaluation?

Answer 21

These are steps in identifying potentially difficult airway. These consist of:
1) Look externally
2) Evaluate 3-3-2 rule
3) Malampati classification
4) Obstruction of the upper airway
5 ) Neck mobility

Question 22

What is the protocol for pre- oxygenation in RSI?

Answer 22

Administration of 100% oxygen for at least 5 min to wash out the nitrogen of the room air in the lungs and replace it with 100% O2. This Ensures availability of oxygen reservoir that allows for prolonged apnea without oxygen desaturation

Question 23

What are the adverse effects of simultaneous succinylcholine and Rapid successive intubation?

Answer 23

Increased ICP, IOP, intragastric pressure, sympathetic discharge, bradycardia and bronchospasm in patients with reactive airway diseases.

Question 24

What does SOAP ME stands for in rapid successive intubation preparatory phase?

Answer 24

S- suction
O- high flow oxygen mask and BMV should be available
A- airway equipment,: two Laryngoscope handles, appropriate size and shape Laryngoscope blades, ETT stylets should be available.
P- pharmacy: RSI medications+ IV line
ME- end tidal CO2 monitoring equipment should be available

Question 25

What is the goal of paralysis with induction agents and rapid administration of NMBA ?

Answer 25

It is to elicit complete unconsciousness and motor paralysis.

Question 26

What is the action of pre- NMBA induction agents?

Answer 26

To achieve complete unconsciousness. Without complete sedation induction of NMBA induced paralysis can have detrimental physiological and psychological sequelae.

Question 27

What are the pretreatment medications used to prevent adverse effects of NMBAs such as succinylcholine?

Answer 27

Lidocaine 1.5 mg/ kg, Fentanyl 3-6mcg/Kg, atropine 2 mg.

Question 28

What is the action of lidocaine in RSI ?

Answer 28

It decreases ICP response to intubation, mitigates bronchospasm in patients with reactive airway diseases.

Question 29

What is the action of fentanyl in RSI?

Answer 29

It helps to blunt sympathetic response to Laryngoscope in patients with elevated ICP, ischemic heart disease, aortic dissection.

Question 30

What is the action of atropine in RSI?

Answer 30

It mitigates bradycardic response to Sch in children<1 year and in adults receiving second dose of Sch

Question 31

Why is etomedate is the choice of induction agent for most patients receiving RSI?

Answer 31

It is a rapid short acting non barbiturate hypnotic agent that provide no analgesia. It is hemodynamically stable, it reduces CBF and cerebral metabolic O2 demand without compromising cerebral perfusion pressure. Therefore, it is an excellent choice for patients with elevated ICP.

Question 32

In hemodynamically unstable patients etomidate dose should be reduced to what percentage?

Answer 32

50

Question 33

What is the origin and action of Ketamine?

Answer 33

It is a dissociative anastatic derived from phencyclidine. It induces cataleptic state rather than true unconsciousness. It provide analgesia, amnesia, and Anastasia while preserving in protective reflexes.

Question 34

Ketamine is an induction agent of choice for what type of patients during RSI?

Answer 34

Hypotensive, hypovolemic, and bronchospastic patients requiring intubation. Due to its sympathetic effect it increases ICP, CBF, cerebral metabolic rate.

Question 35

What are the side effects of Ketamine?

Answer 35

It may produce hallucinations and frightening dreams in the first three hours after awakening from intubation.