Airway CWI's

Question 1

As per CWI OPS 028 Laryngoscopy, ALS paramedics are required to expose the vocal cords
under which circumstances?

Answer 1

Indications for laryngoscope: Altered conscious state, requiring inspection of the airway

Vocal cords exposure:
Identifying the epiglottis and successfully exposing
the vocal cords are only required for
intubation by MICA paramedics.

Question 2

As per CWI OPS 176 Positive end expiratory pressure (PEEP) valve, what are the indications for the application of PEEP?

Answer 2

• All patients receiving intermittent positive pressure ventilation (IPPV) with a cardiac
  output

-All neonatal patients receiving IPPV

Question 3

As per CWI OPS 190 Airway Manoeuvres & Positioning, how does the triple airway manoeuvre
enhance the assessment of the airway?

Answer 3

Corrects the positioning of airway soft tissue (soft palate, tongue and/or epiglottis) which can relax in the unconscious patient obstructing the airway by falling against the posterior wall.

Creates the neutral positioning

Question 4

As per CWI OPS 190 Airway Manoeuvres & Positioning, how would you position an infant or small child’s airway?

Answer 4

In the neutral position which may require ramping under the shoulders of an infant, or small child

Question 5

As per CWI OPS 059 Bag Valve Mask, what are the indications for BVM ventilation?

Answer 5

• Apnoea

* Inadequate ventilation

Question 6

As per CPG A0301 Supra-Glottic Airway (SGA), what are the contraindications to
SGA insertion?

Answer 6

• intact gag reflex or resistance to insertion
• strong jaw tone or trismus
• suspected epiglottis or upper airway obstruction

Question 7

As per CWI OPS 193 Suction, why is epiglottitis listed as a precaution for performing suction?

Answer 7

Stimulation of epiglottis may precipitate complete airway obstruction.

Question 8

As per CWI OPS 126 I-Gel Supraglottic Airway, which of the following are the correct landmarks for measuring length of gastric tube required?

Answer 8

distance from xiphisternum to earlobe to gastric insertion hole

Question 9

As per CWI OPS 190 Airway Manoeuvres & Positioning, which of the following is most suitable for patients at risk of cervical spinal injuries?

Answer 9

Modified triple airway (no head tilt)

Neutral position

Question 10

As per CWI OPS 028 Laryngoscopy, how is an appropriate sized blade selected?

Answer 10

Placing the proximal aspect of the blade at the upper incisor (front) teeth, the tip of an appropriate size blade should fall within 1 cm of the angle of the mandible.

Question 11

As per CWI OPS 192 Nasal Capnography, what are the indications for nasal
capnography?

Answer 11

• Post-sedation

- Altered conscious state in the setting of alcohol / drug intoxication

Question 12

As per CWI OPS 192 Nasal Capnography, a gradually increasing EtCO2 indicates what?

Answer 12

a gradually increasing ETCO2 indicates hypoventilation

Question 13

As per CWI OPS 076, Administration of a nebulised medication to a conscious patient via aerosol mask – what is the minimum oxygen flow rate required to ensure effective nebulisation?

Answer 13

8 L/min is required to ensure effective

nebulisation.

Question 14

As per CWI OPS 020 Oropharyngeal Airway, how does the insertion technique differ in paediatric patients?

Answer 14

Do not insert upside down / rotate. Simply insert with curve in final position.
Paediatric patients have softer palates that are more likely to be damaged by upside down
OPA insertion.

A laryngoscope may be used to help the OPA move past the tongue.
Inserting the OPA without rotation reduces the chance of damaging the soft palate but
increases the likelihood that insertion is obstructed by the tongue. Manipulating the
tongue with a laryngoscope may assist insertion.

Question 15

As per CWI OPS 020 Oropharyngeal Airway, What are the contraindication of OPA inertion

Answer 15

 Trismus
 Gag reflex
 TBI / nTBI with adequate ventilation / oxygenation
->Stimulating a gag reflex in this group can significantly worsen intracranial pressure

Question 16

As per CWI OPS 176 Positive end expiratory pressure (PEEP) valve, what are the precautions?

Answer 16

 Hypovolaemia / severe hypotension
 Tension pneumothorax (current or post chest decompression)
 Elevated intracranial pressure
 Right ventricular failure

Question 17

As per CWI OPS 021 Nasopharyngeal Airway, what are the indications for the insertion of an NPA?

Answer 17

 Support airway patency in the unconscious patient

NPA may be preferable in patients with trismus, gag reflex, oral trauma or in addition to other adjuncts
to optimise airway patency

Question 18

As per CWI OPS 020 Oropharyngeal Airway, what are the indications for the insertion of an OPA?

Answer 18

 Support airway patency in the unconscious patient

 Bite block in intubated patient

Question 19

As per CWI OPS 021 Nasopharyngeal Airway, what are the precautions for the insertion of an NPA?

Answer 19

 Facial fracture or suspected basal skull fracture (i.e. any CSF from nares or ears)
-> Possibility of cerebral intrusion. Only insert if absolutely necessary to maintain patent airway.

 TBI / nTBI
-> Stimulating a gag reflex in this group can significantly worsen intracranial pressure. Only insert if
absolutely necessary to maintain patent airway.

Question 20

As per CWI OPS 176 Positive end expiratory pressure (PEEP) valve, if a PEEP device cannot be adjusted to zero and zero PEEP is required – what action should be taken?

Answer 20

remove the PEEP device from the diverter (the flow diverter can
remain in situ).

Question 21

As per CWI OPS 176 Positive end expiratory pressure (PEEP) valve, which patients should receive PEEP?

Answer 21

 All patients receiving intermittent positive pressure ventilation (IPPV) with a cardiac
output

 All neonatal patients receiving IPPV

Question 22

As per CWI OPS 190 Airway Manoeuvres & Positioning, which positions reduces the risk of aspiration?

Answer 22

• Lateral position