CWI's

Question 1

Sniffing Position

Answer 1

Patients requiring airway management
Optimises conditions to achieve airway patency during basic airway management.
Optimises anatomical position for intubation and insertion of a supraglottic airway.
Generally superior to the neutral position but more difficult to achieve quickly in some patients.
Not appropriate for spinally immobilised patients

Question 2

Triple Airway Manouvre

Answer 2

Head tilt: Place hands on either side of the patient’s head and gently tilt it back.
Jaw thrust: With fingers placed behind the mandibular angle and thumbs on the chin, lift
the jaw upwards. Maintain this position.
Open mouth: Use both thumbs to open the mouth and visualise the oropharynx (looking
for obstruction).

Question 3

NPA Indications

Answer 3

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 4

NPA Contras

Answer 4

none

Question 5

NPA precautions

Answer 5

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 6

Why we insert NPA

Answer 6

The distal end once inserted is intended to displace the tongue and soft tissues anteriorly relieving
obstruction. Nasopharyngeal airflow may also be improved by widening and support of nasal passages.

An NPA does not protect the patient from aspiration.

It is less likely to stimulate the gag reflex by comparison to an oropharyngeal airway and can be used for
patients with a higher conscious state who still require assistance in maintaining a patent airway. It is also
useful where oropharyngeal airways are not possible due to trismus.

Two NPAs may be inserted if required to optimise airway patency.

Question 7

NPA sizing selection

Answer 7

Select size by measuring from corner of nose to earlobe

Question 8

OPA Indication

Answer 8

Support airway patency in the unconscious patient
Bite block in intubated patient

Question 9

OPA Contras

Answer 9

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

Question 10

OPA Sizing guide

Answer 10

Select size by measuring from angle of jaw to middle of incisor (front teeth).
Incorrect size can exacerbate airway obstruction.

Question 11

Why do we insert OPA upside down until halfway in the adult patient

Answer 11

This is to clear the tongue to prevent pushing it back into the airway.

Question 12

Why dont we rotate OPA in paediatrics

Answer 12

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 13

SGA indications

Answer 13

Unconscious patient without gag reflex
Ineffective ventilation with BVM and basic airway management
>10 mins supported ventilations required
Unable to intubate

Question 14

SGA contraindications

Answer 14

Intact gag reflex or resistance to insertion
Strong jaw tone or trismus
Suspected epiglottitis or upper airway obstruction

Question 15

SGA Precautions

Answer 15

Inability to prepare pt into the sniffing position
Pt who requires high airway pressures
Paediatric pts who may have enlarged tonsils
Vomit in the airway

Question 16

SGA Side Effects

Answer 16

Correct placement does not prevent massive regurgitation or gastric distention

Question 17

IM indications

Answer 17

Medications that, as per the AV CPG’s, are required to be administered via the intra-muscular route

Question 18

IM contras

Answer 18

nil

Question 19

IM precautions

Answer 19

Safety – Ensure correct technique for administration, anatomical location, and disposal of sharps technique is
used at all times
* Larger volumes may be painful. Dilution should be avoided

Question 20

IM insertion sites

Answer 20

posterior deltoid in upper arm,
upper outer quarter gluteus medius of the buttock,
vastus lateralis of lateral thigh.

Question 21

MAD indications

Answer 21

• Administration of medications via intranasal route as per Ambulance Victoria Clinical Practice Guidelines.

Question 22

MAD contras

Answer 22

• Severe facial trauma.

Question 23

MAD precautions

Answer 23

• Rhinitis, rhinorrhoea, facial trauma. Where possible rectify (e.g. if possible have patient blow nose before admin).

Question 24

IV Precautions

Answer 24

Wherever possible do not cannulate arms which show evidence of contamination (e.g. dirt, blood, burns,
chemicals etc). If it is necessary then all attempts must be made to properly clean the IV site prior to
decontamination.
* Wherever possible do not cannulate patients with renal failure in the same arm as their arteriovenous fistula if
one is present in the limb.

Question 25

IV Indications

Answer 25

• When intravenous medication administration is required

Question 26

Setting up a line Precautions

Answer 26

• Ensure aseptic technique is practiced at all times
• Do not re-spike fluid bags
  This may introduce air embolism

Question 27

Setting up a line Indications

Answer 27

This method is indicated when intravenous fluid is required as per the Ambulance Victoria CPG’s, including the
dilution and administration of medications

Question 28

BVM Indications

Answer 28

Apnoea
Inadequate ventilation

Question 29

BVM contras

Answer 29

Nil