Advanced Airway Management

Question 1

Indications of LMA

Answer 1

airway management in unconscious pt without gag reflex requiring assisted ventilation
failed attempt at intubation
prolonged assisted ventilation

Question 2

Contras of LMA

Answer 2

pts with intact gag reflex
pts resisting insertion
unable to open mouth sufficiently
suspected epiglottits or other cause of upper airway obstruction

Question 3

Indications for intubation facilitated by sedation

Answer 3

pts unresponsive to non invasive ventilation

diabetic ketoacidosis

Question 4

Precautions for IFS

Answer 4

anticipation of difficulty ventilating with BVM
anticipation of a difficult intubation
transport times off less then 10 mins

Question 5

contras of IFS

Answer 5

where the failed intubation procedure is not able to be carried out
no functional ETCo2
where RSI is indicated

Question 6

when to use RSI

Answer 6

GCS less than 10 and resp failure, neuro injury, status epilepticus, suspected TCA overdose, overdose

Question 7

Indications for RSI

Answer 7

traumatic brain injury
non-traumatic brain injury 
hypoxic brain injury 
overdose with suspected TCA involvement, difficult extrication, prolonged transport time, unable to maintain spo2 over 90 
severe hyperthermia
status epilepticus
suspected airway burns

Question 8

Precautions of RSI

Answer 8

anticipation of difficult intubation: morbid obesity, short neck, facial trauma
anticipation of difficulty with BVM ventilation
transport time of less than 10 mins

Question 9

Contras of RSI

Answer 9

inability to perform failed intubation drill 
no functional ETCO2
any contras to sux admin
coma due to uncontrolled haemorrhage
functional IV access (2 lines preferred)

Question 10

Preparation of RSI

Answer 10

ensure functional ETCo2, ensure equipment is positioned for clear view, mark the crico-thyroid membrane, VSS, prepare induction agents, preload with 10ml/kg normal saline bolus

Question 11

Pharamacology for RSI

Answer 11

Fentanyl 100mcg in 2ml drawn up in 2ml syringe
Midaz 15mg in 3ml diluted to 15ml in a 20ml syringe
Suxamethonium 100mcg in 2ml drawn up in 3ml syringe
Atropine 1.2mg in 1ml drawn up in 1ml sringe - to be used for bradycardia
Pancuronium 8mg drawn up into a 5ml syringe. ONLY when intubation has been successful

Question 12

Procedure of RSI

Answer 12

drug admin - midaz, fentanyl and sux
Cricoid pressure
Fasciculation and signs of paralysis
Intubation - should last no longer than 15 secs

Question 13

ETCo2 rates for intubation

Answer 13

30-35mmHg

Question 14

Cricothyroidotomy when:

Answer 14

the pt is unable to be oxygenated and ventilate where RSI attempted and failed, RSI not authorised, RSI unsafe due to massive facial trauma, no functional IV access, upper airway obstruction present and unable to remove, partial upper airway obstruction and AMI required