Advanced Airway Quiz

Question 1

If a person is clutching their throat and attempting to cough, what is your management?

Answer 1

• encourage the patient to cough

Question 2

When would you give 5 back blows to the choking patient?

Answer 2

• when they become unconscious/have an ineffective cough (think of the patients mouth moving like a fish)

Question 3

When would you resort to using the Magill’s foreceps and laryngoscope?

Answer 3

When back blocks and chest thrusts are ineffective on the uncoscious patient

Question 4

If you are unable to remove the obstruction using laryngoscopy and magills foreceps, waht would you do next?

Answer 4

• 5 forceful ventilations/5 backblows/5 check thrusts - repeat and prepare for cardiac arrest

Question 5

What besides food can cause airway obstructions?

Answer 5

• tonsillitis/quinsy
• epiglottitis
• croup
• ACE inhibitors
• Tongue (anaphylaxis)

Question 6

Describe the neutral anatomical position of the head

Answer 6

• commonly preferred in the supine patient
• the spine and airway are in the most natural alignment. requiring 2-3cm of padding under the occiput
• Intent: align the earlobe witht he middle of the clavicle parallel to the surface the patient is lying on

Question 7

When would the NPA be useful?

Answer 7

To support airway patency in the unconscious patient (e.g. the patient with trismus, gag reflex, oral trauma, or in addition to other airway adjuncts)

Question 8

What is stridor?

Answer 8

• a high pitched sound that occurs with obstruction in or just below the larynx (usually loudest on inspiration)

Question 9

List some causes of stridor

Answer 9

• croup (RSV infection)
• Foreign body
• Tonsilitis/laryngitis
• Post surgery
• Trauma (assault)
• Floppy larynx

Question 10

When would you transport a patient with a post tonsillectomy bleed?

Answer 10

• up to 2 weeks post surgery MUST be transported with ANY oropharyngeal bleed

Question 11

Describe the pathophysiology of a non fatal drowning. Why is this significant?

Answer 11

• Small amount of water entering the lungs during an immersion/submersion event. Inflammatory response leading to altered alveolar capillary permeability
• This in turn leads to irriation of the lining of the lungs, interstitial fluid shifts into the alveoli, surfactant is washed out, leading to a loss of surface tension = APO
• Significant, because, the patient who survives their initial drowning may have these symptoms up to 72 hours later (due to pogression of illness)

Question 12

What is a tracheostomy?

Answer 12

• A surgical opening into the trachea below the larynx to overcome obstruction, facilitate mechanical airway support and or the removal of bronchial secretions
• Often temporary, can be permanent

Question 13

What is the difference between a tracheostomy and a laryngectomy?

Answer 13

• Tracheostomy still has two airway ports into the lungs (mouth and nose and trachy)
• Laryngectomy has no connection to the upper airway. Permanent

Question 14

How would you suction an airway with either of these surgical airways?

Answer 14

• Y suction catheter, 10 FG, insert approx 5-10xm, apply suction on removal of the Y catheter whilst rotating in a clockwise/anticlockwide movement.
• Brief - no more than 10 seconds
• if time permits, preoxygenate first

Question 15

What are your options to ventilate the unconscious tracheostomy patient?

Answer 15

• nasal prongs
• NRM
• Paed BVM over stoma
  OR
• BVM attached directly onto tracheostomy port - need to remove the talking valve first - or leave talking valve insitu and BVM over mouth and nose

Question 16

How should you place the patients head, to be successful in direct laryngoscopy?

Answer 16

• sniffing position