Airway

Question 1

Airway
Decision to Intubate
criteria

Answer 1

Failure to maintain or protect airway (e.g. low GCS, airway trauma)
Failure to ventilate/oxygenate (e.g. low or declining SpO2, rising pCO2)
Anticipatory (e.g. trauma, overdose, inhalation injury, anaphylaxis, inc. WOB)

Question 2

Airway Assessment
Difficult Bag-Valve Mask Ventilation “BOOTS”

Answer 2

B = Beard;
O = Obese;
O = Older;
T = Toothless;
S = Snores/Stridor

Question 3

Airway Assessment
Difficult Laryngoscopy

Answer 3

Look for gestalt signs. Evaluate the 3-3-2 rule. Check for signs of obstruction,
swelling, trauma. Assess neck mobility.
Upper lip bite test: Concern if patient cannot bite past vermillion border

Question 4

Airway Assessment
Difficult Supraglottic Device “RODS”

Answer 4

R = Restricted mouth opening;
O = Obstruction, Obese
D = Disrupted or Distorted anatomy;
S = Stiff lung or cervical Spine

Question 5

Airway Techniques
Temporizing Measures

Answer 5

Chin lift/jaw thrust, BVM,
suctioning, nasal airway, oral
airway, LMA

Question 6

Airway Techniques
Definitive Airway

Answer 6

Orotracheal/nasotracheal
intubation, surgical airway
(percutaneous or open cric)

Question 7

Airway Methods

Answer 7

Rapid Sequence Intubation (RSI)
Awake intubation w/ topicalization
Ketamine-facilitated intubation
Crash airway without meds

Question 8

Rescue Airways

Answer 8

LMA
Cricothyroidotomy

Question 9

Rapid Sequence Intubation (6Ps)

Answer 9

Preparation
Prepare equipment and medications, use checklist if available
Pre-Oxygenation
100% FiO2, employ PEEP valve to improve recruitment
Pre-Treatment (Optional)
Increased ICP: fentanyl 3μg/kg
Hypotension: fluids/vasopressors (infusion or push-dose)
Acidosis: bicarb (controversial), consider maintaining spontaneous respiration
Anxiolysis: midazolam 2-4mg
Positioning
Sniffing position, ramped position if obese, adjust bed height
Paralysis with Induction
Administration of sedative (i.e. Ketamine, Propofol, Etomidate) followed by
muscle relaxant if indicated (i.e. Succinylcholine or Rocuronium)
Place Tube with Proof
Intubate patient and confirm tube placement (continuous waveform EtCO2)
Post-Intubation Management
Post-intubation analgesia, ongoing sedation, ventilator management, further
resuscitation.