Airway Management

Question 1

State 4 main structures of the Upper Respiratory Tract

Answer 1

Nose
Mouth
Pharynx
Epiglottis

Question 2

The Nose, Mouth, Pharynx and Epiglottis are all part of what?

Answer 2

The Upper Respiratory Tract.

Question 3

Describe the function of the Nose and Mouth

Answer 3

Intake of air

Warming and humidification of air

Filtering and expulsion of matter - sneezing

Question 4

What is the Pharynx?

Answer 4

Cavity at the back of nose and mouth

Question 5

What is the Cavity at the back of nose and mouth called?

Answer 5

The pharynx

Question 6

What is the Epiglottis and its function?

Answer 6

Leaf shaped structure which closes to protect airway during swallowing

Question 7

what is the name Leaf shaped structure which covers the trachea during swallowing?

Answer 7

The epiglottis

Question 8

Where can the vocal chords be found?

Answer 8

In the larynx

Question 9

What can be found in the larynx

Answer 9

vocal chords

Question 10

How long does the trachea extend?

Answer 10

from the larynx to fifth thoracic vertabrae

Question 11

What is dead space and why does it occur?

Answer 11

The volume of air which does not participate in gas exchange because either it remains in the conducting airways or enters a poorly perfused alveoli

Question 12

What is Tidal volume?

Answer 12

The volume of air moved in or out of the tracheobronchial tree in a normal breath

Question 13

How do you work out minute volume?

Answer 13

Tidal volume x respiration rate

Question 14

How do you work out alveolar ventilation rate??

Answer 14

minute voulome -dead space.

Question 15

Why are humans vulnerable to airway obstruction and aspiration?

Answer 15

unconsciuosness allows tongue to fall back into pharynx

proximity of oesophagus to airway - loss of glottic closure

Question 16

Who is most vulnerable to airway obstruction?

Answer 16

any patient with altered concious state

any patient witnh loss of swallow cough gag reflexes

any patient with mechanical injury or obstruction

Question 17

What is aspiration in acute medical situations?

Answer 17

Inhilation of of materials other than air into the airway

Question 18

Give examples of common aspirants.

Answer 18

Mucus, Saliva, stomach contents.

Question 19

Why can aspiration be dangerous?

Answer 19

increased risk of aspiration pneumonia.

Can cause a pulmonary edem (fluid in lungs) resulting in less o2 uptake

Question 20

What are the indication for oral intubation?

Answer 20

Hypo ventilation
unfavovourable abg results
gcs<8
Trauma
Surgery
airway protection
drug overdose

Question 21

What should be considered if a patient has to be intubated?

Answer 21

Does patient require ITU bed

What is the purpose of intubation?

What is the underlying condition for intubation

Question 22

What specific nursing consideration should be taken when intubating a patient?

Answer 22

equipment
drugs
patient prep
procedure
ventilation post-intubation?
observations
documentation

Question 23

What complications might
occur during orotracheal
intubation?

Answer 23

intubation of oesophagus

upper airway and nasal trauma, Tooth avulsion, laceration

Question 24

When is cricoid pressure applied?

Answer 24

during intubation of a patient where nil-by-mouth cannot be ascertained or where gastric reflux is likely.

Question 25

What is Cricoid pressure?

Answer 25

also known as sellick manoeuvre is a technique used for the endotracheal intubation of patients to reduce the risk of regurgitation It involved applying pressure on th cricoid cartillage, compressing the esophagus and thus exposes vocal chords.

Question 26

What's different in the asessment of total obstruction and partial obstruction?

Answer 26

Total obstruction in silent, partial obstruction is associated with noise

Question 27

List the hierarchy of airway management (9)

Answer 27

Airway clearance recovory position head-tilt, chin lift manoevre oropharyngeal airway (guedel) Nasopharyngeal airway Bag, valve mask - 2 person ventilation supraglottic airway oral (maybe nasal?0 cuffed endotracheal tube tracheostomy

Question 28

hich form of airway management is considered the gold standrd?

Answer 28

ETT - Endotracheal tube

Question 29

Describe how the recovery position lookes like.

Answer 29

patient on left side right hand underneath cheek, other arm bent out to prevent rolling lft leg bent out to support position

Question 30

What airway/breathing equipment may be found in the crash trolley?

Answer 30

laryngoscope stylet working suction cardiac monitor, pulse ocimeter capnograph

Question 31

In an arrest situation are drugs required?

Answer 31

No - not priority, start CPR

Question 32

What drugs may be involved in rapid sequnce intubation or elective intubation?

Answer 32

sedation/induction agent muscle relaxant atropine Reversal agens for lng acting muscle relaxants

Question 33

When administering a sedation/induction agent, what should be checked and how?

Answer 33

check BP and pulse by lacing finger on pule once practicible check bp

Question 34

What are the contraindications for nasopharyngeal airway?

Answer 34

someone with a head injury because there is a posibilty it could reach the brain

Question 35

How should you prepare patient for intubation?

Answer 35

- position on back - suction on - Pre-oxygenate using bag-valve mask

Question 36

describe the difference between a McItosh and a Straight curved blade laryngascope

Answer 36

McIntosh is cuved, tip lies in vallecula, blade displaces tongue and tissues forward Miller, tip lifts epiglottis, blade flattens tissues with les displacement. ueful for children, anterior larynx, obesity

Question 37

What complications might occur during orotracheal intubation?

Answer 37

Trauma

Question 38

How is tube placement of the ETT verified?

Answer 38

Increase end tidal co2

Question 39

What is capnography?

Answer 39

also known as End Tidal CO2. Monitors amount/concentration/partial pressure of Co2 in respiratory gases

Question 40

What is the purpose of Positive Pressure ventilation (PPV)?

Answer 40

Protect and manage airway – suction, balloon inflated prevents aspiration Ability to manipulate ventilation to improve blood gases and reverse acidosis – Increase tidal volumes to blow off CO2 and increase alveolar ventilation Can control respiratory rate Can apply modes of ventilation that allow patient to do some breathing

Question 41

What are the complications of Pstive presssure ventilation?

Answer 41

Protect airway – risk of tube blockage Invasive ventilation increases risk of chest infection, ventilator acquired pneumonia (VAP) Presence of oral tube very uncomfortable for patient so need for sedation Risk of biting down on tube Oral hygiene difficult (VAP?) Large tidal volumes can cause barotrauma High O2 levels can cause inflammation – risk of ARDS

Question 42

what is non-invasive ventilation (niv)?

Answer 42

the provision of ventilatory support through the patient’s upper airway using a mask or similar device’ This may be: • Continuous positive airway pressure (CPAP) or • Bilevel positive airway pressure (BiPAP

Question 43

wHAT IS THE AIMS OF NON-INVASIVE VENTILATION?

Answer 43

* Decreased work of breathing * Increased tidal volume * Decreased respiratory rate

Question 44

What are the aims for non-invasive ventilation?

Answer 44

* Decreased work of breathing * Increased tidal volume * Decreased respiratory rate

Question 45

What are the indications for non-invasive ventilation?

Answer 45

Acute respiratory failure Hypercapnic acute respiratory failure Post-extubation difficulty Weaning difficulties Post-surgical respiratory failure Acute respiratory failure in obesity hypoventilation syndrome Patients ‘not for intubation’ Hypoxaemic acute respiratory failure-there is limited evidence to support the use of NIV, but patients presenting with cardiogenic pulmonary o

Question 46

How do you insert a guedell into patient?

Answer 46

Insert upside down first in mouth then rotate.

Question 47

What does MAP stand for?

Answer 47

Mean Arterial Blood pressure