Airway Management and Intubation

Question 1

What might gurgling indicate?

Answer 1

Fluid in mouth/upper airway

Question 2

What might snoring indicate?

Answer 2

Pharynx partially obstructed by tongue

Question 3

What might crowing indicate?

Answer 3

Laryngeal spasm

Question 4

What might inspiratory stridor indicate?

Answer 4

Obstruction at/above larynx

Question 5

What might expiratory wheeze indicate?

Answer 5

Airway collapse during expiration

Question 6

What can cause upper airway obstructions?

Answer 6

• Tongue obstructing pharynx: i.e. sedation/neurological compromise
• Vomit/secretions/blood/gastric fluid
• Tissue swelling: i.e. trauma/allergy/infection

Question 7

What can cause lower airway obstructions?

Answer 7

• Laryngeal oedema: i.e. burns/inflammation/allergy
• Laryngeal spasm: i.e. FB/airway stimulation/secretions or blood in airway
• Tracheobronchial obstruction: i.e. secretions/inhaled gastric contents/pulmonary oedema/bronchospasm

Question 8

What are the 2 main airway manoeuvres

Answer 8

1. Chin lift
2. Jaw thrust

Question 9

When is a chin lift contraindicated

Answer 9

Suspected/confirmed c-spine injury

Question 10

What are the 2 main types of airway adjuncts

Answer 10

1. OPA (guedel)
2. NPA

Question 11

How does an OPA work to maintain airway patency?

Answer 11

• Prevents tongue occluding airway

Question 12

How is an OPA measured?

Answer 12

• Central incisors to angle of jaw

Question 13

How is an OPA inserted?

Answer 13

• Upside down and then turned 180 degrees

Question 14

When is an OPA contraindicated?

Answer 14

• Intact gag reflex
  –> can induce vomiting/aspiration

Question 15

How does a NPA work to maintain airway patency?

Answer 15

Sits between nostril and nasopharynx above epiglottis

Question 16

How is a NPA measured?

Answer 16

• Tip of nose to tragus of ear

Question 17

How is a NPA inserted?

Answer 17

• Lubricate end (ensure opening isn’t occluded) and insert along floor of nasopharynx

Question 18

When is a NPA contraindicated?

Answer 18

• Basal skull #
• Nasal trauma
• Coagulopathy

Question 19

Which nostril is the preferred nostril for NPA insertion and why?

Answer 19

• Right
• Generally larger and straighter

Question 20

What is the use of a BVM?

Answer 20

• Delivering additional breaths to patients with low RR
• Manual ventilation of apnoeic patients

Question 21

Can BVM be used on spontaneously breathing patient?

Answer 21

• Yes but must be generating enough negative pressure to open inspiratory valve otherwise won’t receive any O2

Question 22

How do you measure a mask for BVM?

Answer 22

Bridge of nose to cleft of chin

Question 23

How do you insert LMA?

Answer 23

• Partially deflate and lube cuff
• Insert
• Reinflate cuff

Question 24

What are the two options for a surgical airway?

Answer 24

• Surgical airway
• Needle cricothyroidectomy

Question 25

What is the preferred emergency surgical airway in paediatrics?

Answer 25

• Needle cric preferred for kids under 10
  –> Cricothyroid membrane is underdeveloped

Question 26

How do you intubate a patient requiring c-spine precautions

Answer 26

Manual in-line stabilisation
–> dedicated person to maintain c-spine

• 2 techniques:
  > crouch behind patient next to person tubing
• Stand beside patient with forearms resting on patient’s chest

Question 27

What is laryngeal manipulation?

Answer 27

• BURP (backwards upwards rightwards pressure)
  –> can improve visualisation of vocal cords

Question 28

What is the ideal position for intubation?

Answer 28

• ears align with sternal notch
• may require pillows / troop elevation pillow