2.2 Resuscitation Airway Management

Front 1

What techniques are utilised to optimise

oxygenation during the peri-intubation period? [Weingart 2011 ]

Back 1

1. Positioning
2. Preoxygenation / denitrogenation
3. Positive pressure devices
4. Apneic oxygen

Front 2

Which of the following is incorrect regarding

Airway management? [ Weingart 2011 ]
A. All ED patients requiring airway management are assumed to be at risk for aspiration.
B. The duration of "Safe apnea" is defined as the time until a patient reaches a saturation of 92%.
C. High aspiration risk patients include those with critical illness and

obesity.
D. Preoxygenation allows a safe "buffer " during periods of apnea and

hypoventilation.

Back 2

B. 88%-90%

Front 3

The 3 goals for preoxygenation ?

[ Weingart 2011 ]

Back 3

1. Oxygenate the patient to 100%

( or as close as possible)***
2. Denitrogenate the RC (residual capacity ) of the lungs - maximising oxygen storage***
3. Denitrogenate and maximally oxygenate the bloodstream

Front 4

Which is incorrect regarding Airway

management? Weingart 2011 ]
A. The primary benefit of preoxygenation is the creation of a reservoir of oxygen in the alveoli.
B. When an adult patient is breathing room air, there is 450mL of oxygen in the lungs.
C. When the patient is breathing 100% for sufficient time to allow

replacement of alveolar nitrogen , there is 1000mL of oxygen in the

alveoli .
D. Oxygen consumption during apnea in an adult is 250mL/min

[ 3mL/kg/min]

Back 4

C. 3000mL ( 3 Litres )

Front 5

Which of the following is incorrect regarding

pre oxygenation in the adult? [ Weingart 2011]
A. The duration of safe apnea in a healthy adult, breathing a high FiO2 oxygen is 3 minutes.
B. Obese adults can desaturate to less than 90% in under 3 minutes

during apnea.
C. Desaturation to 85% may be as short as 23 seconds in Critically ill

patients, as compared to 502 seconds in a healthy adult .
D. Critically ill patients are at high risk of hyperaemia with prolonged

tracheal intubation efforts- and may desaturate immediately.

Back 5

A. 8 minutes

Front 6

List the Factors in shortening safe apnea time in Critically ill patients. [ Weingart 2011]

Back 6

1. Physiological shunting

[ atelectasis / pneumonia]
2. Increased metabolic demand [ sepsis ]
3. Anaemia
4. Volume depletion
5. Reduced cardiac output
6. Body habitus [ obesity > 30-35 ]

Front 7

Which is incorrect regarding apneic oxygenation? [ Weingart 2011 ]
A. Alveoli continue to take up oxygen EVEN WITHOUT DIAPHRAGMATIC MOVEMENTS / LUNG EXPANSION.
B. Up to 250mL/min oxygen moves from alveoli to bloodstream in the

apneic patient.
C. A lack of ventilation eventually causes marked hypercapnia and

acidosis.
D. 50mL/min of CO2 moves into the alveoli during apnea.

Back 7

D. 8-20mL/min

Front 8

What positioning and manoeuvres exist for the patient during the apneic period of RSI

intubation?

Back 8

1. Elevated had 20 degrees
ear-to-sternal notch positioning
OR reverse Trendelenberg ( c-spine precautions)
2. Chin lift / jaw thrust
3. Airway adjuncts ( OPA / NPA)
4. Beware Cricoid pressure **

Front 9

What does the LEMON mnemonic stand for in the assessment of the airway for intubation

difficulties ?

Back 9

Look

Evaluate ( 3:3:2 rule )

Mallampati assessment

Obstruction

Neck assessment

Front 10

What does the "L" in LEMON stand for in the

airway assessment for intubation difficulties?

Back 10

LOOK

• Obesity
• Short stocky "bull neck"
• Facial hair
• Micrognathia
• Prominent Incisors
• Macroglossia
• High arched palate

Front 11

What does the "E" in LEMON stand for in the airway assessment for intubation difficulties ?

Back 11

EVALUATE "3:3:2 rule"

For successful laryngoscopy -cord visualisation

• 3 fingers between incisors ?
• 3 finger breadth hyo-mental distance ?
• 2 fingerbreadth hyo-throid distance

Front 12

what does the "M" in LEMON Stand for in the airway assessment for intubation difficulties ?

Back 12

Mallampati

Direct pharyngeal visualisation relationship to Cormack Lehane Grade

Class I-IV

Class IV : Hard palate only

Class III : Soft palate only

Class II : Soft palate + partial uvula

Class I : faucial pillars + uvula + Soft palate

Front 13

What does the "O" in LEMON stand for in the airway assessment for intubating difficulties ?

Back 13

Obstruction

Any physical airway obstruction

seen or suspected

• trauma
• quinsy
• Stridor = epiglottitis / croup

Front 14

What does the "N" in LEMON stand for in the airway assessment for intubating difficulties ?

Back 14

Neck

= Mobility assessment

• Cervical spine precautions
• Degenerative OA / Rheumatoid Arthritis