Emergency Airway Management Quiz

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Questions and Answers

What can lead to airway obstruction in a patient with decreased level of consciousness?

Increased muscle flexibility

Strengthening of the epiglottis

Loss of pharyngeal tone (correct)

Enlargement of the airway passage

What is the purpose of an oropharyngeal airway?

To maintain the patency of the upper airway (correct)

To assist with breathing through the nose

To provide oxygen directly to the lungs

To prevent aspiration into the stomach

Which type of oropharyngeal airway is mentioned as the most common?

Guedel airway (correct)

Nasopharyngeal airway

Endotracheal tube

Laryngeal mask airway

What sizes are available for the Guedel airway?

'000' to the largest '9' Signup and view all the answers

What is the purpose of the nasopharyngeal airway?

To maintain an open airway when the oral route is not possible Signup and view all the answers

What does the distal end of the nasopharyngeal airway include?

A 'safety pin' to prevent migration into the nose Signup and view all the answers

When is the nasopharyngeal airway considered an alternative to the oropharyngeal airway?

When the mouth cannot be opened or an oral airway does not alleviate obstruction Signup and view all the answers

What procedure can be performed using a catheter passed through the nasal airway?

Nasotracheal suction Signup and view all the answers

How is the nasopharyngeal airway tolerated by semi-awake patients compared to oral airways?

Better tolerated Signup and view all the answers

What is used to facilitate insertion of the nasopharyngeal airway?

Lubricant Signup and view all the answers

For an average height female, what is the estimated size for a nasopharyngeal airway?

Size 6 Signup and view all the answers

For an average height male, what is the estimated size for a nasopharyngeal airway?

Size 7 Signup and view all the answers

In which of these conditions is the use of nasopharyngeal airway not recommended?

Bleeding disorders Signup and view all the answers

What should be avoided during insertion of a nasopharyngeal airway?

Excessive force Signup and view all the answers

Why is proper sizing crucial for a nasopharyngeal airway?

Oversized airway can cause nasal mucosa pressure necrosis, while an undersized one may be ineffective at relieving airway obstruction. Signup and view all the answers

What is the maximum seal pressure for the LMA-Supreme using the LMA-Proseal?

30-35 cm H2O Signup and view all the answers

What technique do some anesthetists use to facilitate easier insertion of the LMA-Supreme?

Partial inflation of the cuff before insertion Signup and view all the answers

What is the purpose of the reinforced version of the LMA?

To aid in head and neck surgery Signup and view all the answers

What is the Intubating Laryngeal Mask Airway (ILMA) designed to minimize?

Head and neck manipulation requirements Signup and view all the answers

What makes LMAs suitable for long procedures using spontaneous ventilation?

Large internal diameters Signup and view all the answers

What does the deflation and lubrication of the LMA-Supreme cuff before use help with?

Reducing gas leakage during ventilation Signup and view all the answers

What can the LMA be used for in difficult intubations?

Guiding a narrow lumen tracheal tube into the trachea Signup and view all the answers

What is the main advantage of ILMA over traditional LMAs?

Minimizes head and neck manipulation requirements Signup and view all the answers

What does partial inflation of the cuff before insertion help with?

Facilitates easier insertion Signup and view all the answers

Why is the reinforced version of LMA less suitable for prolonged periods of spontaneous ventilation?

Smaller internal diameters and longer lengths Signup and view all the answers

What does ILMA aim to simplify?

Blind or fiberoptic intubation Signup and view all the answers

What is the purpose of the flange at the oral end of oropharyngeal airways?

To prevent falling back into the mouth Signup and view all the answers

What is the material of the bite portion of oropharyngeal airways?

Straight and hard plastic Signup and view all the answers

How is Guedel airway size determined?

By the distance from the patient's incisors to the angle of the mandible or the corner of the mouth to the tragus Signup and view all the answers

What is a feature of Bermann airway?

It has a side opening for removal from fiberscope prior to tracheal tube insertion Signup and view all the answers

What are potential problems associated with oropharyngeal airways?

Trauma to tissues during insertion, trauma to teeth if patient bites, inducing gag reflex, no protection against aspiration Signup and view all the answers

What distinguishes a nasopharyngeal airway from an oropharyngeal airway?

It bypasses the mouth and oropharynx and is inserted through the nose into the nasopharynx Signup and view all the answers

What is the purpose of the black line present on the laryngeal mask tube?

To assess its orientation when inserted Signup and view all the answers

What is a potential problem with using cricoid pressure in relation to the laryngeal mask?

It may prevent correct placement of the laryngeal mask Signup and view all the answers

What is a safety feature of the i-gel airway design?

Epiglottic blocking ridge to reduce the risk of epiglottis downfolding Signup and view all the answers

What distinguishes the i-gel airway from the laryngeal mask in terms of material and structure?

The i-gel airway has a non-inflatable gel-like cuff, while the laryngeal mask has an inflatable cuff Signup and view all the answers

What does the gastric channel in the i-gel airway allow for?

Direct suctioning or passage of a gastric tube Signup and view all the answers

Which patient condition is the i-gel airway intended for use with?

Fasted patients Signup and view all the answers

What is the purpose of the pilot balloon and self-sealing valve in the laryngeal mask?

To allow for inflation of the cuff at the distal end Signup and view all the answers

What is the main advantage of the LMA ProSeal over standard laryngeal masks?

It allows for blind passage of an orogastric tube Signup and view all the answers

What can a well-placed laryngeal mask act as in difficult situations such as 'can't intubate, can't ventilate'?

A conduit for oral intubation Signup and view all the answers

What is one reason why laryngeal masks should not be used in patients with full stomas or those prone to reflux?

They provide little or no protection against aspiration Signup and view all the answers

What is a potential benefit of applying negative pressure or intermittent positive pressure on the laryngeal mask cuff?

Prevention of air leaks around the cuff Signup and view all the answers

What is the purpose of integrating a bite block with laryngeal masks?

To prevent biting on the laryngeal mask Signup and view all the answers

Study Notes

Fiberscope procedure involves inserting a laryngeal mask and then a ramie tube through a sound insulated tube for fiberoptic examination.
Problems with the laryngeal mask in practice and safety features.
- Does not protect against aspiration of gastric contents.
- About 10% of patients develop airway obstruction due to epiglottis downfolding.
- Manufacturers recommend using it for a maximum of 40 times, as the cuff is likely to perish after autoclaving.
- Rotation of the laryngeal mask may result in complete airway obstruction.
- Black line present on the tube to assess its orientation when inserted.
- Cricoid pressure may prevent correct placement of the laryngeal mask.
The i-gel airway is a single-use extraglottic airway with a mask designed to fit the perilaryngeal and hypopharyngeal structures without an inflatable cuff.
- Large lumen for ventilation and a proximally placed non-inflatable gel-like cuff with a ridge at the superior anterior edge.
- Two separate ventilation and gastric channels positioned in the upper esophagus.
- Wide oval body to prevent rotation and act as an integral bite block.
- Epiglottic blocking ridge to reduce the risk of epiglottis downfolding.
- Available in adult, pediatric, and neonatal sizes.
- Intended for use with fasted patients, both spontaneous and controlled ventilation, and can be used as a conduit for tracheal intubation.
- Mechanism of action:
  - Soft, gel-like plastic allows it to mold without an inflatable cuff.
  - Gastric channel allows for direct suctioning or passage of a gastric tube.
  - Wide oval body prevents rotation and acts as an integral bite block.
  - Epiglottic blocking ridge reduces the possibility of epiglottic downfolding.
The Laryngeal Mask (LM) is a commonly used device in anesthesia as an alternative to a face mask or endotracheal tube.
Components include:
- A wide internal diameter, transparent tube with a 15mm proximal end connection.
- An ellipse-shaped cuff with a pilot balloon and self-sealing valve for inflation at the distal end.
- Low-cost disposable LMs are widely used.
- A modified design (LMAProSeal) has an additional lateral lumen for blind passage of an orogastric tube and improved seal pressure.
- A single-use version, LMA Supreme, combines the best features of previous LMA versions and contains an ellipse cuff and anatomically shaped curve for easier insertion and a double seal for improved gas exchange.
LMs can be used for oropharyngeal sealing, reducing the risk of stoma insufflation during ventilation, and providing a passive conduit for unexpected regurgitation or active suctioning.
A well-placed LM can act as a conduit for oral intubation in difficult situations such as "can't intubate, can't ventilate."
LMs provide little or no protection against aspiration and should not be used in patients with full stomas or those prone to reflux.
The use of LMs is increasing in various settings including routine anesthesia, emergency airway management, and as an aid to intubation.
Extraglottic airways (LMAs) require the suppression of airway reflexes such as the gag reflex with general or topical anesthesia.
The use of LMs can lead to increased cardiac stability and improved blood oxygenation during surgery and anesthesia.
The application of negative pressure or intermittent positive pressure on the LM cuff can improve the seal and prevent air leaks.
The use of a bite block integrated with LMs can prevent damage to the teeth and improve patient comfort.
The use of a stylet can facilitate the insertion of a difficult LM and can reduce the risk of trauma to the vocal cords.

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Description

Test your knowledge on emergency airway management with this quiz. The quiz covers topics such as using devices for oral tracheal intubation, decision-making in difficult scenarios, and contraindications for certain airway devices.