The Emergency Airway
In honor of his appearance at Emergency Medicine News' booth at the American College of Emergency Physicians Scientific Assembly in Las Vegas last month, Dr. Darren Braude created a quiz to test readers' knowledge of emergency airway management. Take the quiz in the September issue of EMN at www.EM-News.com or through this link: http://bit.ly/AirwayQuiz.
The answers appear below.
- Reasonable options for managing a predicted difficult airway include all of the following except:
- ⊠ Sedation-facilitated intubation.
- After preoxygenation, patients may be divided into three groups.
- Adequate Reserve: Usually no positive pressure ventilation.
- Limited Reserve: Emphasize optimal first attempt; may require PPV.
- No Reserve: Planned positive pressure ventilation.
- Patients ideally should be preoxygenated with a non-rebreather mask set at 10 to 15 liters per minute for three minutes in what position:
- ⊠ 20-degree head elevation
- Cricoid pressure usually improves the laryngeal view during direct laryngoscopy.
- ⊠ False
- Cricoid pressure may predispose to aspiration by reducing lower esophageal pressures.
- ⊠ True
- In the event the person intubating cannot visualize the cords, cricoid pressure should be reduced. If the view remains inadequate, cricoid pressure should be released, and the assistant should assist with external laryngeal manipulation (ELM).
- List the 10 Ps of rapid sequence intubation:
- Preoxygenate, protect C-spine, pressure to cricoids, ponder, prepare/equip people, premedicate, position optimally, paralyze and induce, pass tube, and post-intubation management.
- Non-Invasive Positive Pressure Ventilation does improve preoxygenation prior to intubation.
- Regarding the article of the year by Levitan, et al, it is clear that bimanual laryngoscopy should be:
- ⊠ Routine
- When I anticipate rapid desaturation, planned positive-pressure ventilation after paralysis and prior to first laryngsocopy is a technique that I:
- ⊠ Routinely use
- When approaching an anticipated difficult airway, clinicians should do all of the following except:
- ⊠ Freebie! The correct answer was inadvertently deleted from the quiz.
- The most overlooked aspect of post-intubation care is:
- ⊠ Cuff pressure
- If getting into trouble on a trauma airway and the patient is becoming hypoxemic yet is a poor candidate for an extraglottic airway, allow some gentle head elevation.
- ⊠ True
- I recommend use of a checklist on:
- ⊠ All but crash intubations
- Atropine should be given routinely for all pediatric patients.
- ⊠ False
- Lidocaine is probably more useful for asthmatics than head injury patients.
- ⊠ True
- For patients with elevated ICP, generally give:
- ⊠ Fentanyl
- Preoxygenation in morbidly obese patients was enhanced by:
- ⊠ NIPPV
- In the Cochrane review of rocuronium vs. succinylcholine for RSI, there was no statistical difference between:
- ⊠ Succinylcholine and the rocuronium group that received 0.9 to 1.2 mg/kg
- The bougie is most useful in patients whose Cormack-Lehane grade is:
- ⊠ Grade 3 (view of epiglottis only)
- Intratracheal position of the bougie may be tactilely confirmed by “clicks” or the inability to pass beyond how many centimeters in an adult?
- ⊠ 40 cm
- Preshaping of the bougie is recommended.
- According to Mort, critically ill patients should be preoxygenated for how many minutes?
- ⊠ 4
- According to Hodzovic, et al, flexible fiberoptic intubation through an LMA requires lots of experience.
- ⊠ False
- All of the following should be on every ED airway cart except:
- ⊠ Retrograde intubation kit
Dr. Braude is an associate professor of emergency medicine at the University of New Mexico School of Medicine, the medical director for PHI Air Medical of New Mexico, both in Albuquerque, a co-director of Airway911 and the National Procedural Sedation Course (http://hsc.unm.edu/emermed), and the author of a new book, Rapid Sequence Intubation, now available athttp://airway911.com.
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