Airway Management & Intubation Flashcards

Sellick's manoeuvre (cricoid pressure) in RSI is designed to:

Answer: Compress the oesophagus against the vertebral body to reduce regurgitation risk during intubation

Cricoid pressure compresses the oesophagus between the cricoid ring and vertebral body, theoretically preventing passive regurgitation of gastric contents during induction; its routine use is now controversial as it may worsen laryngoscopic view.

Succinylcholine (suxamethonium) as an RSI agent is contraindicated in:

Answer: Hyperkalaemia, crush injuries, burns >24 hours old, and known or suspected pseudocholinesterase deficiency

Succinylcholine causes potassium release (∼0.5mEq/L normally); in hyperkalaemic states, or conditions with upregulated acetylcholine receptors (burns, crush, denervation), this can cause fatal cardiac arrest.

The correct depth of insertion for a nasopharyngeal airway (NPA) approximates:

Answer: Distance from the tip of the nose to the earlobe (7-9cm in most adults)

The NPA is sized by measuring from the nostril to the tragus of the ear (approximately 7-9cm in adults), ensuring the tube reaches the posterior pharynx without entering the larynx or oesophagus.

During RSI, the typical induction dose of ketamine for a haemodynamically compromised patient is:

Answer: 1-2mg/kg IV (reduced dose for haemodynamic compromise vs 1-2mg/kg standard)

Ketamine 1-2mg/kg IV provides dissociative anaesthesia with haemodynamic preservation (sympathomimetic properties) — doses at the lower end are used in haemodynamically compromised patients to avoid catecholamine depletion.

A 'difficult airway' algorithm should include which rescue device if intubation fails?

Answer: Supraglottic airway (SGA) such as laryngeal mask airway (LMA) or i-gel as a bridge to oxygenation

Failed intubation should trigger a 'can't intubate, can ventilate' response using an SGA as a rescue device for oxygenation; cricothyrotomy is reserved for 'can't intubate, can't oxygenate' (CICO) scenarios.

Video laryngoscopy (VL) compared to direct laryngoscopy (DL) in pre-hospital intubation:

Answer: Provides an improved glottic view, especially for anticipated difficult airways, but may require a bougie for tube delivery

VL consistently improves the glottic view (Grade I-II on most patients regardless of DL grade), improving first-pass success particularly in difficult airways, though tube delivery through the visualised glottis may require a bougie.