Airway Management & Intubation Flashcards

Rapid Sequence Intubation (RSI) assumes the patient has a 'full stomach' meaning:

Answer: The patient is at high risk of aspiration and steps to minimise this risk (pre-oxygenation, cricoid pressure, rapid drug sequence) are essential

RSI treats all emergency patients as having a full stomach (non-fasted), using rapid drug sequence and technique to minimise the window of vulnerable unprotected airway, reducing aspiration risk.

In a patient with suspected elevated ICP, the pre-oxygenation target before RSI should prioritise:

Answer: Passive oxygenation and avoiding bag-valve-mask over-ventilation (which reduces PaCO2 and increases ICP)

BVM hyperventilation reduces PaCO2, causing cerebral vasoconstriction and reducing ICP — which sounds beneficial but is harmful prophylactically; pre-oxygenation should use passive oxygenation or tightly controlled ventilation.

After intubation, the ETT should be secured to prevent:

Answer: Displacement (accidental extubation), right main bronchus migration, or oesophageal tube movement

ETT security prevents tube displacement — accidental extubation (most dangerous), migration down the right main bronchus (causes single-lung ventilation), or oesophageal entry if the tube was not securely verified.

For every 10cm the ETT moves toward the patient's feet (caudally) during movement, the expected change is:

Answer: Endobronchial intubation (right main bronchus) if the tube was near the carina

Head extension causes the ETT to move cephalad (upward), and head flexion causes caudal (downward) movement; a small amount of inadvertent flexion during movement can advance a correctly placed ETT into the right main bronchus.

Fentanyl given before laryngoscopy in RSI (as a 'blunting agent') is intended to:

Answer: Attenuate the hypertensive and tachycardic response to laryngoscopy, particularly in TBI patients

Laryngoscopy causes a powerful sympathetic response (hypertension, tachycardia); in TBI patients, this raises ICP; fentanyl 1-3 mcg/kg given 3 minutes before laryngoscopy blunts this response to protect ICP.

Which of the following is a sign of right main bronchus intubation?

Answer: Absent or reduced breath sounds over the left lung field with unilateral (right) chest rise

Right main bronchus intubation occurs because the right bronchus is more vertical; the ETT selectively ventilates the right lung, causing absent left breath sounds, unilateral chest rise, and progressive left lung atelectasis with hypoxia.