ACLS – Chapter One, Airway Management Part One

What are the complications of a cricothyroidotomy?
Esophageal or tracheal laceration, hemorrhage, hematoma formation, aspiration, hoarseness, asphyxia, vocal cord
paralysis, mediastinal emphysema, and creation of a false passage.
What are the advantages of the pharyngotracheal lumen airway?
Eliminates the need for an air mask, airway visualization is not required, and avoids hyperextension of the neck.
Why is cricoid pressure applied?
Assists in placement of the endotracheal tube and minimizes gastric aspiration.
When using a face mask, what is the minimum oxygen flow rate that can be used?
5 L/min. Lower rates lead to accumulation of inhaled air in the reservoir.
What is the maximum length of time that a patient should be suctioned?
15 seconds.
What is the maximum length of time that should be spent on an intubation attempt?
30 seconds, by American Heart Association guidelines.
Where should the incision be made in performing a cricothyroidotomy?
Incise the cricothyroid membrane. The superior landmark is the notch at the base of the thyroid cartilage and the
inferior landmark is the cricoid cartilage.
Why avoid a pop-off valve on a bag-valve device during an acute respiratory arrest?
High airway pressures may be needed to ventilate the lungs and a pop-off valve may prevent delivery of sufficient
tidal volume.
What are the signs and symptoms of respiratory distress?
Dyspnea, retractions, nasal flaring, tracheal tugging, jugular venous distention, difficulty speaking, and confusion.
What are the indications for needle cricothyroidotomy?
Upper airway obstruction that cannot be relieved by oral or nasal intubation.
T/F: Cricothyroidotomy is used in patients with severe edema of the glottis, oral and facial injuries, oral
hemorrhage, and laryngeal fractures.
True.
What are contraindications to the esophageal airway?
Avoid in conscious patients, children under the age of 16, esophageal disease such as cancer and caustic substance
ingestion. The EOA should be removed within 2 hours.
When intubating a patient, how far should the endotracheal tube cuff be advanced past the vocal cords?
1-2.5 cm.
T/F: The oropharyngeal airway prevents biting of the endotracheal tube, allows suctioning, and prevents
airway obstruction.
True..
What are the contraindications of the pharyngotracheal lumen airway?
Patients less than 14 years of age, caustic ingestions, semiconscious patients with a gag reflex, and esophageal disease
or injury.
What are the indications for endotracheal intubation?
Lack of gag reflex, inability to protect the airway, difficulty ventilating the patient, and cardiac arrest with ongoing
chest compressions.
An 8-year-old is found by paramedics to be short of breath. What should be used to provide supplemental
oxygen to a conscious child?
Oxygen mask or nasal cannula.
In an infant, what are the signs and symptoms of acute respiratory failure?
Increased respiratory rate, increased respiratory effort, poor skeletal muscle tone, retractions, cyanosis, and
decreased level of consciousness.
In infants and children, what is the most common problem leading to cardiopulmonary arrest?
Respiratory.
What are the advantages of endotracheal intubation?
Protects the airway, reduces the risk of gastric distention, and provides a route for drug administration.
How long can endotracheal suction can be applied?
Less than 10 seconds.
What is the most common problem with bag-valve-mask device use?
Getting an adequate seal with the mask around the mouth and nose.
Endotracheal intubation is most appropriate in what type of patient?
Unconscious patient without a gag reflex.
Can pressure-cycled, oxygen-powered mechanical devices be used during CPR?
No. Use manually triggered mechanical breathing devices.
What type of airway is the best choice for an unconscious patient with no gag reflex?
Endotracheal intubation.
Following intubation, what is the most common cause of decreased or absent breath sounds?
Endotracheal tube inserted into the right main stem bronchus.
A patient is intubated. Breath sounds cannot be auscultated. What is the most likely cause?
Esophageal intubation.
What is the concern with using an oropharyngeal airway in a semiconscious patient
Vomiting or laryngospasm.
T/F: Esophageal obturator airways are contraindicated in children.
.True.
T/F: Bag-valve-mask devices provide close to 100% oxygen if a high flow rate is used and a reservoir is
attached.
True. The flow rate must be at 15 L/min.
Normal resting breathing rate for adults is to per minute.
12 to 20.
A radial pulse should be assessed in patients 12 months or older. In patients less than 12 months, a
pulse should be assessed.
Brachial.
The oxygen liter flow for a nasal cannula ranges between and L/min.
2 and 6.
The oxygen liter flow for a medium flow (simple) mask ranges between and L/min.
6 and 10.
The oxygen liter flow for a non-rebreather mask should be at least L/min.
15.
If a spinal injury is suspected, the is used to bring the patient’s head and neck in a neutral
position.
Jaw thrust maneuver.
To assess breathing, use the , , and method.
Look, listen, and feel.
When assessing respirations, it is necessary to note , , and .
Rate, quality, and depth.
You arrive on scene of a 61-year-old male patient clutching his chest, complaining of chest pain, and in
respiratory distress. What method of oxygen delivery would you use?
Non-rebreather mask.
The tongue is large relative to the small mandible and can block the airway in .
An unconscious child or infant.
Describe how the positioning of the airway is different in infants and children than in adults.
Do not hyperextend the neck.
Explain why suctioning a secretion-filled nasopharynx can improve breathing in an infant.
Infants are obligate nose breathers; therefore, suctioning can improve breathing.
Describe two ways in which children with dyspnea can compensate for short periods of time.
Children compensate by increasing their breathing rate and increasing the effort of breathing.
Describe the technique used to open the airway in an infant or child.
Head-tilt, chin-lift; do not hyperextend.
What technique is used in opening a pediatric airway with suspected spinal injury?
Jaw thrust.
Describe the procedure for clearing a complete airway obstruction in infants less that 1-year-old.
Five back blows or 5 chest thrusts followed by foreign body removal, only if you can see the foreign body. If the
foreign body is not visible, then provide two breaths.
Describe the procedure for clearing a complete airway obstruction in children older than 1-year-old.
Five abdominal thrusts and foreign body removal, only if visible.
T/F: Toddlers will easily tolerate wearing an oxygen mask.
False.
Describe the proper technique for using a bag-valve-mask device.
Hold the mask down over the nose and seal around the mouth and mandible with the left hand. Make sure there
are no air leaks. Squeeze bag slowly and evenly enough to make sure the chest rises adequately.
How can you assess if you are properly using the bag-valve-mask device?
Breath sounds should be heard in the lungs bilaterally and visualization of the chest rising bilaterally.