College tutorial

Question 1

Indications for intubation

Answer 1

1. Protect airway
2. Airway obstruction
3. Resp failure
4. Adjuncts to therapy (provide hyperventilation, reduce work of breathing)

Question 2

Pros of RSI

Answer 2

1. Rapidly create controlled clinical envirovment for ETI
2. Reduce stimulation of potentially harmful autonomic reflexes associated with ETI
3. Reduce risk of aspiration

Question 3

Relative CI to RSI

Answer 3

1. Major laryngeal trauma
2. Upper airway obstruction
3. Distorted facial or airway anatomy

Question 4

CICV

Answer 4

Cannot intubate, cannot ventilate

Question 5

MOANS for difficult BVM

Answer 5

Mask seal - beards, facial trauma
Obesity / Obstruction - BMI > 26, airway obs, obesity
Age - >55y
No teeth
Stiffness - increase airway resistance (asthma, COPD), stiff lungs (APO)

Question 6

Pre-treatment meds
LOAD

Answer 6

Lignocaine (1-1.5mg/kg)
- controversial
- mitigate bronchospasm in severe asthma
- blunt ICP rise

Opioids, e.g. Fentanyl (1-2mcg/kg)
- blunt sympathetic discharge and ICP rise
- use in elevated ICP, aortic dissection, ruptured AAA, IHD

Atropine (0.02mg/kg, min 0.1mg)
- prevent bradycardia (when using Sux in child)

Defasciculation - rare in AED, i.e. non-depolarising relaxant
- 1/10 of paralytic dose

Question 7

Cricoid pressure

Answer 7

10 pounds of force over cricoid cartilage
force enough to stop swallowing, indent a ping pong, cause pain over nose bridge

prevent aspiration of stomach content
prevent insufflation of stomach if IPPV needed
apply till ET position confirmed

Question 8

Dominant R in aVR causes

Answer 8

1. Wrong limb leads
2. Dextrocardia
3. TCA overdose
4. RBBB
5. LM obstruction
6. VT