Advanced Airway Assessment and Strategy Selection - NREMT Paramedic Level

Identify the best next step when BVM ventilation is inadequate due to poor mask seal.

Use a two-person BVM with airway adjuncts and optimized positioning. Two-person technique improves seal integrity, while adjuncts and positioning enhance airway patency and ventilation efficacy.
What does the LEMON mnemonic assess in airway evaluation?

Predictors of difficult laryngoscopy and intubation. LEMON evaluates anatomical and clinical factors that may complicate visualization and tube placement during intubation.
What is the primary purpose of an advanced airway assessment before attempting intubation?

Predict difficulty and select the safest airway strategy. Assessment identifies potential complications to ensure the chosen method optimizes patient safety and success rates.
What is the preferred method to confirm endotracheal tube placement in the field?

Continuous waveform capnography. It provides real-time, objective confirmation of tracheal placement by detecting exhaled CO $_2$ patterns.
What does a Mallampati class $3$ or $4$ suggest about intubation?

Higher likelihood of difficult laryngoscopy. These classes indicate limited oral visibility, correlating with increased challenges in achieving a clear glottic view.
What is the immediate priority if you cannot intubate and cannot ventilate the patient?

Perform an emergency surgical airway. In a 'can't intubate, can't ventilate' scenario, surgical access restores airway patency to prevent hypoxic arrest.
Which condition is a classic contraindication to supraglottic airway use as definitive management?

Intact gag reflex or high aspiration risk requiring cuffed ETT. These factors compromise supraglottic seal and protection, necessitating a more secure cuffed tube for airway management.
What is the key benefit of apneic oxygenation during intubation attempts?

Delays desaturation during apnea. Nasal oxygen during laryngoscopy maintains alveolar oxygenation, extending safe apnea time before hypoxia occurs.
Which finding most strongly suggests esophageal intubation on capnography?

Absent or rapidly disappearing ETCO $_2$ waveform. Lack of sustained CO $_2$ indicates no pulmonary gas exchange, confirming improper tube placement in the esophagus.
Identify the best next step when you see gastric inflation during BVM ventilation.

Reduce ventilation pressure/volume and optimize airway positioning. Lowering pressure minimizes air diversion to the stomach, and positioning reduces resistance for better lung delivery.
Which device is generally preferred as the first rescue airway after failed intubation with poor ventilation?

Supraglottic airway device. It serves as an effective bridge for ventilation when direct laryngoscopy fails, bypassing glottic visualization issues.
Which patient factor most increases aspiration risk during airway management?

Active vomiting or significant upper GI bleeding. Such conditions introduce gastric contents into the airway, heightening the risk during manipulation and ventilation.
Which option is best when laryngoscopy view is poor due to secretions obscuring the cords?

Suction aggressively (SALAD approach) and reattempt. SALAD clears contaminants to restore glottic view, enabling successful intubation on subsequent attempts.
Identify the best action when waveform capnography is lost after moving an intubated patient.

Check for dislodgement/disconnection and reassess tube position. Movement can cause tube migration or equipment failure, necessitating immediate verification to restore monitoring.
What does the RODS mnemonic predict regarding airway management?

Difficulty with supraglottic airway placement or ventilation. RODS highlights anatomical barriers such as restricted opening that impede device insertion and effective ventilation.
Which single finding most strongly indicates the need for immediate airway intervention?

Inability to maintain oxygenation or ventilation. Failure to sustain adequate gas exchange signals critical respiratory compromise requiring prompt advanced intervention.
Identify the best action when post-intubation SpO $_2$ drops and right breath sounds are absent.

Suspect right mainstem; withdraw ETT slightly and reassess. Unilateral sounds suggest over-advancement into the right bronchus, requiring retraction to ensure bilateral ventilation.
What does the SMART mnemonic predict regarding airway management?

Difficulty with cricothyrotomy (front-of-neck access). SMART assesses neck anatomy and prior interventions that complicate surgical access to the cricothyroid membrane.
In LEMON, what does the "3-3-2" rule evaluate?

Mouth opening, mandible size, and laryngeal position. The rule measures key facial dimensions to predict alignment challenges for optimal glottic visualization.
Which airway strategy is most appropriate when both BVM and intubation are predicted difficult?

Plan for early surgical airway with backup oxygenation options. Predicted failures in standard methods necessitate preparation for invasive rescue techniques to maintain oxygenation.
What does the MOANS mnemonic predict regarding airway management?

Difficulty with bag-valve-mask ventilation. MOANS identifies patient factors like obesity or stiff lungs that hinder effective mask seal and ventilation delivery.
Which positioning is preferred to optimize preoxygenation and laryngoscopy in most adults?

Head-elevated (ramped) or sniffing position as appropriate. These positions align the airway axes, improving oxygenation efficiency and laryngoscopic view in non-pediatric patients.
Which option is best when the vocal cords are visualized but the tube will not pass?

Use a bougie (introducer) to facilitate tube passage. The bougie navigates anterior anatomy or partial views, guiding the tube through the cords when direct passage fails.
What is the most reliable clinical sign of tracheal intubation after confirmation devices?

Persistent waveform capnography with ventilation. Ongoing CO $_2$ detection verifies tube position and ventilation efficacy beyond initial placement checks.

Study these flashcards