ADVANCED LIFE SUPPORT ALS QUESTIONS
WITH 100% SOLVED ANSWERS!!
Emergency Intubation via ETT
Endotracheal tube (ETT) intubation is an advanced airway management technique in ALS. Staff
are required to assist in both inserting and securement of the ETT
Indication for an advanced airway during ALS
- Hypoxia management
- Maintain a secure/patent airway
- Allow for mechanical ventilation
- Protect airway from risk of aspiration of gastric contents
Equipment for advanced airway during ALS
- PPE - gloves, eye protection
- Resuscitation bag connected to O2 supply
- Yanker sucker and tubing connected to suction
- ETT of required size
- 10ml syringe to inflate the ETT tube (prior to insertion check balloon patency)
- x 2 Laryngoscopes with blades (ensure light source working)
- Magill's forceps
- Stylet
- Lubrication
- Bougie
,- End tidal CO2 detector
- Tape and/or tracheostomy tape to secure tube
Steps to assisting with intubation
1. Position the patient
Direct visualisation of the vocal cords is required for ETT intubation. Patient's head may need to
be positioned with extension/ramping equipment (pillows, towel) underneath shoulders for
optimal view during laryngoscopy.
2. Intubation Procedure
Cardiac compressions: a priority and should NOT be discontinued for >5 secs. Once intubated,
compressions are performed without pause for ventilation.
Cricoid Pressure: the cricoid cartilage is the only continuous ring of cartilage circling the trachea.
Downwards pressure applied to the ring occludes the oesophagus between the cartilage ring and
spine.
BURP technique may also be used in intubation: Backward Upward Rightward Pressure applied
to complete tracheal ring inferior (below) to the thyroid cartilage. Remove once instructed
"cricoid off."
3. Ensuring Correct Placement of Advanced Airway
- Observe correct change in the ETCO2 indicator
- Observe fogging of the tube during ventilation
,- Equal rise and fall of chest during ventilation
- Auscultation with stethoscope
- Maintenance of SpO2
4. Securing the ETT: with adhesive tape or tracheostomy tape
BURP Technique
Backward
Upward
Rightward
Pressure
Management of Difficult Airway
Bougie
Feed the ETT tube over the bougie and direct the ETT through the vocal cords. Once tube is in
place, carefully remove the bougie on instruction.
Laryngeal Mask Airway (LMA)
LMA is a supraglottic airway device which can be used to provide oxygenation or assistance in
inserting an ETT. Inserted using index finger.
Complications with using LMA include:
- Inability to achieve adequate seal/ventilation
- Regurgitation/aspiration
, - Trauma to upper airways
- Mask displacement causing airway obstruction
Shockable Rhythms
- Ventricular Tachycardia
- Ventricular Fibrillation
- Torsade De Pointes
Non-Shockable Rhythms
- Asystole
- Pulseless Electrical Activity (PEA)
Ventricular Tachycardia (VT)/Pulseless VT
Rate: 100-200bpm
P wave: NO discernible P waves
QRS: Regular and broad QRS complex.
Conduction: Ventricles
Rhythm: Regular
- Pulse/Pulseless
- Conscious/Unconscious
- Sustained or terminated rapidly
- Can progress to ventricular fibrillation
Treatment & Management of Ventricular Tachycardia (VT)
WITH 100% SOLVED ANSWERS!!
Emergency Intubation via ETT
Endotracheal tube (ETT) intubation is an advanced airway management technique in ALS. Staff
are required to assist in both inserting and securement of the ETT
Indication for an advanced airway during ALS
- Hypoxia management
- Maintain a secure/patent airway
- Allow for mechanical ventilation
- Protect airway from risk of aspiration of gastric contents
Equipment for advanced airway during ALS
- PPE - gloves, eye protection
- Resuscitation bag connected to O2 supply
- Yanker sucker and tubing connected to suction
- ETT of required size
- 10ml syringe to inflate the ETT tube (prior to insertion check balloon patency)
- x 2 Laryngoscopes with blades (ensure light source working)
- Magill's forceps
- Stylet
- Lubrication
- Bougie
,- End tidal CO2 detector
- Tape and/or tracheostomy tape to secure tube
Steps to assisting with intubation
1. Position the patient
Direct visualisation of the vocal cords is required for ETT intubation. Patient's head may need to
be positioned with extension/ramping equipment (pillows, towel) underneath shoulders for
optimal view during laryngoscopy.
2. Intubation Procedure
Cardiac compressions: a priority and should NOT be discontinued for >5 secs. Once intubated,
compressions are performed without pause for ventilation.
Cricoid Pressure: the cricoid cartilage is the only continuous ring of cartilage circling the trachea.
Downwards pressure applied to the ring occludes the oesophagus between the cartilage ring and
spine.
BURP technique may also be used in intubation: Backward Upward Rightward Pressure applied
to complete tracheal ring inferior (below) to the thyroid cartilage. Remove once instructed
"cricoid off."
3. Ensuring Correct Placement of Advanced Airway
- Observe correct change in the ETCO2 indicator
- Observe fogging of the tube during ventilation
,- Equal rise and fall of chest during ventilation
- Auscultation with stethoscope
- Maintenance of SpO2
4. Securing the ETT: with adhesive tape or tracheostomy tape
BURP Technique
Backward
Upward
Rightward
Pressure
Management of Difficult Airway
Bougie
Feed the ETT tube over the bougie and direct the ETT through the vocal cords. Once tube is in
place, carefully remove the bougie on instruction.
Laryngeal Mask Airway (LMA)
LMA is a supraglottic airway device which can be used to provide oxygenation or assistance in
inserting an ETT. Inserted using index finger.
Complications with using LMA include:
- Inability to achieve adequate seal/ventilation
- Regurgitation/aspiration
, - Trauma to upper airways
- Mask displacement causing airway obstruction
Shockable Rhythms
- Ventricular Tachycardia
- Ventricular Fibrillation
- Torsade De Pointes
Non-Shockable Rhythms
- Asystole
- Pulseless Electrical Activity (PEA)
Ventricular Tachycardia (VT)/Pulseless VT
Rate: 100-200bpm
P wave: NO discernible P waves
QRS: Regular and broad QRS complex.
Conduction: Ventricles
Rhythm: Regular
- Pulse/Pulseless
- Conscious/Unconscious
- Sustained or terminated rapidly
- Can progress to ventricular fibrillation
Treatment & Management of Ventricular Tachycardia (VT)
