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Chapter 56. Unique Challenges of Ectopic Airway Management

Ectopic airway management is associated with measurable medicolegal risk. Of the closed claims related to difficult airway management in the ASA Closed Claims Database between 1985 and 1999, the approximate percentage of those occurring at an ectopic location is

A. 2%

B. 5%

C. 15%

D. 25%

E. 43%

(C) According to a Closed Claims Analysis in 2005 by Peterson et al., the majority of claims for difficult airway management (156 out of 179 or 87%) involved perioperative care and 23 claims (13%) involved ectopic locations.

The most important factor related to successfully managing an airway in an ectopic location is

A. getting there quickly

B. making it clear that you are the most skilled airway practitioner at the scene

C. you have familiarized yourself with the equipment that will be available to you beforehand

D. that you speak in a low voice to avoid fanning the flames of anxiety

E. that you paralyze the patient quickly to enhance your success rate

(C) Although many factors may influence the successful management of the airway in an ectopic location, familiarization of the equipment and the environment beforehand is probably the most important.

All of the following are associated with ectopic airway management EXCEPT

A. Chaos is the norm.

B. Failure rates are higher in locations where you usually work.

C. Policies with respect to airway management equipment maintenance are the norm.

D. Good help is usually present at the scene.

E. The person who performs the intubation is responsible to see that it is secured in place.

(C) To minimize airway management failure, it is important to establish policies and procedures with respect to the availability of airway management equipment and its maintenance in areas where it is predictable that emergency or urgent airway intervention will occasionally be required.

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