Advanced Airway

Question 1

What dissociative drug utilized in rapid sequence induction makes the patient appear awake however they are unresponsive to pain and amnestic to the procedure?

Answer 1

Ketamine

Question 2

When placing a patient with COPD on a mechanical ventilator, what ventilator setting would you alter to avoid air trapping?

Answer 2

Inspiration/expiration (I/E) ratio. Change from the normal of 1:2 to 1:4 or 1:5

Question 3

What is the difference between the laryngeal mask airway (LMA) and a intubating laryngeal mask airway (LMA Fastrach)?

Answer 3

The patient can be intubated with an 8.0 endotracheal tube through the laryngeal mask airway Fastrach. Once intubated, the laryngeal mask airway Fastrach can be removed or remain in position

Question 4

During rapid sequence induction, muscle fasciculations are observed with the use of which medications?

Answer 4

Depolarizing blocking agents

Question 5

What has typically happened when the mechanical ventilator low pressure has alarmed?

Answer 5

The circuit has been disconnected

Question 6

When should a surgical airway be considered?

Answer 6

When ventilation via the nasal or oral routes cannot be achieved, endotracheal intubation or rescue airways fail to ventilate, massive head or neck trauma, total upper airway occlusion

Question 7

Describe Sellick’s maneuver.

Answer 7

Application of pressure on the cricoid cartilage just below the Adam’s apple to facilitate view of the vocal cords during intubation

Question 8

Neostigmine, pyridostigmine, and edrophonium are medications used for what?

Answer 8

Reversal agents to reverse neuromuscular blockade

Question 9

You have paralyzed your patient but you are unable to intubate. What must you do?

Answer 9

Positive pressure ventilations until the paralytic wears off and consider a rescue or surgical airway

Question 10

What other type of medication should be given to a patient that receives a neuromuscular blockade agent?

Answer 10

Sedative

Question 11

What is a BAAM used for?

Answer 11

Beck airway airflow monitor used to assist with nasotracheal intubation in patients that are still breathing on their own

Question 12

What are causes of decreased end tidal CO2?

Answer 12

Any condition that causes poor perfusion including obstruction, bronchospasm, pulmonary embolism, shock, and cardiac arrest

Question 13

What structures are assessed during the Mallampati classification system?

Answer 13

Tonsillar pillars, uvula, soft and hard palates

Question 14

When the laryngeal mask airway is inflated, where in the airway is the mask seated?

Answer 14

Supraglottic

Question 15

Where is the needle placed for retrograde intubation?

Answer 15

Cricothyroid membrane

Question 16

What methods are used to detect proper placement of an open cricothyrotomy?

Answer 16

Chest rise, auscultation, end-tidal CO2 detector

Question 17

What is a gum elastic bougie or Eschmann tracheal tube?

Answer 17

Straight, semi-rigid stylette with a 30 degree bend at the tip utilized to facilitate difficult intubation

Question 18

What is the short-acting non-barbiturate of choice in the prehospital setting due to its safety and effectiveness?

Answer 18

Etomidate

Question 19

A patient presents with a head injury after falling from a ladder. What premedication should be considered prior to administering a neuromuscular blockade agent?

Answer 19

Lidocaine

Question 20

What are the four phases of rapid sequence induction?

Answer 20

Premedication, induction, neuromuscular blockade, maintenance therapy

Question 21

How is a patient properly ventilated when a needle cricothyrotomy has been established?

Answer 21

Transtracheal jet insufflation or mechanical ventilator

Question 22

What is the BURP maneuver?

Answer 22

Backward Upward Rightward Pressure used to improve visualization of the vocal cords during endotracheal intubation

Question 23

What premedication should be given to all pediatric patients under the age of five prior to rapid sequence induction?

Answer 23

Atropine (note: age ranges for this premedication vary from 3 - 8 years of age)

Question 24

How is proper tidal volume estimated?

Answer 24

5-10 mL/kg ideal body weight

Question 25

What are disadvantages to positive end-expiratory pressure (PEEP)?

Answer 25

Reduction of right ventricular venous return, barotrauma, pneumothorax, pneumomediastinum

Question 26

Inability to be used in pediatrics or patients less than 4 feet or greater than 7 feet tall are disadvantages of which rescue airway?

Answer 26

Endotracheal combitube (ETC)

Question 27

What precautions must be taken for the cornea with the use of paralytics?

Answer 27

Patient does not have a blink reflex when paralyzed and requires instillation of artificial tears at least every 4 hours

Question 28

What are examples of alternative rescue airways?

Answer 28

Endotracheal combitube (ETC), pharyngotracheal lumen airway (PtL), laryngeal mask airway (LMA), intubating laryngeal mask airway (LMA Fastrach), Cobra perilaryngeal airway (PLA), Ambu laryngeal mask (ALM), and King LT airway

Question 29

What drugs block acetylcholine’s neurotransmitter action thus inducing flaccidity of muscles without depolarizing the synaptic membrane?

Answer 29

Nondepolarizing blocking agents

Question 30

After placing an endotracheal combitube (ETC), you observe that you have poor compliance upon ventilating through the blue portion of the tube. Where then is the tip of the tube and what should you do?

Answer 30

Ventilate the patient via the other tube since you essentially have an endotracheal intubation with the tip properly placed in the trachea

Question 31

What is the difference in tidal volume between assist/control (AC) and synchronized intermittent mandatory ventilation (SIMV)?

Answer 31

Assist control tidal volume is preset and delivered with every ventilator breath and patient initiated breath. Synchronized intermittent mandatory ventilation tidal volume is only delivered with the ventilator breath. The patient initiated breaths in between are at the patient’s own volume