Airway management 5

Question 1

The Eschmann introduces provides the most significant benefit when you obtain a

Answer 1

grade 3 view during laryngoscopy

Question 2

The intubating stylet has several names including

Answer 2

Eschmann introducer and gum elastic bougie

Question 3

The angle tip (coude) is used to facilitate intubation of a

Answer 3

very “anterior” glottis

Question 4

The coude is useful when the patient has a

Answer 4

Cormack & Lehane score of 2B or 3

Question 5

Feeling ________ confirms placement of the intubating stylet.

Answer 5

the click of the tracheal rings

Question 6

If the endotracheal tube catches on the soft tissue of the larynx, then you should

Answer 6

rotate the ETT 90 degrees counter-clockwise

Question 7

The EI is also useful for

Answer 7

nasotracheal intubation and orotracheal intubation through a supraglottic airway

Question 8

How far should the Eschmann introducer be advanced into the trachea?

Answer 8

23-25 cm

Question 9

What is the “Hold-up” sign?

Answer 9

it occurs when the introducer encounters resistance at the carina

Question 10

Indications for the lighted stylet include: (select 3)
a. super morbid obesity
b. severe oropharyngeal bleeding
c. mandibular hypoplasia
d. epiglottitis
e. a can’t ventilate and can’t intubate scenario
f. microstomia

Answer 10

b. severe oropharyngeal bleeding
c. mandibular hypoplasia
f. microstomia

Question 11

The lighted stylet uses a

Answer 11

blind intubation technique that transilluminates the anterior neck to facilitate endotracheal intubation

Question 12

When the lighted stylet is in the esophagus, you’ll observe a

Answer 12

more diffuse transillumination of the neck without the circumscribed glow

Question 13

When the lighted stylet is in the trachea, you’ll observe a

Answer 13

well-defined circumscribed glow below the thyroid prominence

Question 14

Benefits of the lighted style include

Answer 14

requires very little neck manipulation
less stimulating and less sore throat vs. direct vision laryngoscopy

Question 15

Disadvantages of the lighted stylet include

Answer 15

it’s difficult to use in the patient with a short, thick neck
it should not be used in an emergency or a “can’t ventilate, can’t intubate scenario”

Question 16

The lighted stylet technique is a blind technique and shouldn’t be used in the presence of a

Answer 16

tumor, foreign body, airway injury, or epiglottitis

Question 17

The lighted stylet is useful for

Answer 17

anterior airway
small mouth opening

Question 18

The lighted stylet requires very little

Answer 18

manipulation of the neck

Question 19

The lighted stylet can be used for

Answer 19

oral or nasal endotracheal intubation

Question 20

The lighted stylet is useful for

Answer 20

cervical spine abnormality, Pierre-Robin syndrome, severe burn contractures

Question 21

When using the Trachlight in the adult, the tip should be bent to

Answer 21

a 90 degree angle

Question 22

When using this device in children, the angle should be

Answer 22

60-80 degrees

Question 23

Choose the MOST appropriate indications for retrograde intubation. (select 2)
a. tracheal stenosis
b. unstable cervical spine
c. upper airway bleeding
d. can’t ventilate and can’t intubate scenario

Answer 23

b. unstable cervical spine
c. upper airway bleeding

Question 24

Retrograde intubation is a _________ procedure

Answer 24

blind

Question 25

Contraindications to retrograde intubation include

Answer 25

poor anatomy (neck deformity, neck mass)
laryngotracheal disease (stenosis)
coagulopathy
infection

Question 26

Complications of retrograde intubation include

Answer 26

bleeding
pneumothorax
trigeminal nerve trauma
breath holding
pneumomediastinum
wire that travels in the wrong direction

Question 27

What are the basic steps of retrograde wire intubation?

Answer 27

1. puncture the cricothyroid membrane with a 14-18 g needle
2. aspirate for air to confirm proper placement inside the tracheal lumen
3. Pass a wire through the needle and advance it in a cephalad direction
4. load the endotracheal tube over the wire and advance into the trachea
5. Once the ETT is in the trachea and cannot be advance any further, withdraw the wire and then advance the ETT into its final position

Question 28

How long does a retrograde intubation typically take?

Answer 28

5-7 minutes for experienced practitioners

Question 29

What are the absolute contraindications to tracheostomy?

Answer 29

there are no absolute contraindications

Question 30

What are the three ways to create a surgical airway:

Answer 30

percutaneous cricothyroidotomy
surgical cricothyroidotomy
tracheostomy

Question 31

Percutaneous cricothyroidotomy with transtracheal jet ventilation is performed by

Answer 31

inserting a large-bore needle through the cricothyroid membrane and ventilating with a high-pressure oxygen source, such as a jet ventilator

Question 32

Transtracheal jet ventilation requires a

Answer 32

high-pressure oxygen source (50 psi) during inspiration

Question 33

With transtracheal jet ventilation, exhalation is

Answer 33

passive

Question 34

__________ can prevent exhalation in the patient receiving transtracheal jet ventilation

Answer 34

Upper airway obstruction

Question 35

Cricothyroidotomy is performed by

Answer 35

creating a small, horizontal incision through the cricothyroid membrane and then inserting a cuffed endotracheal tube through the hole

Question 36

Cricothyroidotomy is contraindicated in

Answer 36

children less than 6 years of age

Question 37

Tracheostomy tends to require _____________ than cricothyroidotomy

Answer 37

more time; makes it less attractive in emergencies

Question 38

Upper airway obstruction with jet ventilation through a percutaneous cricothyroidotomy can lead to

Answer 38

barotrauma
pneumothorax
subcutaneous emphysema
mediastinal emphysema

Question 39

Complications of percutaneous cricothyroidotomy include

Answer 39

hemorrhage
aspiration
tracheal injury
esophageal injury

Question 40

Contraindications to surgical cricothyroidotomy include

Answer 40

laryngeal fracture
laryngeal neoplasm
children under 6

Question 41

Complications of surgical cricothyroidotomy include

Answer 41

tracheal stenosis
tracheal or esophageal injury
hemorrhage
disordered swallowing
subcutaneous or mediastinal emphysema

Question 42

Where is a tracheostomy incision performed

Answer 42

between the 2nd and 3rd tracheal rings

Question 43

Acute complications of tracheostomy include

Answer 43

airway obstruction
hypoventilation
pneumothorax
bleeding

Question 44

Long term complications of tracheostomy include

Answer 44

tracheal stenosis
tracheomalacia
tracheoesophageal fistula
tracheal necrosis