Airway Management

Question 1

What is the purpose of the angle of the bevel on the ET tube?

Answer 1

It minimizes mucosal trauma during insertion.

Question 2

The nasopharyngeal airway is inserted where?

Answer 2

Into the nose and rests behind the tongue just above the epiglottis

Question 3

Can you instill drugs down an ET tube?

Answer 3

Yes; generally the dose is 2X the normal dose

Remember NAVEL: Narcan, Atropine, Valium/Versed, Epinephrine, and Lidocaine

Question 4

How is the ET Tube size measured?

Answer 4

It’s measured in millimeters on the inside diameter.

Question 5

Where is the Macintosh blade designed to fit?

Answer 5

Into the vallecula so that it indirectly picks up the epiglottis

Question 6

What is the purpose of the Murphey’s eye?

Answer 6

It allows for collateral ventilation.

Question 7

Where should the tip of the endotracheal tube rest?

Answer 7

It should rest 2 – 4 cm above the carina.

Question 8

What should the tube depth of the ET tube be for the adults?

Answer 8

21 – 23 cm at the lip

Question 9

How long should you hyperinflate and hyperoxygenate the patient for the oral intubation procedure?

Answer 9

2 to 3 minutes

Question 10

What position should the patient be in for nasal intubation?

Answer 10

Direct – supine blind (fowlers position)

Question 11

What are the advantages of the tracheotomy?

Answer 11

More comfortable, less tube movement, better communication, lower airway resistance, easier suctioning, easier to replace than an ET tube.

Question 12

fenestrated tracheostomy tube?

Answer 12

It can help facilitate speech, it can be cuffed or uncuffed, the inner cannula must also be fenestrated.

Question 13

What is the number one complication post-extubation?

Answer 13

Hoarseness

Question 14

When maintaining cuff pressure, it is important to?

Answer 14

Keep the cuff pressure below tracheal capillary perfusion pressure.

Normal cuff pressure leak is 20 – 30 cmH2O

Question 15

What should you do in the case of a herniated cuff?

Answer 15

Deflate/re-inflate, then try to pass a suction catheter to determine if cuff is herniated.

Question 16

What should you do in the case of the tip of the tube is on the tracheal wall?

Answer 16

Reposition the airway and head/neck

Question 17

What can be used to maintain a trach stoma?

Answer 17

A tracheal button

Question 18

What is the modified jaw thrust?

Answer 18

It is modified to avoid head-extension and is good for suspected neck trauma patients. It is done by pushing the mandibular process to extend the jaw and open the airway.

Question 19

What are hazards of suctioning during an artificial airway?

Answer 19

Bleeding/trauma to the mucosa, so be gentle and use lubricant. Cardiac changes can occur due to vagal reflex (bradycardia) and hypotension from vagal nerve stimulation. Tachycardia due to hypoxemia. Use sterile technique.

Question 20

What is the Minimal Occluding Volume (MOV)?

Answer 20

A technique used to inflate the cuff to 20 – 25 mmHg/25 – 30 cmH20. Listen for an air leak as the cuff is inflated during positive pressure ventilation. Stop inflating at the minimum volume necessary to eliminate air leak via tracheostomy or ET Tube.

Question 21

What is the Minimal Leak Technique (MLT)?

Answer 21

Slowly inject air into the cuff during positive pressure inspiration until the leak stops. A small amount of air is removed to allow a slight leak during peak inspiration. Remove the small amount to prevent aspiration.

Question 22

What are the normal ET tube markings?

Answer 22

For an oral Intubation: 21 – 25 cm mark at the lip. For a nasal Intubation: 26 – 29 cm mark at the nares.

Question 23

What is the Double Lumen Tube (Carlen’s Tube)?

Answer 23

An ET tube with two independent lumens of different lengths. The longer tube is inserted in either the left or right mainstem bronchus. The shorter tube is placed in the trachea above the carina. Each Lumen can ventilate one lung separately or they can be connected via wye and share the ventilation source

Question 24

List two possible immediate complications of the tracheostomy procedure?

Answer 24

Bleeding is a major hazard, and you also have to watch for a Pneumothorax.

Question 25

What does it mean if the therapist recommends a fenestrated tracheostomy tube?

Answer 25

It is used for weaning and temporary mechanical ventilation with an inner cannula.

Question 26

When using a tracheal speaking valve, the tracheostomy tube cuff must be?

Answer 26

The cuff must be deflated.

Question 27

Can incorrect placement of an oropharyngeal airway (OPA) push the tongue further back into the pharynx worsening the obstruction?

Answer 27

Why yes, yes it can.

Question 28

What is a Passy-Muir speaking valve?

Answer 28

It’s a one-way valve that attaches to the 15 mm adaptor and allows for speech and secretion management. It allows air to enter only during inspiration. The blue-colored ones are used with ventilators. The white ones are for spontaneously breathing patients.

Question 29

What is the tracheostomy button used for?

Answer 29

It’s a short, soft hollow tube which fits in stoma in place of the tracheostomy tube. It’s used to aid in weaning from the trach tube. It keeps the stoma open. It extends from the skin to just inside of the tracheal wall.

Question 30

What are the methods for weaning from tracheostomy tube?

Answer 30

Tracheostomy buttons, fenestrated tubes, progressively smaller tracheostomy tubes.

Question 31

What is the laryngeal mask airway?

Answer 31

A hollow tube with a spoon-shaped mask. The mask has a cuff attached to the end of it, which inflates to permit the area around the tracheal glottis and epiglottis to be sealed. It sits on the esophageal sphincter.

Question 32

What is the biggest problem with an LMA?

Answer 32

Regurgitation during insertion

Question 33

What is the purpose of the additional side port (murphy eye) on most modern endotracheal tubes?

Answer 33

To ensure gas flow if the main port is blocked, in addition to the beveled opening at the tip, there should be an additional side port or murphy eye which ensures gas flow if the main port should become obstructed. The tube cuff is permanently bonded to the tube body.

Question 34

A surgical resident has asked that you assist in an elective tracheotomy procedure on an orally intubated patient. which of the following would be appropriate action?

Answer 34

Withdraw the oral tube 2-3 inches while the incision is made.

Question 35

Soon after endotracheal tube extubation, an adult patient exhibits a high pitched inspiratory noise, heard without a stethoscope. Which of the following actions would you recommend?

Answer 35

STAT racemic epinephrine aerosol treatment

Question 36

After removal of an oral endotracheal tube, a patient exhibits hoarseness and strider that do not resolve with racemic epinephrine treatments. What is most likely the problem?

Answer 36

Vocal cord paralysis.

Question 37

Tracheal stenosis occurs in as many as 1 in 10 patients after prolonged tracheostomy. At what sites does this stenosis usually occur?

Answer 37

The cuff site, tip of the tube, and the stoma site.

Question 38

A patient is being evaluated for tracheal damage sustained while having undergone prolonged tracheostomy intubation approximately 3 months earlier. The flow-volume loop demonstrates a fixed obstructive pattern. What is most likely the cause of the problem?

Answer 38

Tracheal stenosis.

Question 39

A patient has been receiving positive pressure ventilation through a tracheostomy tube for 4 days. In the past 2 days, there is evidence of both recurrent aspiration and abdominal distention but minimal air leakage around the tube cuff. What is most likely cause of the problem?

Answer 39

Tracheoesophageal fistula.

Question 40

A physician is concerned about the potential for tracheal damage due to tube movement in a patient who recently underwent tracheostomy and is now receiving 40% oxygen through a T- tube (Briggs adapter). Which of the following would be the best way to limit the tube movement in this patient?

Answer 40

Switch from the T-tube to a tracheostomy collar.

Question 41

To ensure adequate humidification for a patient with an artificial airway, inspired gas at the proximal airway should be 100% saturated with water vapor and at which of the following temperatures?

Answer 41

32 to 35 degrees C.

Question 42

What is a good mnemonic to use to remember what equipment is needed during an intubation?