Mock Exam 1 Apex Flashcards
Which interventions are MOST appropriate in the “can’t ventilate can’t intubate” scenario? (Select 2.)
Retrograde Intubation
Surgical cricothyrotomy
Percutaneous transtracheal jet ventilation
Tracheotomy
Surgical cricothyrotomy
Percutaneous transtracheal jet ventilation
Surgical cricothyrotomy and transtracheal jet ventilation can reestablish ventilation very quickly and are appropriate options in the “can’t ventilate can’t intubate” scenario.
Retrograde intubation is best used when ventilation is possible. It takes 5-7 minutes to complete in the hands of an experienced practitioner. This is often performed for the patient with a suspected or known difficult airway in a controlled setting before the induction of anesthesia. It is also useful in the patient with an unstable cervical spine.
Tracheotomy has no place in emergency airway management.
All of the following are contraindications to retrograde tracheal intubation EXCEPT:
coagulopathy.
neck flexion deformity.
cervical spine injury.
goiter.
cervical spine injury
Explanation:
Retrograde intubation involves puncturing the cricothyroid membrane and passing a wire through the vocal cords and out of the mouth. Next, an endotracheal tube is loaded over the wire and advanced into the trachea.
Most of the reported cases of retrograde intubation described its use in patients with cervical spine injuries.
A neck flexion deformity can make this procedure challenging if not impossible. The presence of a goiter may prevent you from accurately identifying the cricothyroid membrane. Coagulopathy increases the risk of bleeding into the airway following needle puncture.
When providing anesthesia to a patient undergoing video assisted thoracoscopic surgery for removal of bullae:
a small tidal volume with high respiratory rates is preferred.
All of the following physiologic effects are expected to increase in a patient suffering from inadequate pain management after an open abdominal procedure EXCEPT:
vital capacity.
