Airway management exam II
What is the purpose of an endotracheal tube stylet?
Adds rigidity and shape to ease insertion
While checking a Miller and a MacIntosh blade on an intubation tray during an emergency intubation, you find that the Miller blade "lights" but the MacIntosh blade does not. What should you do now?
Check and replace the bulb in the MacIntosh blade
Compared with translaryngeal intubation, the advantages of tracheostomy include all of the following except:
Decreased frequency of aspiration
What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes?
Ensure gas flow if the main port is blocked y
Absolute contraindication for nasotracheal suctioning includes which of the following?
Epiglottis and croup
Which of the following bedside methods can absolutely confirm proper endotracheal tube position in the carina?
Fiberoptic laryngoscope
What is the treatment for glottic edema and vocal cord paralysis
Glottic edema: epinephrine, mucosal vasoconstriction, and steroid may be added to the aerosol to reduce the inflammation even more Vocal cord paralysis: no treatment just time
What is the most common complication of suctioning?
Hypoxemia
What is the primary indication for tracheal suctioning?
Ineffective coughing
What is adequate humidification for a patient with an artificial airway?
Large volume jet neb or heated humidifier can be used on patients who are not ventilated with a tracheostomy. For ventilated patients a heated humidifier or heat and moisture exchanger can be used
What equipment is not needed to perform nasotracheal suctioning?
Laryngoscope with MacIntosh and Miller blades
What is the normal range of negative pressure to use when suctioning an adult patient?
Less than 150 mm ahh
What if the following statements are false about methods used to displace the epiglottis during oral intubation?
Levering the laryngoscope against the teeth can aid displacement
What methods can help to reduce the likelihood of atelectasis due to tracheal suctioning?
Limit the amount of negative pressure used to hyper-inflate patient before and after procedure suction for a short period of time as possible
What is the purpose of a tracheostomy tube obturator?
Minimize trauma to the tracheal mucosal during insertion
Which types of artificial airways are inserted through the larynx?
Nasotracheal tubes and orotracheal tubes
To make oral intubation easier, how should the patients head and neck be positioned?
Neck flexed with head supported by towel and tilted back
In the absence of neck or facial injuries, what is the procedure of choice to establish a patent tracheal airway in an emergency?
Orotracheal intubation
After an intubation attempt and expired capnogram indicated a CO2 level near 0 what does this finding probably indicate?
Placement of the endotracheal tube in the esophagus
To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do what of the following?
Preoxygenate the patient to 100% O2
What to do if ET tube becomes displaced out of the trachea during mechanical ventilation
Tube should be completely removed and RT should provide full manual ventilation until re intubate in the correct location
During oral intubation of an adult, the endotracheal tube should be advanced into the trachea about how far?
Until the cuff has passed the cords
To maintain PEEP and high FiO2 when suctioning a mechanically ventilated patient, what would you recommend?
Use a closed system multi use suction catheter
How often should patients be suctioned?
When physical findings support the need
The removable inner vanilla commonly incorporated into modern tracheostomy tubes serves which of the following purposes?
1. Aid in routine tube cleaning 2. Tracheostomy care 3. Provide a patent airway should it become obstructed
What general condition requires airway management?
1. Airway compromise 2. Respiratory failure 3. The need to protect the airway
Serious complications of or intubation include which of the following?
1. Cardiac arrest 2. Acute hypoxemia 3. Bradycardia
Equipment needed for extubation
1. ET Tube 2. Stylet 3. Syringe 4. Suction catheter 5. Carbon dioxide detector 6. Oral and nasal airways 7. Ambubag 8. Mask attached to oxygen source 9. Nasal cannula
Signs and symptoms of glottic edema and vocal cord paralysis:
1. Hoarseness 2. Stridor
Complications associated with ET tube extubation?
1. Hoarseness 2. Sore throat 3. Cough
Which autonomic or protective neural responses represent potential hazards of emergency airway management?
1. Hypotension 2. Bradycardia 3. Cardiac arrhythmias 4. Laryngoscope
Limitations of a LMA
1. It cannot be used in conscious or semicomatose patient because of stimulation of the gag reflex 2. If ventilating pressures greater than 20 cm H20 are needed, gastric distention may occur
Possible causes of tracheal airway obstruction?
1. Kinking of the tube or the patient biting on the tube 2. Herniation over the cuff of the tube tip 3. Obstruction of the tube orifice against the tracheal wall 4. Mucus plugging
Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following:
1. Laryngoscope light source 2. Endotracheal tube cuff 3. Suction equipment
Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement?
1. Length markings on the curved body of the tube 2. Imbedded radiopaque indicator near the tube tip 3. Additional side port near the tube tip
Compared with oral route, the advantages of nasal intubation include all of the following:
1. Less retching and gagging 2. Less accidental extinction 3. Greater long term affect
Recommendations to help an alert trach patient to communicate better
1. Letter 2. Phrase 3. Picture board
Approaches used in weaning a patient from a trach tube
1. Patient should have sufficient muscle strength to generate an effective cough 2. There should be no active pulmonary infection
Techniques used to diagnose injuries associated with artificial airways
1. Physical examination 2. Air tomography 3. Fluoroscopy 4. Laryngoscope 5. Bronchoscopy 6. MRI 7. Pulmonary function studies
Primary inaction for tracheostomy includes:
1. Primary route for overcoming upper airway obstruction or trauma 2. Patients with poor airway protective reflexes 3. Continues need for an artificial airway after a prolonged period of oral or nasal intubation
Factors to consider when switching from an endotracheal tube to a trach tube?
1. Projected time the patient will need an artificial airway 2. Patients tolerance of endotracheal tube 3. Patients overall condition 4. Patients ability to tolerate a procedure 5. Relative risks of continued endotracheal intubation versus tracheostomy
The advantages of oral intubation include all of the following:
1. Reduced risk of kinking 2. Easier suctioning 3. Less traumatic insertion
Immediately after insertion of an oral ET tube on an adult, what should you do?
1. Stabilize it with your right hand 2. Inflate the tube cuff 3. Provide ventilation or oxygenation
Which checking a crash cart for intubation equipment, you find the following: suction equipment, oxygen apparatus, two laryngoscopes and assorted blades, five tubes, magill forceps, tape, lubrication gel, and local anesthetic. What is missing?
1. Syringe 2. Resuscitator bag or mask 3. Tube stylet
What conditions require emergency tracheal intubation?
1. Upper airway or laryngeal edema 2. Loss of protective reflexes 3. Cardiopulmonary arrest 4. Traumatic upper airway obstruction
All of the following indicate an inability to adequately protect the airway except:
1. Wheezing 2. Coma 3. Lack of gag reflex 4. Inability to cough
You are about to suction a 10 year old patient who has a 6mm endotracheal tube in place. What is the maximum size of catheter that you would use in this case?
10 fr
You are about to suction a female patient who has an 8-mm endotracheal tube in place. What is the maximum size of catheter you would use in this case?
14 fr
What is the standard size for endotracheal or tracheostomy tube adapters
15 mm external diameters
Total application time for endotracheal suction in adults should not exceed which of the following
15 seconds
What should be the maximum time devoted to any intubation attempt?
15-30 seconds
What is the recommended range for tracheal tube cuff pressure?
20-30 mm Hg
Ideally the distal tip of a properly positioned endotracheal tube should be positioned about how far above the carina?
3-6 cm
What size endotracheal tube would you sleet to intubate a 1500-g newborn infant?
3.0
What size endotracheal tube would you select to intubate a 3-year-old child with?
4.5-5.0 mm
What size ET tube would you select to intubate an adult female?
8.0 mm
What is the normal range of negative pressure to use when suctioning children?
80-100 mmHg
Signs and symptoms of tracheaoesophageal fistula?
A history of recurrent aspiration and abdominal distention
What is the purpose of a cuff on an artificial airway
Seal off and protect the lower airway
While suctioning a patient, you observe an abrupt change in the electrocardiogram wave form being displayed on the cardiac monitor. What action would be most appropriate?
Stop suctioning and immediately administer oxygen
After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?
Stop the bleeding and use a nasopharyngeal airway for access
What are the common sites for tracheal stenosis:
Subglottis and larynx
What to do with a patient who has complete airway obstruction of an oral ET tube?
Take it out and get rid of the secretions and intubate again
What is the purpose of the pilot balloon on an endotracheal or tracheostomy tube?
Protect the airway against aspiration
Therapies used to relieve stridor post extubation
Racemic epinephrine is available
After intubation of cardiac arrest victim, you observe a slow but steady rise in the expired CO2 levels as measured by a bedside capnometer. Which of the following best explains this observation?
Return of spontaneous circulation
What can help minimize the likelihood of mucosal trauma during suctioning?
Rotate the catheter while withdrawing, limiting the amount of negative pressure
