Endotracheal Intubation & Extubation

Which of the following is the most appropriate laryngoscope for intubation of a 1 year old?

#1 Miller

Capillary perfusion pressure is about ___ cm H2O.

20

Blood flow to the tracheal mucosa will become compromised if endotracheal tube cuff pressures are greater than ____ mm Hg.

25

For airway cuffs used with tracheostomy tubes, it is generally agreed that which pressure is the maximum acceptable intracuff pressure used in order to minimize the risks of tracheal wall injury and aspiration?

25 cm H2O

___ should be readily available, the anticipated size needed, along with a size above and a size below.

3 endotracheal tubes

The airway examination of a patient reveals Mallampati airway class II and a thyromental distance of 7 cm. The statement that is most appropriate about the intubation of this patient is which of the following?

An oral intubation should be attempted first.

Rapid objective feedback to confirm the correct placement of an ET tube immediately after intubation is achieved by which of the following?

Capnography

rapid objective feedback to confirm the correct placement of an ET tube immediately after intubation is achieved by which of the following?

Capnography

Patient presents with airway anatomy that makes visualization of the airway structures difficult during direct laryngoscopy. This general term is known as:

Class II

Both the respiratory therapist and the physician have made several attempts to intubate a patient. The patient is becoming more and more cyanotic. Face mask ventilation is inadequate. The most appropriate action to take is which of the following?

Establish an airway with a tracheostomy.

The picture above represents a Mallampati airway classification score of:

I

The picture above represents a Mallampati airway classification score of:

II

The picture above represents a Mallampati airway classification score of:

IV

Which of the following are indications for emergency endotracheal intubation?

Inability of rescuers to adequately ventilate with a bag-mask device Inability of the patient to protect his/her airway

_____ are then administered to provide sedation, upper airway relaxation, and amnestic response in patients during intubation

Induction agents

Which type of equipment is used most frequently to perform oratracheal intubation?

Laryngoscope

When ventilating via bvm to hyperoxygenate prior to intubation, inability to maintain an adequate mask seal during manual ventilation will cause:

Lower tidal volumes to be delivered

This term gives an objective way to classify clinical signs of airway predictions.

Mallampati Airway Classification

Tongue, hard palate, soft palate, and part of uvula and posterior pharynx are visible

Mallampati Class II

Tongue, hard palate, soft palate, and part of uvula and posterior pharynx are visible.

Mallampati Class II

Tongue, hard palate, soft palate are visible, posterior pharynx is not visible

Mallampati Class III

A patient's endotracheal tube is sized correctly and the cuff pressure is measured at 35 mm Hg. The most appropriate immediate action to take is:

Remove some volume from the cuff, and recheck pressure

A newly intubated patient is assessed with a color-changing CO2 detection device. The presence of CO2 is confirmed, as is moisture on exhalation. However, auscultation reveals decreased breath sounds on the left side. This problem can be corrected by doing which of the following?

Reposition the ET tube, and auscultate again.

If breath sounds are not heard over the left lung after intubation, the most likely cause is which of the following?

Right mainstem intubation

Why is cardiac and hemodynamic monitoring is essential during intubation?

Risks of vagal stimulation

The most appropriate method for opening the airway of an awake patient with a fractured mandible is which of the following?

Sniffing position

Which of the following statements concerning endotracheal tubes and their insertion is true?

The Miller blade is inserted along the right side of the tongue

A patient has a Class IV difficult airway based on structures visible on direct laryngoscopy. What does this mean?

The epiglottis is not visible

Rapid sequence intubation is used in patients who have ___ who would otherwise be difficult to intubate.

a gag reflex

apid sequence intubation is used in patients who have ___ who would otherwise be difficult to intubate.

a gag reflex

Risks of vagal stimulation include: asystole brady-dysrhythmias ventricular fibrillation all of these

all of these

The ___ is the only complete tracheal ring.

cricoid cartilage

___ is an important landmark for the Sellick maneuver

cricoid cartilage

___ is an important landmark for the Sellick maneuver.

cricoid cartilage

Adults are typically intubated with a ___ ETT, infants and young children are often intubated with an ___ ETT

cuffed; uncuffed

Hazards and complications of extubation include: death hypercapnia tracheal edema hypoxemia due to failure to deliver adequate inspired oxygen through the natural upper airway

death hypercapnia tracheal edema hypoxemia due to failure to deliver adequate inspired oxygen through the natural upper airway

Stimulation of the parasympathetic nervous system results in a ____ in heart rate, contractility and stroke volume

decrease

Stimulation of the parasympathetic nervous system results in a ____ in heart rate, contractility and stroke volume.

decrease

Patient presents with airway anatomy that makes visualization of the airway structures difficult during direct laryngoscopy. This general term is known as:

difficult airway

When a Miller blade is used, the laryngoscope is readjusted to directly lift the tip

epiglottis

When a Miller blade is used, the laryngoscope is readjusted to directly lift the tip of the __.

epiglottis

The _____ nerve is responsible for an active gag reflex.

glossopharyngeal

The ___ is the narrowest portion of the adult airway and is usually the limiting factor that determines the size of the tube that can be placed into the trachea

glottis

Laryngoscopes consist of a/an __ and a/an ___

handle; blade

Indications for intubation include all of the following except: hypocarbia Facilitate mechanical ventilation Hypoxemia Apnea

hypocarbia

Because some risk of extubation failure exists in all patients, it is important that a clinician who can perform ___ be available at the time of extubation.

intubation

____ is performed by deflating the cuff, and then assessing for the presence of a leak through the upper airway.

leak test

Immediately after intubation, one should check which of the following to confirm correct tube placement. Co2 detector (capnometry, colormetric or end tidal co2 monitor) Visualization: look for symmetrical chest movement Auscultation: listen for bilateral breath sounds Cat-Scan

look for symmetrical chest movement Auscultation: listen for bilateral breath sounds Capnography

Common induction agents used for intubation are which of the following? midazolam (Versed) ketamine etomidate propofol (diprivan)

midazolam (Versed) ketamine etomidate propofol (diprivan)

Which of the following may be used to predict a difficult intubation? mouth opening of <4 cm or reduced neck extension large neck circumference Mallampati airway class I or II increased body mass index (BMI) a thyromental distance of <6cm

mouth opening of <4 cm or reduced neck extension large neck circumference increased body mass index (BMI) a thyromental distance of <6cm

In some cases, the upper airway is at risk for swelling and inflammation during the period of intubation. What medication should be available in the event this is noted after extubation?

racemic epinepherine

In some cases, the upper airway is at risk for swelling and inflammation during the period of intubation. What breath sounds are heard post extubation if this swelling occurs?

stridor

When a Macintosh blade is used, the laryngoscope is gently readjusted once the epiglottis is visualized to place the tip of the blade into the __.

vallecula