Airway Management MCQs Quiz With Answers

The decision to intubate should be based on several essential criteria, including failure to maintain or protect the airway, failure of ventilation or oxygenation, and the patient's anticipated clinical course and likelihood of deterioration. These criteria are crucial in determining whether intubation is necessary to ensure the patient's airway is secure and adequate oxygenation and ventilation are maintained. Therefore, the correct answer is "All of the above."

Noninvasive positive-pressure ventilation (NPPV) offers several advantages over endotracheal mechanical ventilation. Firstly, it allows for the preservation of speech, swallowing, and physiologic airway defense mechanisms, which are important for patient comfort and recovery. Secondly, NPPV reduces the risk of airway injury compared to invasive methods. Thirdly, it also decreases the risk of nosocomial infections, which are common in ICU settings. Lastly, NPPV has been shown to decrease the length of stay in the hospital and reduce the need for ICU admission, potentially improving patient outcomes and reducing healthcare costs. Therefore, all of the above advantages are associated with NPPV.

The jaw thrust maneuver is the safest way to manage the airway in a patient with suspected cervical spine injury. This technique involves placing the fingers behind the angle of the jaw and lifting the jaw forward, which helps to open the airway without flexing or extending the neck. By using the jaw thrust maneuver, the healthcare provider can maintain proper alignment of the cervical spine and minimize the risk of further injury. The other options mentioned, such as chin lift, direct tongue depression, and head tilt, may potentially cause movement or manipulation of the cervical spine, which could worsen the injury.

The correct answer is "All of the above are true." This means that all of the statements mentioned in the question are correct. Airways such as the laryngeal mask airway and esophageal obturator airway are indeed available in the event of a failed airway. Awake intubation can be done by the nasotracheal route. Before intubation, it is important to assess the airway for ease of ventilation as well as intubation. In cases where intubation and ventilation fail, cricothyrotomy is considered the crucial rescue procedure.

LEMON is correctly paired with the mnemonic for evaluation of difficult direct laryngoscopy. The LEMON acronym stands for Look externally, Evaluate 3-3-2 rule, Mallampati score, Obstruction, and Neck mobility. It is a systematic approach used to assess the factors that may contribute to difficult direct laryngoscopy. This mnemonic helps healthcare professionals evaluate the patient's airway before attempting laryngoscopy, allowing them to anticipate and manage potential difficulties during the procedure.

The given correct answer states that all of the statements about colorimetric readings are true. This means that a purple color is indeed associated with CO2 levels less than 4mm Hg, a yellow color is associated with CO2 levels greater than 20mm Hg, and a purple color generally indicates esophageal intubation. Additionally, it is true that ambient CO2 levels in the esophagus are less than 4mm Hg. Therefore, all of the given statements are accurate.

Clinical assessment is the most helpful in determining the need for intubation. This is because clinical assessment involves evaluating the patient's overall condition, including their respiratory effort, mental status, oxygenation, and airway patency. It allows healthcare providers to assess the severity of respiratory distress and determine if intubation is necessary to maintain adequate oxygenation and ventilation. Other options such as ABG, lung auscultation, pulse oximetry, and testing the gag reflex may provide additional information, but clinical assessment encompasses a comprehensive evaluation of the patient's condition.

Difficulty with cricothyrotomy can be anticipated with all of the following except Class III or Class IV Mallampati. Mallampati classification is a method used to assess the ease of intubation based on the visibility of the patient's tonsils and uvula. Class III or Class IV Mallampati indicates a difficult airway, which can make cricothyrotomy more challenging. Prior neck surgery, hematoma, tumor, or abscess on the neck, scarring from radiation on the neck, and obesity can all contribute to anatomical difficulties during cricothyrotomy.

Patients who have no teeth have a higher likelihood of easy intubation because the absence of teeth allows for better visualization and access to the airway. Teeth can obstruct the view and make it difficult to insert the endotracheal tube. Therefore, in patients without teeth, intubation can be performed more easily and with less risk of complications.

Tachycardia and hypertension can indicate that the patient is not tolerating the ventilator settings and may need more sedation or adjustment of the ventilatory settings. This means that the patient's heart rate and blood pressure are elevated, which could be a sign of distress or discomfort caused by the ventilator. Increasing sedation or adjusting the ventilatory settings can help alleviate these symptoms and improve the patient's comfort and tolerance to the ventilator.

During intubation with a fiberoptic bronchoscope, bleeding in the airway can be a predicted difficulty. This is because the insertion of the bronchoscope into the airway can cause trauma to the delicate tissues, leading to bleeding. This can obstruct the view and make it challenging to navigate the bronchoscope properly. Additionally, excessive bleeding can also compromise the patient's oxygenation and ventilation, further complicating the intubation process. Therefore, it is important for the healthcare provider to be prepared for this potential difficulty and have appropriate measures in place to manage bleeding if it occurs.

Invasive blood pressure monitoring via an arterial catheter should be considered in patients requiring continuous BP monitoring (sodium nitroprusside), patients with impending shock states, patients with anatomic abnormalities, and patients who require frequent arterial samplings. However, normotensive patients do not typically require invasive blood pressure monitoring as their blood pressure is within the normal range.

Ketamine is a dissociative anesthetic that is commonly used for induction and maintenance of anesthesia. It is known to have bronchodilator properties, meaning it relaxes the smooth muscles of the airways and helps to open up the bronchial tubes. This makes it a useful option for patients with asthma or other respiratory conditions. Therefore, the statement that ketamine is a bronchoconstrictor is incorrect.

Rocuronium should be used for paralysis during rapid sequence intubation. Rocuronium is a non-depolarizing neuromuscular blocking agent that causes skeletal muscle relaxation and paralysis. It is commonly used in emergency intubation because it has a rapid onset of action and a relatively short duration of effect. This allows for quick and effective intubation while minimizing the risk of complications. Etomidate, ketamine, propofol, and thiopental are all sedative agents used for induction of anesthesia, but they do not provide paralysis.

Cricothyrotomy is a procedure used to establish a temporary airway in cases of severe airway obstruction. It involves making an incision in the cricothyroid membrane to access the airway. However, performing cricothyrotomy in children younger than 10 years old is not recommended due to anatomical differences in the airway. The cricothyroid membrane in younger children is smaller and more difficult to access, making the procedure riskier and potentially ineffective. Therefore, age younger than 10 years is a contraindication to cricothyrotomy.

The correct answer is "Less than 3%". In ED studies, the overall intubation failure rates are reported to be less than 3%. This means that out of all the intubation procedures performed in the emergency department, less than 3% of them result in failure. This low failure rate indicates that the majority of intubations in the ED are successful and highlights the proficiency of the medical staff in performing this procedure.

Etomidate is a medication used for induction of anesthesia. The correct answer states that the induction dose of etomidate is 0.3mg/kg IV. This means that when administering etomidate for anesthesia induction, the recommended dose is 0.3 milligrams per kilogram of the patient's body weight, given intravenously. This information is important for healthcare professionals who are responsible for administering anesthesia and need to ensure that the correct dose of etomidate is given to achieve the desired effect.

Thiopental should be avoided when intubating a status asthmaticus because it is a barbiturate that can cause respiratory depression. In status asthmaticus, the patient already has compromised lung function and any further respiratory depression can worsen their condition. Therefore, it is important to avoid medications that can further suppress the respiratory drive, such as thiopental.

Suspected cervical spine injury is not a factor that indicates difficult extra-glottic device (EGD) placement. Difficult EGD placement can be influenced by factors such as restricted mouth opening, stiffness (resistance to ventilation), obstruction or obesity, and distorted anatomy. However, a suspected cervical spine injury does not directly affect the placement of an EGD.

Contraindications to noninvasive-pressure ventilation (NPPV) include severely impaired level of consciousness, uncontrolled vomiting, acute MI, and copious secretions. Pneumonia, on the other hand, is not a contraindication to NPPV. This means that NPPV can still be used in patients with pneumonia as a treatment option.

The gold standard for confirmation of endotracheal tube placement is using a fiberoptic scope to pass through the tube and identify tracheal rings. This method allows for direct visualization of the trachea and provides a reliable confirmation of correct placement. Chest and gastric auscultation, chest x-ray, and end-tidal carbon dioxide (CO2) color change are other methods commonly used, but they may not always provide definitive confirmation.

Succinylcholine has been associated with masseter spasm and malignant hyperthermia. This means that the use of succinylcholine can lead to involuntary contraction of the masseter muscle, causing difficulty in opening the mouth. It is also associated with a rare but potentially life-threatening condition called malignant hyperthermia, which is characterized by a rapid rise in body temperature and severe muscle contractions. These adverse effects of succinylcholine are important considerations when using this medication in clinical practice.

Apnea is a contraindication to nasotracheal intubation in a trauma patient because during the procedure, the patient's airway is temporarily blocked, and if the patient is already experiencing apnea (the absence of breathing), this can lead to a further decrease in oxygen levels and potentially worsen their condition. It is important to ensure that the patient has a stable respiratory status before attempting nasotracheal intubation to prevent any complications.

Propofol can be used as a sedating agent in an asthmatic patient who requires intubation. This is because propofol is a short-acting sedative-hypnotic agent that provides rapid onset and offset of sedation, allowing for better control of the patient's airway. It has bronchodilatory properties and does not cause histamine release, making it a suitable choice for asthmatic patients. Additionally, propofol has antiemetic effects, which can be beneficial in preventing aspiration during intubation.