Deck 6: Airway Management in Mechanical Ventilation

Question 1

In spite of the many advantages of an ET intubation, a tracheostomy tube is preferred as the initial means of establishing an artificial airway.

Answer 1

False

Question 2

The laryngoscope handle is held in the right hand since all standard blades attached to the handle are designed for right-hand intubations.

Answer 2

False

Question 3

The ET tube cuff pressure should be 25 mm Hg or less to minimize pressure-induced injuries to the trachea.

Answer 3

True

Question 4

The design of the speaking valve allows for only exhalation through the tracheostomy tube, but not inhalation.

Question 5

Excessive stimulation of the vagus nerve can cause bradycardia.

Question 6

A tracheostomy tube has a lower ____ than an ET tube.

A) anatomical deadspace volume
B) physiological deadspace volume
C) mechanical deadspace volume
D) alveolar dead space

Question 7

The surgical procedure that creates an opening at the trachea is called a ____.

A) tracheostomy
B) tracheotomy
C) trachesion
D) tracheomalacion

Question 8

The nasal route of intubation may be preferred for ____.

A) basilar skull fractures
B) apneic patients
C) mandible fractures
D) cardiopulmonary resuscitation

Question 9

A tracheostomy tube is used to replace the ET tube that has been in place for ____.

A) 10 days
B) 15 days
C) 21 days or longer
D) a month or longer

Question 10

A curved blade ____.

A) lifts the tongue only
B) functions better in patients with short necks
C) lifts the tongue and epiglottis
D) functions better in obese patients

Question 11

Which of the following is Step 5 of oral intubation, taking place after preoxygenating the patient?

A) Lubricate the deflated cuff with a water-soluble lubricant.
B) Tilt the head back and place in the sniffing position.
C) Open the mouth and apply anesthetic spray.
D) Slide the blade to the base of tongue and sweep the blade to the left.

Question 12

During nasal intubation, which of the following should be performed immediately after you slide the blade to the base of tongue and sweep the blade to the left?

A) Lift the handle and blade up anteriorly to displace the tongue and attached soft tissues.
B) Inflate the cuff and confirm endotracheal placement.
C) The centimeter marking on the ET tube should initially be 26 cm at nare for women and 28 cm for men.
D) Spray anesthetic through the trumpet and remove the trumpet.

Question 13

____ is an indication for rapid sequence intubation.

A) Facilitation of suctioning
B) Support of ventilation
C) Protection of the airway
D) Severe hypoxemia

Question 14

Which of the following is a common pre-RSI medication?

A) vecuronium bromide
B) succinylcholine
C) diazepam
D) fentanyl

Question 15

Frequent and inappropriate ET suctioning can cause mucosal damage and increase the incidence of suction-induced hypoxemia and ____.

A) pneumonia
B) arrhythmias
C) bronchial perforation
D) pulmonary edema

Question 16

When performing endotracheal suctioning, which of the following steps should be completed after you manually hyperinflate the patient's lungs with a resuscitation bag?

A) Test the vacuum and suction with sterile water.
B) Insert the catheter into an ET tube (sterile hand) and advance until resistance is met then withdraw catheter slightly.
C) Remove the ET tube adapter and irrigate with 5 mL of sterile saline or mucolytic agent only if indicated (contaminated hand).
D) Put sterile water in a container.

Question 17

When using a speaking valve in mechanically ventilated patients, an air leak may require careful and periodical adjustments of the ____, PEEP, and alarm settings.

A) expiratory reserve volume
B) inspiratory reserve volume
C) minute volume
D) tidal volume

Question 18

Strong productive coughs, a small amount of secretions, and ____ are good predictors of successful extubation.

A) infrequent need for suctioning
B) ventilatory reserve
C) hemoglobin level >10g/dL
D) being alert

Question 19

Before extubation, the procedure is explained to the patient and the patient is positioned in a ____ position.

A) Fowler's
B) sitting
C) supine
D) semi-Fowler's

Question 20

Which of the following complications related to use of an endotracheal tube may occur during intubation?

A) pneumonia
B) arrhythmias
C) vocal cord paralysis
D) laryngospasm

Question 21

The disadvantages of _______________ include the difficulty of insertion, the need for a smaller ET tube, and the potential development of sinusitis.

Question 22

For adult patients, the tip of an ET tube should be about 1.5 in. above the _______________.

Question 23

The _______________ is obtained by inflating the cuff slowly until reaching a point at which no air leak is heard at end-inspiration.

Question 24

A rapid shallow breathing (f/V_T) value of less than _______________ is highly predictive of successful extubation outcome.

Question 25

_______________ is the harsh or high-pitched sound heard during spontaneous respiration and it is initially treated with racemic epinephrine.

Question 26

Discuss the tracheostomy button.

Question 27

List the minimum supplies needed for ET intubation.

Question 28

What is a speaking valve and how does it make phonation possible?

Question 29

Explain the difference between ET intubation and a tracheostomy tube.

Question 30

What are the predictors of successful extubation?