Question 1

A patient needs to placed on mechanical ventilation.For intubation,the practitioner selects a Macintosh laryngoscope blade.Where in the airway should the tip of the blade be placed?

Accepted Answer

When a Macintosh laryngoscope blade is used,the distal tip is placed in the vallecula.The vallecula is a notch between the base of the tongue and the epiglottis and may be found by advancing the blade along the tongue until advancement terminates.

Question 2

Why is a large endotracheal tube preferred to a small endotracheal tube as an airway for an intubated patient?

Accepted Answer

Use of a larger endotracheal tube will minimize the resistance through the artificial airway.

Question 3

All of the following are conditions requiring management of the airway EXCEPT ____________

Accepted Answer

Secretions in the airway do not require management of the airway.Conditions requiring management of the airway,in general,are impending or actual (1)airway compromise,(2)respiratory failure,and (3)the need to protect the airway.

Question 4

What is the most common cause of upper airway obstruction?

Accepted Answer

The tongue falling back against the posterior pharynx is a common cause of upper airway obstruction.

Question 5

What is the name of the cartilage that protects the trachea from foreign material entering the trachea during swallowing?

Accepted Answer

The epiglottis is a lidlike cartilaginous structure that serves as a cover over the trachea.When closed during swallowing,it protects the trachea from food or other foreign material.

Question 6

Which resuscitation bag would be the best to assess a patient's compliance of the lungs and thorax?

Accepted Answer

A flow-inflating resuscitator,as the name implies,depends on the flow of source gas to inflate.This resuscitator will not operate without a compressed gas source.The construction of this resuscitator is such that the bag is very floppy and compliant.This makes it the easiest and the best resuscitator to assess the compliance of a patient's lungs and thorax.

Question 7

What is the most important consideration in determining endotracheal tube position?

Accepted Answer

Regardless of the method of ventilation used with endotracheal intubation,the most important consideration in endotracheal tube position is detection of esophageal intubation.

Question 8

A patient is admitted to the emergency department following a motor vehicle accident.The patient has obvious head trauma and needs to have his airway maintained.What should be done to open and maintain the patient's airway?

Accepted Answer

Anterior mandibular displacement (jaw thrust)is performed by grasping the jaw at the ramus on each side and lifting the jaw forward.This maneuver can be accomplished without tilting or moving the head,making it the treatment of choice in suspected vertebral column trauma.

Question 9

As a person loses consciousness,what happens to the reflexes that protect the airway?

Accepted Answer

As a person loses consciousness,the reflexes protecting the airway are lost,in descending order,from the swallow reflex to the carinal reflex.The level of consciousness is reflected in the presence or absence of the reflexes.

Question 10

A patient is intubated and the physician would like the respiratory care practitioner to use a manual resuscitator to deliver 100% oxygen.Which of the following devices could be used to satisfy the order?

Accepted Answer

A I)self-inflating resuscitator,II)flow-inflating resuscitator,and III)gas-powered resuscitator can all deliver 100% oxygen to the patient if used correctly.

Question 11

If vomiting and aspiration is a concern with a patient who needs an airway in place,which of the following airways would best protect the patient's airway?

Accepted Answer

The laryngeal mask airway (LMA)is designed to seal the esophagus,preventing gastric aspiration while providing a patent airway for positive-pressure ventilation to the trachea.It is a small triangular-shaped inflatable mask that is secured to a tube.The LMA is designed to be inserted such that once the mask is inflated,the tip rests against the upper esophageal sphincter and the sides face into the pyriform fossae,lying just under the base of the tongue.

Question 12

How is ventilation confirmed through a Combitube airway?

Accepted Answer

Ventilation is attempted through one tube and chest rise and exhaled C0₂ is observed.If ventilation is not confirmed,the same sequence is performed with the other tube of the airway.The combitube airway is a double lumen airway that is inserted blindly (without visualization using a laryngeoscope)into the oropharnyx and advanced into the esophagus or trachea.

Question 13

Which of the following is NOT a contraindication for resuscitation of a patient?

Accepted Answer

Resuscitation is not contraindicated in a patient with a diagnosis of lung cancer with metastases.Resuscitation is contraindicated when the patient's desire not to be resuscitated has been clearly expressed and documented in the patient's medical record or resuscitation has been determined to be futile because of the patient's underlying condition or disease.

Question 14

What is the proper position of a properly placed endotracheal tube in the patient's trachea?

Accepted Answer

The endotracheal tube passes down the posterior pharynx,past the epiglottis,through the vocal cords and the distal tip should rest 1.5-inches or 5 cm above the carina as indicated on a chest radiograph.

Question 15

A patient requires an airway to prevent the tongue from occluding the airway.The patient lapses in and out of conscious periodically.Which airway would be best to use for the patient?

Accepted Answer

The nasopharyngeal airway is far from stable,but it is usually well tolerated by a semi-conscious patient or one who lapses in and out of consciousness.The nasopharyngeal airway is often referred to as a nasal horn or trumpet,names acquired due to its shape.The nasopharyngeal airway is inserted through one of the nares of the nose and past the turbinates with the tip separating the tongue from the posterior soft palate.

Question 16

Partial upper airway obstruction is characterized by ________________

Accepted Answer

Upper airway obstruction is often accompanied by very noisy inspiratory efforts.The noise may vary from a mild snoring sound to a roar.

Question 17

Defibrillation is contraindicated when immediate danger to the rescuers is present due to: I.the environment.
II.the patient's condition.
III.the patient's location.

Accepted Answer

Defibrillation is contraindicated when immediate danger to the rescuers is present due to I)the environment,II)the patient's location,or III)the patient's condition.

Question 18

What is the purpose of all valves used in manual resuscitators?

Accepted Answer

The purpose of all valves used in manual resuscitators is b)to deliver gas to the patient during inspiration and c)to allow the patient to exhale to the ambient atmosphere on exhalation.

Question 19

What should be evaluated once an airway is established on a patient?

Accepted Answer

Once an airway is established,evaluate the adequacy of ventilation.The majority of upper airway obstructions can be relieved using simple positional maneuvers.

Question 20

Which of the following reflexes of the upper airway are cough reflexes?
I.Carinal reflex
II.Tracheal reflex
III.Laryngeal reflex
IV.Gag reflex
V.Swallow reflex

Accepted Answer

The carinal reflex and tracheal reflex are cough reflexes.Stimulation of the trachea will induce a cough.The carina,which is where the trachea branches into the right and left mainstem bronchi,is extremely sensitive to stimulation.Stimulation of this area also causes a cough reflex.

Quiz 20: Emergency Airway Management