Airway and Ventilation Flashcard 4
Rationale
B. Rationale: When attempting to insert an advanced airway, the rescuers must ensure to minimally interrupt chest compressions. In this case, the procedure is taking too long. Hence, it is better to defer the advanced airway and continue CPR at once. Studies have shown no advantage of an advanced airway over bag-mask ventilation for improving survival rates of patients with cardiac arrest.
Question
Placing an advanced airway eases the provision of ventilation and minimizes chest compressions. However, in this case, the EMS provider could not insert the ET tube properly after three tries. What is the appropriate next action?
a. Continue inserting the endotracheal tube.
b. Defer inserting the advanced airway and continue CPR.
c. Call a more experienced rescuer.
d. Use a laryngeal mask.
Answer
b. Defer inserting the advanced airway and continue CPR.
Rationale
D. Rationale: The choice of an advanced airway will be dependent on the rescuer’s training and experience with different advanced airways, the rescuer’s preference, the rescuer’s scope of practice (what they are permitted to do under the law), and the equipment that is available to them.
Question
Selection of an advanced airway depends on:
A. Rescuer’s training
B. Rescuer’s scope of practice
C. Equipment available
D. All of the above
Answer
D. All of the above
Rationale
D. Rationale: The most common cause of upper airway obstruction among unconscious patients is laxity of the throat muscles and lack of tone. The tongue can potentially fall back into the pharynx, causing an upper airway obstruction as well.
Question
The anesthesiologist has a patient under general anesthesia for an exploratory laparotomy. You are asked to monitor the patient closely. What is the most common cause of upper airway obstruction in unconscious patients?
a. Food obstruction
b. Loose dentures
c. Anaphylaxis
d. Laxity of the throat muscles/lack of muscle tone
Answer
d. Laxity of the throat muscles/lack of muscle tone
Rationale
D. Rationale: Respiratory failure is the end stage of respiratory distress. Patients will present with hypercapnia and hypoxemia. Patients with neurologic lesions involving the breathing centers may be in respiratory failure without exhibiting significant signs of respiratory distress due to the disruptions in autonomic control.
Question
The end stage of respiratory distress that requires more advanced interventions to correct the situation or risk immediate cardiac arrest is known as which one of the following medical conditions?
a. Severe respiratory distress
b. Pulmonary arrest
c. Respiratory arrest
d. Respiratory failure
Answer
d. Respiratory failure
Rationale
D. Rationale: Loss of tone in the throat muscles of the unconscious patient can allow the tongue to fall backward, which can block the oropharynx.
Question
The most common cause of airway obstruction in the unconscious patient is:
A. Laryngospasm
B. Blood
C. Broken teeth
D. The tongue falling back and blocking the oropharynx
Answer
D. The tongue falling back and blocking the oropharynx
Rationale
A. Rationale: Asynchronous ventilations are recommended if an advanced airway is in place. Each breath is provided without interruptions in chest compression during chest recoil at a rate of 1 breath every 6 seconds or 10 breaths per minute.
Question
The rescue team decides to pause chest compressions, and they successfully insert an endotracheal tube. You are tasked to provide ventilations. How should you proceed?
a. Give asynchronous ventilations at 10 breaths per minute.
b. Give 2 breaths after 30 chest compressions.
c. Give 2 breaths after 15 chest compressions.
d. Give asynchronous ventilations at 1 breath every 10 seconds.
Answer
a. Give asynchronous ventilations at 10 breaths per minute.
Rationale
A. Rationale: A bag-mask device requires very minimal skill to operate. It is a priority not to delay ventilations at this time, so you should go ahead with bag-mask ventilations without hesitation. If this is adequate, healthcare providers may decide to defer the placement of an advanced airway. Studies have shown that there is no advantage of using an advanced airway such as an ET tube over bag-mask ventilations. You must still inform the team that you are incapable of inserting an advanced airway so that others may help you in this task when it is indicated. An effective team member does not take assignments beyond their level of competence or expertise.
Question
There is a 54-year-old patient with a heart attack in need of ACLS in the emergency department. You have been chosen to take the role as the airway manager by the team leader, but it is not within the scope of your practice to use an advanced airway. What will you do?
a. Ventilate the patient using a bag-mask device
b. Insert an endotracheal tube
c. Facilitate an oropharyngeal airway
d. Tell the team leader that you are inadequate to take the role of the airway manager
Answer
a. Ventilate the patient using a bag-mask device
b. Insert an endotracheal tube
Rationale
B. Rationale: If the diameter of the nasopharyngeal airway causes blanching of the nostrils, then the size is too large. The correct size can be estimated by measuring it against the patient’s smallest finger.
Question
There is a patient in respiratory distress in the emergency department. You have been tasked by the ED consultant to insert a nasopharyngeal airway. How will you determine which size is appropriate?
a. Eyeball the circumference of the nasopharyngeal airway with the inner aperture of the nares; the nasopharyngeal airway must cause sustained blanching of the nostrils to make sure it stays in place.
b. Use the diameter of the patient’s smallest finger as a guide to which size to use.
c. The nasopharyngeal airway must have its opening at the aperture of the nares and the tip toward the angle of the mandible.
d. The appropriate size of the nasopharyngeal airway is determined by the patient’s age.
Answer
b. Use the diameter of the patient’s smallest finger as a guide to which size to use.
Rationale
B. Rationale: The principal advantage of a laryngeal tube is that it can be inserted blindly. An ET tube requires a laryngoscope to be inserted correctly. Capnography can be used with both devices, and ventilation capacity is the same when inserted correctly. A laryngeal tube has a greater aspiration risk compared to an ET tube.
Question
What advantage does a laryngeal tube have over an endotracheal tube?
a. Allows placement of capnography devices
b. Does not require a laryngoscope to insert
c. Better ventilation
d. Prevents aspiration of gastric contents reliably
Answer
b. Does not require a laryngoscope to insert
Rationale
D. Rationale: Delivery of excessive ventilations is likely to cause complications, including gastric insufflation, regurgitation, and aspiration. It can also cause compression of the vital organs of the mediastinum secondary to gastric inflation.
Question
What are the complications of excessive ventilation?
a. Gastric insufflation
b. Compression of the vital mediastinal organs
c. Aspiration
d. All of the above
Answer
d. All of the above