CEP Advanced Airway Management & Ventilation 3 — Questions and Answers
Question 1: When using a video laryngoscope (e.g., GlideScope), the provider achieves an excellent view of the glottis but cannot pass the tube. What is the MOST common reason?
- Blade is inserted too deep
- Tube is not directed anteriorly to match the blade's curve (Correct answer)
- The patient needs more succinylcholine
- The stylet is not being used
Correct answer: Tube is not directed anteriorly to match the blade's curve
Video laryngoscopy provides a hyperangulated view requiring the tube to be directed anteriorly along the blade's curve; failure to angle the tube appropriately is the most common cause of tube delivery failure.
Question 2: A patient with suspected C-spine injury requires intubation. Which technique is PREFERRED to minimize cervical spine movement?
- Blind nasotracheal intubation
- Direct laryngoscopy with manual in-line stabilization
- Video laryngoscopy with manual in-line stabilization (Correct answer)
- Surgical cricothyrotomy
Correct answer: Video laryngoscopy with manual in-line stabilization
Video laryngoscopy with manual in-line stabilization is preferred as it achieves intubation with less cervical spine movement than direct laryngoscopy while maintaining spinal precautions.
Question 3: The King LT airway is inserted with the patient's head in neutral position. After inflation of both cuffs, you ventilate but feel high resistance and see poor chest rise. What is the MOST likely problem?
- The proximal cuff is not sealing the oropharynx
- The tube is advanced too deep, obstructing the laryngeal opening (Correct answer)
- The tube is kinked at the teeth
- The distal cuff is herniated
Correct answer: The tube is advanced too deep, obstructing the laryngeal opening
If the King LT is inserted too deeply, the distal tip can pass beyond the glottis into the trachea or occlude the laryngeal inlet, causing high resistance and poor ventilation.
Question 4: Which tidal volume setting is recommended for lung-protective ventilation in an intubated adult patient?
- 10-15 mL/kg of ideal body weight
- 6-8 mL/kg of ideal body weight (Correct answer)
- 4-5 mL/kg of actual body weight
- 500-700 mL regardless of weight
Correct answer: 6-8 mL/kg of ideal body weight
Lung-protective ventilation uses 6-8 mL/kg of ideal body weight to minimize volutrauma and barotrauma, particularly in ARDS and acute lung injury.
Question 5: A patient with severe asthma is intubated. Ventilator peak airway pressures are 60 cmH2O and rising. Which ventilator adjustment is MOST appropriate?
- Increase respiratory rate to 20 breaths/min
- Increase PEEP to 15 cmH2O
- Decrease respiratory rate and increase expiratory time (Correct answer)
- Increase tidal volume to improve gas exchange
Correct answer: Decrease respiratory rate and increase expiratory time
In obstructive disease, decreasing the respiratory rate and allowing more time for exhalation prevents auto-PEEP and reduces the risk of breath stacking and barotrauma.
Question 6: Which of the following is an absolute contraindication to nasotracheal intubation?
- Suspected cervical spine injury
- Combative patient
- Suspected basilar skull fracture (Correct answer)
- Active upper respiratory infection
Correct answer: Suspected basilar skull fracture
Basilar skull fracture is an absolute contraindication to nasotracheal intubation because the tube can be inadvertently passed into the cranial vault through the fractured cribriform plate.
Question 7: You are managing a pediatric patient with croup and increasing stridor. After high-humidity oxygen and nebulized epinephrine, the child's condition worsens. What is the NEXT intervention?
- Immediate orotracheal intubation with a tube 0.5-1 mm smaller than calculated (Correct answer)
- Cricothyrotomy using standard adult technique
- Nasopharyngeal airway insertion
- Immediate needle cricothyrotomy
Correct answer: Immediate orotracheal intubation with a tube 0.5-1 mm smaller than calculated
When medical management of croup fails, intubation with a tube 0.5-1 mm smaller than age-calculated size accommodates subglottic edema and reduces post-intubation complications.
CEP Advanced Airway Management & Ventilation 3
When using a video laryngoscope (e.g., GlideScope), the provider achieves an excellent view of the glottis but cannot pass the tube.
What is the MOST common reason?