CEP Advanced Airway Management & Ventilation 5 — Questions and Answers
Question 1: A patient with a known history of angioedema from ACE inhibitor use presents with rapidly progressing oropharyngeal swelling. Which airway approach is MOST prudent?
- Wait for epinephrine to work before attempting airway management
- Attempt RSI with video laryngoscopy and have surgical airway immediately available (Correct answer)
- Insert a nasopharyngeal airway and transport
- Apply CPAP at 10 cmH2O
Correct answer: Attempt RSI with video laryngoscopy and have surgical airway immediately available
ACE inhibitor angioedema can rapidly obliterate the airway; RSI with video laryngoscopy should be performed early while surgical airway is prepared as a backup given the potential for complete airway loss.
Question 2: When performing a surgical cricothyrotomy, the incision is made through which structure?
- Thyrohyoid membrane
- Cricothyroid membrane (Correct answer)
- Cricotracheal membrane
- Thyroid cartilage
Correct answer: Cricothyroid membrane
The cricothyroid membrane, located between the thyroid cartilage superiorly and the cricoid cartilage inferiorly, is the target for emergency surgical cricothyrotomy due to its superficial, avascular midline position.
Question 3: Post-intubation, a mechanically ventilated patient has rising PaCO2 despite a respiratory rate of 16. Which ventilator change would BEST address this?
- Increase PEEP from 5 to 10 cmH2O
- Increase tidal volume from 450 mL to 550 mL (Correct answer)
- Switch from AC to SIMV mode
- Increase FiO2 to 100%
Correct answer: Increase tidal volume from 450 mL to 550 mL
Rising PaCO2 indicates inadequate minute ventilation; increasing tidal volume (within lung-protective limits) increases alveolar ventilation and CO2 elimination.
Question 4: Which of the following is the MOST reliable pre-hospital method to confirm endotracheal tube placement?
- Bilateral breath sounds on auscultation
- Absence of gurgling over the epigastrium
- Continuous waveform capnography (Correct answer)
- Chest rise with each ventilation
Correct answer: Continuous waveform capnography
Continuous waveform capnography is the gold standard for confirming and monitoring endotracheal tube placement, as it requires pulmonary blood flow to produce CO2 at the tube tip.
Question 5: A patient with epiglottitis is in the 'tripod position' with audible stridor. You should:
- Lay the patient supine and begin BVM ventilation
- Allow the patient to maintain their position of comfort while preparing for controlled intubation (Correct answer)
- Immediately perform blind nasotracheal intubation
- Insert an oral airway and administer high-flow oxygen via NRB
Correct answer: Allow the patient to maintain their position of comfort while preparing for controlled intubation
Epiglottitis patients should be kept in their position of comfort (upright, tripod) as any manipulation or forced repositioning can precipitate complete airway obstruction; prepare for controlled intubation.
Question 6: During RSI, ketamine is chosen as the induction agent. Which patient condition makes ketamine PARTICULARLY beneficial compared to etomidate?
- Head trauma with suspected elevated ICP
- Reactive airway disease with bronchospasm (Correct answer)
- Hypertensive emergency
- Suspected cocaine toxicity
Correct answer: Reactive airway disease with bronchospasm
Ketamine is a bronchodilator and is particularly beneficial in RSI for patients with bronchospasm or reactive airway disease, as it relaxes bronchial smooth muscle.
Question 7: An unresponsive trauma patient has gurgling respirations and a GCS of 5. After jaw thrust and suctioning, you plan to insert an OPA. How do you confirm the correct OPA size?
- Measure from the corner of the mouth to the earlobe (Correct answer)
- Measure from the center of the mouth to the angle of the jaw
- Measure from the tip of the nose to the earlobe
- Use the patient's age to select from a size chart
Correct answer: Measure from the corner of the mouth to the earlobe
The correct OPA size is determined by measuring from the corner of the mouth to the earlobe (or from the center of the mouth to the angle of the mandible).
CEP Advanced Airway Management & Ventilation 5
A patient with a known history of angioedema from ACE inhibitor use presents with rapidly progressing oropharyngeal swelling.
Which airway approach is MOST prudent?