Advanced Airway Management Flashcards

A CFRN is preparing to intubate an obese patient. What positioning modification is most beneficial for preoxygenation and intubation success?

Answer: Reverse Trendelenburg or ramped position with ear-to-sternal notch alignment

The ramped position (ear-to-sternal notch alignment) improves glottic view, increases FRC, and offsets the weight of abdominal contents from the diaphragm in obese patients.

During intubation of a patient in anaphylaxis, which finding of the airway is MOST concerning and warrants immediate surgical airway consideration?

Answer: Cherry-red epiglottis with complete supraglottic edema obliterating the glottis

Complete supraglottic edema obliterating the glottic opening may make conventional laryngoscopy impossible, requiring immediate surgical cricothyrotomy.

Rocuronium is selected over succinylcholine for RSI in a flight patient. What dose of rocuronium achieves intubating conditions comparable to succinylcholine?

Answer: 1.2 mg/kg IV

A high dose of 1.2 mg/kg rocuronium (approximately twice the standard dose) achieves intubating conditions within 60 seconds, comparable to succinylcholine.

A CFRN confirms ETT placement with waveform capnography but SpO2 remains at 88% despite FiO2 of 100%. What is the most likely cause?

Answer: Carbon monoxide poisoning causing falsely elevated SpO2

CO poisoning causes carboxyhemoglobin, which pulse oximetry misreads as oxyhemoglobin, giving a falsely elevated SpO2 while tissue hypoxia persists.

In a patient with increased intracranial pressure requiring intubation, which induction agent is CONTRAINDICATED due to its potential to increase ICP?

Answer: Ketamine (traditional concern)

Ketamine was traditionally avoided in head injury due to concerns of increasing ICP, though current evidence is mixed; it remains a relative contraindication in many transport protocols.

A CFRN is managing a patient with a tracheostomy whose tube has become dislodged during transport. The stoma is mature (>7 days old). The first intervention should be:

Answer: Attempt to replace the tracheostomy tube through the stoma

In a mature stoma (>7 days), the tract is established and the tracheostomy tube should be replaced directly through the stoma as the first intervention.

What is the purpose of applying cricoid pressure (Sellick's maneuver) during RSI?

Answer: To occlude the esophagus and reduce the risk of passive regurgitation

Cricoid pressure compresses the esophagus between the cricoid ring and vertebral body, theoretically reducing the risk of passive regurgitation and aspiration.