CFRN Advanced Airway Management 2 — Questions and Answers
Question 1: During a flight transport, a patient's endotracheal tube cuff pressure should be maintained at what range to prevent tracheal mucosal ischemia?
- 10-15 cmH2O
- 20-30 cmH2O (Correct answer)
- 35-45 cmH2O
- 50-60 cmH2O
Correct answer: 20-30 cmH2O
ETT cuff pressure should be maintained between 20-30 cmH2O to prevent mucosal ischemia while maintaining an adequate seal.
Question 2: A CFRN is transporting a patient with a known difficult airway. The video laryngoscope fails. Which device is the most appropriate next step for a 'can't intubate, can't oxygenate' scenario?
- Nasopharyngeal airway
- Surgical cricothyrotomy (Correct answer)
- Blind nasotracheal intubation
- King LT airway
Correct answer: Surgical cricothyrotomy
Surgical cricothyrotomy is the definitive rescue airway in a true 'can't intubate, can't oxygenate' situation when all other methods have failed.
Question 3: At altitude, nitrogen-filled ETT cuffs may over-inflate due to gas expansion. What is the preferred filling agent during flight?
- Room air
- Nitrogen
- Normal saline or sterile water (Correct answer)
- Carbon dioxide
Correct answer: Normal saline or sterile water
Normal saline or sterile water is preferred to fill ETT cuffs during flight because liquids are incompressible and do not expand with altitude changes.
Question 4: Which finding during waveform capnography indicates esophageal intubation?
- Continuous plateau waveform at 35-45 mmHg
- Absence of CO2 waveform after intubation (Correct answer)
- Gradually rising ETCO2 over 5 breaths
- Shark fin waveform pattern
Correct answer: Absence of CO2 waveform after intubation
Absence of a CO2 waveform after intubation is the most reliable indicator of esophageal placement, as the esophagus does not produce CO2.
Question 5: A CFRN is managing a pediatric patient requiring intubation. Which formula correctly estimates uncuffed ETT size for a child?
- (Age + 16) / 4
- (Age / 4) + 4 (Correct answer)
- (Weight in kg / 10) + 3
- Age / 2 + 3
Correct answer: (Age / 4) + 4
The formula (Age/4) + 4 estimates uncuffed ETT internal diameter in millimeters for pediatric patients.
Question 6: During a rotor-wing transport, a mechanically ventilated patient develops sudden loss of breath sounds on the left with tracheal deviation to the right. The CFRN should first suspect:
- Right mainstem intubation
- Left tension pneumothorax (Correct answer)
- ETT cuff herniation
- Mucus plug obstruction
Correct answer: Left tension pneumothorax
Absent left breath sounds with tracheal deviation to the right in a ventilated patient is classic for left tension pneumothorax requiring immediate needle decompression.
Question 7: When performing rapid sequence intubation, succinylcholine is contraindicated in which patient population due to risk of fatal hyperkalemia?
- Patients with renal failure on dialysis
- Patients with burns older than 24-72 hours or crush injuries (Correct answer)
- Patients with acute traumatic brain injury
- Patients with coronary artery disease
Correct answer: Patients with burns older than 24-72 hours or crush injuries
Succinylcholine causes hyperkalemia via upregulated acetylcholine receptors in burn injuries older than 24-72 hours, crush injuries, and denervation injuries.
CFRN Advanced Airway Management 2
During a flight transport, a patient's endotracheal tube cuff pressure should be maintained at what range to prevent tracheal mucosal ischemia?