CFRN Advanced Airway Management 3 — Questions and Answers
Question 1: A CFRN is preparing to perform cricothyrotomy. The cricothyroid membrane is located between which two structures?
- Thyroid cartilage superiorly and cricoid cartilage inferiorly (Correct answer)
- Cricoid cartilage superiorly and tracheal ring inferiorly
- Hyoid bone superiorly and thyroid cartilage inferiorly
- Arytenoid cartilage superiorly and cricoid cartilage inferiorly
Correct answer: Thyroid cartilage superiorly and cricoid cartilage inferiorly
The cricothyroid membrane lies between the thyroid cartilage superiorly and the cricoid cartilage inferiorly, and is the target for emergency surgical airway.
Question 2: Which ventilator setting should be adjusted first when a transport ventilator alarms for high peak airway pressure in a patient with bronchospasm?
- Increase PEEP
- Decrease respiratory rate and increase expiratory time (I:E ratio) (Correct answer)
- Increase tidal volume
- Switch to pressure control mode with higher PIP
Correct answer: Decrease respiratory rate and increase expiratory time (I:E ratio)
Decreasing respiratory rate and increasing expiratory time allows complete exhalation and prevents air trapping (auto-PEEP) in obstructive disease.
Question 3: A CFRN is transporting a head-injured patient requiring neuroprotective ventilation. What ETCO2 target is most appropriate?
- 25-30 mmHg
- 35-40 mmHg (Correct answer)
- 45-50 mmHg
- 50-55 mmHg
Correct answer: 35-40 mmHg
Normocapnia (ETCO2 35-40 mmHg) is the target for neuroprotective ventilation; hypocapnia causes cerebral vasoconstriction and worsens ischemia.
Question 4: During nasotracheal intubation in a spontaneously breathing patient, the CFRN hears peak airflow through the tube. What should be done at this moment?
- Pause and wait for the next breath
- Advance the tube rapidly during peak inspiratory airflow (Correct answer)
- Inflate the cuff immediately
- Rotate the tube 90 degrees
Correct answer: Advance the tube rapidly during peak inspiratory airflow
Advancing the tube during peak inspiratory flow maximizes the chance of passing the vocal cords as they are most widely abducted during inspiration.
Question 5: What is the primary advantage of using a supraglottic airway device (SGA) such as an LMA over endotracheal intubation in certain flight patients?
- It provides complete aspiration protection
- It can be inserted without direct visualization of the larynx and requires no neuromuscular blockade (Correct answer)
- It allows delivery of higher tidal volumes
- It is preferred in all trauma patients
Correct answer: It can be inserted without direct visualization of the larynx and requires no neuromuscular blockade
SGAs can be inserted blindly without laryngoscopy or neuromuscular blocking agents, making them valuable rescue airways or when intubation is not feasible.
Question 6: A transport patient receiving positive pressure ventilation develops hypotension, tachycardia, and decreased breath sounds on the right. The CFRN should immediately perform:
- 12-lead ECG
- Needle decompression of the right chest at the 2nd intercostal space, midclavicular line (Correct answer)
- Fluid bolus of 1L normal saline
- Increase FiO2 to 100%
Correct answer: Needle decompression of the right chest at the 2nd intercostal space, midclavicular line
These signs indicate right-sided tension pneumothorax in a ventilated patient, requiring immediate needle decompression.
Question 7: Which preoxygenation technique is MOST effective for extending safe apnea time before RSI in the transport environment?
- Bag-valve-mask ventilation at 10 L/min for 60 seconds
- High-flow nasal cannula at 15 L/min combined with non-rebreather mask (Correct answer)
- Simple face mask at 6 L/min for 3 minutes
- Two-person BVM ventilation with PEEP valve
Correct answer: High-flow nasal cannula at 15 L/min combined with non-rebreather mask
Combining high-flow nasal cannula with a non-rebreather mask achieves near-100% denitrogenation of the FRC, maximizing oxygen reserve before apnea.
CFRN Advanced Airway Management 3
A CFRN is preparing to perform cricothyrotomy.
The cricothyroid membrane is located between which two structures?