CFRN Advanced Airway Management 4 — Questions and Answers
Question 1: A CFRN is preparing to intubate an obese patient. What positioning modification is most beneficial for preoxygenation and intubation success?
- Flat supine position with head ring
- Reverse Trendelenburg or ramped position with ear-to-sternal notch alignment (Correct answer)
- Left lateral decubitus position
- Prone position with towel under chest
Correct 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.
Question 2: During intubation of a patient in anaphylaxis, which finding of the airway is MOST concerning and warrants immediate surgical airway consideration?
- Mild tongue edema
- Cherry-red epiglottis with complete supraglottic edema obliterating the glottis (Correct answer)
- Mild secretions pooling in the oropharynx
- Uvular edema only
Correct 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.
Question 3: Rocuronium is selected over succinylcholine for RSI in a flight patient. What dose of rocuronium achieves intubating conditions comparable to succinylcholine?
- 0.6 mg/kg IV
- 1.0 mg/kg IV
- 1.2 mg/kg IV (Correct answer)
- 1.6 mg/kg IV
Correct 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.
Question 4: A CFRN confirms ETT placement with waveform capnography but SpO2 remains at 88% despite FiO2 of 100%. What is the most likely cause?
- Esophageal intubation
- Right mainstem intubation
- Equipment calibration error
- Carbon monoxide poisoning causing falsely elevated SpO2 (Correct answer)
Correct 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.
Question 5: In a patient with increased intracranial pressure requiring intubation, which induction agent is CONTRAINDICATED due to its potential to increase ICP?
- Etomidate
- Propofol
- Ketamine (traditional concern) (Correct answer)
- Midazolam
Correct 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.
Question 6: 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:
- Orotracheal intubation immediately
- Attempt to replace the tracheostomy tube through the stoma (Correct answer)
- Cover the stoma and apply BVM to the mouth
- Insert a nasopharyngeal airway into the stoma
Correct 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.
Question 7: What is the purpose of applying cricoid pressure (Sellick's maneuver) during RSI?
- To improve visualization of the glottis
- To occlude the esophagus and reduce the risk of passive regurgitation (Correct answer)
- To stabilize the larynx for intubation
- To facilitate jaw thrust in trauma patients
Correct 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.
CFRN Advanced Airway Management 4
A CFRN is preparing to intubate an obese patient.
What positioning modification is most beneficial for preoxygenation and intubation success?