CFRN Advanced Airway Management 5 — Questions and Answers
Question 1: During high-altitude transport, a mechanically ventilated patient's tidal volume delivered by a flow-triggered transport ventilator increases unexpectedly. What is the most likely cause?
- Increased airway resistance from bronchospasm
- Decreased ambient pressure causing the ventilator to deliver more volume to achieve set pressure (Correct answer)
- Right mainstem intubation
- Increased lung compliance
Correct answer: Decreased ambient pressure causing the ventilator to deliver more volume to achieve set pressure
In pressure-controlled modes, lower ambient pressure at altitude means the ventilator delivers more volume to achieve the set driving pressure, potentially causing volutrauma.
Question 2: A CFRN is caring for a patient with a suspected C-spine injury who needs emergent intubation. Which technique is MOST appropriate?
- Blind nasotracheal intubation without cervical precautions
- Video laryngoscopy with manual inline stabilization (MILS) (Correct answer)
- Flexion-extension views before any airway intervention
- Avoid intubation until CT confirms injury
Correct answer: Video laryngoscopy with manual inline stabilization (MILS)
Video laryngoscopy with manual inline stabilization (MILS) provides improved glottic view with minimal cervical spine movement, balancing airway management with C-spine protection.
Question 3: Which sign is the MOST reliable bedside indicator that a King LT or Combitube supraglottic airway is seated in the esophagus (correct position)?
- Chest rise with ventilation
- Positive waveform capnography with each breath (Correct answer)
- Bilateral equal breath sounds
- Absence of abdominal distension
Correct answer: Positive waveform capnography with each breath
Positive waveform capnography confirming CO2 with each breath is the most reliable indicator of ventilation through a correctly positioned supraglottic airway.
Question 4: A CFRN is transporting a pediatric patient who was submerged in cold water. The patient is unconscious with no gag reflex. What is the FIRST priority?
- Place a nasogastric tube to decompress the stomach
- Establish definitive airway control with RSI and orotracheal intubation (Correct answer)
- Administer epinephrine IV
- Place bilateral chest tubes prophylactically
Correct answer: Establish definitive airway control with RSI and orotracheal intubation
An unconscious drowning victim with no protective reflexes requires immediate definitive airway management to protect against aspiration and ensure adequate oxygenation.
Question 5: When using a Macintosh laryngoscope blade, the tip of the blade is correctly positioned in which anatomical structure to elevate the epiglottis?
- Posterior pharynx
- Vallecula (between base of tongue and epiglottis) (Correct answer)
- Directly under the epiglottis
- Right pyriform sinus
Correct answer: Vallecula (between base of tongue and epiglottis)
The Macintosh blade tip is placed in the vallecula; lifting the blade anteriorly creates tension on the hyoepiglottic ligament, indirectly elevating the epiglottis.
Question 6: A flight patient post-RSI develops a 'shark fin' or upsloping waveform on capnography. This pattern is MOST consistent with:
- Correct ETT placement with normal physiology
- Obstructive disease (bronchospasm or COPD exacerbation) causing incomplete exhalation (Correct answer)
- Esophageal intubation
- Apnea with inadequate ventilator rate
Correct answer: Obstructive disease (bronchospasm or COPD exacerbation) causing incomplete exhalation
A 'shark fin' or upsloping capnography waveform reflects incomplete exhalation due to airflow obstruction, as seen in bronchospasm or COPD.
Question 7: A CFRN is managing a patient with Ludwig's angina requiring airway intervention. Why is awake fiberoptic intubation (AFOI) preferred over RSI in this patient?
- AFOI does not require any sedation or analgesia
- Paralysis from RSI may cause complete airway collapse in a patient whose airway is maintained by muscle tone (Correct answer)
- RSI agents are contraindicated in infection
- AFOI is faster than RSI in emergencies
Correct answer: Paralysis from RSI may cause complete airway collapse in a patient whose airway is maintained by muscle tone
In Ludwig's angina, muscle tone and patient positioning may be maintaining a partially obstructed airway; paralysis can cause total airway collapse making ventilation and intubation impossible.
CFRN Advanced Airway Management 5
During high-altitude transport, a mechanically ventilated patient's tidal volume delivered by a flow-triggered transport ventilator increases unexpectedly.
What is the most likely cause?