COPR Airway Management and Respiratory Emergencies 2 — Questions and Answers
Question 1: Which laryngoscope blade is most appropriate for a patient with a suspected anterior (anterior larynx) and with an omega-shaped epiglottis?
- Miller (straight) blade (Correct answer)
- Macintosh (curved) blade
- McCoy blade
- Wis-Hipple blade
Correct answer: Miller (straight) blade
The Miller straight blade is preferred for patients with an anterior airway or a floppy omega-shaped epiglottis because it directly lifts the epiglottis to expose the cords.
Question 2: You are ventilating a patient with a BVM and notice gastric distension developing. What is the BEST intervention to reduce aspiration risk while continuing ventilation?
- Apply cricoid pressure (Sellick maneuver) (Correct answer)
- Increase ventilation rate to prevent hypoventilation
- Switch to mouth-to-mask ventilation
- Insert a gastric tube immediately
Correct answer: Apply cricoid pressure (Sellick maneuver)
Cricoid pressure compresses the esophagus against the cervical vertebrae, reducing passive regurgitation during BVM ventilation when airway is not secured.
Question 3: A patient with suspected anaphylaxis presents with stridor, hoarse voice, and rapidly developing angioedema. What airway management approach is MOST appropriate?
- Administer high-flow oxygen and wait for epinephrine to take effect before intubation
- Perform rapid sequence intubation (RSI) early before the airway completely obstructs (Correct answer)
- Apply a supraglottic airway as a definitive airway
- Perform immediate cricothyrotomy as the first airway intervention
Correct answer: Perform rapid sequence intubation (RSI) early before the airway completely obstructs
Early RSI is indicated because angioedema can rapidly progress to complete obstruction, making intubation impossible and surgical airway the only option if delayed.
Question 4: Which of the following is the MOST appropriate initial approach to managing a pediatric patient with croup (laryngotracheobronchitis) exhibiting moderate respiratory distress?
- Immediate oral endotracheal intubation
- Nebulized epinephrine and corticosteroids (Correct answer)
- Assisted ventilation with BVM
- Needle cricothyrotomy
Correct answer: Nebulized epinephrine and corticosteroids
Nebulized epinephrine reduces subglottic edema and corticosteroids reduce airway inflammation, making them first-line treatment for moderate croup.
Question 5: During RSI, succinylcholine is contraindicated in which of the following clinical situations?
- Open globe eye injury within the last 24 hours
- Patient with a history of malignant hyperthermia or crush injury (Correct answer)
- Patient in cardiac arrest requiring intubation
- Patient with known difficult airway
Correct answer: Patient with a history of malignant hyperthermia or crush injury
Succinylcholine is contraindicated in crush injuries (hyperkalemia risk causing cardiac arrest) and in patients with or at risk for malignant hyperthermia due to potentially fatal muscle rigidity.
Question 6: A patient presents with sudden onset pleuritic chest pain and dyspnea after a long flight. SpO2 is 91%, heart rate 118, respiratory rate 24. Lung sounds are clear bilaterally. What is the MOST likely diagnosis?
- Spontaneous pneumothorax
- Pulmonary embolism (Correct answer)
- Acute coronary syndrome
- Pleural effusion
Correct answer: Pulmonary embolism
Prolonged immobility (long flight), sudden pleuritic chest pain, tachycardia, tachypnea, hypoxia with clear lungs, and no trauma strongly suggests pulmonary embolism.
Question 7: What is the MOST important consideration when using a King LT (supraglottic airway) as a rescue airway device?
- It should be inflated with the maximum volume listed on the device
- It does not protect against aspiration in a patient with a full stomach (Correct answer)
- It provides better ventilation than endotracheal intubation
- It should only be used in cardiac arrest patients
Correct answer: It does not protect against aspiration in a patient with a full stomach
Supraglottic airways like the King LT do not provide the same protection against aspiration as a cuffed endotracheal tube, which is critical to recognize in patients at risk.
COPR Airway Management and Respiratory Emergencies 2
Which laryngoscope blade is most appropriate for a patient with a suspected anterior (anterior larynx) and with an omega-shaped epiglottis?