CRNA CRNA Airway Management 1 — Questions and Answers
Question 1: According to the ASA Difficult Airway Algorithm, what is the first step after recognizing a 'cannot intubate, cannot oxygenate' (CICO) emergency?
- Emergency surgical airway (cricothyrotomy) (Correct answer)
- Attempt blind nasal intubation
- Administer additional muscle relaxant
- Insert a supraglottic airway device
Correct answer: Emergency surgical airway (cricothyrotomy)
In a CICO situation, the ASA algorithm mandates an immediate emergency invasive airway (cricothyrotomy) to establish oxygenation and prevent brain damage.
Question 2: Which Cormack-Lehane grade indicates the most difficult direct laryngoscopy, with only the posterior commissure or no laryngeal structures visible?
- Grade III–IV (Correct answer)
- Grade I
- Grade II
- Grade IIa
Correct answer: Grade III–IV
Cormack-Lehane Grades III (only epiglottis visible) and IV (no laryngeal structures visible) indicate the most difficult direct laryngoscopic views.
Question 3: What is the recommended preoxygenation target end-tidal O2 (EtO2) percentage before rapid sequence intubation (RSI)?
- ≥90% (Correct answer)
- ≥70%
- ≥50%
- ≥80%
Correct answer: ≥90%
Preoxygenation to EtO2 ≥90% (replacing nitrogen with oxygen in the FRC) provides maximum apneic reserve time during RSI.
Question 4: A patient with epiglottitis requires intubation. Which approach is preferred to avoid complete airway obstruction?
- Awake fiberoptic intubation (Correct answer)
- Rapid sequence induction
- Blind nasotracheal intubation
- Direct laryngoscopy after inhalation induction
Correct answer: Awake fiberoptic intubation
Awake fiberoptic intubation preserves spontaneous ventilation and allows continuous assessment of the airway, preventing loss of the airway during instrumentation.
Question 5: What is the primary advantage of video laryngoscopy over direct laryngoscopy for difficult airway management?
- Improved glottic visualization without requiring line-of-sight alignment (Correct answer)
- Faster intubation time in all cases
- Elimination of the need for a stylet
- Reduced risk of dental injury in all patients
Correct answer: Improved glottic visualization without requiring line-of-sight alignment
Video laryngoscopy uses an angulated blade with a camera, allowing visualization of the glottis without requiring oral-pharyngeal-laryngeal axis alignment.
Question 6: Which finding on capnography most reliably confirms correct endotracheal tube placement?
- Persistent end-tidal CO2 waveform over multiple breaths (Correct answer)
- Positive mist in the ETT
- Bilateral chest rise during ventilation
- Oxygen saturation above 95%
Correct answer: Persistent end-tidal CO2 waveform over multiple breaths
A persistent, consistent end-tidal CO2 waveform over 4–6 breaths is the gold standard for confirming tracheal placement, as esophageal intubation cannot sustain CO2 production.
CRNA CRNA Airway Management 1
According to the ASA Difficult Airway Algorithm, what is the first step after recognizing a 'cannot intubate, cannot oxygenate' (CICO) emergency?