DCAS Airway Management & Intubation 1 — Questions and Answers
Question 1: The jaw-thrust manoeuvre is preferred over head-tilt/chin-lift in trauma patients because:
- It opens the airway without extending the cervical spine, reducing spinal injury risk (Correct answer)
- It is more effective at opening the airway in all situations
- It is easier to perform in the supine position
- It allows simultaneous mask ventilation by a single rescuer
Correct answer: It opens the airway without extending the cervical spine, reducing spinal injury risk
Jaw thrust displaces the mandible anteriorly to open the airway while maintaining cervical spine alignment, making it the preferred airway opening manoeuvre when spinal injury is suspected.
Question 2: The correct mask size for a bag-valve-mask (BVM) covers:
- From the bridge of the nose to the cleft of the chin, creating an airtight seal (Correct answer)
- From the nostrils to the upper lip only
- From the eyes to the chin
- From the forehead to below the mandible
Correct answer: From the bridge of the nose to the cleft of the chin, creating an airtight seal
The mask must create an airtight seal covering the nose and mouth, from the bridge of the nose above to the groove between lip and chin below, to deliver effective ventilation.
Question 3: An oropharyngeal airway (OPA) is contraindicated in:
- Conscious patients with intact gag reflex (Correct answer)
- Unconscious patients without a gag reflex
- All trauma patients
- Patients with dentures
Correct answer: Conscious patients with intact gag reflex
The OPA stimulates the gag reflex in conscious patients, causing vomiting, laryngospasm, and aspiration; it is appropriate only in unconscious patients who lack a protective gag reflex.
Question 4: The 'LEMON' assessment tool for predicting difficult intubation evaluates:
- Look externally, Evaluate 3-3-2, Mallampati score, Obstruction, Neck mobility (Correct answer)
- Length of the neck, Ear-to-mouth distance, Mouth opening, Obesity, Nasopharyngeal assessment
- Laryngeal position, Edema, Mandible shape, Oral access, Neck circumference
- Lip size, Epiglottis view, Muscle tone, Obesity, Nasal airway
Correct answer: Look externally, Evaluate 3-3-2, Mallampati score, Obstruction, Neck mobility
LEMON: Look externally (dysmorphic features, trauma), Evaluate 3-3-2 (mouth opening, hyoid to chin, floor of mouth to thyroid), Mallampati class (pharyngeal view), Obstruction (mass, haematoma), Neck mobility (restricted extension).
Question 5: Which laryngoscope blade type is typically used for direct laryngoscopy in pre-hospital intubation?
- Macintosh (curved) blade, with the tip in the vallecula, or Miller (straight) blade under the epiglottis (Correct answer)
- Only the straight Miller blade is used pre-hospital
- Spatula blade only in Dubai EMS
- Video laryngoscopes are never used pre-hospital
Correct answer: Macintosh (curved) blade, with the tip in the vallecula, or Miller (straight) blade under the epiglottis
Both Macintosh (curved, tip in vallecula) and Miller (straight, tip under epiglottis) blades are used; video laryngoscopes (GlideScope, McGrath) are increasingly recommended pre-hospital for improved glottic views.
Question 6: Confirmation of correct endotracheal tube placement requires:
- Waveform capnography plus clinical confirmation (chest rise, auscultation, mist in tube) (Correct answer)
- Auscultation alone
- Chest rise alone
- A single breath CO2 detector only
Correct answer: Waveform capnography plus clinical confirmation (chest rise, auscultation, mist in tube)
Gold standard confirmation requires waveform capnography (most reliable) combined with clinical signs; auscultation alone is insufficient as gastric tube placement can mimic breath sounds, especially in noisy environments.
DCAS Airway Management & Intubation 1
The jaw-thrust manoeuvre is preferred over head-tilt/chin-lift in trauma patients because: