EDAIC Airway Management 4 — Questions and Answers
Question 1: Which videolaryngoscope blade geometry provides the best glottic view in a patient with limited mouth opening (<25 mm)?
- Macintosh-geometry blade (e.g., C-MAC D-Blade)
- Hyperangulated blade (e.g., GlideScope LoPro) (Correct answer)
- Standard Macintosh direct laryngoscope
- Miller straight blade
Correct answer: Hyperangulated blade (e.g., GlideScope LoPro)
Hyperangulated blades require less mouth opening and achieve superior glottic views in restricted-aperture scenarios compared to Macintosh-geometry videolaryngoscope blades.
Question 2: In the 'can't intubate, can't oxygenate' (CICO) scenario, what is the recommended first-line surgical airway technique according to DAS guidelines?
- Percutaneous dilatational tracheostomy
- Scalpel-finger-bougie cricothyroidotomy (Correct answer)
- Needle cricothyroidotomy with jet ventilation
- Retrograde intubation over a guide wire
Correct answer: Scalpel-finger-bougie cricothyroidotomy
The scalpel-finger-bougie technique is the DAS-recommended first-line approach for surgical airway in CICO because it is fast, reliable, and minimizes failed attempts compared to needle or percutaneous methods.
Question 3: A patient undergoing awake fibreoptic intubation develops sudden apnoea after topical airway anaesthesia. What is the most likely cause?
- Laryngospasm from inadequate topicalisation
- Systemic absorption of lidocaine causing CNS toxicity (Correct answer)
- Bilateral recurrent laryngeal nerve block
- Vasovagal syncope from airway instrumentation
Correct answer: Systemic absorption of lidocaine causing CNS toxicity
Excessive systemic absorption of topical lidocaine, especially with high doses or mucosal inflammation, can cause CNS toxicity manifesting as seizures or apnoea.
Question 4: Which anatomical landmark defines the correct position for needle cricothyroidotomy?
- Inferior border of the thyroid cartilage in the midline
- Midpoint of the cricothyroid membrane in the midline (Correct answer)
- Superior border of the cricoid cartilage laterally
- Tracheal rings 2–3 below the cricoid
Correct answer: Midpoint of the cricothyroid membrane in the midline
The cricothyroid membrane lies between the thyroid and cricoid cartilages in the midline, and its midpoint is the target for needle or surgical cricothyroidotomy.
Question 5: During rapid sequence induction, which agent provides the fastest onset of complete neuromuscular blockade for intubating conditions?
- Rocuronium 0.6 mg/kg
- Vecuronium 0.1 mg/kg
- Succinylcholine 1.5 mg/kg (Correct answer)
- Cisatracurium 0.15 mg/kg
Correct answer: Succinylcholine 1.5 mg/kg
Succinylcholine 1.5 mg/kg achieves complete neuromuscular blockade within approximately 60 seconds, faster than any non-depolarising agent at standard doses.
Question 6: What is the primary purpose of applying a 'BURP' manoeuvre during direct laryngoscopy?
- Reduce aspiration risk by compressing the oesophagus
- Improve the laryngoscopic view by displacing the larynx posteriorly, superiorly, and to the right (Correct answer)
- Facilitate cricothyroidotomy landmark identification
- Prevent dental trauma by reducing jaw tension
Correct answer: Improve the laryngoscopic view by displacing the larynx posteriorly, superiorly, and to the right
BURP (Backward, Upward, Rightward Pressure) on the thyroid cartilage displaces the larynx to improve Cormack–Lehane grade and facilitate intubation.
Question 7: Which clinical sign best confirms correct tracheal tube placement after intubation?
- Symmetric chest wall rise bilaterally
- Misting inside the endotracheal tube
- Continuous waveform capnography showing CO₂ (Correct answer)
- Absence of gastric sounds on auscultation
Correct answer: Continuous waveform capnography showing CO₂
Continuous waveform capnography is the gold standard for confirming tracheal intubation, as it reliably distinguishes tracheal from oesophageal placement.
EDAIC Airway Management 4
Which videolaryngoscope blade geometry provides the best glottic view in a patient with limited mouth opening (<25 mm)?