NBCRNA Airway Management 2 — Questions and Answers
Question 1: Cricoid pressure (Sellick maneuver) is applied during RSI to do what?
- Compress the esophagus against the cervical spine to reduce passive regurgitation (Correct answer)
- Improve laryngoscopic view by displacing the larynx
- Prevent laryngospasm during intubation
- Reduce bleeding during nasotracheal intubation
Correct answer: Compress the esophagus against the cervical spine to reduce passive regurgitation
Cricoid pressure applies backward force on the cricoid cartilage to compress the esophagus, theoretically reducing the risk of passive regurgitation of gastric contents during RSI.
Question 2: When confirming endotracheal tube placement, which is considered the gold standard method?
- Continuous waveform capnography (Correct answer)
- Bilateral breath sounds on auscultation
- Chest rise visualization
- Negative bulb aspiration test
Correct answer: Continuous waveform capnography
Continuous waveform capnography is the gold standard for confirming ETT placement because it provides real-time evidence of CO2 being exhaled from the lungs, which cannot occur with esophageal intubation.
Question 3: Laryngospasm occurs when glottic and supraglottic muscles contract in response to a stimulus; the initial treatment is:
- Positive pressure with 100% O2 and jaw thrust, followed by succinylcholine if unresolved (Correct answer)
- Immediate succinylcholine administration
- Deep extubation to prevent stimulation
- Direct laryngoscopy and suction
Correct answer: Positive pressure with 100% O2 and jaw thrust, followed by succinylcholine if unresolved
Partial laryngospasm is treated with sustained CPAP and jaw thrust; if complete laryngospasm causes desaturation, succinylcholine (0.1–1 mg/kg) rapidly breaks the spasm.
Question 4: High-flow nasal cannula (HFNC) used during preoxygenation before RSI provides apneic oxygenation by what mechanism?
- Delivering continuous oxygen flow to maintain FRC oxygen reservoir during apnea (Correct answer)
- Providing PEEP equivalent to 5 cmH2O
- Washing out nitrogen from alveoli faster than standard NC
- Reducing upper airway resistance during bag-mask ventilation
Correct answer: Delivering continuous oxygen flow to maintain FRC oxygen reservoir during apnea
HFNC delivers up to 70 L/min of oxygen, which diffuses from the pharynx to alveoli during apnea (apneic oxygenation), extending safe apnea time significantly.
Question 5: Which anatomical feature makes nasotracheal intubation contraindicated in patients with basilar skull fractures?
- Risk of intracranial placement through cribriform plate defects (Correct answer)
- Increased bleeding from nasal vascularity
- Posterior pharyngeal wall injury
- Nasal polyp disruption causing airway edema
Correct answer: Risk of intracranial placement through cribriform plate defects
Basilar skull fractures can disrupt the cribriform plate, creating a potential path for a nasal tube to enter the cranial vault rather than the trachea.
Question 6: During video laryngoscopy with a hyperangulated blade, a good glottic view is obtained but intubation fails. The most common reason is:
- Difficulty advancing tube around the acute angle of the blade (Correct answer)
- Fogging of the camera lens
- Inadequate muscle relaxation
- Excessive cricoid pressure
Correct answer: Difficulty advancing tube around the acute angle of the blade
Hyperangulated video laryngoscope blades provide excellent views but require a pre-shaped stylet and specific insertion technique; the angle that improves the view also makes tube advancement difficult.
NBCRNA Airway Management 2
Cricoid pressure (Sellick maneuver) is applied during RSI to do what?