ITLS - International Trauma Life Support Airway Management and Ventilation Questions and Answers

Question 1

A 34-year-old male has sustained a severe traumatic brain injury (TBI) and is intubated. According to ITLS guidelines, what is the target range for end-tidal CO2 (EtCO2) when ventilating this patient?

Accepted Answer

35-45 mmHg

Answer

ITLS guidelines recommend maintaining an end-tidal CO2 between 35-45 mmHg for most intubated trauma patients, including those with TBI. Hyperventilation (lower EtCO2) can cause cerebral vasoconstriction and subsequent hypoxia, which can worsen secondary brain injury. It is reserved only for brief periods in cases of active cerebral herniation.

Question 2

You are managing the airway of an unconscious adult trauma patient with a suspected cervical spine injury. Which of the following is the most appropriate initial manual maneuver to open the airway?

Accepted Answer

Jaw-thrust maneuver

Answer

In a trauma patient with a suspected cervical spine injury, the jaw-thrust maneuver is the recommended technique to open the airway. This method minimizes movement of the head and neck, unlike the head-tilt, chin-lift, which is contraindicated due to the risk of exacerbating a spinal injury.

Question 3

A patient involved in a high-speed MVC is unresponsive, apneic, and has significant maxillofacial trauma, making bag-mask ventilation and endotracheal intubation impossible. According to the ITLS Airway Algorithm, what is the next appropriate step?

Accepted Answer

Place a supraglottic airway (SGA)

Answer

In a 'Can't Intubate, Can't Ventilate' scenario, the ITLS algorithm prioritizes oxygenation. After failed intubation, the next step is to attempt placing a supraglottic airway (SGA) like an LMA. If the SGA placement fails or does not provide adequate ventilation, a surgical airway (cricothyrotomy) would then be indicated.

Question 4

Which of the following is the most reliable method for confirming the correct placement of an endotracheal tube in a trauma patient with a pulse?

Accepted Answer

Continuous waveform capnography

Answer

While auscultation, chest rise, and tube condensation are all used as indicators, continuous waveform capnography is the most reliable method to confirm and continuously monitor endotracheal tube placement. It provides a quantitative measure of exhaled CO2, confirming tracheal rather than esophageal placement.

Question 5

When ventilating a non-intubated adult trauma patient with a bag-valve-mask (BVM), which of the following actions is most critical to perform?

Accepted Answer

Ensure a good mask seal and deliver breaths over 1 second

Answer

Effective BVM ventilation requires a proper seal on the face and delivering each breath over 1 second, just enough to cause visible chest rise. This technique minimizes the risk of gastric insufflation, which can lead to vomiting and aspiration. Rapid or forceful ventilations increase the likelihood of air entering the stomach.

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Airway Management and Ventilation Questions and Answers