TNCC - Trauma Nurse Core Curriculum Airway and Ventilation Management Questions and Answers 1 — Questions and Answers
Question 1: A trauma patient with a significant inhalation injury, facial burns, and carbonaceous sputum is becoming increasingly agitated and hoarse. Oxygen saturation is currently 92% on a non-rebreather mask. Which of the following is the most appropriate immediate action?
- Continue to monitor the patient's respiratory status closely.
- Administer a sedative to calm the patient's agitation.
- Prepare for and facilitate early endotracheal intubation. (Correct answer)
- Apply a continuous positive airway pressure (CPAP) mask.
Correct answer: Prepare for and facilitate early endotracheal intubation.
This patient shows signs of impending airway compromise due to inhalation injury and associated edema. Hoarseness, agitation (a sign of hypoxia), and facial burns are critical indicators. A definitive airway via endotracheal intubation should be established proactively before complete obstruction occurs, which can happen rapidly.
Question 2: When assessing a trauma patient's airway, which maneuver is recommended to open the airway when a cervical spine injury is suspected?
- Head-tilt, chin-lift
- Jaw-thrust maneuver (Correct answer)
- Flexion of the neck
- Placement of an oropharyngeal airway without positioning
Correct answer: Jaw-thrust maneuver
In patients with a suspected cervical spine injury, the jaw-thrust maneuver is the recommended technique to open the airway. This method minimizes movement of the cervical spine, unlike the head-tilt, chin-lift maneuver, which involves neck extension and is contraindicated.
Question 3: A trauma nurse is caring for an intubated and ventilated patient. A sudden drop in the end-tidal CO2 (ETCO2) reading to a near-zero value is observed. What is the most likely cause?
- Hypoventilation
- Dislodged endotracheal tube (Correct answer)
- Malignant hyperthermia
- Increased cardiac output
Correct answer: Dislodged endotracheal tube
A sudden and significant drop in the ETCO2 reading to near zero in an intubated patient is a critical alarm, most commonly indicating that the endotracheal tube is no longer in the trachea (e.g., esophageal intubation or displacement). This constitutes a complete loss of ventilation and requires immediate assessment and intervention. Other causes, such as a massive pulmonary embolism or cardiac arrest, can also cause a drop, but tube displacement is the most immediate and correctable cause to rule out.
Question 4: Which of the following is a definitive indication for endotracheal intubation in an adult trauma patient?
- A respiratory rate of 24 breaths per minute
- The presence of a simple rib fracture
- A Glasgow Coma Scale (GCS) score of 7 (Correct answer)
- An oxygen saturation of 95% on room air
Correct answer: A Glasgow Coma Scale (GCS) score of 7
A Glasgow Coma Scale (GCS) score of 8 or less is a widely accepted indication for establishing a definitive airway. Patients with such a low GCS are considered unable to protect their own airway from aspiration, increasing the risk of significant morbidity and mortality.
Question 5: A patient arrives after a motor vehicle crash with significant maxillofacial trauma, making oral intubation difficult. The patient is apneic. If endotracheal intubation attempts are unsuccessful, what is the next appropriate step in securing an airway?
- Perform a blind nasotracheal intubation.
- Ventilate with a bag-valve-mask until an anesthesiologist arrives.
- Insert a supraglottic airway device. (Correct answer)
- Wait for the patient's breathing to resume spontaneously.
Correct answer: Insert a supraglottic airway device.
In a 'can't intubate, can't oxygenate' scenario, or when intubation is unsuccessful, placing a rescue airway such as a supraglottic airway (e.g., LMA, King LT) is a critical next step. These devices can often be placed quickly and provide effective ventilation until a definitive surgical airway can be established if needed. Blind nasotracheal intubation is contraindicated in patients with significant facial trauma.
Question 6: When initiating mechanical ventilation for a trauma patient with suspected Acute Respiratory Distress Syndrome (ARDS), which strategy is most appropriate to prevent further lung injury?
- High tidal volumes and high respiratory rates.
- Low tidal volumes and high PEEP. (Correct answer)
- High FiO2 and minimal PEEP.
- Low respiratory rates and high tidal volumes.
Correct answer: Low tidal volumes and high PEEP.
For patients with or at risk for ARDS, a lung-protective ventilation strategy is recommended. This involves using low tidal volumes (e.g., 4-6 mL/kg of ideal body weight) to prevent volutrauma, and appropriate levels of Positive End-Expiratory Pressure (PEEP) to prevent atelectrauma by keeping alveoli open. The goal is to maintain adequate oxygenation while minimizing ventilator-induced lung injury.
TNCC - Trauma Nurse Core Curriculum Airway and Ventilation Management Questions and Answers 1
A trauma patient with a significant inhalation injury, facial burns, and carbonaceous sputum is becoming increasingly agitated and hoarse.
Oxygen saturation is currently 92% on a non-rebreather mask.
Which of the following is the most appropriate immediate action?