TNCC Airway Management 2 — Questions and Answers
Question 1: Which anatomical landmark is used to confirm correct endotracheal tube placement above the carina?
- Angle of Louis
- Cricoid cartilage
- Carina at T4-T5 (Correct answer)
- Hyoid bone
Correct answer: Carina at T4-T5
The carina, located at the level of T4-T5, is the bifurcation point; the ETT tip should rest 2-3 cm above it.
Question 2: A trauma patient has a suspected cervical spine injury and requires intubation. Which technique best maintains spinal immobilization?
- Blind nasotracheal intubation
- Video laryngoscopy with manual in-line stabilization (Correct answer)
- Cricothyrotomy without stabilization
- Hyperextension of the neck for direct laryngoscopy
Correct answer: Video laryngoscopy with manual in-line stabilization
Video laryngoscopy combined with manual in-line stabilization allows intubation while minimizing cervical spine movement.
Question 3: What is the primary indication for performing a needle cricothyrotomy in a trauma patient?
- Confirmed tracheal transection
- Cannot intubate, cannot oxygenate scenario with no other airway access (Correct answer)
- Prophylactic airway in facial trauma
- Failed nasotracheal intubation on first attempt
Correct answer: Cannot intubate, cannot oxygenate scenario with no other airway access
Needle cricothyrotomy is a rescue technique reserved for the 'can't intubate, can't oxygenate' emergency when other airway methods have failed.
Question 4: Which waveform capnography finding most reliably confirms endotracheal tube placement in the trachea?
- SpO2 >95% after intubation
- Bilateral breath sounds on auscultation
- Persistent rectangular CO2 waveform over multiple breaths (Correct answer)
- Chest rise visible with ventilation
Correct answer: Persistent rectangular CO2 waveform over multiple breaths
A consistent rectangular capnography waveform across multiple ventilations is the gold standard for confirming tracheal intubation.
Question 5: A patient with a stab wound to the neck presents with subcutaneous emphysema and stridor. The MOST appropriate initial airway intervention is:
- High-flow oxygen via non-rebreather mask and observation
- Early definitive airway before edema occludes the airway (Correct answer)
- Immediate tracheostomy by the nurse
- Needle decompression of the neck
Correct answer: Early definitive airway before edema occludes the airway
Expanding neck hematoma or tracheal injury can rapidly occlude the airway; early definitive airway securement is critical before complete obstruction occurs.
Question 6: When using the LEMON mnemonic to predict difficult intubation, what does the 'E' stand for?
- Edema assessment
- Evaluate the 3-3-2 rule (Correct answer)
- Extrinsic airway obstruction
- Extent of airway trauma
Correct answer: Evaluate the 3-3-2 rule
In the LEMON mnemonic, 'E' stands for Evaluate the 3-3-2 rule assessing mouth opening, hyomental distance, and thyromental distance.
Question 7: Rapid sequence intubation (RSI) in trauma includes a defasciculating dose of a non-depolarizing agent before succinylcholine primarily to:
- Prevent bradycardia from succinylcholine
- Reduce muscle fasciculations that may elevate intracranial pressure (Correct answer)
- Increase duration of paralysis
- Reverse succinylcholine if intubation fails
Correct answer: Reduce muscle fasciculations that may elevate intracranial pressure
A small defasciculating dose of a non-depolarizing agent blunts succinylcholine-induced fasciculations, which can transiently raise intracranial and intraocular pressure.
TNCC Airway Management 2
Which anatomical landmark is used to confirm correct endotracheal tube placement above the carina?