TNCC Airway Management 3 — Questions and Answers
Question 1: In a trauma patient with a Glasgow Coma Scale (GCS) score of 8, which airway management approach is generally indicated?
- Simple repositioning and oral airway adjunct
- Definitive airway via endotracheal intubation (Correct answer)
- Nasal cannula oxygen and monitoring
- Supraglottic airway as the sole long-term device
Correct answer: Definitive airway via endotracheal intubation
A GCS ≤8 indicates inability to protect the airway, making definitive airway management via endotracheal intubation the standard of care.
Question 2: Which sign during bag-valve-mask (BVM) ventilation suggests significant gastric insufflation?
- Increasing peak airway pressure
- Visible epigastric distension and regurgitation risk (Correct answer)
- Decreased SpO2 despite ventilation
- Bilateral symmetric chest rise
Correct answer: Visible epigastric distension and regurgitation risk
Epigastric distension during BVM ventilation indicates air is entering the stomach, significantly increasing aspiration risk.
Question 3: When performing BVM ventilation in an apneic trauma patient, the recommended tidal volume is approximately:
- 10-15 mL/kg
- 500-600 mL or enough to produce visible chest rise (Correct answer)
- 1,000 mL to ensure oxygenation
- 250 mL at high frequency
Correct answer: 500-600 mL or enough to produce visible chest rise
Current guidelines recommend 500-600 mL tidal volumes (visible chest rise) during BVM to reduce gastric insufflation while maintaining adequate oxygenation.
Question 4: A trauma patient requiring airway management has a known allergy to succinylcholine. The most appropriate alternative paralytic for RSI is:
- Vecuronium 0.1 mg/kg
- Rocuronium 1.2 mg/kg (Correct answer)
- Pancuronium 0.1 mg/kg
- Atracurium 0.5 mg/kg
Correct answer: Rocuronium 1.2 mg/kg
High-dose rocuronium (1.2 mg/kg) provides intubating conditions comparable to succinylcholine and is the preferred alternative in RSI when succinylcholine is contraindicated.
Question 5: Which finding on chest X-ray after intubation indicates right mainstem bronchus intubation?
- ETT tip at the level of the clavicles
- Left lung atelectasis with right lung hyperexpansion (Correct answer)
- Bilateral opacification of lung fields
- Gastric bubble visible under the diaphragm
Correct answer: Left lung atelectasis with right lung hyperexpansion
Right mainstem intubation selectively ventilates the right lung, causing left lung atelectasis and relative right lung hyperinflation on chest X-ray.
Question 6: Sellick's maneuver (cricoid pressure) during RSI is applied to:
- Open the vocal cords for visualization
- Reduce passive regurgitation and aspiration risk (Correct answer)
- Stabilize the larynx for needle cricothyrotomy
- Increase oxygen reserve during pre-oxygenation
Correct answer: Reduce passive regurgitation and aspiration risk
Cricoid pressure compresses the esophagus against the vertebral body, reducing passive regurgitation during the apneic period of RSI.
Question 7: Which supraglottic airway device is considered a RESCUE device but NOT a definitive airway in the TNCC framework?
- Cuffed endotracheal tube
- King LT or LMA (Correct answer)
- Surgical cricothyrotomy tube
- Nasotracheal tube with cuff
Correct answer: King LT or LMA
Supraglottic airways like the King LT or LMA provide temporary ventilation but do not protect against aspiration and are not considered definitive airways.
TNCC Airway Management 3
In a trauma patient with a Glasgow Coma Scale (GCS) score of 8, which airway management approach is generally indicated?