ACLS ACLS Airway Management 2 — Questions and Answers
Question 1: Which of the following is a contraindication to nasopharyngeal airway insertion?
- Suspected basilar skull fracture (Correct answer)
- Patient is unconscious
- Patient has no gag reflex
- Oropharyngeal airway cannot be tolerated
Correct answer: Suspected basilar skull fracture
A suspected basilar skull fracture is a contraindication to NPA insertion due to the risk of intracranial placement through a cribriform plate fracture.
Question 2: In a patient with a cardiac arrest, a sudden rise in PETCO2 to 35–40 mmHg during CPR most likely indicates:
- Return of spontaneous circulation (ROSC) (Correct answer)
- Hyperventilation by the rescuer
- Correct ETT placement confirmed
- Metabolic alkalosis developing
Correct answer: Return of spontaneous circulation (ROSC)
A sudden significant rise in PETCO2 during CPR is a reliable indicator of ROSC, reflecting restored cardiac output and pulmonary blood flow.
Question 3: What is the appropriate action if PETCO2 is persistently below 10 mmHg after 20 minutes of CPR in an adult?
- Consider terminating resuscitation efforts (Correct answer)
- Increase ventilation rate to 20 breaths/min
- Administer sodium bicarbonate immediately
- Switch to mouth-to-mouth ventilation
Correct answer: Consider terminating resuscitation efforts
A persistently low PETCO2 (<10 mmHg) after 20 minutes of CPR indicates poor prognosis and may support a decision to terminate resuscitative efforts.
Question 4: During CPR, which action should be avoided to prevent hyperventilation?
- Delivering breaths faster than 10 per minute with an advanced airway (Correct answer)
- Using bag-mask ventilation with two rescuers
- Waiting for visible chest fall before next breath
- Maintaining a 30:2 compression-to-ventilation ratio without an advanced airway
Correct answer: Delivering breaths faster than 10 per minute with an advanced airway
Hyperventilation increases intrathoracic pressure, reduces venous return, and decreases cardiac output; ventilation rates above 10/min with an advanced airway should be avoided.
Question 5: The cricoid pressure (Sellick maneuver) during intubation is currently:
- Not routinely recommended as it may worsen laryngeal view (Correct answer)
- Mandatory for all emergency intubations per AHA guidelines
- Required only in pediatric patients
- Proven to prevent aspiration in all patients
Correct answer: Not routinely recommended as it may worsen laryngeal view
Routine cricoid pressure is not recommended because evidence shows it may impair laryngeal visualization and does not reliably prevent aspiration.
Question 6: Which of the following best describes the two-thumb encircling technique during bag-mask ventilation?
- It is preferred over the C-E clamp in two-rescuer CPR for better mask seal (Correct answer)
- It is used only for advanced airway insertion
- It is the standard single-rescuer ventilation method
- It is only indicated in pediatric patients under 1 year
Correct answer: It is preferred over the C-E clamp in two-rescuer CPR for better mask seal
The two-thumb encircling technique provides a superior mask seal and is the preferred method when two rescuers are available to manage the airway.
ACLS ACLS Airway Management 2
Which of the following is a contraindication to nasopharyngeal airway insertion?