CPR Advanced Airway Management 3 — Questions and Answers
Question 1: Which device is considered the gold standard for confirming endotracheal tube placement in the prehospital setting?
- Chest auscultation
- Colorimetric CO2 detector
- Continuous waveform capnography (Correct answer)
- Chest rise assessment
Correct answer: Continuous waveform capnography
Continuous waveform capnography is the gold standard for confirming and monitoring ETT placement, providing real-time CO2 waveforms.
Question 2: A King LT supraglottic airway is inserted, and you are unable to ventilate. What is the most likely cause?
- The cuffs are overinflated
- The tube was inserted too shallowly (Correct answer)
- The patient's glottis is in spasm
- The tube was inserted into the trachea
Correct answer: The tube was inserted too shallowly
Shallow insertion of the King LT positions the distal cuff above the glottis rather than in the esophagus, obstructing ventilation.
Question 3: Which medication used in RSI is contraindicated in patients with burns covering more than 10% BSA, crush injuries, or prolonged immobilization?
- Etomidate
- Ketamine
- Succinylcholine (Correct answer)
- Midazolam
Correct answer: Succinylcholine
Succinylcholine causes massive potassium release via upregulated acetylcholine receptors in denervated/damaged muscle, risking lethal hyperkalemia.
Question 4: During needle cricothyrotomy, the needle is inserted through the cricothyroid membrane and angled:
- 90 degrees perpendicular to the skin
- 45 degrees cephalad (toward the head)
- 45 degrees caudad (toward the feet) (Correct answer)
- Parallel to the skin horizontally
Correct answer: 45 degrees caudad (toward the feet)
The needle is angled 45 degrees caudally (toward the feet) to direct it into the tracheal lumen and avoid the vocal cords.
Question 5: A patient in cardiac arrest has an LMA in place. During CPR, you notice gastric contents in the LMA tube. You should:
- Continue CPR and suction the LMA in place
- Remove the LMA and insert an ETT after pre-oxygenation (Correct answer)
- Leave the LMA and increase ventilation rate
- Apply more cricoid pressure
Correct answer: Remove the LMA and insert an ETT after pre-oxygenation
Regurgitation through an LMA indicates inadequate airway protection; the LMA should be removed and a definitive airway (ETT) established.
Question 6: Which of the following is an absolute contraindication to nasotracheal intubation?
- Suspected cervical spine injury
- Suspected basilar skull fracture (Correct answer)
- Active upper GI bleed
- Facial hair obscuring landmarks
Correct answer: Suspected basilar skull fracture
Basilar skull fracture is an absolute contraindication because the nasotracheal tube could enter the cranial vault through fractured structures.
Question 7: The BURP maneuver (Backward, Upward, Rightward Pressure) is used to:
- Reduce risk of aspiration during intubation
- Improve glottic visualization during laryngoscopy (Correct answer)
- Seat a King LT airway correctly
- Confirm ETT placement after intubation
Correct answer: Improve glottic visualization during laryngoscopy
BURP maneuver externally manipulates the larynx to bring the glottis into the laryngoscopist's line of sight, improving Cormack-Lehane grade.
CPR Advanced Airway Management 3
Which device is considered the gold standard for confirming endotracheal tube placement in the prehospital setting?