NRP Airway Management and Intubation 2 — Questions and Answers
Question 1: What is a laryngeal mask airway (LMA) used for in neonatal resuscitation?
- Alternative airway when intubation fails or is not feasible in ≥34-week infants (Correct answer)
- First-line airway device replacing bag-mask ventilation
- Airway for infants requiring chest compressions
- Routine airway for all preterm infants
Correct answer: Alternative airway when intubation fails or is not feasible in ≥34-week infants
An LMA is an acceptable alternative when intubation is not possible and may be used in infants ≥34 weeks gestation and ≥2 kg.
Question 2: What complication is suggested if the ETT fogs with each breath but the infant does not improve?
- Right mainstem intubation causing unilateral ventilation (Correct answer)
- Esophageal intubation
- Equipment failure
- Mucus plug in the tube
Correct answer: Right mainstem intubation causing unilateral ventilation
Fogging indicates gas is passing through the tube, but absent improvement with decreased left breath sounds suggests right mainstem placement.
Question 3: After intubation, which clinical sign most reliably confirms bilateral equal lung ventilation?
- Equal bilateral breath sounds in the axillae (Correct answer)
- Equal chest rise visually
- Absence of gastric gurgling
- SpO₂ rise above 95%
Correct answer: Equal bilateral breath sounds in the axillae
Auscultation in both axillae (rather than over the chest wall) minimizes transmitted sounds and confirms equal bilateral ventilation.
Question 4: What is the most common cause of unsuccessful intubation during neonatal resuscitation?
- Incorrect positioning or inadequate visualization of the glottis (Correct answer)
- Equipment malfunction
- Laryngospasm
- Excessive secretions obstructing the view
Correct answer: Incorrect positioning or inadequate visualization of the glottis
Poor visualization due to incorrect head position, inadequate blade placement, or insufficient suctioning is the most common intubation failure cause.
Question 5: Which structure should the ETT pass through to confirm tracheal placement during direct laryngoscopy?
- Vocal cords (glottis) (Correct answer)
- Epiglottis
- Vallecula
- Uvula
Correct answer: Vocal cords (glottis)
The ETT must be directed through the vocal cords (glottis) into the trachea; the glottis appears as a 'V'-shaped opening.
Question 6: What is the role of CO₂ detectors in the presence of extremely poor cardiac output?
- They may give a false negative (no color change) even with correct tracheal placement (Correct answer)
- They are more reliable than in normal perfusion states
- They consistently show positive CO₂ regardless of placement
- They detect only esophageal placement accurately
Correct answer: They may give a false negative (no color change) even with correct tracheal placement
In severe bradycardia or cardiac arrest, little CO₂ may be exhaled, causing a false-negative reading even with correct tracheal tube position.
NRP Airway Management and Intubation 2
What is a laryngeal mask airway (LMA) used for in neonatal resuscitation?