PALS Airway Management 1 — Questions and Answers
Question 1: What is the preferred initial airway opening maneuver for an unresponsive pediatric patient without suspected cervical spine injury?
- Jaw thrust maneuver
- Head-tilt chin-lift maneuver (Correct answer)
- Insertion of a nasopharyngeal airway
- Immediate orotracheal intubation
Correct answer: Head-tilt chin-lift maneuver
Head-tilt chin-lift is the preferred initial airway opening maneuver in patients without suspected cervical spine injury because it quickly repositions anatomy to open the airway.
Question 2: Which oxygen delivery device provides the highest concentration of supplemental oxygen to a spontaneously breathing child in respiratory distress?
- Nasal cannula at 4 L/min
- Simple face mask at 8 L/min
- Non-rebreather mask at 10–15 L/min (Correct answer)
- Partial rebreather mask at 6 L/min
Correct answer: Non-rebreather mask at 10–15 L/min
A non-rebreather mask with flow rates of 10–15 L/min can deliver oxygen concentrations up to 90–95% by preventing exhaled gas from diluting the oxygen supply.
Question 3: When performing bag-mask ventilation on a child with a pulse but absent respirations, what is the recommended ventilation rate?
- 8–10 breaths per minute
- 12–20 breaths per minute (Correct answer)
- 20–30 breaths per minute
- 30–40 breaths per minute
Correct answer: 12–20 breaths per minute
For a child with a pulse, deliver 1 breath every 3–5 seconds (12–20 breaths per minute) to support oxygenation without causing hyperventilation.
Question 4: What is the correct method for sizing an oropharyngeal airway (OPA) in a pediatric patient?
- Measure from the center of the mouth to the angle of the jaw (Correct answer)
- Measure from the tip of the nose to the earlobe
- Estimate based on weight in kilograms divided by 10
- Measure from the corner of the mouth to the tragus of the ear
Correct answer: Measure from the center of the mouth to the angle of the jaw
The OPA is sized by measuring from the center of the mouth (midline of lips) to the angle of the jaw to ensure correct airway length.
Question 5: In which clinical situation should a jaw thrust be used instead of a head-tilt chin-lift for airway management?
- When the child is completely unresponsive
- When cervical spine injury is suspected (Correct answer)
- When foreign body airway obstruction is present
- When the child has severe bronchospasm
Correct answer: When cervical spine injury is suspected
The jaw thrust without head extension is preferred when cervical spine injury is suspected because it opens the airway without moving the neck.
Question 6: What does the E-C clamp technique accomplish during pediatric bag-mask ventilation?
- It maintains a tight seal between the mask and the patient's face (Correct answer)
- It compresses the chest during CPR cycles
- It secures an endotracheal tube at the lip
- It assesses level of consciousness before ventilation
Correct answer: It maintains a tight seal between the mask and the patient's face
The E-C clamp uses thumb and index finger in a 'C' shape to hold the mask while the remaining fingers form an 'E' to lift the jaw, creating an effective mask seal.
Question 7: What is the primary indicator of adequate ventilation during bag-mask ventilation in a pediatric patient?
- A respiratory rate of 20 breaths per minute is achieved
- Visible, gentle chest rise with each delivered breath (Correct answer)
- Heart rate increases by at least 10 bpm after ventilation
- Symmetric breath sounds heard on auscultation of the axillae
Correct answer: Visible, gentle chest rise with each delivered breath
Visible, gentle chest rise with each breath confirms that the tidal volume is being effectively delivered to the lungs.
PALS Airway Management 1
What is the preferred initial airway opening maneuver for an unresponsive pediatric patient without suspected cervical spine injury?