PALS Airway Management 2 — Questions and Answers
Question 1: A 5-year-old child is semiconscious with an intact gag reflex requiring airway support. Which airway adjunct is most appropriate?
- Oropharyngeal airway (OPA)
- Nasopharyngeal airway (NPA) (Correct answer)
- Laryngeal mask airway (LMA)
- Cuffed endotracheal tube
Correct answer: Nasopharyngeal airway (NPA)
The nasopharyngeal airway is better tolerated in patients with an intact gag reflex because it does not stimulate the posterior pharynx as readily as an OPA.
Question 2: What is the correct technique for inserting an oropharyngeal airway (OPA) in a young child, unlike the adult technique?
- Insert upside-down and rotate 180 degrees as in adults
- Insert with the concave side directed toward the tongue using a tongue blade (Correct answer)
- Insert at a 45-degree angle and straighten once in place
- Insert sideways and rotate 90 degrees into position
Correct answer: Insert with the concave side directed toward the tongue using a tongue blade
In pediatric patients, the OPA is inserted directly with the curve following the tongue using a tongue depressor to avoid injuring the delicate soft palate.
Question 3: Which of the following is a contraindication to inserting a nasopharyngeal airway (NPA) in a pediatric patient?
- Intact gag reflex
- Suspected basilar skull fracture (Correct answer)
- Glasgow Coma Scale score less than 8
- Respiratory rate greater than 30 breaths per minute
Correct answer: Suspected basilar skull fracture
Suspected basilar skull fracture is a contraindication to NPA insertion because of the risk of inadvertent intracranial placement through the fractured cribriform plate.
Question 4: Which formula is most commonly used to estimate uncuffed endotracheal tube size for a child older than 1 year?
- (Age in years / 4) + 4 (Correct answer)
- (Age in years / 2) + 4
- Weight (kg) / 10
- Age in years + 4
Correct answer: (Age in years / 4) + 4
The formula (Age in years ÷ 4) + 4 provides a reliable estimate of uncuffed ET tube internal diameter in millimeters for children over 1 year old.
Question 5: How is a laryngeal mask airway (LMA) classified based on its anatomical position?
- Definitive airway
- Supraglottic airway (Correct answer)
- Subglottic airway
- Infraglottic airway
Correct answer: Supraglottic airway
The LMA sits above the glottis in the hypopharynx and is classified as a supraglottic airway, as it does not pass through the vocal cords.
Question 6: What is the primary advantage of using a cuffed endotracheal tube in a hospitalized pediatric patient?
- Cuffed tubes are easier to insert than uncuffed tubes
- They provide better control of ventilation pressures and reduce air leak (Correct answer)
- They are appropriate for all pediatric ages including neonates
- They eliminate the need for continuous CO2 monitoring
Correct answer: They provide better control of ventilation pressures and reduce air leak
Cuffed ET tubes allow better control of ventilatory pressures, reduce air leak around the tube, and may decrease aspiration risk in hospitalized children.
Question 7: Which method is considered the gold standard for confirming correct endotracheal tube placement in a pediatric patient?
- Bilateral auscultation over the lung fields
- Chest radiograph showing tube at the carina
- Continuous waveform capnography (end-tidal CO2) (Correct answer)
- Direct observation of chest rise with ventilation
Correct answer: Continuous waveform capnography (end-tidal CO2)
Continuous waveform capnography is the gold standard for confirming and monitoring ET tube placement because it provides real-time evidence of CO2 exchange from the lungs.
PALS Airway Management 2
A 5-year-old child is semiconscious with an intact gag reflex requiring airway support.
Which airway adjunct is most appropriate?