1. Airway Management

2. The narrowest portion of the adult airway is the:
Cricoid cartilage
Glottic opening
Trachea
epiglottis
Glottic opening. Although the cricoid cartilage is the narrowest portion of the peds airway, the glottic opening is the narrowest in an adult.

3. Which of the following is an absolute contraindication for the use of Succinylcholine?
Burns 24 hrs post-injury
Upper airway obstruction
Severe traumatic brain injury
Spontaneously breathing pt
Upper airway obstruction, or cases in which intubation would be difficult is an absolute contraindication for the use of Succinylcholine. Burns greater than 24 hrs old is a relative contraindication. Subarachnoid Intracranial Hemorrhage, and the spontaneously breathing pt are both conditions in which Succinylcholine use would be acceptable.

4. Which of the following is the first step in the four-step cricothyrotomy procedure?
Sedation
Incision
Palpation
The first step is palpation. Locating landmarks and sedation are not specific to the four-step procedure, but they are essential to being able to perform the procedure. Incision is step 2.

5. Which of the following medications can be used to reverse a non-depolarizing neuromuscular blocking agent?
Diphenhydramine
Pyridostigmine
Calcium Gluconate
Mivacurium
Diphenhydramine and Calcium Gluconate have no effect on the action of the nondepolarizing NMBA. Pyridostigmine, Neostigmine, and Edrophonium can all be utilized for reversal of a nondepolarizing NMBA. Mivacurium is a nondepolarizing NMBA.

6. When performing CPR, tracheal intubation attempts should be limited to:
5 seconds
15 seconds
20 seconds
30 seconds
B. When performing CPR, intubation attempts should be limited to 15 seconds.

7. You are called to a referring hospital for a 4 year old peds trauma pt with facial trauma. You and your partner decide to perform RSI with tracheal intubation prior to transporting. Which of the following is the proper ET size for this pt?
4.0
4.5
5.0
5.5
The correct ETT size is The formula for calculating an uncuffed ET tube size in peds is (Age+16)/4

8. When performing translaryngeal jet ventilation, which of the following is the minimum oxygen pressure needed to perform this procedure?
50 psi
100 psi
500 psi
1000 psi
A. The minimum oxygen pressure needed is 50 psi

9. Which airway device is inappropriate for the pediatric pt?
Laryngeal Mask Airway
Needle Cricothyrotomy
Esophageal – Tracheal Combitube
Nasopharyngeal Airway
Esophageal Obturator Airway. The Esophageal – Tracheal Combitube Airway is contraindicated in children. Laryngeal Mask Airways and Nasopharyngeal Airways are available in various sizes and are appropriate for Adults and Peds. Needle Cricothyroitomy is appropriate for children.

10. You are on scene with a 42/m involved in an MVC
You are on scene with a 42/m involved in an MVC. The pt is intubated and being ventilated with a BVM. Your transport time is 30 minutes to the receiving facility and you choose to place the pt on the transport ventilator. Which of the following is the appropriate Tidal Volume for this 80 kg pt?
400 ml
450 ml
500 ml
850 ml
The correct calculation for determining TV on a ventilator is 6-10ml/kg. A & B are calculated at TV less than 6ml/kg. D is calculated at 10.6ml/kg. 500ml is an appropriate TV for an 80 kg pt.

11. Which of the following statements is correct regarding the anatomical differences between the ped and adult airway?
The tongue in infants is relatively smaller in proportion to the oropharynx than that of adults
The vocal cords are more rigid than in the adult and are more susceptible to damage
The narrowest portion of the ped airway is below the vocal cords whereas the narrowest portion of the adult airway is at the vocal cords
The larynx is more posterior in the ped pt which requires greater manipulation of the head to align the three axis’ of the airway
The narrowest portion of the ped airway is at the cricoid rings, below the vocal cords.

12. Which of the following statements is correct regarding the oropharyngeal airway?
The oropharyngeal airway works by protecting the airway from blood, vomitus, and secretions
To place an oropharyngeal airway in a ped pt, the airway is inserted backwards until it reaches the posterior wall and then is rotated 180 degrees
Oropharyngeal airways are contraindicated in pts with suspected skull fractures
An incorrectly place oropharyngeal airway may worsen airflow or create an airway obstruction where none existed
An incorrectly placed oropharyngeal airway may actually impede airflow and create an airway obstruction. Oropharyngeal airways do not protect the airway from blood, vomitus or secretions. Instead, it prevents the tongue from obstructing the airway. OPAs should be inserted with a tongue depressor in the ped pt. OPAs are not contraindicated in pts with suspected skull fractures.

13. The 4-step technique for performing a surgical cricothyrotomy includes which of the following key components?
Palpation, Incision, Traction, Intubation
Location, Traction, Incision, Intubation
Sedation, inspection, Incision, Intubation
Palpation, Incision, Guide wire Insertion, Intubation
The 4 key components that are required for a successful cricothyrotomy include palpation of the cricoid membrane, a horizontal incision in the inferior aspect of the cricothyroid membrane followed by a horizontal incision through the membrane, traction on the trachea using a tracheal hook, and then intubation with an endotracheal tube or tracheostomy tube.

14. Which of the following medications that produces neuromuscular blockade in RSI is a depolarizing agent?
Vecuronium
Succinylcholine
Rocuronium
Pancuronium
B. Succinylcholine, all other choices are non-depolarizing agents

15. Which of the following pts is the administration of Succinylcholine contraindicated?
A pt with 45% 2nd and 3rd degree burns to their body resulting from a fire 18 hrs ago
A pt involved in a MVC 16 hrs earlier with spinal cord paralysis at the level of C5 and C6
An asthmatic with a hx of myasthenia gravis requiring emergent intubation
A pt who has been given narcan for a suspected OD
Any pt with a hx of pseudocholinesterase deficiency should not be given Succinylcholine. Since plasma cholinesterase is synthesized in the liver, pts with pseudocholinesterase deficiency may produce prolonged motor blockade. Pts with burn injuries and spinal cord injuries are not at risk for hyperkalemia until two or three days post-burn. Narcan has no effect on Succinylcholine and the indication for Narcan is not a contraindication for its administration.

16. Which of the following medications are commonly used to pretreat pts prior to RSI?
Atropine for ped pts and Metpropol for all adult pts
Atropine for all adult and ped pts and Mannitol for pts with suspected head injuries
Narcan for ped pts and Potassium for suspected hyperkalemic pts
Atropine for ped pts, and Lidocaine for pts with suspected head injuries
Atropine 0.02 mg/kg is advised for all ped pts to prevent bradycardia from vagal nerve stimulation and the administration of Succs, Atropine is not commonly used to pretreat adult pts unless they are receiving multiple doses of Succs. Lidocaine use in head injury pts has been shown to attenuate the rise in ICP associated with endotracheal intubation. Narcan, lopressor, and mannitol are not indicated in adult pts as a pretreatment agent prior to RSI.

17. Which of the following is the only absolute contraindication for nasotracheal intubation?
Suspected basilar skull fracture
Blood clotting abnormalities
Acute epiglottis
Apnea or near apnea
The only absolute contraindication to the standard blind nasotracheal intubation technique is apnea or near apnea. The pt must be breathing in order to effectively pass the endotracheal tube through the vocal cords. Your other choices are relative contraindications.

18. Which of the following is an example of a dual lumen airway which allows for the distal balloon to either occlude the esophagus in the event of esophageal intubation, or occlude the trachea and prevent aspiration if the trachea is intubated?
LMA
Combitube
EOA
OPA
The combitube is a dual lumen airway device that is designed for either esophageal or tracheal intubation.

19. Which of the following medications produces dissociative anesthesia?
Fentanyl
Succinylcholine
Ketamine
Pancuronium
C. Ketamine produces dissociative anesthesia which resembles a cataleptic state caused by dissociation between the mocortical and limbic systems. A side effect of Ketamine can be emergence delirium. This is not seen in the other choices.

20. Which of the following is an absolute contraindication for surgical airway management?
Total upper airway obstruction
Pts who are predicted to have a difficult airway
Epiglottitis or bacterial tracheitis
Transection of the trachea with retraction of the distal end into the mediastinum
He only absolute contraindication for surgical airway are a transection of the trachea with retraction of the distal end into the mediastinum, penetrating or crush injury to the larynx, expanding hematoma on the anterior neck, and known laryngeal pathology. Surgical airway management is indicated in the other choices.

21. Which of the following is a negative side effect of PEEP?
It increases functional residual capacity causing alveoli to remain open
It causes an increase of ventilation-perfusion matching in the alveoli
It causes an increase in intrathoracic pressure which can decrease cardiac output
It results in the need for lower inspired O2 concentrations at lower peak inspiratory pressures
PEEP causes an increase in intrathorasic pressures which may impede venous return and subsequently decrease in cardiac output. PEEP increases functional residual capacity increasing lung capacity and promotes alveoli opening. PEEP can improve oxygenation at lower inspired O2 concentration and improve ventilation at lower peak inspiratory pressures.

22. Pts requiring immediate definitive airway interventions are:
Pts with respiratory failure, GCS<8, or status epilepticus
Pts with a flailed chest and respiratory compromise, partial thickness burns of 40% BSA, or respiratory acidosis
Pts with flash burns to the face and an inhalation injury, direct injury to the soft tissues around the airway, or brochospasms
Status asthmaticus, compartment syndrome, or chemical ingestion
Pts with respiratory failure, GCS,8, or status epilepticus can not maintain or protect their airway. A flailed chest with respiratory compromise may or may not require intubation, 40% partial thickness burns is not an indication for immediate intubation, and respiratory acidosis maybe corrected without immediate intubation. Broncospasms is not an indication for immediate intubation. Compartment syndrome and chemical ingestion do not require immediate intubation.