A therapist is preparing a steel-type laryngoscope for an anesthesiologist. The light does not shine. Which of the following should be done to solve the problem?
B) tighten the bulb & replace the batteries
An oropharyngeal airway would be indicated under which of the following conditions?
D) seizure activity is present or expected & supine unconscious person w/ upper airway obstruction & an orally intubated pt is biting the tube
An RT has just assisted w/ ET intubation of a normotensive adult pt. To minimize the risk of soft-tissue injury to the trachea, the cuff pressure should be:
C) < 30 cm H2O
A 50 YO male pt w/ throat CA will be having a laryngectomy tomorrow w/ the placement of a voice prosthesis. What type of airway would best serve the pt's long term needs?
D) fenestrated laryngectomy tube
An Rt replaces a pt's trach tube w/ another one of the same size & inflates the cuff w/ 5 ml of air as was done previously. Immediately, the pt has difficulty breathing & no air can be felt coming from the tube. What could be the problem?
D) the tip of the tube has been placed into the sub-q tissues
While assisting a CPR attempt, the anesthesiologist asks for a properly sized ETT so that the pt can be intubated. The pt is a large, physically fit man. What size would be best?
D) 9.0 mm ID oral ETT
A spontaneously breathing pt's trach tube cuff pressures has been measured at 10mm Hg. What would be recommended?
D) increase the cuff pressure to 15 mm Hg
A 45 YO female ot is brought to the ED from an MVA. She has facial trauma, including a broken nose & jaw. Because of heavy bleeding into her mouth, she is having difficulty breathing. Which of the following should be recommended to ensure a safe, effective airway?
D) place a trach tube
While working in the NICU, a ET is called to assist in the care of a 900-gram newborn. The neonatologist asks you to get the proper ET for intubation. What would be the correct sized tube?
A) 2.5mm ID
A 59kg (130 lbs) woman must be intubated to initiate mechanical ventilation. What size tube should be used?
C) 7.5mm ID
An RT is going to assist in the ambulance transport of a 25 YO pt. The pt has an oral ETT and bag/mask ventilation will be performed during the trip. Which of the following should be chosen to help ensure that the ETT stays properly placed in the trachea?
B) colorimetric CO2 detector
All of the following should be monitored after a pt returns from having a trach tube placed EXCEPT:
D) bowel sounds
Auscultation of a recently intubated pt in respiratory failure reveals absent breath sounds on the L side of the chest. The most likely cause of this finding is:
C) placement of the ETT into the R mainstem bronchus
While working the night shift, a RT is called to intubate an apenic patient. Which of the following would be needed for an emergency oral intubation?
A) scope handle & stylet & 10 ml syringe & proper blade
A RT is assisting with the extubation of an adult pt. At what point in the procedure should the tube be removed?
D) at the end of a peak expiratory effort
A pt with a trach has just returned from a series of radiography procedures. SUddenly, the pt develops respiratory distress & cannot breathe. A suction catheter cannot be passed through the trach tube. What should be done?
C) remove the trach tube
After a successful CPR attempt, a pt with an oral ETT is placed on mechanical ventilation in the ICU. The RT notices that the exhaled CO2 monitor is approrpaitely changing color with each breath cycle. The pt's breath sounds are present on the R side but diminished on the L. What is the most likely cause of this situation?
C) R bronchial intubation
An 18 Yo woman has been admitted after being found unconscious from a drug OD. She has severe atelectasis of the L lung caused by lying on her L side x 2 days. Her R lung is normal. She is going to require mechanical ventilation to open the atelectatic areas. What ETT should be suggested to properly treat the abnormal lung?
D) double lumen
An adult pt with epilepsy has been having unpredictable seizure activity. What oral ETT should be suggested to provide a secure airway?
C) wire reinforced
A consious pt is recovering from Guillain-Barré syndrome & is able to breathe spontaneously off the ventilator for several hours. The pt currently has a single cannula 7.5mm ID trach tube. To help the pt's weaning process but enable the pt to be ventilated at night, what should be done?
A) substitute a fenestrated tube
A semiconscious pt with many trach secretions will need frequent nasotracheal suctioning/ What can be done to minimze trauma from the procedure?
D) insert a nasophayngeal airway
An adult pt with a trach button and an attached speaking valve is c/o it is difficult to breathe. You find that a 12-Fr suction catheter cannot be passed through the button. What should be done?
B) remove the speaking valve & reassess the pt
During a surgical procedure, the anesthesiologist wishes to protect the airway & proviide mechanical ventilation but does not want to place an ETT. What airway should be used?
C) laryngeal mask airway
An unconscious 17 YO pt has arrived in the ED. The pt was involved in an MVA, has a neck injury & is wearing a neck brace. If the pt were to show signs of an upper airway obstruction, all of the following could be used to maintain the airway EXCEPT:
D) Oral ETT
Immediate complications of an oral intubation include all of the following:
C) tooth trauma & esophageal intubation & tracheoesophageal fistula
A hospitalized pt rapidly develops ventilatory failure because of an OD of morphine for pain control. The preferred way to quickly provide a safe, secure airway is to:
D) place an oral ETT
Indications for oral intubation include all of the following EXCEPT:
C) pt has a cervical spine injury
A 2 YO child admitted with severe croup has just been extubated after 2 days with an oral ETT. THe child is given O2 and aerosolized HOH through a heated large-volume nebulizer. Thirty minutes later, mild inspiratory stridor is heard over the child's throat area. What should be done first?
A) deliver nebulized racemic epinephrine
A 55 YO 77kg (170 lbs) ventilator dependent male pt has returned from the OR with a 6.0mm ID trach tube. The RT determines the cuff pressure to be 35 mm Hg. The ventilator is driving a Vt of 750ml and returning a Vt of 650ml, and a leak can be heard at the trach site. What should be done?
D) replace the trach tube with an 8.5mm ID tube
An intubated and ventilated adult pt has been returned to the long term care unit after being transported to Radiology for an abdominal film. The RT notices the trachea is midline; however the pt's L chest does not rise with inspitation as much as the R. THe ETT is at 28-cm mark at the teeth. What should be done now?
D) Pull the ETT back about 4 cm
A pt is about to have an oral ETT inserted. What can be done during and/or after the procedure to determine its position within the trachea?
C) CXR, palpate the larynx, auscultate bilateral BS, attach an EDD, check for exhaled CO2
A pt who suffered facial burns and smoke inhalation has recovered enough to be extubated. Although the pt is receiving 40% O2 with a bland aerosol, significant inspiratory stridor is noticed within 15 minutes. Following the inhalation of a vasoconstricting med, the pt's BS are improved. THirty minutes later the pt's SpO2 is 80% and the inspiratory stridor is more serious. The pt is very anxious & is pulling off the O2 mask. What should be recommended to best manage this pt?
C) intubate
During a CPR attempt, a peds pt had an oral ETT placed. To ensure that the ETT is placed properly, all of the following should be recommended EXCEPT:
B) have a lateral neck xray taken
A pt in the PAR is found to have a trach tube cuff pressure of 35 mm Hg. If left unchanged, this pressure could cause which of the following:
B) tracheomalacia & trancheoesophageal fistula & innominate artery erosion &loss of venous flow through the tracheal soft tissues
A properly inserted Combitube will usually:
B) intubate the esophagus & prevent vomiting & maintain the airway
A newborn child with macroglossia is having moderate airway obstruction episodes. What could be done to manage the current situation?
A) place a nasopharyngeal airway & place the newborn in a prone position
A 28 YO pt is brought to the ED. The pt has a cervical spine injury from a diving accident & is wearing a neck brace. THe pt is unconscious & inspiratory stridor can be heard. ABFs on 40% O2 are Ph 7.30 PaCO2 56 PaO2 57. The physician has decided to establish a secure airway. What device should be recommended?
A) 7.0mm ID nasotracheal tube
An adult female pt is recovering from her neuromuscular disease. She has a standard trach tube and requires mechanical ventilation only while sleeping. The physician asks the RT for a recommendation about what can be done to enable her to communicate during the day but be put on the ventilator at night. What should be recommended?
C) change her to a fenestrated trach tube
The Combitube has advantages over the standard LMA because:
A) a gastric tube can be placed through it to empty the stomach & the pt can be centilated whether it is placed into the esophagus or trachea