SUMMER ATC MIDTERM

What is the primary goal of bag-mask ventilation (BMV) in managing a patient’s airway?

To provide positive-pressure gas movement through a patient’s otherwise unprotected airway.

What is the primary advantage of armored tracheal tubes (TTs), and in which surgical scenarios are they often used?

Armored TTs are resistant to kinking and compression and are often used in head, neck, and tracheal surgery, as well as in positions where the neck is flexed.

During an oromaxillofacial surgery, which type of preformed tube would be most appropriate to use to direct the connector away from the surgical field, and why?

A Ring-Adair-Elwyn (RAE) tube because it has a manufactured, preformed bend that directs the connector away from the surgical field, with nasal and oral designs available.

Which of the following functions does an oropharyngeal airway (OPA) perform?

It bypasses the nasal cavities and nasopharynx, lifts the tongue and possibly the epiglottis, supports mandibular advancement, and improves the bag-mask ventilation (BMV) seal in edentulous patients.

Which of the following is essential for establishing and maintaining airway patency and/or achieving noninvasive and invasive airway access?

Correct patient head and neck positioning

Which of the following describes the shape and function of an oropharyngeal airway (OPA)?

A caudally facing, concave device that follows the oropharyngeal anatomy and contours to the tongue

What is the primary advantage of the Parker Flex-Tip tracheal tube (TT) during endoscopic-aided intubation compared to standard tracheal tubes?

It decreases the gap between the bevel of the tube and the endoscope body, reducing the risk of entrapment of anatomical structures and increasing the success of first-attempt passage.

Which of the following correctly identifies the primary difference between the Mac (Macintosh) and Miller laryngoscope blades?

The Mac blade is curved and designed for indirect lifting of the epiglottis, while the Miller blade is straight and designed for direct lifting of the epiglottis.

In anesthetized and sedated patients, airway obstruction is commonly caused by which of the following anatomical structures?

The tongue and soft palate

What are some key features of the C-Mac (Karl Storz,) video laryngoscope?

It offers a variety of reusable and disposable blades, including curved (Macintosh), straight (Miller type), and hyperangulated blades for all age groups. It also features a cable-free Pocket Monitor (PM) device that mounts the video screen directly to the laryngoscope handle.

A patient with a history of difficult airway management is undergoing planned extubation after a surgical procedure. The anesthesia care team is concerned about the risk of urgent reintubation. Which airway management device would be most appropriate to have on hand, and why?

A single-lumen Cook AEC because it is a hollow, flexible, straight tube designed as a TT exchanger, available in different sizes, and can be fitted with a “Rapi-Fit” adapter for oxygen insufflation. It is recommended for use in patients at risk of urgent reintubation and in those with a difficult airway.

Nasopharyngeal airways (NPA) are sized based on their outer diameter (OD) in French scale.

Which statement accurately describes how these sizes are determined?

NPA sizes are determined by the length of the device in millimeters. Larger OD corresponds to shorter length.

A 45-year-old male patient is brought into the operating room for a surgical procedure. During the pre-anesthesia assessment, the anesthesia care team notes that the patient is edentulous and has a history of chronic nasal congestion. Which airway management device would be most appropriate to use in this scenario, and why?

An oropharyngeal airway (OPA) because it bypasses nasal cavities and lifts the tongue, providing a clear airway for bag-mask ventilation (BMV) in an edentulous patient

When preparing to insert a nasopharyngeal airway (NPA), which of the following is the recommended practice to ensure smooth insertion and minimize patient discomfort?

Lubricate the NPA with a water-based lubricant

According to the International Organization for Standardization (ISO) standard ISO 5361:2016, which specifications must be met for tracheal tubes, and what purpose does the cuff serve in a cuffed tracheal tube?

Specifications include internal diameters (IDs), outer diameters (ODs), angle and direction of the bevel, size and shape of the Murphy eye, and radius of tube curvature. The cuff provides a seal between the tracheal tube (TT) and trachea, protecting the trachea from aspiration of gastric contents and facilitating positive-pressure ventilation.

What features make the Glide Scope, distinctive as the first commercially available video laryngoscope (VL)?

It combines a high-resolution, full-color digital camera with an integrated light-emitting diode (LED) light source and an antifog feature, and offers both multi- and single-use systems.

During an airway surgery involving the use of lasers, what precautions and equipment should an anesthesia care team consider to minimize the risk of airway fires?

Use tracheal tubes made from noncombustible materials, fill tracheal tube cuffs with saline or water containing a dye indicator, and consider laser-resistant tubes with double cuffs to reduce the risk of TT combustion and enhance detection of accidental cuff compromise.

Which of the following best describes the function of a nasopharyngeal airway (NPA)?

A disposable soft tubular device that supports nasal breathing and controls airway obstruction at the nasal cavities, nasopharynx, soft palate, and the base of the tongue.

When considering the McGrath MAC VL (Medtronic, Dublin, Ireland) for airway management, which features make it suitable for both routine and difficult intubations?

It is a small, portable, cable-free video laryngoscope (VL) with a 2.5 cm liquid crystal display (LCD) video monitor screen attached to the handle. It has a long-lasting, nonrechargeable proprietary battery and is available with disposable curved blades (sizes 2, 4) and a hyperangulated X blade (size 3) for difficult intubations. The curved blades can be used with either a direct or indirect approach.

During an induction, an anesthesia provider is performing bag-mask ventilation (BMV) on a 60-year-old female patient. To determine if the BMV is successful, which of the following clinical and objective measurements should be observed?

The patient’s chest rises with each ventilation, there is no excessive gas leak, oxygen saturation is maintained, waveform-exhaled carbon dioxide is present, peak airway pressure is within normal limits, and exhaled tidal volume is adequate.

Nasal cannula is considered what type of oxygen delivery system?

C. Low flow

Which of the following is the most commonly used low-flow oxygen delivery system in anesthesia practice?

Nasal cannula

Non-rebreather mask

BMV

Bag-Mask Ventilation

Effective BMV increases urgency to intubate

False

Jaw-thrust maneuver purpose

Restore upper airway patency by displacing mandible forward, relieving tongue obstruction of glottis

Oral and nasal airways prevent occlusion of:

A. Tongue

Goal: effective oxygenation/ventilation without excessive inspiratory pressure (10–12 breaths/min, 1–2 sec)

True

Sellick maneuver

Apply firm pressure to cricoid cartilage to occlude esophagus and reduce aspiration risk

LMA

Laryngeal mask airway

When to use LMA?

Airway rescue device when BMV is difficult and intubation has failed

FastTrach

LMAs are effective in pediatrics

True

Retroglottic airway devices (Combitube, King LT, Rusch Easy Tube)

Used in emergency airway management, blindly inserted into esophagus behind larynx/glottis

Combitube is a regular airway device

False

Importance of history and physical exam

Identifies comorbidities and assesses airway/anatomy for anesthetic challenges

History of asthma, COPD, sleep apnea

Respiratory

History of hypertension, heart failure

Cardiac

Pregnancy

Obstetric

Liver disease or hepatitis

Liver

Kidney disease

Renal

GERD

Gastric

Weakness or nerve injury

Neuromuscular

Diabetes or thyroid dysfunction

Endocrine

Blood disorders

Hematologic

Alcohol or recreational drug use

Social History

The airway examination is a minor part of the physical exam and has little impact on how the airway is managed during anesthesia.

False

Mallampati classification assesses

Visibility of pharyngeal structures to estimate tongue-to-oropharynx ratio

Mallampati III

_____________ is the most common technique for tracheal intubation in the emergency setting

Direct Laryngoscopy

Tracheal intubation is accomplished by passing the ETT through the

Vocal cords

Assists with positioning, equipment, and airway manipulation

Anesthesia Tech

Provides visualization of the vocal cords

Laryngoscope blade and handle

Anesthesia Tech supports the anesthesiologist during intubation

Pass equipment to provider

Ensures patient is ready and vital signs are tracked

Established IV and monitoring

Connects patient to ventilator and gas delivery system

Hook patient to anesthesia circuit

Clears secretions for better visualization

Suction

Inflates the cuff of the endotracheal tube

10cc syringe

Used to guide the endotracheal tube during intubation

Stylet

What size and blade do most prefer for emergency airway

Mac 4

Patient positioning for DL is often described as sniffing position

True

During direct laryngoscopy, what is the key difference between Macintosh and Miller blades?

The Mac blade is inserted along the right molars and indirectly lifts the epiglottis, while the Miller blade is inserted paraglossally and directly lifts the epiglottis

Endotracheal tube introducer and bougie are the same item

True

What are considered video laryngoscopes

C-MAC, McGrath, GlideScope

Video laryngoscopy is a first-line technique for ____________ and ____________ airway

Difficult and routine

Flexible Endoscopic Bronchoscope

Blind intubation techniques are done with visualization of the larynx or glottis

False

Surgical airway management is defined as the creation of an opening to the _____________

Trachea

Cricothyrotomy involves creating a surgical opening through the tracheal rings below the cricoid cartilage and inserting a nasopharyngeal airway

False

Mnemonic for difficult cricothyrotomy (Surgery, Mass, Access/Anatomy, Radiation, Trauma)

Smart

Surgical airway management is rarely the first choice in emergency airway management

True

The management of ____________ values and maintenance of ____________ anesthesia is essential following induction

Physiological and Surgical

What best describes the emergence phase of general anesthesia?

Return of consciousness, neuromuscular function, and airway reflexes

There are four stages of anesthesia according to Guedel’s classification

True

Once a patient is extubated, reintubation equipment no longer needs to be immediately available

False

Endotracheal tube introducer and the bougies are the same item.

True

The decision to intubate is based on Three fundamental clinical assessment.

Failed airway maintenance or Protection, Failed ventilation or oxygenation, Clinical course

Endotracheal tube introducer and the bougies are the same item.

True

The decision to intubate is based on Three fundamental clinical assessment.

Failed airway maintenance or Protection, Failed ventilation or oxygenation, Clinical course

Tracheal intubation is accomplished by passing the ETT through the

vocal cords

When troubleshooting the machine there is expiratory backflow to the machine, This is most likely a problem with the

Unidirectional expiratory flow

The first monitor that should be placed on the patient when entering the operation room and the last monitor to be taken off the patient before they leave the operation room should be

Pulse oximeter to measure oxygen saturation

The __________ Algorithm demonstrates how the emergency airway algorithms work together

Universal Emergency AirwaY

Surgical airway management is defined as the creation of an opening to the _____________ by invasive, surgical means to provide ventilation and oxygenation

Trachea

Which of the following correctly identifies the three anatomical segments of the pharynx in order from superior to inferior?

Nasopharynx, Oropharynx, Laryngopharynx

Grade 2

An intubated patient is transported to the SICU. All will probably be needed except for____________

N2O

Awake laryngoscopy has ___________ main roles, both of which apply to patients with anticipated difficult intubation

two

This ETT is commonly used in laser procedure, has two small cuffs on the distal end, one for saline and the other a dye solution

Laser

Grade 1

Naloxone reverses Respiratory depression and pain relief due to the use of

Opioids

Lidocaine functions by blocking fast__________ channel in neurons

sodium

66 years old male. History of lung cancer and hypotension

This patient is having an open left thoracotomy with wedge resection.

Position: right lateral

Surgery type: General

ETT: double lumen

Monitoring: ECG, pulse ox, capnography, NIBP and A line, Temp probe, TOF monitor

Nasal cannula is considered what type of oxygen delivery system

low flow

Fast Trach

If the provider is not able to maintain a patient airway upon induction. They will insertion what two airways to restore ventilation

1. Supraglottic

2. OPA and NPA with bag mask ventilation

The Vasopressor used to increase the heart rate and blood pressure and to treat asthma and bronchospasm is

Epinephrine

The cricothyroid membrane extends between___________ surface of the cricoid cartilage to the _________ border of the thyroid

Upper Anterior, Inferior anterior

Etomidate has become the induction agent of choice for most emergent RDI because of its rapid onset, its hemodynamic stability, it positive effect on CMRO2 and cerebral perfusion pressure, and its rapid recovery

True