A 68-year-old intubated ICU patient with retained secretions cannot tolerate routine endotracheal suctioning because of severe oxygen desaturation. Which intervention best maintains oxygenation while clearing secretions?
Manage Airways
Question · Easy
Why is a bougie used during a difficult intubation?
Airway Management
Flashcard
An adult with anticipated difficult intubation has a Mallampati IV, restricted mouth opening, and limited neck extension. Which device is most appropriate to load on the endotracheal tube to aid first-pass success?
Question · Medium
Flexible introducer passed into the trachea when direct laryngoscopy shows only a grade 2 or 3a view of the larynx, over which a tracheal tube is advanced.
Airway management
Guess the Term
Chapter 1: Airway Management
1.1 Airway Clearance & Suctioning
Study guide
Cheat sheet
During rapid sequence intubation of a 90 kg adult, the operator asks for cricoid pressure. The most appropriate teaching point about cricoid (Sellick) maneuver is that it:
Read the clue and guess the term in 6 tries.
Game
What does video laryngoscopy improve over direct laryngoscopy?
A patient who is mechanically ventilated requires ongoing sedation but is having frequent ventilator dyssynchrony with biting on the endotracheal tube. The team plans to exchange the standard oral ETT for a wire-reinforced (armored) tube. The primary advantage of a wire-reinforced tube is that it:
Low-density breathing gas, most often an 80:20 blend, used as a bridge to cut airway resistance in upper airway obstruction or post-extubation stridor.
Specialty inhalants
A patient is undergoing one-lung ventilation for a left thoracotomy with a left-sided double-lumen endobronchial tube. SpO2 falls to 85% on FiO2 1.0 with the right (nondependent) lung deflated. The most appropriate first respiratory therapist intervention is to:
Question · Hard
What is cricoid pressure intended to do during intubation?
A patient with subglottic stenosis is scheduled for bronchoscopy. Which tracheostomy tube is most appropriate to allow the patient to phonate when the cuff is deflated?
Ventilator setting paired with the fraction of inspired oxygen in a standard lung-protective protocol table and set to a minimum of 5 cm H2O.
Ventilation and oxygenation
1.2 Intubation Techniques & Difficult Airways
An ICU patient with a 7.5 mm orotracheal tube has developed a leak around the cuff that does not resolve at the maximum recommended cuff pressure. After confirming the cuff is intact, which procedure is most appropriate?
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Term Match
What does the Mallampati classification predict?
Routine measurement of endotracheal tube cuff pressure on rounds shows a value of 35 cm H2O. The most appropriate action is to:
Kind of volume that a lung-protective protocol lowers to 6 mL/kg of predicted body weight.
A 72-year-old with COPD exacerbation needs noninvasive ventilation. After 90 minutes of bilevel pressure support, pH is 7.18, PaCO2 92 mm Hg, and the patient is increasingly somnolent. The most appropriate next step is to:
How does a subglottic suction endotracheal tube reduce risk in ventilated ICU patients?
A respiratory therapist is preparing an awake fiberoptic intubation in a patient with rheumatoid cervical instability. To facilitate the procedure, which topical agent provides effective laryngotracheal anesthesia?
Circuit that pumps blood through an artificial lung; its venovenous form is considered for severe, reversible respiratory failure that has not responded to optimal medical management.
1.3 Specialty Endotracheal & Endobronchial Tubes
During a percutaneous tracheostomy at the bedside, the surgeon asks the respiratory therapist to verify intratracheal needle placement. The single most reliable bedside confirmation is:
Flip two cards at a time to find matching terms.
Term Pairs
When is a double-lumen endotracheal tube indicated?
For a mechanically ventilated patient with profuse purulent secretions and lobar atelectasis on chest x-ray that does not resolve with suctioning, which airway clearance therapy is most likely to be helpful?
Face-down position used in severe ARDS; guidelines recommend sessions of at least 16 consecutive hours for patients receiving invasive mechanical ventilation.
After a difficult intubation, you suspect right mainstem intubation. Which finding most strongly supports that diagnosis?
What is the purpose of an airway exchange catheter?
A patient with severe maxillofacial trauma cannot be intubated or oxygenated by mask. The most appropriate immediate rescue airway is:
Condition that a landmark low tidal volume protocol enrolls at PaO2/FiO2 of 300 or less with bilateral infiltrates; its 2012 Berlin definition requires at least 5 cm H2O of PEEP.
Respiratory failure
1.4 Tracheostomy Tubes & Cuff Care
After 12 days of intubation, an ICU patient is extubated and within 30 minutes develops biphasic stridor and increased work of breathing. The most appropriate immediate intervention is:
Find five hidden terms in a grid of letters.
Term Search
What does a tracheostomy T-tube trial assess?
A 60-year-old with COPD presents in respiratory failure with poor cough and copious sputum. The intensivist asks for a pharmacologic adjunct to enhance airway clearance. Which agent is most appropriate?
Breathing support that can deliver a higher pressure during inspiration and a lower pressure during expiration through a nasal, oronasal, or facial interface.
A patient with severe ARDS on FiO2 1.0 and PEEP 18 cm H2O has refractory hypoxemia. The team initiates inhaled nitric oxide. The recommended initial dose is:
Specialty Inhalants
What tidal volume target defines lung-protective ventilation in ARDS?
ARDS & Lung-Protective Ventilation
A patient receiving inhaled nitric oxide for 36 hours develops cyanosis with SpO2 88% but PaO2 of 110 mm Hg on FiO2 0.6. The most likely cause is:
Antifibrinolytic drug, labeled as a 650 mg oral tablet, that blocks plasmin from binding fibrin.
Aerosolized agents
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