The Difficult Airway Course: Emergency - Pre-test (Atlanta, 2016)

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* 1. A 17-year-old boy presents to the Emergency Department with severe sore throat that has come on over approximately 12 hours. For the last two hours, he has been unable to handle his secretions and has been spitting into a cup. Vital signs are: BP = 130/70, HR = 98, RR = 18, T = 38.4 degrees C. The patient is complaining of his pain, and appears distressed and anxious. There is no stridor, but the patient reports that it is "hard to breathe." Oxygen saturation on room air is 96%. A non-rebreather mask is applied, the patient is on a cardiac monitor, and an intravenous line has been established. The most appropriate initial management is:

Portable lateral neck X-ray, sedation and topical anesthesia, awake direct laryngoscopy

Portable lateral neck X-ray, arrange immediate ICU admission

Topical anesthesia, awake nasotracheal intubation

Fiberoptic nasopharyngoscopy

Preparation for cricothyrotomy, sedation and topical anesthesia, direct or fiberoptic laryngoscopy

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* 2. A 200kg, 5'9" morbidly obese patient presents with a severe bilateral pneumonia. You estimate his ideal body weight at 75 kg. As you consider the role of his obesity in planning your RSI drugs, which of the following is true?

Lidocaine pretreatment is contraindicated because the patient is morbidly obese

The recommended dose of succinylcholine is 300 mg

Rocuronium dosing is based on Lean Body Weight

The duration of action of most of the commonly used RSI drugs is significantly reduced

Lean Body Weight = Ideal Body Weight x 1.5

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* 3. A 19-year-old man has sustained a significant head injury after riding his new Harley Davidson into a bridge embankment. Paramedics on the scene call for medical direction, and report that they have immobilized his spine, established IV access and are administering supplemental oxygen via a NRB mask. The patient is obviously intoxicated and minimally arousable, with a BP of 110/60, heart rate of 110, RR of 20 with "noisy" respirations and oxygen saturation of 95%. They are en route to your ED with an ETA of four minutes and the scope of practice includes RSI and LMA insertion. The paramedics request permission to manage the patient's airway. Which of the following is the best first action to advise in this case:

RSI and preform endotracheal intubation

Perform an awake nasal intubation

Perform an immediate cricothyroidotomy

Perform a jaw-thrust maneuver and insert a nasal airway

Continue oxygen and transport with no further intervention

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* 4. Each of the following patients receives succinylcholine for intubation. Which is not at risk for succinylcholine-induced
hyperkalemia?

a three year old boy with Muscular Dystrophy

a 29 year old woman who fell and sustained C7 quadriplegia six hours earlier

a 35 year old man with multiple sclerosis and respiratory failure

a 68 year old man with 45% TBSA burns sustained one week earlier

78 year old woman with hemiplegia from a stroke two months ago, now with severe pneumonia

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* 5. While awaiting the anesthesiologist and ENT surgeon to arrive for controlled definitive airway management in the OR, your 3-year-old patient with suspected epiglottis becomes unresponsive and apneic and his heart rate drops to the
40 - 50's. The patient has no venous access. The most appropriate initial step in management is:

Needle cricothyroidotomy

Surgical cricothyroidotomy

Start an IV for medication administration

Bag Mask Ventilation

Insertion of a size appropriate LMA