(A) - Common Procedures

Question 1

What is an endotracheal tube (ETT)?

Answer 1

A flexible plastic tube with an inflatable cuff that is placed through the mouth and vocal cords into the trachea to secure the airway and allow ventilation

Question 2

What is the function of the cuff on an endotracheal tube?

Answer 2

Forms a seal within the trachea
Prevents air leak during ventilation
Reduces risk of aspiration of gastric contents

Question 3

How is correct inflation of an endotracheal tube cuff assessed?

Answer 3

Pilot balloon gives a rough estimate of cuff inflation
Cuff pressure can be measured accurately using a manometer
Over inflation risks tracheal injury

Question 4

What is the pilot balloon and pilot line on an ETT?

Answer 4

Pilot line connects the cuff to the pilot balloon
Pilot balloon inflates when cuff inflates
Valve prevents air from escaping

Question 5

What is Murphy’s eye and why is it important?

Answer 5

An additional opening on the side of the ETT tip
Allows gas flow if the main lumen becomes blocked
Reduces risk of complete airway obstruction

Question 6

What are typical adult endotracheal tube sizes?

Answer 6

Women usually 7 to 7.5 mm
Men usually 8 to 8.5 mm

Question 7

What is a laryngoscope used for?

Answer 7

To visualise the vocal cords during intubation
To guide placement of an endotracheal tube into the trachea

Question 8

What is a McGrath laryngoscope?

Answer 8

Video laryngoscope
Has a camera and screen
Allows indirect visualisation of the vocal cords
Useful in difficult airways

Question 9

What is a bougie and when is it used?

Answer 9

Flexible introducer placed into the trachea
Used when vocal cords cannot be clearly visualised
ETT is railroaded over the bougie into position

Question 10

What is a stylet and how does it help intubation?

Answer 10

A stiff wire placed inside the ETT
Allows shaping of the tube
Helps direct the tube anteriorly towards the trachea
Reduces oesophageal intubation

Question 11

What is awake fibre-optic intubation?

Answer 11

Intubation performed while the patient is awake
Uses a flexible endoscope to guide the tube into the trachea
Avoids loss of airway control

Question 12

When is awake fibre-optic intubation indicated?

Answer 12

Difficult airway
Restricted mouth opening
Altered neck anatomy
Post radiotherapy to head and neck

Question 13

What is trismus and why is it important for airway management?

Answer 13

Painful restriction of jaw opening
Makes laryngoscopy difficult
May necessitate awake fibre-optic intubation

Question 14

Why is awake fibre-optic intubation safer in difficult airways?

Answer 14

Maintains spontaneous breathing
Avoids hypoxia if intubation is delayed
Reduces risk of failed airway after induction

Question 15

What are supraglottic airway devices (SADs)?

Answer 15

Airway devices placed above the vocal cords
Alternative to endotracheal intubation
Used for ventilation during anaesthesia

Question 16

Where does a supraglottic airway device sit anatomically?

Answer 16

Tip sits at the entrance of the oesophagus
Cuff forms a seal around the laryngeal inlet

Question 17

What is a laryngeal mask airway (LMA)?

Answer 17

SAD with an inflatable cuff

Question 18

What is an i-gel airway?

Answer 18

A non inflatable supraglottic airway
Uses a gel cuff that moulds to the larynx

Question 19

What role do SADs have in difficult airway management?

Answer 19

First option if intubation fails
Used in DAS difficult airway algorithms

Question 20

What is an oropharyngeal (Guedel) airway used for?

Answer 20

Maintains airway patency by preventing tongue obstruction
Used during bag mask ventilation

Question 21

How is the correct size of an oropharyngeal airway measured?

Answer 21

From the centre of the mouth to the angle of the jaw

Question 22

What is a nasopharyngeal airway?

Answer 22

A flexible tube inserted through the nose
Maintains airway patency to the pharynx

Measured from nostril to tragus of the ear

Question 23

What is a contraindication to nasopharyngeal airway insertion?

Answer 23

Suspected base of skull fracture

Question 24

What is a tracheostomy?

Answer 24

A surgically created opening into the trachea
Allows direct airway access through the neck

For prolonged ventilation or airway protection

Permanent after laryngectomy

Question 25

Common indications for a tracheostomy?

Answer 25

Prolonged mechanical ventilation Upper airway obstruction Poor airway protection Secretion management

Question 26

What are the DAS difficult airway plans?

Answer 26

* Plan A laryngoscopy and intubation * Plan B supraglottic airway * Plan C face mask ventilation and wake patient * Plan D emergency cricothyroidotomy

Question 27

What is an arterial line used for?

Answer 27

Continuous real time blood pressure monitoring Repeated arterial blood gas sampling **Cannot give medications as risk of severe tissue damage and arterial thrombosis**

Question 28

What is a central venous catheter?

Answer 28

A long catheter placed into a large central vein Tip sits in the vena cava

Question 29

What sites are used for central line insertion?

Answer 29

Internal jugular vein Subclavian vein Femoral vein

Question 30

Why are central lines useful compared to peripheral cannulas?

Answer 30

Longer lasting access Multiple lumens Safe delivery of irritant medications

Question 31

What is a Vas Cath used for?

Answer 31

Temporary haemodialysis access Short term use in renal failure

Question 32

What is a PICC line?

Answer 32

**Peripherally inserted central catheter** Inserted through arm vein Low infection risk Suitable for medium term IV therapy

Question 33

What is a Hickman line?

Answer 33

Tunnelled central venous catheter Has a cuff for tissue adhesion Used for long term treatments like chemotherapy

Question 34

What is a pulmonary artery catheter?

Answer 34

**Swan-Ganz catheter** Measures pulmonary artery wedge pressure Used for advanced cardiac monitoring

Question 35

What is a Portacath and its advantage?

Answer 35

Fully implanted central venous access device No external tubing when not accessed Lowest infection risk Used for long term treatments