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Chapter 31. Airway Management of a Patient in a Halo-Jacket with Acute Obstruction of a Reinforced Tracheal Tube

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Which of the following methods is NOT suitable for the exchange of an endotracheal tube in a patient with anticipated difficult airway, such as in a halo jacket?

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A. video-laryngoscopy

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B. flexible bronchoscopic intubation

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C. laryngoscopy with a McCoy blade

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D. airway exchange catheter

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E. tracheotomy

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(C) Direct laryngoscopy using a Macintosh laryngoscope is known to be difficult in patients in a halo jacket.

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A possible complication during an airway exchange is

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A. massive bleeding

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B. increased abdominal pressure

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C. acute respiratory failure

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D. ventilator associated pneumonia (VAP)

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E. acute airway obstruction

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(E) The likely complications that occur during airway exchange are acute airway obstruction and failure to intubate.

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All of the following can be tried if the tracheal tube cannot be advanced over the tube exchanger through the glottis EXCEPT

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A. counterclockwise rotation of the tube

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B. gentle pressure to force the tube through the glottis

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C. lubrication of the tip of the tube

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D. jaw thrust

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E. assist with video-laryngoscopy

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(B) To avoid laryngeal injury, the endotracheal tube should never be advanced over the airway exchange catheter by force.

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