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Chapter 38. Airway Management of a Patient in Prone Position

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Which of the following is not acceptable initial method to provide oxygenation and ventilation to an awake cooperative patient lying prone with a knife in the thoracic spine in the emergency department?

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A. Advancing the ETT over a flexible bronchoscope into the trachea

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B. Establish a surgical airway

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C. Insertion of a Laryngeal Mask Airway

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D. Bag-mask-ventilation

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E. Intubation through an Intubating LMA

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(B) Emergency airway management in a patient lying prone should include BMV, the use of an EGD, the placement of an endotracheal tube, and a surgical airway. But a surgical airway is generally reserved as a last resort.

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Following orotracheal intubation, which of the following is NOT an acceptable method of securing the endotracheal tube (ETT) in a patient with facial hair?

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A. Tie the ETT around the neck with an umbilical tape.

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B. Tie the ETT to the upper incisors.

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C. Secure the ETT with a waterproof tape after the application of tincture of benzoin to the face.

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D. Shave the patient's beard under general anesthesia.

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E. None of the above.

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(E) All of these techniques (A, B, C, and D) are acceptable methods of securing the endotracheal tube (ETT) in a patient with facial hair. However, shaving the beard would require patient's consent.

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Which of the following is most reliable in assessing postoperative airway edema in a patient who was placed prone for the procedure?

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A. The amount of intraoperative fluid administered to the patient.

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B. The presence of facial edema.

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C. The leak test.

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D. Flexible nasopharyngoscopy.

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E. None of the above.

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(E) While all these methods may provide helpful clues of airway edema, none of them has been proven scientifically to be a reliable method in assessing postoperative airway edema in a patient who has been placed prone for a surgical procedure.

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