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

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?

A. video-laryngoscopy

B. flexible bronchoscopic intubation

C. laryngoscopy with a McCoy blade

D. airway exchange catheter

E. tracheotomy

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

A possible complication during an airway exchange is

A. massive bleeding

B. increased abdominal pressure

C. acute respiratory failure

D. ventilator associated pneumonia (VAP)

E. acute airway obstruction

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

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

A. counterclockwise rotation of the tube

B. gentle pressure to force the tube through the glottis

C. lubrication of the tip of the tube

D. jaw thrust

E. assist with video-laryngoscopy

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

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