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Chapter 38. Airway Management of a Patient in Prone Position

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?

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

B. Establish a surgical airway

C. Insertion of a Laryngeal Mask Airway

D. Bag-mask-ventilation

E. Intubation through an Intubating LMA

(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.

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

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

B. Tie the ETT to the upper incisors.

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

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

E. None of the above.

(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.

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

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

B. The presence of facial edema.

C. The leak test.

D. Flexible nasopharyngoscopy.

E. None of the above.

(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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