Surgical and Rescue Airways Practice Questions

30 multiple-choice questions on Surgical and rescue airways for paramedic and EMT students, from Chapter 16 (Airway Management). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. What is the primary indication for an emergency cricothyrotomy?

   1. A. Two failed intubation attempts
   2. B. First intubation attempt failed
   3. C. A failed SGA but good BVM seal
   4. D. Cannot intubate or oxygenate
   Show answer

   Answer: D. Cannot intubate or oxygenate

   A surgical airway is indicated when oxygenation cannot be maintained by BVM, SGA, or intubation. Failed intubation attempts, whether one or two, are not an indication while oxygenation is maintained, and a failed SGA with effective bag-mask ventilation means the patient can still be oxygenated.

2. After a failed intubation attempt, you can maintain SpO2 at 95% with a BVM and two adjuncts. What is the best next step?

   1. A. Continue oxygenating and place an SGA
   2. B. Repeated attempts without oxygenating
   3. C. Immediate needle cricothyrotomy
   4. D. Immediate surgical cricothyrotomy
   Show answer

   Answer: A. Continue oxygenating and place an SGA

   "Can't intubate, can oxygenate" is not an emergency surgical airway. Keep oxygenating and use a rescue device such as an SGA.

3. A tracheostomy patient wearing a one-way speaking valve stops breathing. What must you do before bagging through the trach tube?

   1. A. Inflate the tube's cuff first
   2. B. Remove the speaking valve
   3. C. Cover the stoma with gauze
   4. D. Insert a smaller inner cannula
   Show answer

   Answer: B. Remove the speaking valve

   A one-way speaking valve lets air in but not out through the tube, so bagging through it traps air and causes barotrauma. Remove it, then ventilate (inflate the cuff if there is one). Inflating the cuff before removing the valve blocks exhalation completely. Covering the stoma is for ventilating by mouth. A smaller inner cannula does not solve a one-way valve.

4. When identifying landmarks for cricothyrotomy, you slide your finger down from the thyroid cartilage. The first depression you feel is the:

   1. A. Cricothyroid membrane
   2. B. Thyrohyoid membrane
   3. C. Suprasternal notch
   4. D. Second tracheal ring gap
   Show answer

   Answer: A. Cricothyroid membrane

   Moving down from the thyroid prominence, the small depression before the cricoid ring is the cricothyroid membrane.

5. Why is surgical cricothyrotomy generally avoided in young children?

   1. A. The larynx sits too low
   2. B. The thyroid gland is too large
   3. C. The trachea is too rigid
   4. D. The membrane is too small
   Show answer

   Answer: D. The membrane is too small

   In young children the cricothyroid membrane is small and the larynx is difficult to identify. Needle cricothyrotomy is preferred. The child's larynx sits higher, not lower, the trachea is soft and pliable rather than rigid, and the thyroid gland is not what blocks the approach.

6. In the scalpel-finger-bougie technique, what type of incision is usually made through the skin when landmarks are hard to feel?

   1. A. Vertical
   2. B. Curved
   3. C. Diagonal
   4. D. Horizontal
   Show answer

   Answer: A. Vertical

   A vertical skin incision allows the operator to extend up or down to find the membrane. The membrane itself is then incised horizontally.

7. In the scalpel-finger-bougie technique, how is the cricothyroid membrane itself incised?

   1. A. Not at all
   2. B. Horizontally
   3. C. Vertically
   4. D. In a cross pattern
   Show answer

   Answer: B. Horizontally

   The membrane is cut horizontally, then a finger confirms the opening and guides a bougie into the trachea.

8. What size cuffed endotracheal tube is commonly placed over the bougie during an adult surgical cricothyrotomy?

   1. A. 9.0 mm
   2. B. 8.5 mm
   3. C. 3.5 mm
   4. D. 6.0 mm
   Show answer

   Answer: D. 6.0 mm

   A 6.0-mm cuffed tube passes easily through the small membrane opening. Larger tubes may not fit.

9. You need to reinsert a dislodged tracheostomy tube. What is the obturator in the trach kit used for?

   1. A. It inflates the cuff after it is inserted
   2. B. It is left in place to ventilate
   3. C. It smooths the tube's tip for insertion
   4. D. It measures the depth of the stoma
   Show answer

   Answer: C. It smooths the tube's tip for insertion

   The obturator fills the tube and gives it a rounded tip so it slides into the stoma without catching tissue. It is not left in place to ventilate; remove it right after insertion, because the patient cannot breathe through it. It does not inflate the cuff (a syringe does) or measure the stoma.

10. What is a serious complication of surgical cricothyrotomy?

    1. A. Creating a false passage
    2. B. Rib fractures
    3. C. Pulmonary embolism
    4. D. Injury to the cervical spine
    Show answer

    Answer: A. Creating a false passage

    The tube can be placed into the soft tissues rather than the trachea. Bleeding, subcutaneous emphysema, and esophageal injury are other complications. Pulmonary embolism, cervical spine injury and rib fractures are not complications of the procedure.

11. When performing a needle cricothyrotomy, the catheter should be directed:

    1. A. Laterally to the right
    2. B. Cephalad, toward the chin
    3. C. Straight back to the spine
    4. D. Caudally, at about 45°
    Show answer

    Answer: D. Caudally, at about 45°

    Aim the needle downward toward the feet at roughly 45 degrees to follow the trachea and avoid the vocal cords.

12. While advancing a needle through the cricothyroid membrane, how can you confirm entry into the trachea?

    1. A. Watch for bright red blood
    2. B. Note the patient coughing hard
    3. C. Aspirate air into a syringe
    4. D. Feel the needle hit bone
    Show answer

    Answer: C. Aspirate air into a syringe

    Free aspiration of air into a syringe (often partially filled with saline) confirms the catheter tip is in the trachea.

13. What is the main limitation of needle cricothyrotomy with jet ventilation?

    1. A. It needs a large incision
    2. B. CO2 builds up over time
    3. C. It requires a cuffed tube
    4. D. Oxygen flow is far too low
    Show answer

    Answer: B. CO2 builds up over time

    Jet ventilation through a small catheter oxygenates well, but exhalation is limited, so CO2 accumulates. It is a temporary bridge. It uses an over-the-needle catheter rather than a cuffed tube, a high-pressure oxygen source drives a high flow, and a large incision belongs to surgical cricothyrotomy.

14. During transtracheal jet ventilation, what is a major risk if the upper airway is completely obstructed?

    1. A. Barotrauma from trapped air
    2. B. Excess CO2 elimination
    3. C. Sudden hypoglycemia
    4. D. Bradycardia from vagal tone
    Show answer

    Answer: A. Barotrauma from trapped air

    Exhalation occurs through the upper airway. If it is blocked, gas cannot escape, causing breath stacking and barotrauma such as pneumothorax.

15. A 60-year-old with a tracheostomy is in respiratory distress. You hear gurgling from the tube. What should you do first?

    1. A. Begin chest compressions
    2. B. Suction the trach tube
    3. C. Intubate the patient orally
    4. D. Remove it immediately
    Show answer

    Answer: B. Suction the trach tube

    Mucus plugging is the most common cause of trach obstruction. Suction with a soft catheter after preoxygenating.

16. Suctioning does not clear an obstructed tracheostomy tube that has a removable inner cannula. What is the next step?

    1. A. Push the tube deeper
    2. B. Perform a needle cric
    3. C. Instill saline and resuction
    4. D. Remove the inner cannula
    Show answer

    Answer: D. Remove the inner cannula

    Removing the inner cannula often clears the obstruction. If it does not, the outer tube may need to be replaced. Routine saline instillation is not recommended and does not clear a blocked cannula, pushing the tube deeper can create a false passage, and a needle cric is not needed when the stoma is available.

17. A patient's tracheostomy tube has fallen out and no replacement is available. Which device can be placed into the stoma?

    1. A. A nasopharyngeal airway
    2. B. A King LT airway
    3. C. An endotracheal tube
    4. D. An oropharyngeal airway
    Show answer

    Answer: C. An endotracheal tube

    A small cuffed ET tube can be inserted into the stoma and advanced only a short distance beyond the cuff to avoid a mainstem placement.

18. You ventilate a patient with a tracheostomy through a BVM attached to the trach tube, but air escapes from the mouth and nose. What should you do?

    1. A. Insert an oral airway
    2. B. Deflate the trach cuff
    3. C. Seal the mouth and nose
    4. D. Remove the trach tube now
    Show answer

    Answer: C. Seal the mouth and nose

    In a tracheostomy, the upper airway may still connect to the trachea. Seal the mouth and nose to prevent air escaping. Deflating the cuff would let even more air escape upward, an oral airway does not stop the leak, and removing the tube loses the airway.

19. A patient who had a total laryngectomy is apneic. How should you ventilate him?

    1. A. Through the mouth by BVM
    2. B. With a supraglottic airway
    3. C. Through the nose by BVM
    4. D. Through the neck stoma
    Show answer

    Answer: D. Through the neck stoma

    After total laryngectomy, the trachea is completely separated from the mouth and nose. Ventilate and oxygenate only through the stoma.

20. A trach patient has new swelling and crackling under the skin of the neck, no chest rise with bagging, and high resistance. What is most likely?

    1. A. The inner cannula has a mucus plug
    2. B. The cuff has ruptured and is now leaking air
    3. C. The tube has slipped into the soft tissue
    4. D. The tube has entered the right mainstem
    Show answer

    Answer: C. The tube has slipped into the soft tissue

    Subcutaneous emphysema with no chest rise means the tube has partly dislodged and is blowing air into the tissues of the neck. Deflate the cuff, remove the tube, and oxygenate by the stoma or the face, then reinsert. A mucus plug in the inner cannula causes resistance but not air under the skin. A ruptured cuff causes a leak with low resistance, and a tube in the right mainstem would still produce chest rise.

21. A 33-year-old has severe angioedema of the lips and tongue. Two intubation attempts failed, an SGA does not ventilate, and SpO2 is 72% and falling despite BVM. What is indicated?

    1. A. Surgical cricothyrotomy
    2. B. Nebulized albuterol
    3. C. Nasal airway with BVM
    4. D. A third intubation attempt
    Show answer

    Answer: A. Surgical cricothyrotomy

    This is a cannot-intubate, cannot-oxygenate situation. Proceed directly to a surgical airway.

22. A trach tube has come out and you cannot reinsert one of the same size. What is the best next step?

    1. A. Try a tube one half size smaller
    2. B. Push the same tube in with force
    3. C. Leave the stoma open and wait
    4. D. Insert a nasal airway into the stoma
    Show answer

    Answer: A. Try a tube one half size smaller

    Stomas can narrow within minutes. A tube a half size smaller (or a small ET tube) usually passes. Forcing the same tube can create a false passage. Waiting leaves the patient without a secure airway. A nasal airway is too short and has no connector for bagging, so it is a poor stoma device.

23. Which finding is a contraindication to cricothyrotomy?

    1. A. Severe facial trauma
    2. B. Massive vomiting
    3. C. Angioedema
    4. D. Tracheal transection
    Show answer

    Answer: D. Tracheal transection

    If the trachea is transected or the larynx is fractured, a cric may worsen the injury or fail. Facial trauma and angioedema are indications, not contraindications.

24. What is a common source of bleeding during surgical cricothyrotomy?

    1. A. The internal jugular vein
    2. B. The subclavian vein
    3. C. Superficial neck veins
    4. D. The common carotid artery
    Show answer

    Answer: C. Superficial neck veins

    Anterior jugular veins and small cricothyroid vessels can bleed. Major vessels lie lateral and should be avoided by staying midline. The internal jugular, carotid and subclavian vessels lie lateral or low and are not usually injured when you stay midline.

25. Why is it important to stay midline when performing a surgical cricothyrotomy?

    1. A. To avoid the esophagus
    2. B. Major vessels lie laterally
    3. C. The membrane lies off-center
    4. D. The thyroid gland is midline
    Show answer

    Answer: B. Major vessels lie laterally

    The carotid arteries and jugular veins lie laterally. Stabilizing the larynx and staying midline reduces the risk of major bleeding.

26. Which hand typically stabilizes the larynx during a surgical cricothyrotomy for a right-handed provider?

    1. A. An assistant only
    2. B. Neither hand
    3. C. Left hand
    4. D. Right hand
    Show answer

    Answer: C. Left hand

    The nondominant hand stabilizes the larynx (the "laryngeal handshake") while the dominant hand holds the scalpel.

27. After a needle cricothyrotomy is placed in a child, how should that airway be regarded?

    1. A. As safe for several hours
    2. B. As a temporary bridge
    3. C. As protection from aspiration
    4. D. As a definitive airway
    Show answer

    Answer: B. As a temporary bridge

    Needle cricothyrotomy provides oxygenation but limited ventilation, so it is a temporary bridge: the child needs rapid transport and a definitive airway. It does not protect against aspiration, it is not a definitive airway, and CO2 builds up within roughly 30 to 45 minutes, so it is not safe for several hours.

28. In the scalpel-finger-bougie cricothyrotomy, what is the main purpose of inserting a finger into the incision?

    1. A. Stop all of the bleeding
    2. B. Feel for the carotid pulse
    3. C. Confirm and hold the opening
    4. D. Measure the needed tube depth
    Show answer

    Answer: C. Confirm and hold the opening

    The finger confirms entry into the trachea and keeps the tract open so the bougie can be guided in, after which a tube is railroaded over it.

29. A patient with a tracheostomy (not a laryngectomy) has a blocked tube that you removed, and you cannot reinsert one. He is apneic. How can you ventilate him?

    1. A. Bag the mouth with the stoma left open
    2. B. Bag the mouth while sealing the stoma
    3. C. Pass a King LT through the stoma
    4. D. Use a nonrebreather over the stoma
    Show answer

    Answer: B. Bag the mouth while sealing the stoma

    With a tracheostomy the upper airway still connects to the trachea, so you can bag the face while covering the stoma, or use a small mask over the stoma. Bagging the mouth with the stoma open lets the air escape through the stoma instead of filling the lungs. A King LT is not designed for a stoma. A nonrebreather does not ventilate an apneic patient. (After a laryngectomy, only the stoma works.)

30. Which statement about the timing of a surgical airway decision is correct?

    1. A. It should be the first step
    2. B. It should wait for cardiac arrest
    3. C. Delay worsens hypoxic injury
    4. D. It should follow three failed attempts
    Show answer

    Answer: C. Delay worsens hypoxic injury

    Hesitation is a common cause of hypoxic injury. When CICO is recognized, move promptly to a surgical airway as protocols allow. Paramedics may perform it under protocol; waiting for arrest or for a set number of failed attempts lets hypoxic injury progress, and it is a rescue step rather than the first step.