Adult Critical Care Specialty (ACCS) Practice Exam

If oral endotracheal intubation is unsuccessful, what alternative method should a specialist recommend for airway management?

1. An oropharyngeal airway

2. A blind nasal intubation

3. An esophageal obturator airway

4. A percutaneous tracheostomy

The correct answer is: A percutaneous tracheostomy

In situations where oral endotracheal intubation is unsuccessful, a percutaneous tracheostomy serves as a viable alternative for airway management. This procedure involves creating an incision in the neck to directly access the trachea, providing a secure airway, especially in critically ill patients or when other methods have failed. This method is advantageous in emergency scenarios where rapid airway control is needed, and it helps to mitigate complications from prolonged intubation. Furthermore, unlike the other methods listed, which may offer temporary support or be limited in specific situations, a percutaneous tracheostomy can be a more definitive solution, allowing for long-term airway management in patients requiring ongoing respiratory support. Other options, while applicable in certain contexts, do not serve as robust alternatives when endotracheal intubation fails. An oropharyngeal airway may maintain airway patency but does not secure it for effective ventilation. Blind nasal intubation poses risks of trauma and is not always possible in the emergency setting. The esophageal obturator airway primarily supports ventilation when standard methods are unsuccessful but lacks the effectiveness and security offered by a tracheostomy, particularly for long-term needs.