Adult Critical Care Specialty (ACCS) Practice Exam

What device is most appropriate for intubating a patient with a short neck and a thyromental distance of 4cm in respiratory failure?

1. Esophageal tracheal combitube

2. Needle cricothyrotomy

3. Gum elastic bougie

4. Retrograde wire kit

The correct answer is: Gum elastic bougie

In the context of intubating a patient with specific anatomical challenges such as a short neck and a limited thyromental distance, the gum elastic bougie is particularly advantageous. This tool is designed to facilitate the intubation of patients where visualization of the vocal cords may be difficult or obstructed. In the scenario presented, the patient's short neck and minimal thyromental distance indicate that direct visualization for intubation could be challenging, potentially increasing the risk of airway obstruction or unsuccessful intubation attempts. The gum elastic bougie allows for a flexible approach; it can be introduced into the airway with a greater possibility of guiding the endotracheal tube into the trachea even if the airway is not easily seen. The other devices mentioned are less suitable for this specific situation. An esophageal tracheal combitube generally serves as a rescue airway but may not provide the necessary precision for direct intubation in a complex case. A needle cricothyrotomy is typically used as an emergency procedure for establishing an airway in severe circumstances, not as a primary method of intubation. A retrograde wire kit is effective for difficult airways but requires advanced skill and is usually a secondary option after more straightforward methods have been attempted