Adult Critical Care Specialty (ACCS) Practice Exam

If a patient has a bull neck, receding mandible, and a thyromental distance of 3 cm, what should be the next step for intubation?

1. Use a straight laryngoscope blade

2. Request the difficult airway cart

3. Perform a Sellick maneuver

4. Intubate using a nasal approach

The correct answer is: Request the difficult airway cart

The scenario describes a patient with significant anatomical challenges to intubation, including a bull neck, receding mandible, and a short thyromental distance of 3 cm. These features raise the suspicion of a potentially difficult airway, which is supported by the limited space and possibility of poor visualization during laryngoscopy. In this context, the most prudent action to take is to request the difficult airway cart. This cart is specifically equipped with tools and devices that are valuable in managing challenging airways, including alternative intubation devices and adjuncts that can facilitate the process. Having this cart on hand ensures readiness to address any complications that may arise during intubation, thereby enhancing patient safety. The other options may not adequately address the specific concerns presented by this patient's anatomy. Using a straight laryngoscope blade or performing a Sellick maneuver may not be effective given the expected difficulty, and intubating via a nasal approach introduces additional risks, particularly in patients with potential anatomical irregularities or concerns such as trauma. Therefore, preparing for a difficult airway by utilizing the dedicated resources in the difficult airway cart is the most appropriate next step.