Adult Critical Care Specialty (ACCS) Practice Exam

What is the most appropriate action for a specialist when a patient demonstrates a low tidal volume alarm due to a gurgling sound from the mouth?

1. Use an airway exchange catheter to replace the ET tube

2. Attach a three-way stopcock to the pilot balloon valve

3. Use hemostats to clamp the pilot balloon line

4. Introduce a blunt 22 gauge needle into the pilot line

The correct answer is: Attach a three-way stopcock to the pilot balloon valve

The most appropriate action when a patient demonstrates a low tidal volume alarm accompanied by a gurgling sound from the mouth is to attach a three-way stopcock to the pilot balloon valve. This approach allows for the assessment and management of the cuff pressure of the endotracheal (ET) tube. When the patient exhibits gurgling sounds, it may indicate that the cuff may not be sealing properly, allowing air to escape from the trachea and potentially compromising ventilation and gas exchange. By utilizing a three-way stopcock, the clinician can easily inflate or deflate the cuff, ensuring that it maintains proper sealing against the tracheal wall, thereby providing the necessary ventilation pressures. This action helps mitigate the risk of aspiration and ensures that the ventilator can effectively deliver the set tidal volumes without air leaks. The other options may not adequately address the underlying issue of cuff pressure and seal integrity. Utilizing an airway exchange catheter to replace the ET tube could be premature if the primary problem is merely a loss of cuff integrity. Clamping the pilot balloon line might not provide the necessary control over cuff inflation, and using a blunt needle could risk damage to the pilot line or cuff system. Thus, the option of employing a three-way stopcock is the most