BHU NO-2019
Child Health Nursing (Pediatrics)
Easy
For tracheal tube insertion in a newborn following is the combination of tube and laryngoscope blade:
Appeared in: BHU NO-2019
Explanation
- The correct choice for a newborn is an uncuffed endotracheal tube combined with a straight laryngoscope blade.
- An uncuffed tube is used because the cricoid cartilage, the narrowest part of a newborn's airway, acts as a natural cuff, preventing the need for an artificial one and reducing the risk of tracheal injury.
- A straight blade (e.g., Miller blade) is preferred because it is designed to directly lift the newborn's long, floppy epiglottis, providing a clear view of the vocal cords for intubation.
- This combination is standard practice to ensure safe and effective airway management while minimizing the risk of complications like subglottic stenosis.
Why Other Options Were Wrong
- Option A: While the uncuffed tube is correct for a newborn, a curved blade (Macintosh) is not ideal. It is designed for indirect laryngoscopy by being placed in the vallecula, which is less effective for lifting a newborn's floppy epiglottis.
- Option B: Both components are incorrect for a newborn. A cuffed tube poses a significant risk of pressure injury (subglottic stenosis) to the delicate tracheal mucosa, and a curved blade provides a suboptimal view of the neonatal larynx.
- Option C: While the straight blade is the correct choice for a newborn, the cuffed tube is inappropriate. The cuff can cause pressure necrosis and long-term airway narrowing in an infant.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Equipment selection for neonatal endotracheal intubation as background academic context rather than a clinical decision trigger.
- Using the correct equipment for neonatal intubation is critical for patient safety. The primary goal is to secure the airway quickly and atraumatically.
- Choosing an uncuffed tube significantly reduces the risk of iatrogenic subglottic stenosis, a serious complication that can lead to long-term respiratory problems.
- Nurses assisting with or performing neonatal resuscitation must be able to identify and prepare the correct size and type of ETT and laryngoscope blade.
How to Approach the Question
- First, identify the patient population in the question: a 'newborn'. This is the most critical piece of information.
- Break the question into two parts: the type of tracheal tube and the type of laryngoscope blade.
- For the tube, recall the unique anatomy of the neonatal airway. The cricoid cartilage is the narrowest point and acts as a natural cuff. This should lead you to select 'uncuffed' to prevent injury.
- For the blade, recall the characteristics of the neonatal epiglottis (long, floppy). This requires a blade that can directly lift it, which points to a 'straight' blade (Miller).
- Combine the two correct choices: 'Uncuffed tube' and 'straight blade' to find the correct option.
Concept Tested & Keywords
- Concept Tested: Equipment selection for neonatal endotracheal intubation.
- Stem keywords: tracheal tube insertion, newborn, laryngoscope blade
- Lead-in keywords: combination
- Clinical cues: Patient age: newborn, which dictates specific anatomical considerations.
Question ID
Q1qKgMoVCaMud0r_JBLIUB
Reference Book
E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 777-779
E6 Nursing Fundamentals Taylor p. 736-738
Practise the full BHU NO-2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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