Adult Critical Care Specialty (ACCS) Practice Exam

Which strategy should be used for pre-op intubation of a patient with rheumatoid arthritis and a Mallampati score of 3?

1. Traditional laryngoscopy

2. Fiberoptic bronchoscopy

3. Video laryngoscopy

4. Bag-mask ventilation

The correct answer is: Fiberoptic bronchoscopy

In the context of pre-operative intubation for a patient with rheumatoid arthritis and a Mallampati score of 3, fiberoptic bronchoscopy is the most appropriate strategy. Patients with rheumatoid arthritis often have anatomical changes in the airway due to joint involvement, which can lead to difficulty in achieving optimal visualization during intubation. The Mallampati score of 3 indicates that the oropharynx is partially visible, suggesting the possibility of a more challenging airway. Fiberoptic bronchoscopy allows for direct visualization of the airway, maneuvers to navigate any potential obstacles, and the ability to visualize the trachea and place the endotracheal tube directly into the airway with minimal manipulation. This technique is particularly beneficial when there are concerns about airway obstruction or limited neck mobility, which is common in patients with rheumatoid arthritis. While traditional laryngoscopy and video laryngoscopy are useful techniques, they may not provide adequate visualization in more complex airway situations as efficiently as fiberoptic bronchoscopy. Bag-mask ventilation is typically used in pre-oxygenation and may not be adequate for securing the airway in a patient with anticipated difficulties due to anatomical considerations linked to rheumatoid arthritis.