American Association of Critical-Care Nurses (AACN) Certification Practice Test

What action should be taken initially in the management of suspected tracheoinnominate artery fistula?

1. Perform a bronchoscopy

2. Apply manual pressure

3. Start intravenous fluid resuscitation

4. Intubate the patient

The correct answer is: Perform a bronchoscopy

The initial action in the management of a suspected tracheoinnominate artery fistula is to perform a bronchoscopy. This diagnostic procedure allows the healthcare provider to visualize the airway directly and assess the extent of the injury or abnormality. In the case of a tracheoinnominate artery fistula, where there is a risk of exsanguination due to a connection between the trachea and the innominate artery, bronchoscopy can help identify the source of the bleeding and other related complications. While other interventions may be necessary after assessment, such as controlling bleeding or maintaining airway patency, recognizing the fistula through visual inspection provides critical information that dictates subsequent management. Addressing the situation through direct visualization is essential in guiding further treatment steps, such as potential surgical intervention or advanced airway management.