BCA Airway Management & Emergency Response 2 — Questions and Answers
Question 1: A patient with a known difficult airway requires emergent intubation. The 'can't intubate, can't oxygenate' (CICO) scenario is declared. What is the immediate next step after failed oxygenation with a supraglottic airway?
- Attempt a 4th laryngoscopy with a different blade
- Perform front-of-neck access (surgical airway) (Correct answer)
- Increase the fraction of inspired oxygen and reposition
- Administer a second dose of succinylcholine
Correct answer: Perform front-of-neck access (surgical airway)
In a CICO emergency, front-of-neck access (cricothyrotomy or surgical tracheotomy) is mandatory when oxygenation cannot be achieved by other means.
Question 2: When using video laryngoscopy with a hyperangulated blade, the anesthesiologist achieves an excellent glottic view but cannot advance the endotracheal tube. What is the most likely cause?
- Tube is too large for the glottic opening
- Acute angle between blade geometry and tracheal axis requires a stylet with matching curvature (Correct answer)
- The cuff is inflated prematurely
- Laryngospasm has developed
Correct answer: Acute angle between blade geometry and tracheal axis requires a stylet with matching curvature
Hyperangulated video laryngoscope blades create a sharp anterior angle requiring a pre-shaped stylet that matches the blade curve to navigate the tube into the trachea.
Question 3: During rapid sequence induction, succinylcholine 1.5 mg/kg is administered. How long should the anesthesiologist wait before intubating to ensure maximum fasciculation and relaxation?
- 15–20 seconds
- 45–60 seconds (Correct answer)
- 90–120 seconds
- 3–5 minutes
Correct answer: 45–60 seconds
Optimal intubating conditions after succinylcholine occur at approximately 45–60 seconds, coinciding with peak neuromuscular blockade.
Question 4: A patient develops subcutaneous emphysema and decreasing SpO2 shortly after endotracheal intubation. Breath sounds are absent on the left. The most likely diagnosis is:
- Left main-stem bronchus intubation
- Right main-stem bronchus intubation (Correct answer)
- Tension pneumothorax on the right
- Esophageal intubation
Correct answer: Right main-stem bronchus intubation
Right main-stem intubation is the most common endobronchial intubation because the right bronchus has a less acute angle from the carina, resulting in absent left breath sounds.
Question 5: Which capnography waveform pattern is most consistent with a bronchospasm during mechanical ventilation?
- Flat EtCO2 at zero
- Shark-fin (sloping plateau) waveform with elevated EtCO2 (Correct answer)
- Normal waveform with low EtCO2
- Cardiogenic oscillations on the plateau
Correct answer: Shark-fin (sloping plateau) waveform with elevated EtCO2
Bronchospasm causes prolonged expiration and uneven gas emptying, producing the characteristic shark-fin capnography waveform with elevated end-tidal CO2.
Question 6: A patient with Ludwig's angina presents for emergency airway management. Which approach is considered safest as the initial strategy?
- Rapid sequence induction with direct laryngoscopy
- Awake flexible bronchoscopic intubation with topical anesthesia (Correct answer)
- Blind nasotracheal intubation
- Immediate surgical tracheotomy under general anesthesia
Correct answer: Awake flexible bronchoscopic intubation with topical anesthesia
Awake flexible bronchoscopic intubation preserves spontaneous respiration and airway patency, making it the safest initial technique in the setting of severe submandibular infection and airway distortion.
Question 7: During a cricothyrotomy using the Seldinger technique, the anesthesiologist cannot pass the guidewire easily. What should be done first?
- Apply more force to advance the wire
- Confirm needle position by aspirating air, then rotate the needle bevel (Correct answer)
- Switch immediately to an open surgical technique
- Attempt to dilate over the needle without a wire
Correct answer: Confirm needle position by aspirating air, then rotate the needle bevel
Confirming intratracheal needle placement by free aspiration of air and adjusting bevel orientation is the first step before re-attempting wire advancement.
BCA Airway Management & Emergency Response 2
A patient with a known difficult airway requires emergent intubation.
The 'can't intubate, can't oxygenate' (CICO) scenario is declared.
What is the immediate next step after failed oxygenation with a supraglottic airway?