Clinical Procedures and Protocols Flashcards

A patient with a predicted difficult airway is scheduled for elective surgery. Which preoperative preparation is MOST important before attempting laryngoscopy?

Answer: Preoxygenation to maximize apneic oxygenation time

Adequate preoxygenation maximizes oxygen reserve, extending safe apneic time and providing the most critical safety margin during a difficult airway attempt.

During placement of a central venous catheter via the internal jugular vein, bright red blood aspirates with pulsatile flow. What is the correct immediate management?

Answer: Withdraw the needle and apply firm direct pressure for at least 10 minutes

Inadvertent carotid artery puncture requires immediate needle withdrawal and firm direct compression for at least 10 minutes to achieve hemostasis.

A patient undergoing a combined spinal-epidural (CSE) technique for labor analgesia develops sudden fetal bradycardia after intrathecal fentanyl 25 mcg is administered. What is the most likely cause?

Answer: Uterine tachysystole secondary to rapid pain relief

Intrathecal opioids cause rapid pain relief, reducing circulating maternal epinephrine, which can result in uterine tachysystole and fetal bradycardia.

What is the preferred management of total spinal anesthesia developing shortly after epidural top-up with 20 mL of 0.5% bupivacaine?

Answer: Vasopressor support, airway management, and left uterine displacement

Total spinal requires immediate airway control and ventilatory support, vasopressors for hypotension, and left uterine displacement in obstetric patients.

Which test best confirms correct endotracheal tube placement in an apneic patient when end-tidal CO2 waveform is absent due to cardiac arrest?

Answer: Direct visualization of tube through the vocal cords

In cardiac arrest, colorimetric detectors may give false negatives and auscultation is unreliable; direct visualization of the tube passing through the cords is the most reliable confirmation.

A patient develops a tension pneumothorax during positive-pressure ventilation. Where is the correct needle decompression site?

Answer: Second intercostal space, midclavicular line

Needle decompression is performed at the second intercostal space in the midclavicular line to quickly decompress a tension pneumothorax.

During a laparoscopic procedure, the surgeon notes CO2 gas entering the vascular system. What is the hallmark hemodynamic finding of venous gas embolism?

Answer: Sudden increase in end-tidal CO2 followed by a decrease

Venous gas embolism causes an initial transient rise then a precipitous fall in EtCO2 as gas obstructs pulmonary blood flow and reduces CO2 delivery to the lungs.