Airway Management & Emergency Response Flashcards

An unconscious trauma patient arrives with facial burns and singed nasal hair. The cervical spine is immobilized. Which intubation approach best balances airway security with spinal precautions?

Answer: Video laryngoscopy with in-line stabilization

Video laryngoscopy with manual in-line stabilization provides improved glottic visualization while minimizing cervical spine movement compared to direct laryngoscopy.

During awake intubation with topical anesthesia, the patient begins to cough vigorously as the bronchoscope passes the cords. The most appropriate immediate action is:

Answer: Instill 2–3 mL of 2% lidocaine through the bronchoscope working channel into the trachea

Instilling lidocaine transtracheally through the bronchoscope working channel quickly anesthetizes the subglottic mucosa and suppresses the cough reflex.

A laryngeal mask airway (LMA) is placed for a 20-minute procedure. The provider notices the EtCO2 is 58 mmHg and peak airway pressure is 28 cmH2O. The most likely cause is:

Answer: LMA malposition causing partial airway obstruction

Elevated airway pressures with hypercapnia suggest the LMA cuff is not properly seated over the laryngeal inlet, creating partial obstruction and increased resistance.

The 'BURP' maneuver (Backward, Upward, Rightward Pressure) applied during laryngoscopy is intended to:

Answer: Improve the laryngoscopic view by shifting the larynx into a more favorable position

BURP displaces the larynx posteriorly, superiorly, and to the right, converting a poor laryngoscopic view into a better one by bringing the glottis into the line of sight.

A 70 kg patient receives rocuronium 1.2 mg/kg for RSI. Intubation attempts fail and oxygenation is deteriorating. Sugammadex is available. The appropriate reversal dose is:

Answer: 16 mg/kg IV

Sugammadex 16 mg/kg is the recommended dose for immediate reversal of profound rocuronium-induced neuromuscular blockade in a life-threatening cannot-intubate situation.

Which physiologic consequence is most immediately life-threatening during laryngospasm in a pediatric patient?

Answer: Rapid hypoxemia due to high oxygen consumption relative to FRC

Children have high metabolic rates and small functional residual capacity, so oxygen stores are rapidly depleted during laryngospasm, making hypoxemia the most immediate threat.

A patient with a tracheal stent in place requires general anesthesia. The primary airway concern specific to this anatomy is:

Answer: Difficulty ventilating if the ETT tip abuts the stent and causes partial occlusion

Advancing the ETT past the stent or resting its tip against the stent can create partial or complete obstruction, so careful positioning under bronchoscopic or fluoroscopic guidance is essential.