ABA Emergency Response Procedures 2 — Questions and Answers
Question 1: A patient under general anesthesia develops sudden bradycardia (HR 28 bpm) with hypotension. What is the FIRST drug to administer?
- Epinephrine 1 mg IV
- Atropine 0.5–1 mg IV (Correct answer)
- Vasopressin 40 units IV
- Norepinephrine infusion
Correct answer: Atropine 0.5–1 mg IV
Atropine is the first-line agent for symptomatic bradycardia due to increased vagal tone, given as 0.5–1 mg IV.
Question 2: During a difficult airway emergency, after two failed intubation attempts, the patient's SpO2 drops to 82%. What is the next best step per the ASA Difficult Airway Algorithm?
- Attempt a third laryngoscopy with video laryngoscope
- Proceed to emergency surgical airway (Correct answer)
- Awaken the patient and attempt awake fiberoptic intubation
- Call for a second anesthesiologist and wait
Correct answer: Proceed to emergency surgical airway
When oxygenation fails after multiple attempts, the ASA algorithm directs emergency surgical airway (cricothyrotomy) as the 'can't intubate, can't oxygenate' rescue.
Question 3: A patient receiving neuraxial anesthesia develops a total spinal block. Which hemodynamic change is most immediately life-threatening?
- Hypertension with reflex bradycardia
- Severe hypotension with bradycardia (Correct answer)
- Tachycardia with mild hypotension
- Hypertension with tachycardia
Correct answer: Severe hypotension with bradycardia
Total spinal causes profound sympathectomy and vagal predominance, resulting in severe hypotension and bradycardia that can progress to cardiac arrest.
Question 4: A pediatric patient (20 kg) in the OR develops laryngospasm with complete obstruction after extubation. Which intervention is most appropriate after positive-pressure oxygen fails?
- Immediate reintubation with a standard laryngoscope
- Succinylcholine 4 mg/kg IM (80 mg) (Correct answer)
- Propofol 0.5 mg/kg IV to deepen anesthesia
- Cricothyrotomy with a 14-gauge catheter
Correct answer: Succinylcholine 4 mg/kg IM (80 mg)
When IV access is unavailable and CPAP fails in complete laryngospasm, succinylcholine 4 mg/kg IM (up to 150 mg) rapidly relieves the spasm.
Question 5: Intraoperative TEE reveals a new large pericardial effusion with right ventricular diastolic collapse. What is the most appropriate immediate anesthetic management?
- Increase PEEP to improve venous return
- Avoid high-dose vasopressors; maintain heart rate and preload (Correct answer)
- Administer beta-blockers to reduce myocardial oxygen demand
- Induce controlled hypotension to decrease afterload
Correct answer: Avoid high-dose vasopressors; maintain heart rate and preload
Cardiac tamponade management focuses on maintaining heart rate, preload, and contractility while avoiding vasodilators; definitive treatment is pericardiocentesis.
Question 6: During a liver transplant, the anesthesiologist notices signs of air embolism: mill-wheel murmur, sudden hypotension, and end-tidal CO2 drop. What position change is most helpful?
- Trendelenburg with left lateral decubitus (Durant's maneuver) (Correct answer)
- Reverse Trendelenburg
- Right lateral decubitus
- Prone position
Correct answer: Trendelenburg with left lateral decubitus (Durant's maneuver)
Durant's maneuver (left lateral decubitus + Trendelenburg) traps air in the right ventricular apex away from the outflow tract, improving cardiac output.
Question 7: A patient under monitored anesthesia care (MAC) develops respiratory depression with SpO2 of 85% following midazolam and fentanyl. The MOST immediate intervention is:
- Administer flumazenil 0.2 mg IV
- Administer naloxone 0.04 mg IV titrated
- Apply jaw thrust and supplemental oxygen (Correct answer)
- Perform endotracheal intubation
Correct answer: Apply jaw thrust and supplemental oxygen
Airway positioning and supplemental oxygen to restore oxygenation is always the first step before pharmacologic reversal in sedation-related respiratory depression.
ABA Emergency Response Procedures 2
A patient under general anesthesia develops sudden bradycardia (HR 28 bpm) with hypotension.
What is the FIRST drug to administer?