Airway Management & Emergency Response Flashcards

An obese patient (BMI 48) undergoes elective laparoscopic surgery. Which positioning strategy best optimizes preoxygenation and delays desaturation during apnea?

Answer: 25-degree reverse Trendelenburg (ramped) with head-up positioning

Ramped, head-up positioning in obese patients increases functional residual capacity, reduces diaphragmatic impingement, and significantly prolongs the safe apnea time.

High-flow nasal cannula (HFNC) used during apneic oxygenation in a difficult intubation scenario works primarily through:

Answer: Mass-flow apneic diffusion driven by the oxygen concentration gradient

HFNC provides a continuous flow of 100% O2 that maintains an apneic oxygenation mechanism via mass movement of oxygen down the concentration gradient into the alveoli.

After extubation, a patient develops inspiratory stridor and a negative-pressure pulmonary edema (NPPE) pattern on CXR. The pathophysiology is best explained by:

Answer: Laryngospasm causing forced inspiration against a closed glottis, generating high negative intrathoracic pressure that draws fluid into alveoli

NPPE occurs when a patient forcefully inspires against complete upper airway obstruction (e.g., laryngospasm), creating extreme negative intrathoracic pressure that drives fluid into the pulmonary interstitium.

A double-lumen endobronchial tube (DLT) is placed for one-lung ventilation. Fiberoptic bronchoscopy confirms correct initial placement. After lateral repositioning of the patient, SpO2 decreases to 88%. The first step is:

Answer: Reconfirm DLT position with fiberoptic bronchoscopy as repositioning often causes tube migration

Lateral repositioning frequently displaces DLTs from their confirmed position; fiberoptic re-examination is the first step before attributing desaturation to other causes.

Which medication should be immediately available when performing awake nasal fiberoptic intubation specifically to manage epistaxis?

Answer: Phenylephrine or oxymetazoline nasal spray applied prior to scope insertion

Topical vasoconstrictors such as phenylephrine or oxymetazoline nasal spray applied before bronchoscope insertion reduce mucosal blood flow and significantly lower epistaxis risk.

A patient on anticoagulation develops an expanding neck hematoma 30 minutes after central line placement, with progressive hoarseness and stridor. The most critical immediate airway management decision is:

Answer: Perform awake intubation while the patient can still cooperate and before complete obstruction

Awake intubation while the patient is still cooperative and partially patent is the safest approach, as complete obstruction may occur rapidly and render any technique impossible.

The Cormack-Lehane grading system classifies laryngoscopic views into grades I–IV. A grade III view is defined as:

Answer: Only the epiglottis visible, no glottic structures seen

Grade III means only the epiglottis is visible and no part of the glottis can be seen, indicating a significantly difficult laryngoscopy.