Airway Management & Emergency Response Flashcards

A patient in the PACU develops acute respiratory distress with a paradoxical breathing pattern (chest retracting while abdomen protrudes) after reversal of neuromuscular blockade. Train-of-four ratio is 0.72. The most appropriate intervention is:

Answer: Administer additional sugammadex to achieve TOF ratio ≥ 0.9

A TOF ratio below 0.9 indicates residual neuromuscular blockade; sugammadex provides reliable and complete reversal to achieve the recommended ≥0.9 threshold.

During nasotracheal intubation with a flexible bronchoscope, the scope passes into the trachea but the ETT cannot be advanced past the nasal turbinates. The best technique to facilitate tube advancement is:

Answer: Rotate the tube 90 degrees counterclockwise (bevel facing posteriorly) while applying gentle forward pressure

Rotating the ETT 90° counterclockwise reorients the bevel so the tip faces posteriorly, reducing the risk of catching on the turbinates or nasal septum during advancement.

Which of the following is the most sensitive indicator of inadvertent esophageal intubation?

Answer: Absence of a sustained EtCO2 waveform after multiple breaths

Absence of a sustained quantitative EtCO2 waveform is the most sensitive indicator of esophageal intubation, as the esophagus cannot produce continuous CO2 over multiple breaths.

A patient with rheumatoid arthritis and atlantoaxial instability requires airway management. The primary concern during laryngoscopy is:

Answer: Cervical cord compression from atlantoaxial subluxation caused by neck extension or manipulation

Atlantoaxial instability in rheumatoid arthritis carries risk of spinal cord injury with neck extension; awake fiberoptic intubation in a neutral position is strongly preferred.

Rocuronium 0.6 mg/kg is given for intubation during a standard (non-RSI) induction. Approximately how long until spontaneous respiration returns without reversal agent?

Answer: 45–70 minutes

At an intubating dose of 0.6 mg/kg, rocuronium provides approximately 45–70 minutes of neuromuscular blockade before spontaneous recovery begins.

A 3-year-old child undergoing tonsillectomy develops complete laryngospasm at emergence. SpO2 drops to 80%. Initial management with 100% oxygen and CPAP (Larson's maneuver) fails. The next step is:

Answer: IV or IM succinylcholine 2 mg/kg followed by assisted ventilation

When complete laryngospasm fails to respond to CPAP and positive pressure, succinylcholine 2 mg/kg IV (or 4 mg/kg IM if no IV access) breaks the spasm and allows ventilation.

During rigid bronchoscopy performed under general anesthesia for foreign body removal, the anesthesiologist notes a progressive decrease in SpO2 to 88% and increased airway pressures. The foreign body has not yet been retrieved. The most appropriate next action is:

Answer: Ask the surgeon to pause, then ventilate the patient through the bronchoscope side port and allow for oxygenation before continuing

During rigid bronchoscopy the anesthesiologist and surgeon must communicate and pause to allow adequate ventilation through the bronchoscope side port before desaturation becomes critical.