BCA Airway Management & Emergency Response 3 — Questions and Answers
Question 1: 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?
- Blind nasotracheal intubation
- Video laryngoscopy with in-line stabilization (Correct answer)
- Bag-mask ventilation until imaging is complete
- Retrograde intubation over a wire
Correct 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.
Question 2: During awake intubation with topical anesthesia, the patient begins to cough vigorously as the bronchoscope passes the cords. The most appropriate immediate action is:
- Withdraw the bronchoscope and abort the procedure
- Instill 2–3 mL of 2% lidocaine through the bronchoscope working channel into the trachea (Correct answer)
- Administer IV propofol 100 mg to suppress the cough
- Increase the oxygen flow via nasal cannula
Correct 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.
Question 3: 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:
- Laryngospasm
- LMA malposition causing partial airway obstruction (Correct answer)
- CO2 absorber exhaustion
- Hypoventilation due to opioid excess
Correct 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.
Question 4: The 'BURP' maneuver (Backward, Upward, Rightward Pressure) applied during laryngoscopy is intended to:
- Reduce regurgitation risk by compressing the esophagus
- Improve the laryngoscopic view by shifting the larynx into a more favorable position (Correct answer)
- Stabilize the cervical spine during intubation
- Reduce blood pressure by stimulating vagal reflexes
Correct 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.
Question 5: 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:
- 2 mg/kg IV
- 4 mg/kg IV
- 16 mg/kg IV (Correct answer)
- 200 mg IV regardless of weight
Correct 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.
Question 6: Which physiologic consequence is most immediately life-threatening during laryngospasm in a pediatric patient?
- Hypercapnia leading to respiratory acidosis
- Rapid hypoxemia due to high oxygen consumption relative to FRC (Correct answer)
- Aspiration of gastric contents
- Laryngeal edema from repeated attempts to breathe
Correct 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.
Question 7: A patient with a tracheal stent in place requires general anesthesia. The primary airway concern specific to this anatomy is:
- Risk of stent migration into the bronchus during coughing
- Difficulty ventilating if the ETT tip abuts the stent and causes partial occlusion (Correct answer)
- Increased risk of bronchospasm from stent material
- Inability to confirm tube position by capnography
Correct 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.
BCA Airway Management & Emergency Response 3
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?