CAA Risk Management & Mitigation 3 — Questions and Answers
Question 1: A fire occurs in the airway during a laser procedure on the oropharynx. What is the CORRECT immediate response sequence?
- Increase FiO2 and call for help
- Remove the endotracheal tube, stop gas flow, and flood the airway with saline (Correct answer)
- Administer IV steroids immediately and continue ventilation
- Deflate the ETT cuff and ventilate with 100% oxygen
Correct answer: Remove the endotracheal tube, stop gas flow, and flood the airway with saline
Airway fire management requires immediately removing the ETT, halting all gas flow to eliminate oxidizer, and flooding the airway with saline to extinguish the fire.
Question 2: Which patient population has the highest risk for perioperative peripheral nerve injury during positioning?
- Pediatric patients undergoing tonsillectomy
- Obese patients in lithotomy position for prolonged procedures (Correct answer)
- ASA I patients for outpatient arthroscopy
- Elderly patients undergoing cataract extraction under MAC
Correct answer: Obese patients in lithotomy position for prolonged procedures
Obese patients in lithotomy position during prolonged procedures are at high risk for compartment syndrome and compression-related peripheral nerve injuries.
Question 3: The Failure Mode and Effects Analysis (FMEA) is used in anesthesia practice primarily to:
- Investigate adverse events after they occur
- Proactively identify potential failure points before an event happens (Correct answer)
- Determine legal liability following a sentinel event
- Allocate blame among team members after a near-miss
Correct answer: Proactively identify potential failure points before an event happens
FMEA is a prospective risk assessment tool that identifies potential failure modes in a process before they result in harm.
Question 4: A patient develops sudden hypotension, bronchospasm, and urticaria shortly after antibiotic administration. What anesthetic risk does this scenario represent?
- Vasovagal syncope
- Anaphylaxis requiring immediate epinephrine (Correct answer)
- Carcinoid crisis managed with octreotide
- Pulmonary embolism treated with anticoagulation
Correct answer: Anaphylaxis requiring immediate epinephrine
The triad of hypotension, bronchospasm, and urticaria following drug administration is classic for anaphylaxis, which requires immediate epinephrine as first-line treatment.
Question 5: Which intervention most effectively reduces the risk of postoperative nausea and vomiting (PONV) in high-risk patients?
- Using higher doses of opioids to ensure adequate analgesia
- Multimodal prophylaxis combining TIVA, ondansetron, and dexamethasone (Correct answer)
- Limiting IV fluid administration intraoperatively
- Performing regional anesthesia exclusively for all procedures
Correct answer: Multimodal prophylaxis combining TIVA, ondansetron, and dexamethasone
Multimodal PONV prophylaxis targeting multiple receptor pathways and using TIVA to avoid volatile anesthetics is most effective in high-risk patients.
Question 6: An anesthesia machine check reveals a leak in the breathing circuit before a case. What is the appropriate action?
- Proceed with the case and monitor SpO2 closely
- Use the leaky circuit only for short procedures under 30 minutes
- Remove the machine from service and use a backup until repaired (Correct answer)
- Compensate by increasing fresh gas flow throughout the case
Correct answer: Remove the machine from service and use a backup until repaired
A breathing circuit leak compromises ventilation and anesthetic delivery; the machine must be removed from service and a verified backup used.
Question 7: Which documentation practice BEST protects against medico-legal risk in anesthesia care?
- Writing brief notes only when complications occur
- Contemporaneous, objective, and complete documentation of all events and interventions (Correct answer)
- Avoiding documentation of adverse events to reduce liability exposure
- Recording only vital signs and omitting clinical decision rationale
Correct answer: Contemporaneous, objective, and complete documentation of all events and interventions
Contemporaneous, complete, and objective anesthesia records demonstrate adherence to the standard of care and provide the strongest medicolegal protection.
CAA Risk Management & Mitigation 3
A fire occurs in the airway during a laser procedure on the oropharynx.
What is the CORRECT immediate response sequence?