1. Scenario-Based OSCE Flashcards (Airway & RSI)

What is your immediate priority for a patient with decreased LOC and snoring respirations?

Airway positioning, suction if required, high-flow oxygen.

What definitive management is indicated for a GCS ≤ 8?

Endotracheal intubation.

What must be done before intubation?

Pre-oxygenation for 3-5 minutes, equipment check, backup airway plan.

What airway approach is indicated for a trauma patient with GCS 7?

Rapid Sequence Intubation (RSI).

What modification is required for RSI in a trauma patient?

Manual in-line stabilization for C-spine protection.

What are the steps of RSI in order?

Preparation, pre-oxygenation, induction, paralysis, intubation, confirmation, post-intubation care.

What is your immediate action after two failed intubation attempts?

Revert to BVM ventilation.

What is the next escalation after failed intubation?

Insert supraglottic airway.

What should be done if unable to ventilate?

Perform cricothyroidotomy.

How do you confirm correct placement of an endotracheal tube?

Continuous waveform capnography, bilateral chest rise, auscultation.

What is the expected EtCO₂ range?

35-45 mmHg.

What does a 'shark fin' waveform on capnography indicate?

Bronchospasm or airway obstruction.

What are the management priorities for bronchospasm?

Bronchodilators and ventilation optimization.

What is the role of induction agents in RSI?

Rapid unconsciousness and facilitate intubation.

What are key features of ketamine?

Dissociative anaesthetic, preserves airway reflexes, increases HR and BP, useful in hypotension.

What are key features of etomidate?

Haemodynamically stable, rapid onset, minimal cardiovascular effects.

What is the role of paralytics in RSI?

Eliminate muscle tone and improve intubation conditions.

What are characteristics of suxamethonium?

Rapid onset, short duration, depolarising agent.

What are contraindications to suxamethonium?

Hyperkalaemia, burns/crush injuries (>24 hrs), neuromuscular disease.

What are characteristics of rocuronium?

Non-depolarising, longer duration, alternative to suxamethonium.

Why is post-intubation sedation required?

To prevent awareness, ensure comfort, and facilitate ventilation.

What are common post-intubation medications?

Sedatives (e.g., midazolam) and analgesics (e.g., fentanyl).

What are indications for endotracheal intubation?

GCS ≤ 8, airway compromise, hypoxia despite oxygen, cardiac arrest.

What is the indication for cricothyroidotomy?

Cannot intubate, cannot ventilate.

What are common errors in airway management?

Failure to pre-oxygenate, no backup airway plan, not using capnography, multiple intubation attempts without oxygenation.

What is a high-yield clinical pearl regarding airway management?

Oxygenation is prioritized over intubation.