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Post-intubation hypotension from dynamic hyperinflation — RCPSC EM MCQ

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HardResuscitation, procedures, airwayPost-intubation hypotension from dynamic hyperinflationRCPSC EM

CTAS 1: A 56-year-old with severe asthma is intubated for exhaustion. Immediately after ventilation, BP falls to 58/32 and oxygen saturation is 90%. Breath sounds are bilateral, trachea is midline, and capnography shows a prolonged expiratory phase. Manual ventilation feels difficult with high pressures. What is the most appropriate next step?

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Correct answer: B — Disconnect the ventilator briefly and allow prolonged exhalation

Obstructive lung disease can cause auto-PEEP and obstructive shock after intubation. Brief disconnection and ventilator changes allowing expiration can be lifesaving.

Reference: CAEP airway education; critical care asthma ventilation principles