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Post-intubation cardiovascular collapse — SCE Acute Medicine MCQ

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HardCritical care medicinePost-intubation cardiovascular collapseSCE Acute Medicine

A 70-year-old man is intubated for pneumonia-related respiratory failure. Immediately after intubation his blood pressure falls to 62/38 mmHg, oxygen saturation is 86% and capnography confirms tracheal placement. Ventilator pressures are high and breath sounds are reduced on the left. What is the most appropriate immediate action?

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Correct answer: D — Disconnect the ventilator briefly, assess for tension pneumothorax and treat reversible causes of peri-intubation collapse

Peri-intubation collapse requires rapid assessment of displacement, obstruction, pneumothorax and equipment problems; high pressures and unilateral reduced breath sounds raise concern for tension pneumothorax or mainstem intubation. More PEEP or propofol may worsen hypotension. Continuous waveform capnography confirms tracheal placement but does not exclude complications after intubation.

Reference: Resuscitation Council UK ALS; Difficult Airway Society guidance