Adult Critical Care Specialty (ACCS) Practice Exam

In the event of being unable to intubate a patient on the first attempt, what action should be taken next after unsuccessful intubation attempts?

1. Apply cricoid pressure

2. Continue attempting intubation

3. Administer sedatives to the patient

4. Prepare for immediate surgical intervention

The correct answer is: Apply cricoid pressure

Applying cricoid pressure is a key maneuver in emergency airway management, particularly when intubation attempts have been unsuccessful. This technique, also known as the Sellick maneuver, involves applying pressure to the cricoid cartilages to occlude the esophagus, thereby reducing the risk of aspiration. When facing difficulty in securing an airway, preventing aspiration is crucial, especially if the patient has not been adequately pre-oxygenated or is at high risk for aspiration due to altered consciousness or other factors. Maintaining airway control becomes critical after an unsuccessful intubation attempt. Cricoid pressure can help stabilize the airway environment and allow for potential reattempts to be more successful, as it mitigates the risk of stomach contents entering the trachea or lungs. Continuing to attempt intubation without an interim measure might increase the risk of complications or trauma to the airway. Administering sedatives at this point could further compromise the airway and respiratory drive, creating a more precarious situation. Preparing for immediate surgical intervention is typically considered after multiple failed attempts and if there are signs of complete airway obstruction, but in the initial step after a first failure, securing the airway using cricoid pressure is the most appropriate choice.