Notify team to cease stimulation/surgery

Give 100% O₂, evaluate ventilation

Apply CPAP and jaw thrust

Confirm or establish adequte IV access

Deepen anesthesia with IV and/or inhaled agents. Consider propofol 1-3 mg/kg IV

Give succinylcholine 0.1-2 mg/kg (if no IV: 2-4 mg/kg IM)

If bradycardia, give atropine 0.02 mg/kg IV (if no IV: 0.04 mg/kg IM)

Consider direct laryngoscopy to secure the airway and/or suction

Avoid further patient stimulation during stage 2 anesthesia

If further airway instrumentation needed, consider airway topicalization with lidocaine

Monitor for negative pressure pulmonary edema (pink frothy secretions). If present, consider ETT, PPV, PEEP, ICU

Consider DDx

Crisis Management (If Severe)

Notify surgeon, call for help and code cart

Call for Transesophageal Echocardiography

Start chest compressions

Give epinephrine 10 MICROgrams/kg IV/IO

If cardiac arrest, go to CARDIAC ARREST

Consider ECMO