Meconium aspiration syndrome — structured oral (viva)

Branch 1 — Immediate resuscitation (5 minutes)

Examiner: The infant is floppy, apnoeic, heart rate 70. The midwife asks whether you want to intubate and suction. Talk me through your immediate management. ^[1]

Expected:

• Confirm non-vigorous state (poor tone, apnoea, heart rate below 100).
• State clearly: the presence of meconium does not mandate tracheal suctioning; resuscitate per standard NRP — initiate positive-pressure ventilation ^[1].
• Routine intubation-suction abandoned (2015 NRP); intubation only if ventilation ineffective due to suspected obstruction.
• Intrapartum oronasal suctioning before shoulders abandoned (Vain 2004).
• Assess response at 30 to 60 seconds; escalate to intubation/ventilation and chest compressions per NRP if heart rate remains below 60.

Branch point (if candidate suggests intubating to suction): Probe — what evidence changed this practice? Expect Vain et al. 2004 and the 2015 NRP update ^[1].