Which is a relative contraindication to endotracheal intubation?

• A. Presence of a gag reflex
• B. Unsuccessful ventilation with a basic airway
• C. Hypoxia
• D. Respiratory arrest

Answer: (A)

Concerns about protecting the airway are what determine whether intubation is relatively contraindicated. If a patient still has a gag reflex, stimulating the oropharynx during laryngoscopy can trigger gagging, coughing, laryngospasm, or even vomiting and aspiration. That makes the procedure riskier and less controllable, so having an active gag reflex is considered a relative, not absolute, contraindication to endotracheal intubation. In practice, you’d weigh proceeding with intubation (often with adequate sedation and paralysis) against choosing an alternative airway device or other airway management strategies to minimize aspiration risk.

The other situations described are not contraindications to intubation: if a basic airway fails ventilation, you escalate to an advanced airway; hypoxia and respiratory arrest require securing the airway urgently, not avoiding it.