CEP Advanced Airway Management & Ventilation 2 — Questions and Answers
Question 1: A patient in respiratory failure has a SpO2 of 82% despite high-flow oxygen via NRB mask. You attempt RSI but cannot visualize the cords. What is the MOST appropriate next step?
- Perform a surgical cricothyrotomy
- Attempt blind nasotracheal intubation
- Insert a supraglottic airway device (Correct answer)
- Continue BVM ventilation and transport
Correct answer: Insert a supraglottic airway device
When intubation fails and oxygenation is inadequate, a supraglottic airway (LMA, King LT, i-gel) is the recommended rescue device before proceeding to a surgical airway.
Question 2: Which waveform capnography finding is MOST consistent with severe bronchospasm?
- Flat waveform with ETCO2 of 0 mmHg
- Shark-fin waveform with elevated plateau (Correct answer)
- Normal waveform with ETCO2 of 45 mmHg
- Rapid upstroke with steep downstroke
Correct answer: Shark-fin waveform with elevated plateau
A shark-fin (sloped plateau) capnography waveform indicates obstructive airway disease such as severe bronchospasm or COPD exacerbation.
Question 3: During BVM ventilation of an apneic adult, you notice the abdomen rising with each ventilation. What is the MOST likely cause?
- Adequate tidal volume delivery
- Esophageal intubation
- Gastric inflation from excessive pressure (Correct answer)
- Pneumothorax
Correct answer: Gastric inflation from excessive pressure
Abdominal rise during BVM ventilation indicates gastric insufflation caused by excessive ventilation pressure or volume exceeding the lower esophageal sphincter threshold.
Question 4: A 45-year-old male requires RSI. His BMI is 42. Which positioning strategy BEST optimizes laryngoscopy conditions?
- Supine with neck extended
- Ramped position with ear aligned to sternal notch (Correct answer)
- Left lateral decubitus
- Trendelenburg position
Correct answer: Ramped position with ear aligned to sternal notch
The ramped or 'sniffing' position with the external auditory meatus level with the sternal notch improves laryngoscopic view in obese patients by aligning oral, pharyngeal, and laryngeal axes.
Question 5: After RSI with succinylcholine and etomidate, you confirm ET tube placement via waveform capnography. The ETCO2 is 12 mmHg. What should you suspect?
- Correct tube placement with normal ventilation
- Esophageal intubation
- Pulmonary embolism or severely reduced cardiac output (Correct answer)
- Hyperventilation
Correct answer: Pulmonary embolism or severely reduced cardiac output
A very low ETCO2 (under 15 mmHg) with confirmed tube placement suggests severe reduction in pulmonary blood flow, as seen in pulmonary embolism or low cardiac output states.
Question 6: Which medication used in RSI is CONTRAINDICATED in a patient with a crush injury and suspected hyperkalemia?
- Etomidate
- Ketamine
- Succinylcholine (Correct answer)
- Rocuronium
Correct answer: Succinylcholine
Succinylcholine causes potassium efflux from muscle cells and is contraindicated in hyperkalemia, crush injuries, burns >24 hours, denervation injuries, and prolonged immobilization.
Question 7: A ventilated patient develops acute hypotension, absent breath sounds on the left, and tracheal deviation to the right. The FIRST intervention should be:
- Increase FiO2 to 100%
- Perform needle decompression on the left side (Correct answer)
- Reposition the endotracheal tube
- Administer 1L normal saline bolus
Correct answer: Perform needle decompression on the left side
Absent breath sounds, tracheal deviation away from the affected side, and hypotension in a ventilated patient indicate tension pneumothorax requiring immediate needle decompression.
CEP Advanced Airway Management & Ventilation 2
A patient in respiratory failure has a SpO2 of 82% despite high-flow oxygen via NRB mask.
You attempt RSI but cannot visualize the cords.
What is the MOST appropriate next step?