CSC Airway Management & Emergency Preparedness 2 — Questions and Answers
Question 1: A patient receiving moderate sedation develops stridor and paradoxical chest movement. The FIRST intervention should be:
- Administer flumazenil
- Perform a jaw thrust maneuver (Correct answer)
- Insert a laryngeal mask airway
- Call for the crash cart
Correct answer: Perform a jaw thrust maneuver
Jaw thrust opens the airway by displacing the tongue anteriorly and is the first-line maneuver for airway obstruction in a sedated patient.
Question 2: Which capnography waveform pattern indicates a completely obstructed airway during conscious sedation?
- Shark-fin waveform
- Flat (absent) ETCO2 waveform (Correct answer)
- Elevated plateau above 45 mmHg
- Normal rectangular waveform with elevated amplitude
Correct answer: Flat (absent) ETCO2 waveform
A flat, absent ETCO2 waveform indicates no CO2 is being exhaled, consistent with complete airway obstruction or apnea.
Question 3: During conscious sedation, a patient's SpO2 drops from 99% to 88% over 2 minutes. After repositioning the airway, what is the next priority action?
- Administer reversal agent immediately
- Apply supplemental oxygen via face mask (Correct answer)
- Obtain a 12-lead ECG
- Reduce the infusion rate by 50%
Correct answer: Apply supplemental oxygen via face mask
Supplemental oxygen corrects hypoxemia rapidly while the cause is assessed; reversal agents are reserved for opioid/benzodiazepine-induced respiratory depression.
Question 4: The maximum recommended time a sedation team should attempt bag-valve-mask ventilation before escalating to advanced airway management is:
- 30 seconds
- 1 minute
- 2–3 minutes (Correct answer)
- 5 minutes
Correct answer: 2–3 minutes
If BVM ventilation fails to maintain adequate oxygenation after 2–3 minutes, advanced airway intervention (LMA or intubation) is indicated.
Question 5: A patient with a Mallampati Class IV airway is scheduled for a procedure requiring moderate sedation. The most important pre-procedure action is:
- Pre-oxygenate for 3 minutes with 100% O2
- Ensure an anesthesiologist or provider skilled in advanced airway management is immediately available (Correct answer)
- Administer prophylactic flumazenil
- Limit sedation to anxiolysis only per facility policy
Correct answer: Ensure an anesthesiologist or provider skilled in advanced airway management is immediately available
Mallampati Class IV indicates a difficult airway; having advanced airway-skilled personnel present is the critical safety measure.
Question 6: Flumazenil reverses benzodiazepine-induced respiratory depression but carries the risk of:
- Hypertensive crisis
- Re-sedation after its short duration wears off (Correct answer)
- Anaphylaxis in >10% of patients
- Permanent benzodiazepine receptor blockade
Correct answer: Re-sedation after its short duration wears off
Flumazenil has a shorter half-life than most benzodiazepines, so re-sedation can occur after 45–90 minutes, requiring continued monitoring.
Question 7: Which of the following is the MOST reliable indicator that bag-valve-mask ventilation is effective during an emergency?
- Absence of resistance when squeezing the bag
- Visible bilateral chest rise and rising SpO2 (Correct answer)
- Audible air movement over the stomach
- Patient becoming more alert
Correct answer: Visible bilateral chest rise and rising SpO2
Bilateral chest rise combined with improving pulse oximetry confirms adequate lung ventilation rather than gastric insufflation.
CSC Airway Management & Emergency Preparedness 2
A patient receiving moderate sedation develops stridor and paradoxical chest movement.
The FIRST intervention should be: