CSC Airway Management & Emergency Preparedness 3 — Questions and Answers
Question 1: A patient receiving IV midazolam and fentanyl for a colonoscopy becomes apneic. Naloxone is administered. Which concurrent action is ALSO required?
- Administer flumazenil simultaneously
- Provide positive-pressure ventilation until spontaneous breathing returns (Correct answer)
- Increase the oxygen flow rate only
- Position the patient prone
Correct answer: Provide positive-pressure ventilation until spontaneous breathing returns
Naloxone reverses opioid-induced apnea but takes 1–2 minutes to act; BVM ventilation must bridge the gap to prevent hypoxic injury.
Question 2: When using a nasopharyngeal airway (NPA) during sedation, the correct size is estimated by measuring from:
- Earlobe to the corner of the mouth
- Tip of the nose to the earlobe (Correct answer)
- Center of the mouth to the mastoid process
- Nare to the thyroid cartilage
Correct answer: Tip of the nose to the earlobe
NPA length is estimated by measuring from the tip of the nose to the earlobe, ensuring the device reaches the pharynx without entering the larynx.
Question 3: A patient undergoing conscious sedation develops sudden hypotension (BP 70/40), tachycardia, urticaria, and bronchospasm after a contrast dye injection. The PRIORITY intervention is:
- Administer IV diphenhydramine 50 mg
- Give IM epinephrine 0.3 mg (1:1,000) and call a code (Correct answer)
- Start a normal saline bolus only
- Administer IV methylprednisolone 125 mg
Correct answer: Give IM epinephrine 0.3 mg (1:1,000) and call a code
This presentation is anaphylaxis; IM epinephrine is the first-line life-saving treatment, and a code response is warranted for cardiovascular collapse.
Question 4: During moderate sedation, ETCO2 rises from 38 to 58 mmHg over 10 minutes. This finding most likely indicates:
- Airway obstruction with apnea
- Hypoventilation with CO2 retention (Correct answer)
- Equipment malfunction only
- Adequate ventilation and normal variant
Correct answer: Hypoventilation with CO2 retention
Rising ETCO2 above 45 mmHg reflects inadequate minute ventilation and CO2 accumulation, a hallmark of opioid/sedative-induced hypoventilation.
Question 5: The oropharyngeal airway (OPA) is contraindicated in which patient scenario during sedation?
- A patient with edentulous upper jaw
- A patient with an intact gag reflex who is not fully obtunded (Correct answer)
- A patient with a history of sleep apnea
- A patient receiving supplemental oxygen
Correct answer: A patient with an intact gag reflex who is not fully obtunded
An OPA in a patient with an intact gag reflex causes vomiting and potential aspiration; it is used only in unconscious or deeply sedated patients.
Question 6: What is the primary purpose of pre-oxygenation before initiating moderate sedation?
- To reduce the patient's anxiety before medication administration
- To extend the safe apnea window by increasing oxygen reserves in the lungs (Correct answer)
- To prevent hypercapnia during the procedure
- To confirm the pulse oximeter probe is functioning correctly
Correct answer: To extend the safe apnea window by increasing oxygen reserves in the lungs
Pre-oxygenation with 100% O2 for 3 minutes replaces nitrogen in the FRC with oxygen, giving the provider additional time to manage airway emergencies before desaturation.
Question 7: Which medication is used to reverse respiratory depression caused by opioids, and what is the IV adult dose for sedation-related emergencies?
- Flumazenil 0.2 mg IV
- Naloxone 0.4–2 mg IV, titrated to effect (Correct answer)
- Physostigmine 1 mg IV
- Atropine 0.5 mg IV
Correct answer: Naloxone 0.4–2 mg IV, titrated to effect
Naloxone 0.4–2 mg IV (titrated in 0.1 mg increments) reverses opioid-induced respiratory depression; full-dose reversal can precipitate acute pain and tachycardia.
CSC Airway Management & Emergency Preparedness 3
A patient receiving IV midazolam and fentanyl for a colonoscopy becomes apneic.
Naloxone is administered.
Which concurrent action is ALSO required?