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Procedural sedation hypoventilation — SCE Acute Medicine MCQ

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EasyProcedural Knowledge and Acute Management DecisionsProcedural sedation hypoventilationSCE Acute Medicine

A 57-year-old man is assessed on the acute medical unit. During procedural sedation for cardioversion he becomes unresponsive with snoring respirations and oxygen saturation 82%. Pulse is present. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most important immediate action?

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Correct answer: E — Give high-flow oxygen and prepare for airway support

Give high-flow oxygen and prepare for airway support is the best answer because sedation-related airway obstruction and hypoventilation require immediate airway manoeuvres and oxygenation. Give intramuscular adrenaline 500 micrograms is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Monitoring and trained airway support are mandatory for procedural sedation.

Reference: Academy of Medical Royal Colleges safe sedation guidance