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PARAMEDIC FINAL > AIRWAY > Flashcards

AIRWAY Flashcards

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1
Q

What sign is unique to a severe foreign body upper airway obstruction?

A

perioral cyanosis

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2
Q

Quick breaths followed by prolonged exhalation. On the basis of this clinical finding, you should…

A

provide some form of positive-pressure ventilation

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3
Q

60 y/o man reports dyspnea. While auscultation his chest, you hear fine, moist, thin sounds in all lung fields. What is this most suggestive of?

A

Fluid in the small lower airways (crackles/rales)

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4
Q

Ventilation of an adult patient with a stoma and no tracheostomy tube is MOST effectively achieved by:

A

Using an infant or child-size mask attached to an adult-size BVM

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5
Q

Pt that would benefit from CPAP

A

61 y/o M with severe respiratory distress and diffuse crackles

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6
Q

Pt that is a candidate for nasotracheal intubation?

A

semiconscious, pulmonary edema, tachypnea. Need to be conscious and breathing spontaneously.

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7
Q

Most appropriate interventions when treating an unresponsive adult with severe foreign body airway obstruction?

A

chest compressions, laryngoscopy, use of Magill forceps and cricothyrotomy

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8
Q

Normal partial pressure of oxygen in arterial blood

A

80-100 mm Hg

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9
Q

You would MOST likely encounter bradypnea in a patient who:

A

has metabolic alkalosis

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10
Q

A 70-year-old man complains of dyspnea that began 2 days ago. He cannot speak more than three words at a time without stopping to catch his breath. Which of the following assessments would give the paramedic the MOST information regarding the possible cause of his dyspnea?

A

Lung sounds

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11
Q

A selective beta-2 adrenergic agonist will produce which of the following effects?

A

Bronchodilation

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12
Q

When arterial oxygen levels in the body fall, chemoreceptors in the brain send messages to the diaphragm via the:

A

Phrenic nerve

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13
Q

What is the fraction of inspired oxygen (FiO2) delivered to an apneic patient who is receiving bag-mask ventilation without supplemental oxygen attached?

A

0.21

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14
Q

A patient was bitten by fire ants and is unresponsive. He has severe edema to the face and neck and generalized urticaria. Breath sounds are difficult to hear, and loud inspiratory stridor is noted. Which of the following interventions has the highest priority?

A

Endotracheal intubation

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15
Q

While intubating a 44-year-old man in respiratory arrest, you note that his pulse rate increases during the procedure. What should you do?

A

Recognize this as a normal response during intubation and monitor the pulse rate.

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16
Q

Which of the following medications is used to sedate a patient prior to performing orotracheal intubation?

A

Amidate

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17
Q

Assessment of a patient with respiratory distress reveals that his expiratory phase is 4 times longer than his inspiratory phase. Which of the following conditions would MOST likely cause this?

A

Bronchospasm

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18
Q

Which of the following is MOST consistent with inadequate breathing in an adult?

A

14 breaths/min with reduced tidal volume (shallow)

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19
Q

You are assessing an unresponsive man’s respirations and note that he is taking irregular breaths that vary in volume and rate with periods of apnea. This breathing pattern is MOST consistent with:

A

Biot’s respirations (ataxic breathing). This respiratory pattern is commonly seen in patients with increased intracranial pressure, either from closed head trauma or hemorrhagic stroke.

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20
Q

The exchange of oxygen and carbon dioxide between inspired air and the pulmonary capillaries is called:

A

External respiration

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21
Q

The transfer of oxygen and carbon dioxide between the capillaries and tissue cells is called:

A

Internal respiration

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22
Q

What is PaO2

A

Partial pressure of oxygen

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23
Q

What is PaCO2

A

Partial pressure of carbon dioxode

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24
Q

An unresponsive man is brought to the emergency department by his wife. Initial arterial blood gas analysis reveals a pH of 7.1, a PaO2 of 81 mm Hg, and a PaCO2 of 60 mm Hg. These findings are MOST consistent with:

A

Respiratory acidosis

A pH of less than 7.35 indicates acidosis; alkalosis of any kind is quickly ruled out by simply noting the low pH. An elevated (greater than 45 mm Hg) PaCO2 indicates carbon dioxide retention, and a low (less than 80 mm Hg) PaO2 indicates hypoxia

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25
Q

Which of the following corresponds with phase 3 (C-D) on a normal capnographic waveform?

A

Alveolar gas is passing by the CO2 sensor

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26
Q

In which of the following situations would it be MOST appropriate to insert a King LT supraglottic airway?

A

Comatose patient who ingested aspirin

King LT is only used in unresponsive patients; it is contraindicated in those with an intact gag reflex (even if the gag reflex is minimal), in patients who ingested a caustic substance (eg, oven cleaner [strong acid]), and in patients with known esophageal disease (eg, cancer, varices).

27
Q

With regard to endotracheal intubation, which of the following is the MOST harmful to your patient if unrecognized?

A

Esophageal intubation

28
Q

Assessment of a patient with acute respiratory distress reveals that he is conscious and alert, but wheezing on exhalation. In addition to oxygen, management should include:

A

Administration of an inhaled beta-2 agonist medication (ex. albuterol). Promotes bronchodilator and improves ventilation

29
Q

In an otherwise healthy individual, breathing is primarily stimulated by:

A

An increase in arterial CO2

30
Q

A firefighter was exposed to smoke during a structure fire. He is conscious, alert, and oriented, but is experiencing respiratory distress. His oxygen saturation is 91% on room air and his heart rate is rapid and strong. Which of the following is the MOST appropriate initial means of oxygenating this patient?

A

NRB 12-15 Lpm

31
Q

A hypoxemic patient

A

Has a decreased oxygen level in the arterial blood

32
Q

Tidal volume is

A

Volume of air moved in and out of the lungs per breath.

33
Q

This does not increase the amount of energy needed for ventilation

A

Stimulation of beta-2 receptors. Stimulation of beta-2 receptors would facilitate ventilation by dilating the bronchioles, and would not increase the amount of energy required for ventilation.

34
Q

When passing an endotracheal tube in between the vocal cords, the paramedic should recall that:

A

The trachea descends into the chest cavity just beyond the vocal cords

35
Q

When performing tracheobronchial suctioning on an adult, it is important to:

A

Monitor the pt O2 sat and cardiac rhythm

36
Q

A 44-year-old male was found unresponsive by his wife. According to the wife, he had been drinking bourbon whiskey all day. He is unresponsive; has slow, shallow respirations; and a slow, weak pulse. You should:

A

Promptly intubate his trachea and support his ventilations.

37
Q

Which technique or device will provide the highest tidal volume to a patient?

A

Pocket face mask with oxygen attached

38
Q

Which of the following respiratory diseases is associated with decreased alveolar elasticity, air trapping in the lungs, and an increase in residual lung volume?

A

Emphysema

39
Q

A 60-year-old man was injured when his tractor rolled over on him. The tractor has been stabilized by rescue personnel. When you assess the man, you note that he is responsive to pain only. You should:

A

Open his airway with the jaw-thrust maneuver

40
Q

After inserting a King LT supraglottic airway device into a patient and inflating the cuff with 40 mL of air, the paramedic meets resistance when ventilating and cannot see the patient’s chest rise. The paramedic should:

A

Slowly pull back on the King airway while observing for chest rise.

41
Q

Which of the following clinical presentations is MOST indicative of a patent airway?

A

Diaphoresis, tachycardia, gagging. Gagging indicates an intact gag reflex.

42
Q

A trauma patient is being transferred from one facility to another. The patient is intubated and is on a mechanical transport ventilator. During transport, the high-pressure alarm sounds on the ventilator. Which of the following would MOST likely cause this?

A

The ET tube is in the right mainstem bronchus

43
Q

Which of the following processes occurs during inhalation?

A

The diaphragm contracts and descends, intrathoracic pressure decreases, and air enters the lungs via negative pressure.

44
Q

Which of the following airway devices is MOST appropriate to use in a deeply unresponsive intoxicated patient?

A

Endotracheal tube

45
Q

What is the approximate minute alveolar volume of a patient who is breathing at a rate of 26 breaths/min with an estimated tidal volume of 450 mL?

A

Approx. 8200 mL

30% of 450 mL x 26 breaths/min = 8190

46
Q

Initial management of an unresponsive 20-year-old patient with respirations of 14 breaths/min and adequate depth should include:

A

Inserting an airway adjunct and administering supplemental oxygen

47
Q

After placing an endotracheal tube in a cardiac arrest patient, large amounts of vomitus immediately begin flowing out of the tube. You should:

A

Leave the ET tube in place, fold it to the side so the vomitus can drain, and resume bag-mask ventilations.

48
Q

In which condition would you MOST likely detect a drop in systolic blood pressure during inhalation?

A

Severe asthma

49
Q

A 40-year-old patient has a blood glucose level of 800 mg/dL and is breathing deeply at a rate of 34 breaths/min. Which of the following should the paramedic expect to observe?

A

Small capnographic waveforms; low end-tidal CO2 reading

50
Q

You have been ventilating an unresponsive apneic 42-year-old male for approximately 12 minutes. After securing his airway with an endotracheal tube and confirming proper ET tube placement, you should:

A

Insert an orogastric or nasogastric tube

51
Q

During an intubation attempt, you are having difficulty viewing the patient’s vocal cords. Which of the following actions would MOST likely help?

A

Ask your partner to manipulate the external larynx - BURP (backward upward and rightward pressure)

52
Q

A 60-year-old woman presents with difficulty breathing. She is conscious and alert, but anxious, and tells you that she was suddenly awakened with the feeling that she was suffocating. She has dried blood on her lips and cyanosis around her mouth. Her heart rate is 120 beats/min and her oxygen saturation is 89%. Your initial action should be to:

A

apply supplemental O2

53
Q

You are treating a 50-year-old male who ingested a significant amount of his prescribed propranolol. He is unresponsive, bradycardic, hypotensive, and has poor respiratory effort. In addition to assisting his ventilations, applying a cardiac monitor, and establishing vascular access, the MOST appropriate treatment for him includes:

A

Cardiac pacing, glucagon, and a vasopressor.

He is in beta-blocker toxicity.

54
Q

Normal breathing in a resting adult male:

A

Should be marked by only subtle changes in rate or regularity

55
Q

In contrast to the pneuomotaxic center of the medulla, the apneustic center:

A

Influences the respiratory rate by increasing the number of inspirations per minute

56
Q

A hiker was bitten on the leg by a rattlesnake approximately 20 minutes ago. He complains of pain to the lateral aspect of his left leg, just proximal to the ankle. Assessment of that area reveals two small puncture wounds surrounded by edema. You also note localized twitching of his calf muscles. He is conscious and alert, but anxious. His blood pressure is 112/70 mm Hg, pulse is 120 beats/min, and respirations are 24 breaths/min with adequate depth. In addition to keeping him calm, you should:

A

Administer high-flow oxygen via nonrebreathing mask, apply a sterile dressing to the wound, immobilize his leg and keep it below the level of the heart, start an IV line and set it at a KVO rate, and transport

57
Q

Correct statement regarding physiologic dead space

A

Diffuse alveolar collapse increases the size of the physiologic dead space.

58
Q

An unresponsive trauma patient has sonorous respirations and blood draining from the corner of his mouth. What should be your FIRST action?

A

Jaw thrust maneuver THEN suction

59
Q

A 60-year-old female presents with acute respiratory distress. The patient has a tracheostomy tube in place, but is able to breathe spontaneously. She is conscious, but restless. Her heart rate is 120 beats/min and her oxygen saturation is 82%. You should:

A

Assess for secretions in the tracheostomy tube and suction the tube if needed

60
Q

During your assessment of a patient with labored breathing, you note asymmetric chest wall movement. This indicates that:

A

Airflow into one lung is reduced

61
Q

An older woman presents with respiratory distress. She is conscious and alert and is able to answer your questions with slight difficulty. Her respirations are 24 breaths/min and labored and her oxygen saturation is 89%. Further assessment reveals slight cyanosis around her mouth. You should:

A

Apply a NRB at 15 Lpm

62
Q

What is the approximate minute alveolar volume of a patient who breathes in 550 mL of air at a rate of 14 times per minute?

A

5.4 L

Alveolar volume is the amount of air that actually reaches the lungs per breath. Minute alveolar volume, also called minute alveolar ventilation, is calculated by multiplying the patient’s tidal volume, minus dead space volume, and the respiratory rate.

Therefore, a patient with an alveolar volume of 385 mL (550 - 165 [30% of 550] = 385) and a respiratory rate of 14 breaths/min has an approximate minute alveolar volume of 5.4 L (385 × 14 = 5,390 mL [5.4 L]).

63
Q

You are ventilating an intubated patient and note decreased compliance with each delivered ventilation. What would be the LEAST likely cause of this?

A

Beta-2 receptor stimulation

PARAMEDIC FINAL (6 decks)

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