Chapter 15 Airway Management and Ventilation Flashcards
1
Q
The upper airway of an adult consists of all the structures above the: A) carina. B) bronchus. C) vocal cords. D) cricoid ring
A
vocal cords
2
Q
The ______________ is the lowest portion of the pharynx and opens into the larynx anteriorly and the esophagus posteriorly. A) oropharynx B) nasopharynx C) hyperpharynx D) laryngopharynx
A
laryngopharynx
3
Q
The nasal cavity: A) contains two bony shelves known as turbinates. B) is extremely delicate and has a rich blood supply. C) requires significant trauma to result in hemorrhage. D) is separated by a septum that is midline in all people
A
is extremely delicate and has a rich blood supply
4
Q
The ________ are formed by the cranial bones and prevent contaminants from entering the respiratory tract. A) sinuses B) turbinates C) bony nasal shelves D) nasal mucous membranes
A
sinuses
5
Q
The oropharynx: A) contains the adenoids on its posterior wall. B) forms the posterior portion of the oral cavity. C) is bordered superiorly by the hard palate only. D) consists of the anterior portion of the oral cavity.
A
forms the posterior portion of the oral cavity.
6
Q
From an airway management perspective, the MOST important anatomic consideration regarding an adult’s tongue is: A) that it is easily lacerated, but bleeds minimally. B) that it attaches directly to the mandible and hyoid bone. C) its proportionately large size compared to a child’s tongue. D) its tendency to fall back and occlude the posterior pharynx.
A
its tendency to fall back and occlude the posterior pharynx.
7
Q
The anterior portion of the palate is formed by the: A) hyoid bone and mandible. B) union of the facial bones. C) maxilla and palatine bones. D) soft tissues of the posterior pharynx.
A
maxilla and palatine bones.
8
Q
Which of the following statements regarding the tonsils is correct? A) The tonsils are located on the posterior nasopharyngeal wall. B) The tonsils rarely become swollen enough to obstruct the airway. C) The tonsils are comprised of lymphatic tissue and help to trap bacteria. D) The tonsils are located in the anterior pharynx and filter bacteria.
A
The tonsils are comprised of lymphatic tissue and help to trap bacteria.
9
Q
The __________ is an anatomic space located between the base of the tongue and the epiglottis. A) vallecula B) uvula C) adenoid D) larynx
A
vallecula
10
Q
Anatomically, the ________ is directly anterior to the glottic opening. A) thyroid gland B) vallecular space C) cricoid cartilage D) thyroid cartilage
A
thyroid cartilage
11
Q
Paramedics must use extreme caution when accessing the airway via the cricothyroid membrane because: A) the cricothyroid membrane is highly vascular and tends to bleed profusely when it is incised. B) the cricothyroid membrane is bordered laterally and inferiorly by the highly vascular thyroid gland. C) cricothyrotomy is associated with a high incidence of inadvertent laceration of a carotid artery. D) the thyroid cartilage is smaller than the cricoid cartilage and makes the cricothyroid membrane difficult to locate.
A
the cricothyroid membrane is bordered laterally and inferiorly by the highly vascular thyroid gland.
12
Q
During forceful inhalation, the vocal cords: A) are partially open to allow for turbulent air flow. B) open widely to provide minimum resistance to air flow. C) abruptly spasm in order to protect the lower airway. D) bulge anteriorly to facilitate air flow into the trachea.
A
open widely to provide minimum resistance to air flow
13
Q
The ____________ are pyramid-like structures that form the posterior attachment of the vocal cords. A) palatine tonsils B) pyriform fossae C) arytenoid cartilages D) hypoepiglottic ligaments
A
arytenoid cartilages
14
Q
Tenting of the skin under the jaw often occurs when airway devices are inadvertently inserted into the: A) pyriform fossae. B) vallecular space. C) laryngopharynx. D) hypopharyngeal space
A
pyriform fossae.
15
Q
Laryngospasm is defined as: A) aspiration of foreign material. B) spasmodic closure of the vocal cords. C) voluntary closure of the glottic opening. D) spontaneous collapsing of the trachea.
A
spasmodic closure of the vocal cords
16
Q
The function of the lower airway is to: A) warm, filter, and humidify air. B) protect the lungs from aspiration. C) deliver oxygenated blood to the cells. D) exchange oxygen and carbon dioxide
A
exchange oxygen and carbon dioxide.
17
Q
The trachea and mainstem bronchi: A) constrict violently when their beta-2 receptors are stimulated excessively. B) are approximately 10 to 12 cm in length and are joined together at the hilum. C) do not contain mucous-producing cells in patients without a respiratory disease. D) are lined with beta-2 receptors that result in bronchodilation when stimulated.
A
are lined with beta-2 receptors that result in bronchodilation when stimulated.
18
Q
In contrast to the right lung, the left lung: A) has two lobes. B) has three lobes. C) is encased in the parietal pleura. D) can only hold a small volume of air.
A
has two lobes.
19
Q
Surfactant is: A) produced by the mucous cells of the left and right mainstem bronchi. B) quickly destroyed in patients who have a severe upper airway obstruction. C) a phospholipid compound that decreases surface tension on the alveolar walls. D) a lubricating substance that increases alveolar surface tension during breathing.
A
a phospholipid compound that decreases surface tension on the alveolar walls
20
Q
Atelectasis occurs when: A) the alveoli are overinflated and rupture. B) a deficiency of surfactant causes alveolar collapse. C) deoxygenated blood diffuses across the alveoli. D) surface tension on the alveolar walls is decreased
A
a deficiency of surfactant causes alveolar collapse
21
Q
The volume of air that is moved into or out of the respiratory tract in one breath is called: A) tidal volume. B) alveolar volume. C) minute volume. D) inspiratory reserve volume
A
tidal volume
22
Q
Physiologic dead space increases with: A) tachypnea. B) deep breathing. C) alveolar inflation. D) pulmonary obstructions.
A
pulmonary obstructions
23
Q
Approximately ____ mL of air remains in the anatomic dead space of an adult with a tidal volume of 500 mL. A) 100 B) 125 C) 150 D) 175
A
150
24
Q
The normal alveolar volume in a healthy adult is: A) 250 mL. B) 300 mL. C) 350 mL. D) 400 mL.
A
350 mL
25
What is the alveolar minute volume of a patient with a respiratory rate of 12 breaths/min, a tidal volume of 450 mL, and a dead space volume of 135 mL? A) 3,650 mL B) 3,780 mL C) 4,260 mL D) 5,400 mL
3,780 mL
26
When a patient's respirations are too rapid and too shallow: A) the majority of inhaled air lingers in areas of physiologic dead space. B) inhaled air may only reach the anatomic dead space before being exhaled. C) the increase in tidal volume will compensate for a rapid respiratory rate. D) minute volume increases because a larger amount of air reaches the lungs
inhaled air may only reach the anatomic dead space before being exhaled.
27
Following an optimal inspiration, the amount of air that can be forced from the lungs in a single exhalation is called the: A) functional reserve capacity. B) expiratory reserve volume. C) residual expiratory volume. D) fraction of inspired oxygen
functional reserve capacity
28
The fraction of inspired oxygen (FIO2) increases with: A) increased tidal volume. B) forceful inhalation. C) supplemental oxygen. D) an increase in respirations.
supplemental oxygen
29
The process of moving air into and out of the lungs is called: A) respiration. B) inhalation. C) ventilation. D) exhalation.
ventilation.
30
Changes in the rate and depth of breathing are regulated primarily by the: A) pH of venous blood. B) pH of the CSF. C) saturation of oxygen and hemoglobin. D) amount of oxygen in the blood plasma.
pH of the CSF.
31
The involuntary control of breathing originates in the: A) diencephalon. B) hypothalamus. C) cerebral cortex. D) pons and medulla.
pons and medulla.
32
The Hering-Breuer reflex is a protective mechanism that: A) terminates inhalation and prevents lung overexpansion. B) decreases pneumotaxic function during severe hypoxia. C) sends messages to the diaphragm via the phrenic nerves. D) allows the apneustic center to influence the respiratory rate.
terminates inhalation and prevents lung overexpansion
33
The dorsal respiratory group is primarily responsible for: A) motor control of the inspiratory and expiratory muscles. B) decreasing the respiratory rate when the blood pH is above 7.45. C) terminating inspiration in order to prevent pulmonary overexpansion. D) initiating respiration based on information received from the chemoreceptors
initiating respiration based on information received from the chemoreceptors.
34
Chemoreceptors located in the carotid bodies and aortic arch sense minute changes in the ______ and send signals to the respiratory centers via the _______________ nerves. A) PaO2, vagus and intercostal B) PaCO2, glossopharyngeal and vagus C) PaCO2, phrenic and glossopharyngeal D) PaO2, hypoglossal, vagus, and intercostal
PaCO2, glossopharyngeal and vagus
35
Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the: A) PaO2 level falls quickly. B) pH of the CSF decreases. C) PaCO2 decreases slowly. D) pH of the CSF increases
pH of the CSF decreases
36
The hypoxic drive stimulates breathing in patients with: A) chronically decreased PaO2 levels. B) emphysema or chronic bronchitis. C) chronically decreased PaCO2 levels. D) mild bronchospasm caused by asthma
chronically decreased PaO2 levels
37
All of the following factors would increase a person's respiratory rate, EXCEPT: A) narcotic analgesic use. B) increased metabolism. C) the use of amphetamines. D) a rise in body temperature.
narcotic analgesic use
38
During sleep, the metabolic rate is ________ and the number of respirations _________. A) low, increases B) high, decreases C) low, decreases D) high, increases
low, decreases
39
Negative-pressure ventilation occurs when: A) the diaphragm ascends and the intercostal muscles retract. B) air is drawn into the lungs when intrathoracic pressure decreases. C) pressure within the chest decreases and air is forced from the lungs. D) the phrenic nerves stop sending messages to the diaphragm
air is drawn into the lungs when intrathoracic pressure decreases.
40
In contrast to negative-pressure ventilation, positive-pressure ventilation occurs when: A) the diaphragm contracts. B) air is drawn into the lungs. C) intrathoracic pressure falls. D) air is forced into the lungs.
air is forced into the lungs
41
The exchange of oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries is called: A) internal respiration. B) external respiration. C) pulmonary ventilation. D) intrapulmonary shunting
external respiration
42
Oxygen that is dissolved in the blood plasma: A) can be measured with a pulse oximeter. B) makes up the partial pressure of oxygen. C) is quickly absorbed by bicarbonate ions. D) cannot participate in pulmonary respiration
makes up the partial pressure of oxygen
43
Which of the following statements regarding anemia is correct? A) Anemia results in a decreased ability of the blood to carry oxygen. B) Patients with anemia have a chronically low level of hemoglobin. C) Anemia is a condition caused exclusively by a deficiency of iron. D) Anemic patients typically present with flushed skin and bradycardia.
Anemia results in a decreased ability of the blood to carry oxygen
44
A patient with respiratory splinting: A) is often tachypneic with deep breathing. B) is holding his or her arm against the chest. C) is breathing shallowly to alleviate chest pain. D) has an increased tidal volume due to a chest injury.
is breathing shallowly to alleviate chest pain.
45
Intrapulmonary shunting is defined as: A) the return of unoxygenated blood to the left side of the heart. B) a decrease in the surface area of the alveoli caused by damage. C) a condition in which too much carbon dioxide is eliminated. D) failure of blood to bypass an obstruction in a pulmonary artery.
) the return of unoxygenated blood to the left side of the heart
46
All of the following conditions will cause an increase in the circulating levels of carbon dioxide in the blood, EXCEPT: A) lactic acidosis. B) increased metabolism. C) anaerobic metabolism. D) acute hyperventilation
acute hyperventilation.
47
Hypoventilation causes a(n) __________ and leads to __________. A) increased minute volume, hypocarbia B) decreased minute volume, hypocarbia C) increased minute volume, hypercarbia D) decreased minute volume, hypercarbia
decreased minute volume, hypercarbia
48
Normally, an adult at rest should have respirations that: A) are 20 to 24 breaths/min with adequate chest rise. B) follow a regular pattern of inhalation and exhalation. C) have a slightly reduced tidal volume and normal rate. D) are adequate to sustain a heart rate of 80 beats/min
follow a regular pattern of inhalation and exhalation
49
An adult patient with an abnormal respiratory rate should: A) be given oxygen at 4 L/min with a nasal cannula. B) be assessed immediately for heart rate abnormalities. C) be evaluated for other signs of inadequate ventilation. D) receive ventilatory assistance with a bag-mask device.
be evaluated for other signs of inadequate ventilation.
50
The condition in which the body's tissues and cells do not receive enough oxygen is called: A) anoxia. B) hypoxia C) asphyxia. D) hypoxemia
hypoxia
51
Which of the following represents the correct sequence for managing a patient's airway? A) Open, clear, assess, intervene B) Clear, open, assess, intervene C) Assess, clear, open, intervene D) Open, assess, clear, intervene
Open, clear, assess, intervene
52
A patient with orthopnea: A) has blood-tinged sputum. B) awakens at night with dyspnea. C) has dyspnea while lying flat. D) is breathing through pursed lips.
has dyspnea while lying flat.
53
Asymmetric chest wall movement is characterized by: A) chest rise that is minimally visible. B) one side of the chest moving less than the other. C) alternating movement of the chest and abdomen. D) a part of the chest wall that bulges during exhalation.
one side of the chest moving less than the other
54
When ventilating a patient with a bag-mask device, you note increased compliance. This means that: A) you are meeting resistance when ventilating. B) air can be forced into the lungs with relative ease. C) a lower airway obstruction should be suspected. D) the patient likely has an upper airway obstruction.
air can be forced into the lungs with relative ease
55
In which of the following conditions would you be LEAST likely to encounter pulsus paradoxus? A) Moderate asthma attack B) Pericardial tamponade C) Tension pneumothorax D) Decompensating COPD
Moderate asthma attack
56
Which of the following clinical findings would be of LEAST significance in a patient experiencing respiratory distress? A) Fever of 102.5°F B) Productive cough C) Chest pain or pressure D) BP of 148/94 mm Hg
BP of 148/94 mm Hg
57
Which of the following findings is MOST significant in a patient with acute respiratory distress? A) A regular heart rate of 110 beats/min B) A family history of pulmonary embolism C) Prior ICU admission for the same problem D) Low-grade fever and flu-like symptoms
Prior ICU admission for the same problem
58
A patient with a suppressed cough mechanism: A) should be intubated at once. B) is at serious risk for aspiration. C) often requires ventilation support. D) will have a positive eyelash reflex
is at serious risk for aspiration.
59
Biot respirations are characterized by: A) slow, shallow irregular respirations or occasional gasping breaths. B) an irregular pattern of breathing with intermittent periods of apnea. C) deep, gasping respirations that are often rapid but may be slow. D) increased respirations followed by apneic periods.
an irregular pattern of breathing with intermittent periods of apnea
60
Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia? A) Biot respirations B) Agonal respirations C) Kussmaul respirations D) Cheyne-Stokes respirations
Kussmaul respirations
61
Pulse oximetry is used to measure the: A) percentage of hemoglobin that is saturated with oxygen. B) exchange of oxygen and carbon dioxide at the cellular level. C) percentage of carbon dioxide that is eliminated from the body. D) amount of oxygen dissolved in the plasma portion of the blood
percentage of hemoglobin that is saturated with oxygen
62
The pulse oximeter would be LEAST useful when: A) identifying deterioration of the cardiac patient. B) assessing vascular status in orthopaedic trauma. C) monitoring oxygenation status during intubation. D) determining if a patient should receive oxygen.
determining if a patient should receive oxygen
63
Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading? A) Carboxyhemoglobin B) Peripheral vasodilation C) A dimly lit environment D) Heart rate above 120 beats/min
Carboxyhemoglobin
64
An increasing peak expiratory flow reading in a patient with respiratory distress suggests that the patient is: A) experiencing worsened hypoxemia. B) no longer experiencing bronchospasm. C) responding to bronchodilator therapy. D) in need of further bronchodilator therapy
responding to bronchodilator therapy.
65
The average peak expiratory flow rate in a healthy adult is approximately: A) 450 mL. B) 550 mL. C) 650 mL. D) 750 mL
550 mL.
66
When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should: A) ask the patient to fully exhale before blowing into the mouthpiece. B) perform the test three times and take the best rate of the three readings. C) administer one bronchodilator treatment before obtaining the first reading. D) ensure that the patient is in a supine position to obtain an accurate reading
perform the test three times and take the best rate of the three readings
67
It would NOT be appropriate to place a patient in the recovery position if he or she: A) is tachycardic. B) is semiconscious. C) has not been injured. D) is breathing shallowly
is breathing shallowly
68
If you suspect that an unconscious patient has experienced a spinal injury, you should open his or her airway by: A) applying firm pressure to the patient's forehead and tilting the head back. B) placing your fingers behind the angle of the jaw and lifting the jaw forward. C) carefully grasping the tongue and jaw and slowly lifting the jaw forward. D) lifting up on the jaw while placing the head in a slightly extended position.
placing your fingers behind the angle of the jaw and lifting the jaw forward.
69
If several attempts to open a patient's airway with the jaw-thrust maneuver are unsuccessful, you should: A) carefully tilt the patient's head back while lifting up on the chin. B) maintain the patient's head in a neutral position and intubate at once. C) insert an oropharyngeal airway and reattempt the jaw-thrust maneuver. D) suction the mouth for 15 seconds and then reattempt to open the airway
carefully tilt the patient's head back while lifting up on the chin.
70
A foreign-body airway obstruction should be suspected in a child who presents with: A) diffuse wheezing and nasal flaring. B) a productive cough and flushed skin. C) acute respiratory distress without fever. D) progressive respiratory distress and hoarseness
acute respiratory distress without fever
71
An airway obstruction secondary to a severe allergic reaction: A) requires specific and aggressive treatment. B) often responds well to humidified oxygen. C) is usually the result of pulmonary aspiration. D) is treated effectively with abdominal thrusts.
requires specific and aggressive treatment.
72
Which of the following conditions would MOST likely cause laryngeal spasm and edema? A) Croup B) Inhalation injury C) Viral pharyngitis D) Mild asthma attack
Inhalation injury
73
Complications of aspiration include all of the following, EXCEPT: A) airway obstruction. B) intrapulmonary infection. C) bronchiolar tissue damage. D) excess surfactant production
excess surfactant production
74
Poor lung compliance during your initial attempt to ventilate an unconscious, apneic adult should be treated by: A) sweeping the patient's mouth with your fingers. B) reopening the airway and reattempting to ventilate. C) performing 30 chest compressions and reassessing. D) administering 15 subdiaphragmatic thrusts at once
reopening the airway and reattempting to ventilate
75
If chest compressions and repositioning of the airway are unsuccessful in removing a severe airway obstruction in an unconscious patient, you should: A) perform a blind finger sweep of the mouth. B) alternate chest compressions and abdominal thrusts. C) perform laryngoscopy and use Magill forceps. D) gain airway access via the cricothyroid membrane
perform laryngoscopy and use Magill forceps
76
A whistle-tip suction catheter is MOST often used to: A) suction large debris from the oropharynx. B) rapidly remove large volumes of vomitus. C) remove secretions from an ET tube. D) suction an adult's mouth for 15 to 30 seconds
remove secretions from an ET tube.
77
Placing a suction catheter past the base of the tongue: A) may cause the patient to gag or vomit. B) will result in aspiration of gastric contents. C) is effective in thoroughly clearing the airway. D) commonly causes bradycardia in adult patients
may cause the patient to gag or vomit
78
An artificial airway adjunct: A) effectively protects the airway from aspiration. B) is a suitable substitute for manual head positioning. C) should be inserted in any patient who is semiconscious. D) does not obviate the need for proper head positioning
does not obviate the need for proper head positioning.
79
If an unresponsive patient does not have a gag reflex, an oropharyngeal airway: A) should only be inserted if the patient is not breathing. B) should be inserted whether the patient is breathing or not. C) will effectively prevent aspiration if the patient vomits. D) must be inserted by depressing the tongue with a tongue blade.
should be inserted whether the patient is breathing or not
80
The MOST significant complication associated with the use of an oropharyngeal airway is: A) soft-tissue trauma with oral bleeding. B) mild bradycardia in pediatric patients. C) significant bruising of the hard palate. D) a tachycardic response in adult patients.
soft-tissue trauma with oral bleeding
81
Inserting a nasopharyngeal airway in a patient with CSF drainage from the nose following head trauma may: A) result in ventricular dysrhythmias secondary to intracranial pressure. B) cause acute herniation of the brainstem through the foramen magnum. C) cause the device to enter the brain through a hole caused by a fracture. D) result in acute hypertension and decreased cerebral perfusion pressure
cause the device to enter the brain through a hole caused by a fracture
82
It would be appropriate to insert a nasopharyngeal airway in patients who: A) are unresponsive with multiple facial bone fractures. B) have an altered mental status with an intact gag reflex. C) are semiconscious with active vomiting and cyanosis. D) have CSF leakage from the nose and are semiconscious
have an altered mental status with an intact gag reflex.
83
Supplemental oxygen given to a patient with an acute myocardial infarction: A) will prevent the patient from developing a lethal cardiac dysrhythmia. B) should not exceed 3 L/min in order to prevent oxidative injury. C) oxygenates the myocardium that is distal to the occluded coronary artery. D) enhances the body's compensatory mechanisms during the cardiac event
enhances the body's compensatory mechanisms during the cardiac event.
84
A full (2,000 psi) D cylinder will last approximately ______ minutes if you are administering oxygen at 12 L/min.
24
85
A Bourdon-gauge oxygen flowmeter: A) reduces the high pressure in the oxygen cylinder to a safe pressure. B) allows you to administer oxygen to a patient under high pressures. C) is used for transferring oxygen from a larger tank to a smaller tank. D) must be placed in an upright position because it is affected by gravity
reduces the high pressure in the oxygen cylinder to a safe pressure.
86
Which of the following statements regarding oxygen is correct? A) Oxygen is a highly flammable gas. B) Grease prevents oxygen from exploding. C) Oxygen supports the process of combustion. D) Oxygen must be stored in a warm environment.
Oxygen supports the process of combustion
87
When administering oxygen via a nonrebreathing mask, you must ensure that the: A) reservoir is half-filled first. B) one-way valves are disabled. C) patient has adequate tidal volume. D) flow rate is set to at least 6 L/min.
patient has adequate tidal volume
88
The nasal cannula is of MOST benefit to patients: A) who require high oxygen concentrations. B) with mild hypoxemia and claustrophobia. C) with an acute exacerbation of emphysema. D) who are hypoxic and are mouth-breathers.
with mild hypoxemia and claustrophobia
89
The Venturi mask is MOST useful in the prehospital setting when: A) a patient requires less than 15% oxygen. B) high-flow oxygen is required for severe hypoxia. C) patients cannot tolerate a nonrebreathing mask. D) a COPD patient requires a long-range transport.
a COPD patient requires a long-range transport.
90
Oxygen that is entirely devoid of moisture: A) is less combustible than humidified oxygen. B) will dry the patient's mucous membranes quickly. C) is optimum for patients requiring long-term oxygen. D) should be given in conjunction with bronchodilators
will dry the patient's mucous membranes quickly
91
In contrast to negative-pressure ventilation, positive-pressure ventilation: A) may impair blood return to the heart. B) moves air into the esophagus and trachea. C) causes decreased intrathoracic pressure. D) is the act of normal, unassisted breathing.
may impair blood return to the heart
92
Compared to mouth-to-mouth ventilation, mouth-to-mask ventilation is more advantageous in that it: A) can be used in conjunction with supplemental oxygen. B) carries a lower risk of gastric distention and vomiting. C) is less likely to result in hyperventilation of the rescuer. D) allows greater tidal volume to be delivered to the patient
can be used in conjunction with supplemental oxygen
93
. When ventilating an apneic adult with a pulse with a bag-mask device, you should: A) deliver 8 to 10 breaths/min and make the chest wall rise visibly. B) make the chest rise visibly and deliver one breath every 8 seconds. C) deliver each breath over 1 second at a rate of 10 to 12 breaths/min. D) squeeze the bag once every 3 seconds until the chest expands widely.
deliver each breath over 1 second at a rate of 10 to 12 breaths/min.
94
Hyperventilating an apneic patient: A) is appropriate if the patient is an adult. B) may decrease venous return to the heart. C) is beneficial if the pulse rate is too slow. D) reduces the incidence of gastric distention
may decrease venous return to the heart.
95
Complications associated with the one-person bag-mask ventilation technique are MOST often related to: A) hyperinflation of the lungs. B) unrecognized rescuer fatigue. C) improper manual head positioning. D) inadequate tidal volume delivery
inadequate tidal volume delivery
96
When two paramedics are ventilating an apneic patient with a bag-mask device, the paramedic not squeezing the bag should: A) apply posterior cricoid pressure. B) manually position the patient's head. C) continually auscultate breath sounds. D) maintain an adequate mask-to-face seal.
maintain an adequate mask-to-face seal
97
An 8-year-old child in cardiac arrest has been intubated. When ventilating the child, the paramedic should: A) observe for full chest expansion. B) deliver 8 to 10 breaths per minute. C) allow partial exhalation between breaths. D) deliver one breath every 15 seconds.
deliver 8 to 10 breaths per minute
98
The flow-restricted, oxygen-powered ventilation device: A) has a demand valve that is triggered by the negative pressure generated during inhalation. B) is the preferred initial device for ventilating an apneic or inadequately breathing patient. C) delivers 100% oxygen to apneic patients at a fixed flow rate of 50 to 60 L/min. D) should be used in patients with thoracic trauma because it is less likely to cause barotrauma
has a demand valve that is triggered by the negative pressure generated during inhalation
99
Which of the following is an indicator of inadequate artificial ventilation when ventilating an apneic, tachycardic adult with a bag-mask device? A) The patient's heart rate slows down. B) One breath is given every 10 to 12 seconds. C) About 12 to 20 breaths/min are being delivered. D) Each ventilation is delivered over 1 second.
About 12 to 20 breaths/min are being delivered
100
Which of the following statements regarding the automatic transport ventilator (ATV) is correct? A) The ATV should not be used to ventilate a patient who is intubated and in cardiac arrest. B) Inadvertent variations in the rate and duration of ventilations often occur when the ATV is used. C) The paramedic can control an apneic patient's minute volume with accuracy when using an ATV. D) Most ATVs are large and cumbersome and are therefore impractical to use in the prehospital setting.
The paramedic can control an apneic patient's minute volume with accuracy when using an ATV.
101
The pressure relief valve on an automatic transport ventilator may lead to unrecognized hypoventilation in patients with all of the following conditions, EXCEPT: A) airway obstruction. B) prolonged apnea. C) poor lung compliance. D) increased airway resistance
prolonged apnea
102
A length-based resuscitation tape measure can be used to determine the most appropriate size of bag-mask device for pediatric patients who weigh up to: A) 34 kg. B) 38 kg. C) 42 kg. D) 46 kg.
34 kg
103
Physiologic effects of CPAP include: A) increased intrathoracic pressure. B) forcing of fluid into the alveoli. C) increased alveolar surface tension. D) opening of collapsed alveoli
opening of collapsed alveoli.
104
Indications for CPAP include: A) cardiopulmonary arrest. B) acute pulmonary edema. C) severe opiate toxicity. D) acute bacterial pneumonia
acute pulmonary edema
105
CPAP is NOT appropriate for patients with: A) acute or chronic bronchospasm. B) slow, shallow respiratory effort. C) an oxygen saturation less than 90%. D) evidence of congestive heart failure.
slow, shallow respiratory effort
106
Which of the following patients may benefit from CPAP? A) Alert patient with respiratory distress following submersion in water B) Comatose patient with shallow breathing after overdosing on heroin C) Trauma patient with labored breathing and extensive chest wall bruising D) Patient with pulmonary edema who is unable to follow verbal commands
Alert patient with respiratory distress following submersion in water
107
When administering CPAP therapy to a patient, it is important to remember that: A) acute symptomatic bradycardia has been directly linked to CPAP therapy. B) SpO2 of 100% must be achieved as quickly as possible. C) the increased intrathoracic pressure caused by CPAP can result in hypotension. D) the head straps must be secured immediately in order to achieve an adequate seal
the increased intrathoracic pressure caused by CPAP can result in hypotension
108
Signs of clinical improvement during CPAP therapy include: A) a decrease in systolic BP. B) an increase in the heart rate. C) increased ETCO2. D) increased ease of speaking
increased ease of speaking
109
A gastric tube is MOST useful for: A) performing prehospital gastric lavage in patients with a toxic ingestion. B) blocking off the esophagus so that an ET tube can be placed. C) decompressing the stomach and decreasing pressure on the diaphragm. D) removing blood from the esophagus in patients with esophageal varices.
decompressing the stomach and decreasing pressure on the diaphragm
110
Which of the following is NOT proper procedure when inserting a nasogastric tube in a responsive patient? A) Administering a topical alpha agonist to constrict the nasal vasculature B) Keeping the patient's head in an extended position while inserting the tube C) Injecting 40 mL of air into the tube while auscultating over the epigastrium D) Encouraging the patient to swallow or drink to facilitate passage of the tube
Keeping the patient's head in an extended position while inserting the tube
111
In contrast to the nasogastric tube, the orogastric tube: A) is safer to use in patients with severe facial trauma. B) should only be used in patients who are conscious. C) can be used in patients who require gastric lavage. D) is not necessary in patients who have been intubated
is safer to use in patients with severe facial trauma
112
When determining the correct-sized nasogastric tube for a patient, you should measure the tube: A) from the nose to the ear and to the xiphoid process. B) from the nose to the chin and to the epigastric region. C) from the mouth to the chin and to the xiphoid process. D) from the nose, around the ear, and to the xiphoid process.
from the nose to the ear and to the xiphoid process
113
Endotracheal intubation is MOST accurately defined as: A) inserting an ET tube through the vocal cords via the patient's mouth. B) passing an ET tube through an opening in the cricothyroid membrane. C) inserting an ET tube through the glottic opening via the patient's nose. D) passing an ET tube through the glottic opening and sealing off the trachea
passing an ET tube through the glottic opening and sealing off the trachea.
114
All of the following are complications associated with orotracheal intubation, EXCEPT: A) laryngeal swelling. B) damage to the vocal cords. C) necrosis of the nasal mucosa. D) barotrauma from forceful ventilation
necrosis of the nasal mucosa
115
The major advantage of ET intubation is that it: A) facilitates tracheal suctioning. B) protects the airway from aspiration. C) is an easy skill to learn and perform. D) provides a route for certain medications.
protects the airway from aspiration
116
A disadvantage of ET intubation is that it: A) is associated with a high incidence of vocal cord damage and bleeding into the oropharynx. B) bypasses the upper airway's physiologic functions of warming, filtering, and humidifying. C) does not eliminate the incidence of gastric distention and can result in pulmonary aspiration. D) is only a temporary method of securing the patient's airway until a more definitive device can be inserted.
bypasses the upper airway's physiologic functions of warming, filtering, and humidifying
117
Murphy's eye, an opening on the distal side of an ET tube, allows ventilation to occur: A) whether the tube is in the trachea or in the esophagus. B) even if the tip of the tube is occluded by blood or mucus. C) if the tube is inserted into the right mainstem bronchus. D) even if the ET tube does not enter the patient's trachea fully
even if the tip of the tube is occluded by blood or mucus.
118
An ET tube that is too large for a patient: A) is much more likely to enter the esophagus. B) will lead to an increased resistance to airflow. C) will make ventilating the patient more difficult. D) can be difficult to insert and may cause trauma
can be difficult to insert and may cause trauma
119
Normally, an adult male will require an ET tube that ranges from: A) 6.5 to 7.0 mm. B) 7.0 to 7.5 mm. C) 7.5 to 8.5 mm. D) 8.5 to 9.0 mm.
7.5 to 8.5 mm
120
Regardless of the internal diameter, all ET tubes have: A) a 15/22-mm proximal adaptor. B) an inflatable cuff at the distal tip. C) a pilot balloon on the proximal end. D) black millimeter markings on the side.
a 15/22-mm proximal adaptor
121
The procedure in which the vocal cords are visualized for placement of an ET tube is called direct: A) bronchoscopy. B) tracheostomy. C) pharyngoscopy. D) laryngoscopy.
laryngoscopy.
122
In contrast to a curved laryngoscope blade, a straight laryngoscope blade is designed to: A) move the patient's tongue to the left. B) extend beneath the epiglottis and lift it up. C) fit into the vallecular space at the base of the tongue. D) indirectly lift the epiglottis to expose the vocal cords.
extend beneath the epiglottis and lift it up.
123
When inserting a stylet into an ET tube, you must ensure that: A) the stylet rests at least ½ in back from the end of the tube. B) you use a petroleum-based gel to facilitate easy removal. C) the stylet is rigid and does not allow the ET tube to bend. D) the tube is bent in the form of a U to facilitate placement
the stylet rests at least ½ in back from the end of the tube.
124
Which of the following statements regarding orotracheal intubation is correct? A) Orotracheal intubation should be performed on any patient who is apneic. B) Orotracheal intubation is the most common method of performing ET intubation. C) You cannot perform orotracheal intubation on patients who are breathing. D) Orotracheal intubation is most commonly performed without a laryngoscope.
Orotracheal intubation is the most common method of performing ET intubation
125
Before performing orotracheal intubation, it is MOST important for the paramedic to: A) monitor the patient's cardiac rhythm. B) preoxygenate with a bag-mask device. C) wear gloves and facial protection. D) apply a pulse oximeter to the patient.
wear gloves and facial protection
126
Most of the complications caused by intubation-induced hypoxia: A) are easily reversible. B) are subtle and occur gradually. C) can be predicted with pulse oximetry. D) are dramatic and occur immediately.
are subtle and occur gradually
127
Orotracheal intubation should be performed with the patient's head: A) slightly flexed. B) hyperextended. C) in a neutral position. D) in the sniffing position.
in the sniffing position.
128
Intubation of the trauma patient is MOST effectively performed: A) with a curved blade. B) by two paramedics. C) with a cervical collar in place. D) with the patient's head elevated.
by two paramedics.
129
After properly positioning the patient's head for intubation, you should open his or her mouth and insert the blade: A) into the right side of the mouth and sweep the tongue to the left. B) in the midline of the mouth and gently lift upward on the tongue. C) into the left side of the mouth and move the blade to the midline. D) in the midline of the mouth and gently sweep the tongue to the left.
into the right side of the mouth and sweep the tongue to the left.
130
After correctly positioning the laryngoscope blade in the patient's mouth, you should: A) ask your partner to apply firm posterior pressure to the cricoid cartilage. B) gently pry back on the laryngoscope to obtain a view of the vocal cords. C) exert gentle traction at a 45° angle to the floor as you lift the patient's jaw. D) pull slightly back on the laryngoscope blade in order to view the epiglottis.
exert gentle traction at a 45° angle to the floor as you lift the patient's jaw
131
You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see: A) two white fibrous bands that lie vertically within the glottic opening. B) the tip of the straight blade touching the posterior wall of the pharynx. C) the thyroid cartilage bulge anteriorly as you lift up on the laryngoscope. D) the epiglottis lift when the tip of the curved blade is resting underneath it.
two white fibrous bands that lie vertically within the glottic opening
132
The BURP maneuver usually involves applying backward, upward, and rightward pressure to the: A) upper third of the cricoid cartilage. B) lower third of the cricoid cartilage. C) upper third of the thyroid cartilage. D) lower third of the thyroid cartilage.
lower third of the thyroid cartilage
133
The BEST way to be certain that the ET tube has passed through the vocal cords is to: A) feel the ridges of the tracheal wall with the ET tube. B) visualize the tube passing between the vocal cords. C) note the appropriate color change of the capnographer. D) ensure the presence of bilaterally equal breath sounds.
visualize the tube passing between the vocal cords
134
You should insert the ET tube between the vocal cords until the: A) centimeter marking reads 15 cm at the patient's teeth. B) distal end of the cuff is 1 to 2 cm past the vocal cords. C) proximal end of the cuff is 1 to 2 cm past the vocal cords. D) tube meets resistance as it makes contact with the carina.
proximal end of the cuff is 1 to 2 cm past the vocal cords
135
When using a straight blade, a major mistake of new paramedics is to: A) try to pass the ET tube down the barrel of the blade. B) insert the blade directly between the vocal cords. C) use traction while lifting up on the patient's mandible. D) insert the blade into the left side of the patient's mouth.
try to pass the ET tube down the barrel of the blade
136
After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then: A) attach the bag-mask device and ventilate. B) secure the tube with a commercial device. C) attach an ETCO2 detector to the tube. D) inflate the distal cuff with 5 to 10 mL of air.
inflate the distal cuff with 5 to 10 mL of air.
137
If the ET tube has been positioned properly in the trachea: A) breath sounds should be somewhat louder on the right side and the epigastrium should be silent. B) you should not see vapor mist in the ET tube during exhalation when ventilating with a bag-mask. C) breath sounds should be loud at the apices of the lungs but somewhat diminished at the bases. D) the bag-mask device should be easy to compress and you should see corresponding chest expansion.
the bag-mask device should be easy to compress and you should see corresponding chest expansion
138
Decreased ventilation compliance following intubation is LEAST suggestive of: A) gastric distention. B) left bronchus intubation. C) esophageal intubation. D) tension pneumothorax
left bronchus intubation
139
Capnography is a reliable method for confirming proper ET tube placement because: A) carbon dioxide is not present in the esophagus. B) it is a reliable indicator of the patient's PaO2 level. C) capnographers measure the amount of exhaled oxygen. D) capnographers measure the amount of carbon dioxide in inhaled air.
carbon dioxide is not present in the esophagus
140
If the ET tube is placed in the trachea properly, the colorimetric paper inside the ETCO2 detector should: A) not change colors. B) turn yellow during inhalation. C) turn yellow during exhalation. D) remain purple during ventilations
turn yellow during exhalation
141
The use of capnography in patients with prolonged cardiac arrest may be limited because: A) of an excess buildup of nitrogen in the blood. B) the paramedic often ventilates the patient too slowly. C) of acidosis and minimal carbon dioxide elimination. D) metabolic alkalosis damages the colorimetric paper.
of acidosis and minimal carbon dioxide elimination.
142
Typically, ETCO2 is approximately: A) 2 to 5 mm Hg higher than the arterial PaCO2. B) 2 to 5 mm Hg lower than the arterial PaCO2. C) 5 to 10 mm Hg higher than the arterial PaCO2. D) 5 to 10 mm Hg lower than the arterial PaCO2
2 to 5 mm Hg lower than the arterial PaCO2
143
What point(s) on the capnographic waveform represent(s) a mixture of alveolar gas and dead space gas? A) A-B B) B C) B-C D) D
B
144
What phase of the capnographic waveform is called the expiratory upslope? A) A-B B) B-C C) C-D D) D-E
B-C
145
On a capnographic waveform, point ___ is the maximal ETCO2 and is the best reflection of the alveolar CO2 level. A) B B) C C) D D) E
D
146
According to the most current guidelines for emergency cardiac care, the MOST reliable method for monitoring correct ET tube placement is: A) pulse oximetry. B) the esophageal detector device. C) waveform capnography. D) colorimetric capnography
waveform capnography
147
Following ET intubation, the ideal time to attach the capnography T-piece is: A) when the bag is attached to the ET tube. B) after 6 to 8 positive pressure breaths. C) immediately after removing the stylet. D) after auscultating the lungs and epigastrium.
when the bag is attached to the ET tube
148
Capnography can serve as an indicator of: A) proper ventilatory depth. B) cerebral perfusion pressure. C) coronary perfusion pressure. D) chest compression effectiveness.
chest compression effectiveness
149
If using a bulb-style esophageal detector device to assist you in confirming proper ET tube placement, you should expect the bulb to: A) inflate slowly when you let go of it. B) refill briskly if the tube is in the trachea. C) stay collapsed if the tube is in the trachea. D) expand quickly if the tube is in the esophagus.
refill briskly if the tube is in the trachea
150
The average depth of ET tube insertion for adult patients is: A) 21 to 25 cm. B) 22 to 26 cm. C) 23 to 27 cm. D) 24 to 28 cm.
21 to 25 cm.
151
Before securing the ET tube in place with a commercial device, you should: A) remove the bag-mask device from the ET tube. B) hyperventilate the patient for 30 seconds to 1 minute. C) move the ET tube to the center of the patient's mouth. D) note the centimeter marking on the ET tube at the patient's teeth.
note the centimeter marking on the ET tube at the patient's teeth
152
Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because: A) it must be performed on spontaneously breathing patients. B) the procedure should be performed in less than 10 seconds. C) it does not involve direct visualization of the vocal cords. D) patients requiring nasotracheal intubation are usually stable
it must be performed on spontaneously breathing patients
153
Which of the following is NOT a contraindication for nasotracheal intubation? A) Apnea B) Spinal injury C) Frequent use of cocaine D) Patients taking an anticoagulant
Spinal injury
154
The paramedic should be especially diligent when confirming tube placement following blind nasotracheal intubation because: A) the ET tube cannot be secured effectively when it is in the nose. B) most patients who are intubated nasally are extremely combative. C) he or she did not visualize the tube passing between the vocal cords. D) most nasotracheal intubation attempts result in esophageal placement.
he or she did not visualize the tube passing between the vocal cords.
155
The MOST common complication associated with nasotracheal intubation is: A) bleeding. B) aspiration. C) hypoxemia. D) regurgitation.
bleeding.
156
The use of phenylephrine hydrochloride (Neo-Synephrine) during nasotracheal intubation will: A) reduce the likelihood and severity of nasal bleeding. B) sedate the patient and facilitate his or her compliance. C) dilate the nasal vasculature and facilitate tube insertion. D) anesthetize the nasopharynx and reduce patient discomfort
reduce the likelihood and severity of nasal bleeding
157
When performing nasotracheal intubation, you should use an ET tube that is: A) equipped with a stylet in order to make the tube formfitting. B) uncuffed so as to avoid unnecessary damage to the nasal mucosa. C) slightly larger than the nostril into which the tube will be inserted. D) 1 to 1.5 mm smaller than you would use for orotracheal intubation
1 to 1.5 mm smaller than you would use for orotracheal intubation
158
When nasally intubating a patient, the ET tube is advanced: A) as the patient exhales. B) when the patient inhales. C) when the patient swallows. D) in between the patient's breaths.
when the patient inhales
159
If you must insert the ET tube into the patient's left nostril, you should: A) insert the tube straight back without rotating it. B) insert the tube with the beveled tip facing upward. C) ensure that the bevel is facing away from the septum. D) rotate the tube 180° as its tip enters the nasopharynx
rotate the tube 180° as its tip enters the nasopharynx
160
If you see a soft-tissue bulge on either side of the airway when performing nasotracheal intubation: A) inadvertent esophageal intubation has likely occurred. B) you should completely remove the tube and reoxygenate. C) you have probably inserted the tube into the pyriform fossa. D) the tube is positioned correctly just above the glottic opening.
you have probably inserted the tube into the pyriform fossa
161
Which of the following is NOT a step that is performed during nasotracheal intubation? A) Advancing the ET tube as the patient inhales B) Preoxygenating with a bag-mask as necessary C) Ensuring that the patient's head is hyperflexed D) Placing the patient's head in a neutral position
Ensuring that the patient's head is hyperflexed
162
Digital intubation is absolutely contraindicated if the patient: A) has copious airway secretions. B) is unconscious but breathing. C) is trapped in a confined space. D) is extremely obese or has a short neck.
is unconscious but breathing
163
Digital intubation can be performed on trauma patients because: A) the head does not have to be placed in a sniffing position. B) most trauma patients have distortion of the airway anatomy. C) orotracheal intubation is unsafe to perform on trauma patients. D) the technique is easier to perform than other forms of intubation.
the head does not have to be placed in a sniffing position.
164
Digital intubation should be performed only on a patient who has a bite block inserted in his or her mouth and who is_______ and _______. A) unconscious, apneic B) stuporous, bradypneic C) comatose, breathing inadequately D) semiconscious, tachypneic
unconscious, apneic
165
The MOST significant complication associated with digital intubation is: A) hypoxia. B) dental trauma. C) airway swelling. D) vocal cord damage.
hypoxia
166
Rigorous tube confirmation protocol must be followed after performing digital intubation because: A) inadvertent extubation of the patient is very common. B) capnography is unreliable in digitally intubated patients. C) ET tubes that are placed digitally do not have a pilot balloon. D) the procedure of digital intubation is truly a blind technique.
the procedure of digital intubation is truly a blind technique
167
When determining whether transillumination-guided intubation should be attempted, you should: A) consider the amount of soft tissue that is overlying the trachea. B) avoid the procedure if the patient is thin or is greater than 6 ft tall. C) ensure the airway is clear of secretions by suctioning for 30 seconds. D) recall that patients with short necks are often easy to transilluminate.
consider the amount of soft tissue that is overlying the trachea
168
Transillumination-guided intubation can be difficult or impossible to perform: A) in any patient with dentures. B) if the patient has oral secretions. C) in a brightly lit environment. D) in patients over 70 years of age.
in a brightly lit environment
169
Which of the following represents the MOST correct technique for performing transillumination-guided intubation? A) Place the patient's head in a hyperflexed position and insert the tube-stylet combination into the left side of the mouth. B) Grasp the lower jaw with your thumb and forefinger, displace it forward, and insert the tube-stylet combination in the midline of the patient's mouth. C) Hyperextend the patient's head, pull the jaw down, and insert the tube-stylet combination into the right side of the patient's mouth. D) Place the patient's head in a neutral position, displace the tongue with a tongue blade, and insert the tube-stylet combination in the midline of the mouth.
Grasp the lower jaw with your thumb and forefinger, displace it forward, and insert the tube-stylet combination in the midline of the patient's mouth
170
Which of the following indicates that the lighted stylet has entered the trachea? A) Dim, diffuse light at the anterior part of the neck B) Bulging of the soft tissue above the thyroid cartilage C) Tightly circumscribed light below the thyroid cartilage D) Absent illumination at the midline of the patient's neck
Tightly circumscribed light below the thyroid cartilage
171
Once you have confirmed that the lighted stylet-ET tube combination has entered the trachea, you should: A) secure the tube manually, remove the stylet, and attach a bag-mask device. B) slightly withdraw the stylet and tube to ensure placement above the carina. C) remove the lighted stylet and inflate the distal cuff with 5 to 10 mL of air. D) hold the stylet in place and advance the tube about 2 to 4 cm into the trachea
hold the stylet in place and advance the tube about 2 to 4 cm into the trachea
172
During tracheobronchial suctioning, it is MOST important to: A) apply suction for no longer than 5 seconds in the adult. B) avoid rotating the catheter as you are suctioning the trachea. C) monitor the patient's cardiac rhythm and oxygen saturation. D) inject 10 mL of saline down the ET tube to loosen secretions
monitor the patient's cardiac rhythm and oxygen saturation
173
Appropriate insertion of a soft-tip (whistle-tip) suction catheter down the ET tube involves: A) gently inserting the catheter until resistance is felt. B) inserting the catheter until secretions are observed. C) inserting the catheter no farther than 6 to 8 in. D) applying suction while gently inserting the catheter
gently inserting the catheter until resistance is felt
174
After tracheobronchial suctioning is complete, you should: A) visualize the vocal cords to ensure the tube is still in the correct position. B) hyperventilate the patient at 24 breaths/min for approximately 3 minutes. C) instill 3 to 5 mL of saline down the tube to loosen any residual secretions. D) reattach the bag-mask device, continue ventilations, and reassess the patient
reattach the bag-mask device, continue ventilations, and reassess the patient
175
Which of the following statements regarding field extubation is correct? A) It is generally better to sedate the patient rather than extubate. B) The patient should be extubated if spontaneous breathing occurs. C) The risk of laryngospasm following extubation is relatively low. D) Extubation should be performed with the patient in a supine position
It is generally better to sedate the patient rather than extubate
176
The MOST obvious risk associated with extubation is: A) moderate airway swelling as the ET tube is removed. B) overestimating the patient's ability to protect his or her own airway. C) patient retching and gagging as you remove the ET tube. D) stimulation of the parasympathetic nervous system with resulting bradycardia
overestimating the patient's ability to protect his or her own airway.
177
After confirming that an intubated patient remains responsive enough to maintain his or her own airway, you should first: A) fully deflate the distal cuff on the ET tube. B) have the patient sit up or lean slightly forward. C) suction the oropharynx to remove any secretions. D) insert an orogastric tube to ensure the stomach is empty
have the patient sit up or lean slightly forward
178
Which of the following statements regarding pediatric ET intubation in the prehospital setting is correct? A) An average-sized toddler would require a 4.5-mm cuffed ET tube to secure the airway adequately. B) When intubating an infant or small child, it is important to remember that the epiglottis is less floppy. C) Bag-mask ventilation can be as effective as intubation for EMS systems that have short transport times. D) Because the pediatric airway is smaller than an adult's, paramedics should routinely intubate children in the field.
Bag-mask ventilation can be as effective as intubation for EMS systems that have short transport times.
179
In which of the following situations would ET intubation of a pediatric patient be LEAST necessary? A) Traumatic brain injury with unconsciousness B) Administration of certain resuscitative medications C) Cardiopulmonary arrest due to respiratory failure D) Difficulty effectively ventilating with a bag-mask
Administration of certain resuscitative medications
180
When intubating a 3-year-old child, you would MOST likely use a: A) size 2 straight blade. B) 6.5-mm uncuffed ET tube. C) 5.0-mm cuffed ET tube. D) size 1 curved blade
size 2 straight blade
181
What size ET tube would be MOST appropriate to use for a 4-year-old child? A) 3.5 mm B) 4.0 mm C) 4.5 mm D) 5.0 mm
5.0 mm
182
Cuffed ET tubes are generally not used in the field until the child is 8 to 10 years old because: A) the cuff would apply pressure and obstruct the airway. B) the high-pressure cuff would likely rupture the trachea. C) most children are only intubated for short periods of time. D) a cuff at the cricoid ring is not necessary to obtain a seal.
a cuff at the cricoid ring is not necessary to obtain a seal
183
Approximately how far should you insert a 5.0-mm ET tube in a 4-year-old child? A) 12 cm B) 15 cm C) 17 cm D) 19 cm
15 cm
184
When preoxygenating an uninjured child prior to ET intubation, you should: A) place the child's head in the sniffing position, insert an oral airway if needed, and ventilate with a bag-mask for at least 2 minutes. B) hyperextend the child's head, insert an oral airway if needed, and hyperventilate the child at 40 breaths/min for at least 2 to 3 minutes. C) maintain the child's head in a neutral position, insert an oral airway if needed, and deliver 1 breath every 10 seconds for at least 3 minutes. D) place the child's head in the sniffing position, insert an oral airway if needed, and moderately hyperventilate the child at 24 breaths/min for 30 seconds
place the child's head in the sniffing position, insert an oral airway if needed, and ventilate with a bag-mask for at least 2 minutes.
185
In some cases, atropine sulfate, in a dose of ______, may be given to children to prevent vagal-induced bradycardia during ET intubation. A) 0.5 mg B) 1 to 2 mg C) 0.02 mg/kg D) at least 0.01 mg
0.02 mg/kg
186
When intubating a 3-year-old child, you should insert the ET tube until: A) the distal cuff is 1 to 2 cm beyond the vocal cords. B) you meet resistance, and then withdraw the tube 2 cm. C) the vocal cord mark is 2 to 3 cm beyond the vocal cords. D) the cm marking on the tube reads 15 cm at the child's lips
the vocal cord mark is 2 to 3 cm beyond the vocal cords
187
Which of the following is NOT an appropriate method for confirming proper ET tube placement in a 15-kg child? A) Waveform capnography B) Esophageal bulb or syringe C) Bilateral auscultation of breath sounds D) Assessment of skin color and oxygen saturation
Esophageal bulb or syringe
188
If intubation of a child is unsuccessful after two attempts, your MOST appropriate action is to: A) have your partner attempt to intubate as you apply gentle posterior pressure to the cricoid cartilage. B) insert a multilumen airway device and confirm placement by means of auscultation of breath sounds and capnography. C) turn the child on his or her side, apply manual pressure to the epigastrium to relieve distension, and reattempt intubation. D) discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately.
discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately.
189
Which of the following clinical findings is LEAST suggestive of a pneumothorax in an intubated child? A) Decreased ventilation compliance B) Stronger breath sounds on the right side C) Persistent cyanosis despite ventilations D) Stronger breath sounds on the left side
Stronger breath sounds on the right side
190
Using the DOPE mnemonic, which of the following interventions would you MOST likely have to perform if you suspect "O" as the cause of acute deterioration in the intubated child? A) Tracheobronchial suctioning B) Immediate extubation of the child C) Needle decompression of the chest D) Checking the bag-mask device for defects
Tracheobronchial suctioning
191
The MOST effective way to minimize the risk of hypoxia while intubating a child is to: A) limit your intubation attempt to 20 seconds. B) monitor the child's cardiac rhythm at all times. C) premedicate the child with 0.02 mg/kg of atropine. D) not allow the oxygen saturation to fall below 100%.
limit your intubation attempt to 20 seconds
192
Which of the following statements regarding multilumen airways is correct? A) Multilumen airways can be used safely in pediatric patients if ET intubation is unsuccessful. B) To ensure proper placement, multilumen airways should be inserted under direct laryngoscopy. C) Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal. D) Compared with esophageal airways, multilumen airway devices have not been shown to provide better ventilation.
Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal.
193
The major advantage of the multilumen airway is that: A) it can be used in children and adults as an alternative airway device. B) no mask seal is required to ventilate with either of the multilumen airways. C) intubating the trachea with the multilumen airway in place is extremely easy. D) effective ventilation is possible if the tube enters the esophagus or the trachea.
effective ventilation is possible if the tube enters the esophagus or the trachea.
194
The MOST significant complication associated with the use of multilumen airways is: A) laryngospasm or vomiting during insertion of the tube. B) unrecognized displacement of the tube into the esophagus. C) vocal cord damage if the tube inadvertently enters the trachea. D) pharyngeal or esophageal trauma secondary to poor technique.
unrecognized displacement of the tube into the esophagus.
195
In general, a multilumen airway should not be used in patients who are: A) greater than 6 ft tall. B) younger than 16 years of age. C) older than 65 years of age. D) less than 4 ft 5 in tall.
younger than 16 years of age.
196
Multilumen airways are contraindicated in patients with: A) esophageal cancer. B) cervical spine trauma. C) traumatic cardiac arrest. D) a history of gastric ulcers.
esophageal cancer.
197
After inserting the Combitube to the proper depth, you should next: A) inflate the distal cuff with 5 mL of air. B) ventilate through the pharyngeal tube. C) inflate the pharyngeal cuff with 100 mL of air. D) apply a cervical collar to minimize head movement.
inflate the pharyngeal cuff with 100 mL of air
198
The LMA is: A) a suitable airway device for use in morbidly obese patients. B) an alternative to bag-mask ventilation when intubation is not possible. C) associated with a higher risk of damage to the vocal cords than intubation. D) especially effective for CHF patients who require high pulmonary pressures.
an alternative to bag-mask ventilation when intubation is not possible.
199
The main disadvantage of the LMA is that it: A) does not provide protection against aspiration. B) spontaneously dislodges in the majority of patients. C) is associated with significant upper airway swelling. D) is technically more difficult to perform than intubation.
does not provide protection against aspiration
200
During ventilation with the LMA, the paramedic should: A) observe the patient for signs of inadequate ventilation. B) maintain the patient's head in a slightly flexed position. C) suction the patient's oropharynx at least every 2 minutes. D) hyperventilate the patient to maximize tidal volume delivery.
observe the patient for signs of inadequate ventilation.
201
When checking the cuff of the LMA prior to insertion, you should: A) stretch the cuff to check for tears or other damage. B) inflate the cuff with 100 mL of air and then deflate. C) gently pull on the cuff at the tube to ensure integrity. D) inflate the cuff with 50% more air than is required
inflate the cuff with 50% more air than is required
202
A size 3 or 4 LMA: A) is most suitable for use in morbidly obese patients. B) is less likely to become dislodged than smaller sizes. C) will accommodate the passage of a 6.0-mm ET tube. D) is appropriate to use in children younger than 6 years of age.
will accommodate the passage of a 6.0-mm ET tube.
203
Proper insertion of the LMA involves: A) inserting the LMA into the patient's mouth by following the curvature of the patient's tongue. B) lifting the patient's jaw upward and blindly inserting the LMA until you meet resistance. C) flexing the patient's neck, depressing the tongue with a tongue blade, and blindly inserting the LMA. D) inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.
inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.
204
The King LT airway can be used to: A) administer certain cardiac medications directly into the trachea. B) maintain a patent airway in spontaneously breathing patients. C) establish a patent airway in patients of any age and body size. D) suction pulmonary secretions from the tracheobronchial tree
maintain a patent airway in spontaneously breathing patients
205
Which of the following statements regarding the King LT airway is correct? A) In the prehospital setting, the King LTS-D is only used in adults. B) The King LT airway provides better airway protection than the ET tube. C) The King LT airway has two lumens that effectively seal the esophagus. D) In contrast to the King LT-D, the LTS-D is closed at the distal end.
In the prehospital setting, the King LTS-D is only used in adults.
206
The King LT-D airway features a: A) straight tube with two inflatable cuffs that hold an equal amount of air. B) port through which gastric contents can be suctioned from the stomach. C) curved tube with ventilation ports located between two inflatable cuffs. D) universal size with two inflation ports and is used for patients of any age
curved tube with ventilation ports located between two inflatable cuffs
207
The King airway should NOT be used in patients: A) with known esophageal disease. B) with prolonged cardiac arrest. C) with a traumatic brain injury. D) who weigh less than 25 kg
with known esophageal disease
208
Proper placement of the King LT airway is performed by all of the following techniques, EXCEPT: A) auscultation of bilateral breath sounds. B) the esophageal detector device. C) quantitative waveform capnography. D) observation for symmetrical chest rise.
the esophageal detector device
209
If ventilation is difficult after inserting a King LT airway, you should: A) deflate both of the cuffs, withdraw the device 2 cm, and reattempt ventilation. B) remove the King LT and immediately resume ventilation with a bag-mask. C) attach a manually triggered ventilator and observe for adequate chest rise. D) gently withdraw the device, without deflating the cuffs, until ventilation is easier.
gently withdraw the device, without deflating the cuffs, until ventilation is easier.
210
When correctly placed, the distal tip of the Cobra perilaryngeal airway (CobraPLA): A) enters the esophagus and provides complete obturation. B) is proximal to the esophagus and seals the hypopharynx. C) is in almost perfect alignment with the esophageal opening. D) rests against the arytenoid cartilage and enters the glottis
is proximal to the esophagus and seals the hypopharynx
211
If used properly, and under the correct circumstances, sedation during airway management: A) chemically paralyzes the patient, thus facilitating placement of an advanced airway device. B) effectively increases patient compliance, thus making definitive airway management safer to perform. C) significantly reduces the pain and discomfort associated with laryngoscopy and ET intubation. D) minimizes the risks of bradycardia and hypotension that occasionally occur during advanced airway management.
effectively increases patient compliance, thus making definitive airway management safer to perform.
212
Undersedation of a patient during airway management would likely result in all of the following, EXCEPT: A) respiratory depression. B) trauma to the airway. C) poor patient compliance. D) tachycardia and hypertension
respiratory depression
213
Fentanyl (Sublimaze) is a: A) narcotic analgesic. B) benzodiazepine sedative. C) sedative-hypnotic drug. D) butrophenone sedative.
narcotic analgesic
214
Which of the following medications does NOT possess hypnotic properties? A) Versed B) Brevital C) Alfentanil D) Etomidate
Alfentanil
215
Diazepam and midazolam provide all of the following therapeutic effects, EXCEPT: A) sedation. B) analgesia. C) anxiolysis. D) retrograde amnesia.
analgesia.
216
Which of the following medications is safest to use in patients with borderline hypotension or hypovolemia? A) Brevital B) Pentothal C) Sublimaze D) Etomidate
Etomidate
217
Neuromuscular blocking agents: A) are most commonly used as the sole agent to facilitate placement of an ET tube. B) convert a breathing patient with a marginal airway into an apneic patient with no airway. C) induce total body paralysis within 10 to 15 minutes following administration via IV push. D) have a negative effect on both cardiac and smooth muscle and commonly cause dysrhythmias.
convert a breathing patient with a marginal airway into an apneic patient with no airway
218
When a patient is given a paralytic without sedation: A) he or she is fully aware and can hear and feel. B) you should only give one tenth of the standard dose. C) placement of an ET tube is less traumatic. D) paralysis is not achieved and intubation is not possible
he or she is fully aware and can hear and feel
219
Paralytic medications exert their effect by: A) blocking the release of epinephrine and norepinephrine from the sympathetic nervous system. B) competitively binding to the motor neurons in the brain, thus blocking their ability to send messages. C) functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine. D) blocking the function of the autonomic nervous system and impeding the action of acetylcholinesterase.
functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine
220
Nondepolarizing neuromuscular blocking agents include all of the following, EXCEPT: A) vecuronium bromide. B) rocuronium bromide. C) pancuronium bromide. D) succinylcholine chloride.
succinylcholine chloride.
221
Which of the following is NOT characteristic of a depolarizing neuromuscular blocking agent? A) Bradycardia B) Tachycardia C) Muscle fasciculations D) Short duration of action
Tachycardia
222
To prevent muscular fasciculations associated with the use of succinylcholine, you should administer: A) 0.5 mg of atropine sulfate via rapid IV push. B) 10% of the usual dose of a nondepolarizing paralytic. C) an infusion of potassium chloride set at 5 mEq per hour. D) 1 to 1.5 mg/kg of lidocaine over 10 to 15 minutes.
10% of the usual dose of a nondepolarizing paralytic.
223
Drugs such as vecuronium bromide (Norcuron) and pancuronium bromide (Pavulon) are MOST appropriate to administer when: A) extended periods of paralysis are needed. B) longer-acting paralytics are contraindicated. C) you have a transport time of less than 15 minutes. D) intubation of the patient is anticipated to be difficult.
extended periods of paralysis are needed
224
Before intubating a patient who has been chemically sedated and paralyzed, it is MOST important for the paramedic to: A) administer 0.5 mg of atropine sulfate. B) hyperventilate the patient at 24 breaths/min. C) adequately preoxygenate with 100% oxygen. D) suction the oropharynx to clear any secretions
adequately preoxygenate with 100% oxygen
225
Which of the following medications has been shown to blunt the increase in intracranial pressure associated with suctioning and laryngeal stimulation? A) Atropine B) Lidocaine C) Amiodarone D) Furosemide
Lidocaine
226
If the patient's oxygen saturation drops at any point during rapid-sequence intubation, you should: A) stop and hyperventilate the patient at a rate of 24 breaths/min. B) abort the intubation attempt and ventilate with a bag-mask device. C) apply posterior cricoid pressure and continue the intubation attempt. D) continue the intubation attempt and monitor the cardiac rhythm closely
abort the intubation attempt and ventilate with a bag-mask device.
227
The external jugular veins run ____________ and are located ____________ to the cricothyroid membrane. A) vertically, lateral B) vertically, medial C) horizontally, lateral D) horizontally, medial
vertically, lateral
228
When performing an open cricothyrotomy, you will MOST likely avoid damage to the jugular veins if: A) the patient's head is hyperextended. B) you incise the cricothyroid membrane at a transverse angle. C) the patient's head is in a neutral position. D) the cricothyroid membrane is incised vertically
the cricothyroid membrane is incised vertically
229
The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because: A) no important structures lie between the skin covering the cricothyroid membrane and the airway. B) the tough cartilage that comprises the cricothyroid membrane can easily be incised with a scalpel. C) there are no major blood vessels or other structures that lie adjacent to the cricothyroid membrane. D) the cricoid cartilage helps prevent accidental perforation through the back of the airway and into the esophagus
no important structures lie between the skin covering the cricothyroid membrane and the airway.
230
Open cricothyrotomy is indicated when: A) ET intubation is unsuccessful after three attempts. B) all other methods of advanced airway management have failed. C) you are unable to secure a patent airway with less invasive means. D) the patient has a head injury that precludes nasotracheal intubation.
you are unable to secure a patent airway with less invasive means
231
Open cricothyrotomy is generally contraindicated in all of the following situations, EXCEPT: A) tracheal tumors or subglottic stenosis. B) any patient who is younger than 16 years of age. C) crushing laryngeal injuries or tracheal transection. D) inability to identify the correct anatomic landmarks.
any patient who is younger than 16 years of age.
232
In contrast to a needle cricothyrotomy, an open cricothyrotomy: A) involves the use of a high-pressure jet ventilator. B) enables the paramedic to provide greater tidal volume. C) is the preferred technique in patients with short, fat necks. D) is easier to perform in children younger than 8 years of age.
enables the paramedic to provide greater tidal volume.
233
Incising the cricothyroid membrane vertically will: A) minimize the risk of damaging the thyroid gland. B) facilitate insertion of an 8.0- to 9.0-mm ET tube. C) completely eliminate the risk of any external bleeding. D) increase the risk of damaging the external jugular veins
minimize the risk of damaging the thyroid gland
234
You should be MOST suspicious of tube misplacement following an open cricothyrotomy if: A) bleeding from the subcutaneous tissues is observed. B) there is minimal rise of the chest during ventilations. C) progressive redness is noted around the insertion site. D) a crackling sensation is noted when palpating the neck.
a crackling sensation is noted when palpating the neck.
235
When performing an open cricothyrotomy, you should FIRST: A) maintain aseptic technique as you cleanse the area with iodine. B) slide your index finger between the thyroid and cricoid cartilages. C) palpate for the V notch of the thyroid cartilage and stabilize the larynx. D) hyperextend the patient's neck and then palpate the cricoid cartilage.
palpate for the V notch of the thyroid cartilage and stabilize the larynx
236
Which of the following statements regarding translaryngeal catheter ventilation is correct? A) It is more difficult to perform than an open cricothyrotomy. B) It provides a more definitive airway than an open cricothyrotomy. C) Ventilation is achieved by the use of a high-pressure jet ventilator. D) The technique uses the tracheal wall as an entry point to the airway.
Ventilation is achieved by the use of a high-pressure jet ventilator.
237
Needle cricothyrotomy is contraindicated in patients with: A) uncontrolled oropharyngeal bleeding. B) obstruction above the catheter insertion site. C) massive maxillofacial trauma and trismus. D) a suspected injury to the cervical spine.
obstruction above the catheter insertion site.
238
Because the high-pressure ventilator used with needle cricothyrotomy would cause an increase in intrathoracic pressure, ___________ and ___________ may result. A) hypercarbia, hypoxia B) barotrauma, pneumothorax C) hypoventilation, hypocarbia D) esophageal rupture, hemorrhage
barotrauma, pneumothorax
239
Compared with an open cricothyrotomy, needle cricothyrotomy: A) allows for subsequent attempts to intubate the patient. B) requires the paramedic to manipulate the patient's cervical spine. C) is technically more difficult and takes longer to perform. D) is associated with a higher risk of damage to adjacent structures.
allows for subsequent attempts to intubate the patient
240
The MOST significant disadvantage associated with needle cricothyrotomy is: A) air leakage around the insertion site. B) the inability to exhale via the glottis. C) local infection due to poor technique. D) the potential for pulmonary aspiration.
the potential for pulmonary aspiration.
241
After inserting the needle into through the cricothyroid membrane, you should next: A) change your angle to 90° and advance the catheter over the needle. B) aspirate with the syringe and then insert the needle about 2 cm farther. C) insert the needle about 1 cm farther and then aspirate with the syringe. D) advance the catheter over the needle until the hub is flush with the skin.
insert the needle about 1 cm farther and then aspirate with the syringe
242
You should turn the jet ventilator release valve off when: A) the audible alarm sounds. B) wide chest expansion is noted. C) the patient's chest visibly rises. D) you can auscultate breath sounds.
the patient's chest visibly rises.
243
Proper insertion of the needle into the cricothyroid membrane involves a ___ angle toward the ________. A) 45°, feet B) 90°, posterior trachea C) 45°, posterior trachea D) 90°, feet
45°, feet
244
A surgical opening into the trachea is called a: A) stoma. B) laryngectomy. C) laryngectomee. D) tracheostomy.
tracheostomy.
245
Patients with a partial laryngectomy: A) have had their entire larynx removed and breathe through an opening in the neck called a stoma. B) are called partial neck breathers because they breathe through both a stoma and the nose and mouth. C) are easy to differentiate from patients who have had a total laryngectomy, especially when they are apneic. D) cannot be ventilated with the mouth-to-mask technique because there is no connection between the pharynx and lower airway
are called partial neck breathers because they breathe through both a stoma and the nose and mouth.
246
Patients with laryngectomies MOST commonly develop mucous plugs in their stoma because: A) they are at higher risk for pneumonia. B) they do not possess an efficient cough. C) the diameter of the stoma is small. D) their swallowing mechanism is suppressed
they do not possess an efficient cough
247
When suctioning a patient's stoma, you should: A) insert the catheter until resistance is felt. B) ask the patient to inhale as you are suctioning. C) insert the catheter no more than 15 cm. D) provide suction for no longer than 20 seconds.
insert the catheter until resistance is felt
248
If a patient has a stoma and no tracheostomy tube in place: A) you should not seal the nose and mouth when ventilating. B) suctioning of the stoma must be performed before ventilating. C) ventilations can be performed by placing a mask over the stoma. D) you must perform a head tilt-chin lift maneuver before ventilating.
ventilations can be performed by placing a mask over the stoma
249
Whether you are providing ventilations to a patient with a stoma using a resuscitation mask or bag-mask device, you must FIRST: A) perform a head tilt-chin lift maneuver. B) place the patient's head in a neutral position. C) adequately cleanse the stoma site with iodine. D) suction the stoma for no longer than 10 seconds
place the patient's head in a neutral position
250
In order for a tracheostomy tube to be compatible with a mechanical ventilator or bag-mask device: A) it should have a stylet that can be removed easily. B) it should have an internal diameter of at least 6.0 mm. C) the patient's head must be in a hyperextended position. D) it must be equipped with a 15/22-mm proximal adaptor.
it must be equipped with a 15/22-mm proximal adaptor
251
When replacing a dislodged tracheostomy tube, it is MOST important that you: A) insert the tube 2 cm beyond the cuff. B) take appropriate standard precautions. C) lubricate the tube before insertion. D) use a tracheostomy tube of the same size.
take appropriate standard precautions
252
Removal of a dental appliance after intubating a patient is: A) dangerous and may cause dislodgement of the tube. B) generally preferred but should be performed carefully. C) mandatory in the event the patient will require surgery. D) acceptable only if the device is an upper or lower bridge.
dangerous and may cause dislodgement of the tube
253
Which of the following interventions is NOT appropriate when treating an unresponsive patient whose airway is obstructed by a dental appliance? A) Abdominal thrusts B) Chest compressions C) Direct laryngoscopy D) Use of Magill forceps
Abdominal thrusts
254
When ventilating a patient with facial injuries, it is MOST important to: A) ventilate with a higher-than-normal volume. B) suction the oropharynx every 2 to 3 minutes. C) be alert for changes in ventilation compliance. D) ensure that a cervical collar has been applied.
be alert for changes in ventilation compliance
255
If the distance between the hyoid bone and the thyroid notch is at least ___ cm wide, the difficulty of intubation should be low. A) 1 B) 2 C) 3 D) 4
2
256
A mouth-opening width of less than ___ cm indicates a potentially difficult airway. A) 3 B) 4 C) 5 D) 6
3
257
When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of a Mallampati Class: A) I. B) II. C) III. D) IV.
III
258
With regard to intubation difficulty, neck mobility problems are MOST commonly associated with: A) female patients. B) tall, thin patients. C) small children. D) elderly patients.
elderly patients.
259
Which of the following patients has the lowest minute volume? A) Tidal volume of 400 mL; respiratory rate of 14 breaths/min B) Tidal volume of 350 mL; respiratory rate of 12 breaths/min C) Tidal volume of 400 mL; respiratory rate of 24 breaths/min D) Tidal volume of 300 mL; respiratory rate of 16 breaths/min
Tidal volume of 350 mL; respiratory rate of 12 breaths/min
260
After opening an unresponsive patient's airway, you determine that his respirations are rapid, irregular, and shallow. You should: A) intubate him at once. B) apply a nonrebreathing mask. C) suction his mouth for 15 seconds. D) begin positive-pressure ventilations.
begin positive-pressure ventilations
261
Which of the following patients is LEAST likely in need of positive-pressure ventilation? A) Confused 46-year-old woman with labored respirations, adventitious breath sounds, and pallor B) Conscious 41-year-old woman with two-word dyspnea, perioral cyanosis, and tachycardia C) Semiconscious 39-year-old man with shallow chest wall movement, cyanosis, and bradypnea D) Conscious 36-year-old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin
Conscious 36-year-old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin
262
Which of the following findings is MOST clinically significant in a 30-year-old woman with difficulty breathing and a history of asthma? A) Oral temperature of 97.9°F B) Expiratory wheezing on exam C) Prior ICU admission for her asthma D) 3 mm Hg drop in systolic BP during inhalation
Prior ICU admission for her asthma
263
After obtaining a peak expiratory flow reading of 200 mL, you administered one bronchodilator treatment to a 21-year-old woman with an acute episode of expiratory wheezing. The next peak flow reading is 400 mL. You should: A) recognize that the patient's condition has improved. B) give another bronchodilator treatment and reassess. C) try another treatment modality to treat her wheezing. D) assist ventilations and be prepared to intubate her.
recognize that the patient's condition has improved
264
You respond to a residence for a possible overdose. The patient, a young man, is unresponsive with slow, snoring respirations. There are obvious needle track marks on his arms. Your FIRST action should be to: A) insert an oral airway. B) suction his oropharynx. C) manually open his airway. D) begin ventilation assistance.
manually open his airway.
265
A 40-year-old man fell 20 ft from a tree while trimming branches. Your assessment reveals that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver. You should: A) insert a nasopharyngeal airway and assess his respirations. B) carefully open his airway with the head tilt-chin lift maneuver. C) assist his ventilations and prepare to intubate him immediately. D) suction his oropharynx and reattempt the jaw-thrust maneuver
carefully open his airway with the head tilt-chin lift maneuver
266
A 50-year-old woman presents with acute respiratory distress while eating. Upon your arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals that her skin is pink and moist. In addition to transporting her to the hospital, you should: A) perform abdominal thrusts until she becomes unconscious. B) encourage her to cough and closely monitor her condition. C) deliver positive-pressure ventilations via bag-mask device. D) look in her mouth and attempt to visualize a foreign body.
encourage her to cough and closely monitor her condition
267
Two attempts to ventilate an unconscious 10-year-old boy have been unsuccessful. You should next: A) intubate his trachea. B) deliver abdominal thrusts. C) look inside the patient's mouth. D) perform chest compressions.
perform chest compressions
268
Several cycles of basic life support maneuvers have failed to relieve a severe airway obstruction in an unresponsive 44-year-old woman. You should: A) intubate the patient and attempt to push the foreign body into one of the mainstem bronchi. B) continue basic life support maneuvers and transport the patient to the hospital immediately. C) perform direct laryngoscopy and attempt to remove the obstruction with Magill forceps. D) place the patient's head in a neutral position and perform an emergency cricothyrotomy.
perform direct laryngoscopy and attempt to remove the obstruction with Magill forceps
269
After inserting an oropharyngeal airway in an unresponsive woman, the patient begins to gag. You should: A) remove the airway and have suction ready. B) suction her oropharynx for up to 15 seconds. C) spray an anesthetic medication into her mouth. D) turn the patient on her side in case she vomits.
remove the airway and have suction ready
270
A construction worker fell approximately 15 ft and landed on his head. He is semiconscious. His respiratory rate is 14 breaths/min with adequate depth. Further assessment reveals blood draining from his nose. You should: A) administer oxygen via nonrebreathing mask and continue your assessment. B) insert a nasopharyngeal airway and assist ventilations with a bag-mask device. C) suction his nasopharynx for up to 30 seconds and apply oxygen via nasal cannula. D) insert a nasopharyngeal airway and administer oxygen via nonrebreathing mask
administer oxygen via nonrebreathing mask and continue your assessment
271
A 19-year-old woman ingested a large quantity of Darvon. She is responsive to pain only and has slow, shallow respirations. The MOST appropriate airway management for this patient involves: A) inserting an oral airway and assisting ventilations with a bag-mask device. B) inserting a nasal airway and assisting ventilations with a bag-mask device. C) inserting an oral airway and administering oxygen via nonrebreathing mask. D) suctioning her airway, inserting an oral airway, and administering 100% oxygen.
inserting a nasal airway and assisting ventilations with a bag-mask device
272
A 66-year-old woman is found to be unresponsive and apneic. Her carotid pulse is weak and rapid. When ventilating this patient, you should deliver: A) each breath over 2 seconds at a rate of 8 to 10 breaths/min. B) one breath over 1 second every 3 to 5 seconds C) one breath over 2 seconds every 5 to 6 seconds. D) each breath over 1 second at a rate of 10 to 12 breaths/min.
each breath over 1 second at a rate of 10 to 12 breaths/min
273
You have been providing bag-mask ventilations to an unresponsive, apneic patient with facial trauma for approximately 10 minutes. After intubating the patient, you should: A) hyperventilate the patient with 100% oxygen. B) insert a nasogastric tube to decompress the stomach. C) insert an orogastric tube to relieve gastric distention. D) ventilate the patient at a rate of 12 to 20 breaths/min
insert an orogastric tube to relieve gastric distention
274
Approximately 10 seconds into an intubation attempt, you catch a glimpse of the patient's vocal cords, but quickly lose sight of them. You should: A) sweep the patient's tongue to the right side of the mouth and revisualize. B) abort the intubation attempt and ventilate the patient with a bag-mask device. C) ask your partner to apply backward, upward, rightward pressure to the thyroid. D) gently pry back on the laryngoscope to improve your view of the upper airway
ask your partner to apply backward, upward, rightward pressure to the thyroid
275
You are intubating a 60-year-old man in cardiac arrest and have visualized the ET tube passing between the vocal cords. After removing the laryngoscope blade from the patient's mouth, manually stabilizing the tube, and removing the stylet, you should: A) inflate the distal cuff with 5 to 10 mL of air. B) attach an ETCO2 detector to the tube. C) secure the ET tube with a commercial device. D) begin ventilations and auscultate breath sounds
inflate the distal cuff with 5 to 10 mL of air.
276
After you have intubated an apneic patient with chest trauma, your partner is auscultating breath sounds and tells you that breath sounds are faint on the right side of the chest. You should: A) slightly withdraw the tube as your partner auscultates breath sounds. B) suspect that the patient has a pneumothorax on the right side of the chest. C) immediately remove the ET tube and oxygenate the patient for 30 seconds. D) increase the force of your ventilations as your partner reauscultates the lungs.
suspect that the patient has a pneumothorax on the right side of the chest
277
You are transporting an intubated patient and note that the digital capnometry reading has quickly fallen below 30 mm Hg. You should: A) hyperventilate the patient to see if the ETCO2 reading increases. B) slow your ventilation rate to see if the ETCO2 reading decreases. C) promptly extubate the patient and ventilate with a bag-mask device. D) take immediate measures to confirm proper placement of the ET tube
take immediate measures to confirm proper placement of the ET tube
278
You are caring for a 69-year-old man with congestive heart failure. His breathing is profoundly labored, his oxygen saturation reads 79% on oxygen via nonrebreathing mask, and he is showing signs of physical exhaustion. Considering that your protocols do not allow you to perform rapid-sequence intubation, you should: A) insert an oral airway, assist ventilations with a bag-mask device, and transport at once. B) preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation. C) give him Valium for sedation, perform orotracheal intubation, and transport to the hospital at once. D) insert a nasopharyngeal airway and ensure that the nonrebreathing mask is tightly secured to his face.
preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation
279
Several attempts to orotracheally intubate an unresponsive, apneic young man have failed. You resume bag-mask ventilations and begin transport to a hospital located 25 miles away. En route, you begin having difficulty maintaining an adequate mask-to-face seal with the bag-mask device. Assuming that you have the proper equipment, which of the following techniques to secure a patent airway would be MOST appropriate? A) Transillumination intubation B) Blind nasotracheal intubation C) An open or needle cricothyrotomy D) Further attempts at orotracheal intubation
Transillumination intubation
280
You have intubated a 70-year-old man with chronic bronchitis and are en route to the hospital. During transport, you note that ventilations are becoming increasingly difficult and the digital capnometry reading is falling. Your partner tells you that she can still hear bilaterally equal breath sounds, but they are faint. She further tells you that there are no sounds over the epigastrium. What intervention is MOST likely indicated for this patient? A) Immediate extubation B) Withdrawing the tube 2 cm C) Tracheobronchial suctioning D) Hyperventilation at 24 breaths/min
Tracheobronchial suctioning
281
An intubated 33-year-old man is becoming agitated and begins moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should: A) administer a sedative medication. B) suction his airway and carefully extubate. C) chemically paralyze him with vecuronium. D) physically restrain his head to the stretcher.
administer a sedative medication
282
You are attempting to intubate a 5-year-old girl when you note that her heart rate has fallen from 120 beats/min to 80 beats/min. A patent IV line has been established. The MOST appropriate action is to: A) administer 0.02 mg/kg of atropine to increase her heart rate. B) abort the intubation attempt and begin chest compressions at 100/min. C) give a 20 mL/kg normal saline bolus and continue your intubation attempt. D) abort the attempt and ventilate with a bag-mask device and 100% oxygen.
abort the attempt and ventilate with a bag-mask device and 100% oxygen.
283
While transporting an intubated 8-year-old boy, he suddenly jerks his head and becomes cyanotic shortly thereafter. His oxygen saturation and capnometry readings are both falling, and he is becoming bradycardic. You attempt to auscultate breath sounds, but are unable to hear because of the drone of the engine. What has MOST likely happened? A) Tension pneumothorax B) Inadvertent extubation C) Obstruction of the tube D) Right mainstem intubation
Inadvertent extubation
284
You have just inserted a Combitube in a 59-year-old cardiac arrest patient. You attach the bag-mask device to the pharyngeal (blue) tube, begin ventilations, and note the presence of bilaterally equal breath sounds, absent epigastric sounds, and visible chest rise. You should: A) perform laryngoscopy to visualize placement of the Combitube. B) continue to ventilate and use additional confirmation techniques. C) continue ventilating the patient at a rate of 10 to 12 breaths/min. D) ventilate through the clear tube and auscultate all four lung fields
continue to ventilate and use additional confirmation techniques
285
You are assessing a young woman who was struck in the head with a baseball bat. The patient is semiconscious and has slow, irregular respirations. Further assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood in her mouth, but clenches her teeth and becomes combative when you attempt to suction her oropharynx. The MOST appropriate airway management for this patient involves: A) sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea. B) suctioning along the inside of her cheek with a whistle-tip catheter and then performing blind nasotracheal intubation. C) opening her mouth with a dental prod, suctioning her oropharynx for 15 seconds, and intubating her trachea via direct laryngoscopy. D) inserting a nasopharyngeal airway, administering supplemental oxygen via nonrebreathing mask, and continuing suction attempts.
sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea.
286
A 36-year-old man experienced significant burns to his face, head, and chest following an incident with a barbeque pit. Your assessment of his airway reveals severe swelling. After administering medications to sedate and paralyze the patient, you are unable to intubate him. Furthermore, bag-mask ventilations are producing minimal chest rise. The quickest way to secure a patent airway in this patient is to: A) ventilate with a demand valve. B) insert a LMA. C) perform a needle cricothyrotomy. D) perform an open cricothyrotomy
perform a needle cricothyrotomy.
287
You are dispatched to the residence of a 19-year-old man who has a tracheostomy tube and is on a mechanical ventilator. According to the patient's mother, he began experiencing difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally diminished breath sounds, and his oxygen saturation is 90%. You disconnect the patient from the mechanical ventilator and begin bag-mask ventilations; however, you meet significant resistance. You should: A) suspect that he has bilateral pneumothoraces. B) ventilate with a demand valve and transport at once. C) remove the bag-mask and suction his tracheostomy tube. D) remove his tracheostomy tube and replace it with a new one.
remove the bag-mask and suction his tracheostomy tube
288
A young woman experienced massive facial trauma after being ejected from her car when it struck a tree. She is semiconscious, has blood draining from her mouth, and has poor respiratory effort. The MOST appropriate initial airway management for this patient involves: A) vigorously suctioning her oropharynx for no longer than 15 seconds and then inserting a multilumen airway device. B) alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2 minutes until you can definitively secure her airway. C) suctioning her oropharynx and performing direct laryngoscopy to assess the amount of upper airway damage or swelling that is present. D) providing positive-pressure ventilatory support with a bag-mask device and making preparations to perform an open cricothyrotomy.
alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2 minutes until you can definitively secure her airway.
