EMT Practice Exam. Airway/Respiration/Ventilation Flashcards
Upson insertion of an oropharyngeal airway (OPA), the tip of the device should be positioned in what anatomical space?
a. Oropharynx
b. Nasopharynx
c. Hyperpharynx
d. Laryngopharynx
D. Rationale: The OPA works by lifting the base of the tongue off the posterior pharynx. With proper insertion, the tip should rest in the laryngopharynx so it can fully support the tongue. The nasopharynx is where the nasal cavity empties into the pharynx and would be too superior, as would the oropharynx as this is where the oral cavity connects with the pharynx. There is no location referred to as the hyperpharynx.
The administration of a beta2-specific drug to a patient with respiratory distress is done to effect a change to what portion of the respiratory tree?
a. Alveoli
b. Vocal cords
c. Bronchioles
d. Mainstem bronchi
C. Rationale: A beta2-specific drug will relax smooth muscle, the kind that wraps the bronchioles of the lungs. This relaxation will allow better airflow to the alveoli for gas exchange. The vocal cords are composed of fibrous tissue that is unresponsive to beta2 stimulation, and the bronchi are supported by cartilage, which is also unresponsive to beta2 stimulation. Finally, there are no smooth muscle fibers in the alveoli; hence, this drug will not have an effect at that level.
Which of the following statements from the patient would BEST indicate severe difficulty in breathing?
a. “I…can’t…b—breathe.”
b. “I feel like I’m breathing through a straw.”
c. “I am struggling to catch my breath…real bad.”
d. “I can’t breathe regular ‘cause my chest is hurting.”
A. Rationale: A key ability of the EMT is to recognize the difference between adequate and inadequate breathing. A patient who can speak in full sentences (multiple words in one breath) is typically breathing adequately. A patient who cannot speak in full sentences (usually less than two to three words per breath) is not breathing adequately and will need oxygen (and probably PPV support).
Which of the following patients is most likely about to lose total airway patency, thereby requiring immediate intervention by the EMT?
a. A ninety-eight-year-old female with brain cancer who is confused
b. A fifty-two-year-old male who is intoxicated and has recurrent vomiting
c. A twenty-nine-year-old female in active labor who is complaining of severe pain
d. A sixty-eight-year-old male seizing with sonorous sounds heard with each breath
D. Rationale: Airway patency is an absolute requirement for patient survival. An indication of partial upper airway occlusion is sonorous breath sound (snoring). While the unresponsive female and intoxicated male may deteriorate more, as of yet they are not showing indications of partial airway occlusion. The active labor patient also does not show indications of acute airway deterioration.
Upon assessment of the patient’s airway, you note significant gurgling with each breath. What would be the next appropriate airway intervention the EMT should perform to eliminate this finding?
a. Head-tilt, chin-lift maneuver
b. Modified jaw-thrust maneuver
c. Oropharyngeal suctioning
d. Insertion of a nasopharyngeal airway
C. Rationale: the upper airway sound described as “gurgling” is secondary to fluid accumulation in the pharynx that has air passing through it while the patient breathes (think about blowing air through a straw in water). The only way intervention listed that will remove the fluid from the airway is suctioning. The other interventions are more appropriate if the tongue is blocking the airway (commonly this causes snoring sounds with each breath).
You are managing a female patient who has been in an auto accident and is now unresponsive. As you manage her airway, which of the following interventions would you likely NOT employ?
a. Insertion of an OPA
b. Upper airway suctioning
c. A modified jaw-thrust maneuver
d. Application of a head-tilt, chin-lift maneuver
D. Rationale: A patient who has potential cervical-spinal trauma, such as this patient who was in an auto accident, should not have cervical manipulation due to the possibility of spinal trauma. The insertion of an OPA, airway suctioning, and a jaw-thrust maneuver are all airway interventions that can be applied without cervical manipulation.
When sizing an OPA for insertion in a forty-eight-year-old male, which sizing technique is most appropriate?
a. You should measure the OPA from the tip of the nose to the angle of the jaw.
b. You should measure the OPA from the center of the teeth to the angle of the jaw.
c. The OPA should fit between the corner of the mouth and the angle of the jaw.
d. The OPA should be large enough that the lips do not seal shut when it is properly inserted.
B. Rationale: There are two measuring techniques for the OPA; either is appropriate. The first is to measure the OPA from the center of the mouth (center of the teeth) to the angle of the jaw. The other is to measure from the corner of the mouth to the earlobe on the same side of the face. While the length is measured, there is no measuring technique for the size as it relates to the mouth opening.
During your initial airway management, your patient needs suctioning for prolonged vomiting. How long should you provide this oral suctioning?
a. For 5 to 10 seconds
b. No greater than 10 seconds
c. Less than 25 seconds initially
d. For as long as needed to remove vomitus
D. Rationale: During airway management, the guidance is to suction for no longer than 10 seconds; however, in a patient who has prolonged vomiting as this patient did, the suctioning should proceed until the vomit has been removed. Failure to do so will allow the patient to aspirate the vomit with detrimental effects. Generally speaking, when doing routine suctioning of small fluid amounts, the patient should be preoxygenated pre- and postsuctioning, with suctioning lasting only about 10 seconds.
The mechanical process of respiration (i.e., ventilation) occurs in two phases. Which phase sees a negative pressure inside the thorax to make the ventilation process work?
a. Inhalation
b. Exhalation
c. Pause before inhalation
d. Pause before exhalation
A. Rationale: Ventilation occurs due to a changing of pressure within the thorax as compared to atmospheric pressures. During inhalation, the diaphragm drops and the rib cage flares up and out, creating a larger intrathoracic cavity, which causes the development of a negative pressure (Boyle’s law). The negative pressure then causes air to flow from outside the body (higher pressure) to inside the lungs (lower pressure) to equalize. During exhalation, there is a positive pressure in the thorax, forcing air out. Pauses that occur before a phase of ventilation are nonmaterial to the process or to pressure changes.
A patient with severe asthma is having trouble breathing and adequately ventilating. What portion of normal tidal volume is this patient most likely experiencing the greatest disturbance in?
a. Base respiratory rate
b. Dead space ventilation
c. Alveolar space ventilation
d. Overall ventilation per minute
C. Rationale: Tidal volume is composed of the amount of air in one ventilation. For the average person, this volume is roughly 500 mL. Of this 500 mL., though, not all of it participates in gas exchange because it fills the dead space regions of the respiratory tree (roughly 150 mL). The balance of the tidal volume is alveolar ventilation. In situations of impaired breathing, the alveolar ventilation normally suffers because the dead space volume does not change (i.e., the body has to fill the dead spaces to reach the alveolar space).
A patient with a change in his ventilation status secondary to a severe chest wall injury will likely display what specific early finding indicative of poor alveolar ventilation?
a. Altered mental status
b. Absent breath sounds in the bases of the lungs
c. Poor pulse oximetry and a change in the heart rate
d. Dropping systolic blood pressure and narrowing pulse pressure
B. Rationale: When a patient has poor alveolar ventilation, the first thing that will always be noted is an absence of breath sounds over the lungs’ periphery (apical and basal regions). This is from an absence of ventilation making it to the alveoli to create a breath sound. Eventually the absence of diffusion of gases through the alveoli will cause changes in mental status, pulse rate, blood pressure, and pulse oximetry. Basically, once the breath sounds go off line, then everything else starts to fail from a lack of oxygenation and ventilation.
A patient is found with a respiratory rate of 8 per minute, absent basal breath sounds, a pulse ox reading of 83 percent, and cyanotic lips and fingernails. This patient is in immediate need of what intervention?
a. Ventilation
b. Oxygenation
c. Airway suctioning
d. Semi-Fowler’s position
A. Rationale: The patient in this scenario is in immediate need of ventilation. Although he has a spontaneous respiratory rate of 8/minute, if the depth of breathing is not sufficient to create alveolar breath sounds, then the rate really doesn’t matter; the patient is still breathing inadequately. There is no indication in the scenario that the patient needs suctioning, and changing the body position may help with breathing but does not inherently imply that breathing will become adequate.
Which of the following findings would still be present in a patient suffering from mild respiratory distress?
a. Cyanotic
b. Full speech patterns
c. Altered mental status
d. Pulse oximeter reading of 85 percent
B. Rationale: A patient with respiratory distress is still able to maintain adequate ventilation with the body’s compensatory mechanisms—as such, his speech patterns should remain essentially the same. During respiratory distress, the pulse oximeter readings and mental status findings also should remain normal, and no cyanosis to the nail beds should be present. Altered mental status, cyanosis, and low pulse oximeter readings are more consistent with respiratory failure and arrest, not simply distress.
You are managing a patient who was in a fight and was struck in the head with a large pipe. You find the patient to be unresponsive, apneic, bradycardic, bleeding from the head, and bleeding into the airway from oral trauma. Assuming you had all your EMT equipment available to you, what should be the initial action?
a. Suction the airway
b. Immobilize the patient
c. Provide positive pressure ventilation
d. Administer high-flow oxygen at 15 lpm
A. Rationale: The patient in this scenario needs multiple interventions, almost simultaneously. However, the patient is certainly in dire need of positive pressure ventilation since he is not breathing. However, since there is blood in the airway, this will need to be suctioned out first. After suctioning, positive pressure ventilation can be initiated with high-flow oxygen. Immobilization of the patient should occur following treatment of life threats but prior to moving the patient.
Which of the following clinical indications would first appear to indicate that the patient is being adequately ventilated with a BVM?
a. The chest wall moves with each breath.
b. The ventilations are at a rate of 12/minute.
c. The patient has breath sounds in all lung fields.
d. The vital signs and pulse oximeter readings start to normalize.
C. Rationale: When a patient is being adequately ventilated, one of the first things to ensure is that the patient is being ventilated deep enough to create breath sounds bilaterally. Although chest wall motion is an indication, you may still see some chest wall motion even though the patient is not being ventilated deep enough (i.e., just dead space ventilation is being done). The rate of ventilation is not a key finding since ventilating at the right rate but insufficient depth is of no use to the patient. Finally, changes in the vital signs and pulse oximeter readings will occur only after good ventilations are being performed; their pressure is a good finding but not as reliable or as early as the presence of bilateral breath sounds in all lung fields.
