Chapter 40

The MOST appropriate size ET tube for a 6-year-old child is: A. 4.5 mm. B. 5.0 mm. C. 5.5 mm. D. 6.0 mm.

A. 4.5 mm.

Nasogastric (NG) tube insertion is contraindicated in all of the following situations, EXCEPT: A. an intact gag reflex. B. major head trauma. C. severe facial trauma. D. spinal cord injury.

A. an intact gag reflex.

Blind nasotracheal intubation should ONLY be performed on patients who: A. are unconscious and apneic. B. have damaged vocal cords. C. are breathing spontaneously. D. have experienced head trauma.

A. are unconscious and apneic.

Immediately after you place an ET tube in the trachea, you should remove the stylet and then: A. attach the BVM and ventilate the patient. B. listen for breath sounds to confirm placement. C. secure the ET tube with the appropriate device. D. inflate the distal cuff and detach the syringe.

A. attach the BVM and ventilate the patient.

When inserting the stylet inside an ET tube, you should: A. bend the ET tube in the shape of a "U." B. recede the stylet 3" from the tube's distal tip. C. apply petroleum jelly to the tube's distal tip. D. avoid inserting the stylet past Murphy's eye.

A. bend the ET tube in the shape of a "U."

When determining the proper size ET tube to use in an infant or small child, you should: A. double the child's age in years and add two. B. use a length-based resuscitation tape measure. C. select the smallest possible tube with a cuff. D. use a tube that is the size of the child's thumb.

A. double the child's age in years and add two.

A 50-year-old female is found semiconscious by her son. Your assessment reveals that her respirations are slow and shallow and there is vomitus draining from her mouth. When you attempt to suction her oropharynx, she begins to gag. You should: A. ensure that her airway is patent, attempt to insert a nasopharyngeal airway, and assist her ventilations with a BVM device. B. abort the suction attempt at once, preoxygenate her with a BVM device, and prepare to perform endotracheal intubation. C. continue to suction her airway until the secretions are clear, insert an oropharyngeal airway, and ventilate with a BVM device. D. remove the suction catheter immediately, insert a nasopharyngeal airway, and administer oxygen via a nonrebreathing mask.

A. ensure that her airway is patent, attempt to insert a nasopharyngeal airway, and assist her ventilations with a BVM device.

The Macintosh (curved blade) lifts the epiglottis when the tip of the blade is placed into the: A. glottic opening. B. vallecular space. C. pyriform sinuses. D. cricothyroid space.

A. glottic opening.

You should NOT attempt to insert an Esophageal Tracheal Combitube (ETC) in patients who: A. have ingested a caustic substance. B. are in full cardiopulmonary arrest. C. are unconscious without a gag reflex. D. have experienced a severe spinal injury.

A. have ingested a caustic substance.

A lighted stylet is used to: A. improve visualization in the dark. B. assist EMTs who have poor vision. C. perform blind endotracheal intubation. D. provide direct esophageal visualization.

A. improve visualization in the dark.

You have attempted to intubate a 66-year-old male twice without success. Medical control is unable to be contacted. Your MOST appropriate action should be to: A. insert an oral airway, ventilate with a BVM, and transport. B. have your partner attempt to successfully intubate the patient. C. preoxygenate with a BVM and insert a multilumen airway device. D. continue intubation attempts until medical control has been contacted.

A. insert an oral airway, ventilate with a BVM, and transport.

The MOST appropriate method of inserting a laryngoscope blade into the patient's mouth to visualize the vocal cords is to: A. insert the blade in the left side of the mouth, sweep the tongue to the left, and pry. B. insert the blade in the right side of the mouth, sweep the tongue to the left, and pry. C. insert the blade in the right side of the mouth, sweep the tongue to the left, and lift. D. use the tongue-jaw lift maneuver, insert the blade in the center of the mouth, and lift.

A. insert the blade in the left side of the mouth, sweep the tongue to the left, and pry.

A major benefit when using a multilumen airway device is that: A. it can be used on patients of any age and size. B. it can be visualized as it enters the esophagus. C. the airway is better protected than with an ET tube. D. maintenance of a mask-to-face seal is not required.

A. it can be used on patients of any age and size.

After successfully intubating a 56-year-old man who is in cardiac arrest, you should: A. perform asynchronous CPR. B. defibrillate him with the AED. C. ventilate at a rate of 30 breaths/min. D. insert a PtL to occlude the esophagus.

A. perform asynchronous CPR.

On a pharyngeotracheal lumen airway (PtL), the large balloon cuff on the No. 2 tube is designed to: A. seal the oropharynx. B. occlude the esophagus. C. be inflated with 10 mL of air. D. secure the tube in the trachea.

A. seal the oropharynx.

The Sellick maneuver is performed by applying pressure to the: A. tracheal rings. B. thyroid cartilage. C. cricoid cartilage. D. cricothyroid membrane.

A. tracheal rings.

The distal cuff on an ET tube should be inflated with ___ mL of air after it is placed into the trachea. A. 10 B. 15 C. 20 D. 25

B. 15

Which of the following statements regarding multilumen airway devices is MOST correct? A. They are contraindicated in patients who have experienced a severe spinal injury. B. Ventilations can be provided whether the device is in the trachea or the esophagus. C. Insertion of a multilumen airway device requires visualization of the upper airway. D. Multilumen airway device insertion does not require medical control authorization.

B. Ventilations can be provided whether the device is in the trachea or the esophagus.

You are transporting an intubated 24-year-old female when her level of consciousness improves and she becomes extremely combative. Without assisted ventilation, she appears to be breathing adequately. You should: A. request a paramedic to give her a sedative drug. B. contact medical control for further instructions. C. have suction available and remove the ET tube. D. carefully restrain her and continue ventilations.

B. contact medical control for further instructions.

Approximately 10 seconds into an intubation attempt, you are unable to view the vocal cords. You should: A. abort the attempt and preoxygenate for 30 seconds. B. direct your partner to apply posterior cricoid pressure. C. gently pry on the laryngoscope to improve your view. D. continue the intubation attempt until 30 seconds pass.

B. direct your partner to apply posterior cricoid pressure.

After opening a patient's airway, you should: A. insert an airway adjunct. B. ensure the airway is clear. C. assess for breathing effort. D. administer oxygen as needed.

B. ensure the airway is clear.

Confirmation techniques and devices used to determine correct ET tube placement include all of the following, EXCEPT: A. pulse oximetry monitoring. B. esophageal detector devices. C. auscultation of breath sounds. D. end-tidal carbon dioxide detectors.

B. esophageal detector devices.

In contrast to the curved blade, the straight (Miller) blade: A. directly lifts the epiglottis and exposes the vocal cords. B. indirectly lifts the epiglottis by fitting into the vallecula. C. is contraindicated in infants and children less than 5 years of age. D. has a broad flange and provides better tongue displacement.

B. indirectly lifts the epiglottis by fitting into the vallecula.

Proper confirmation of correct nasogastric or orogastric tube placement includes: A. attaching an end-tidal carbon dioxide detector to the end of the tube. B. injecting air into the tube and auscultating the stomach for gurgling. C. instilling 25 mL of saline down the tube and connecting the tube to suction. D. applying manual pressure to the stomach and observing the tube for contents.

B. injecting air into the tube and auscultating the stomach for gurgling.

Visualized endotracheal intubation requires all of the following equipment, EXCEPT a: A. lighted stylet. B. laryngoscope. C. 10-mL syringe. D. straight or curved blade.

B. laryngoscope.

A 30-year-old female has overdosed on a large quantity of narcotics. She is unconscious, apneic, and has a slow and weak pulse. You should: A. insert a gastric tube to decompress her stomach. B. maintain her airway and ventilate with a BVM. C. insert a Combitube and confirm proper placement. D. open her airway and perform endotracheal intubation.

B. maintain her airway and ventilate with a BVM.

When using an LMA to secure a patient's airway, it is MOST important to: A. fully inflate the mask before the device is inserted. B. recall that active vomiting may dislodge the device. C. hyperextend the patient's neck prior to inserting it. D. ensure the presence of a gag reflex before insertion.

B. recall that active vomiting may dislodge the device.

Intubating a patient who is in cardiac arrest should occur after: A. the stomach has been adequately decompressed with a gastric tube. B. the patient has been assessed to determine if defibrillation is indicated. C. adequate chest compressions have been performed for at least 5 minutes. D. two attempts to insert a multilumen airway device have been unsuccessful.

B. the patient has been assessed to determine if defibrillation is indicated.

Prior to attempting endotracheal intubation, the EMT-B should: A. obtain authorization from medical control. B. ventilate the patient for at least 30 seconds. C. contact a paramedic and obtain permission. D. suction the patient's airway for 30 seconds.

B. ventilate the patient for at least 30 seconds.

Endotracheal intubation is indicated for patients: A. prior to defibrillation if ventricular fibrillation is present. B. who are unconscious and cannot protect their own airway. C. in need of assisted ventilation due to reduced tidal volume. D. who are extremely combative and have an intact gag reflex.

B. who are unconscious and cannot protect their own airway.

Uncuffed ET tubes should be used in children less than ___ years of age. A. 8 B. 10 C. 12 D. 15

C. 12

When an ET tube is placed in an adult patient, the cm marking at the teeth is usually around: A. 15 cm. B. 20 cm. C. 22 cm. D. 25 cm.

C. 22 cm.

The proper size ET tube for the average size adult female ranges from: A. 5.0-6.0 mm. B. 5.5-6.5 mm. C. 6.0-7.5 mm. D. 6.5-8.0 mm.

C. 6.0-7.5 mm.

Which of the following statements regarding the laryngeal mask airway (LMA) is MOST correct? A. You must inflate the mask on the device prior to inserting it. B. The LMA provides greater airway protection than an ET tube. C. The device is inserted into the hypopharynx until resistance is felt. D. You should hear epigastric sounds when the LMA is correctly inserted.

C. The device is inserted into the hypopharynx until resistance is felt.

Complications associated with endotracheal intubation include all of the following, EXCEPT: A. left mainstem bronchus intubation. B. hypoxia due to prolonged attempts. C. a marked decrease in the heart rate. D. trauma to the soft tissues in the mouth.

C. a marked decrease in the heart rate.

Advanced airway management techniques are performed ONLY after: A. the patient is assessed as being apneic. B. the patient has been delivered to the hospital. C. basic airway techniques have been completed. D. the upper airway has been thoroughly suctioned.

C. basic airway techniques have been completed.

To avoid obscuring your view of the vocal cords during intubation, you should: A. not pass the ET tube down the center of the laryngoscope blade. B. gently pry against the patient's teeth to achieve adequate leverage. C. direct your assistant to apply firm pressure to the thyroid cartilage. D. ensure that the straight blade is in the vallecular space before lifting.

C. direct your assistant to apply firm pressure to the thyroid cartilage.

Prior to performing endotracheal intubation in a cardiac arrest patient, it is MOST important to: A. ensure that the stomach is not distended. B. perform CPR for at least 5 to 10 minutes. C. hyperventilate the patient for 3 to 5 minutes. D. clear the airway and ventilate with a BVM.

C. hyperventilate the patient for 3 to 5 minutes.

Regardless of the size ET tube that you will use to intubate your patient with, you should: A. have one tube smaller and one tube larger. B. have several ET tubes of the identical size. C. only use a stylet for tubes larger than 7.0 mm. D. always have a 9.0 mm tube in case it is needed.

C. only use a stylet for tubes larger than 7.0 mm.

After intubating a 44-year-old unconscious, apneic male, you place him on the ambulance stretcher and prepare to load him into the ambulance. After he is placed into the ambulance, you should: A. continue ventilations with an automatic ventilator. B. reassess the patient's vital signs and attach an AED. C. reconfirm that the ET tube is still correctly positioned. D. hyperventilate the patient for approximately 30 seconds.

C. reconfirm that the ET tube is still correctly positioned

After performing endotracheal intubation on an elderly male in cardiac arrest, you think you hear breath sounds, but also hear gurgling over the epigastrium. You should: A. withdraw the ET tube approximately 1 inch and then reauscultate over the epigastrium. B. attach an end-tidal CO2 detector to the ET tube and observe for the appropriate color change. C. remove the ET tube at once, ventilate with a BVM for 2 to 3 minutes, and reattempt intubation. D. secure the tube with the proper device, continue ventilations, and confirm placement with an esophageal bulb.

C. remove the ET tube at once, ventilate with a BVM for 2 to 3 minutes, and reattempt intubation.

To determine the proper size nasogastric tube, you should measure from the: A. corner of the nose, around the ear, to the distal tip of the xiphoid process. B. tip of the nose, around the ear, to the epigastric area below the xiphoid process. C. tip of the nose, to the earlobe, to the epigastric area below the xiphoid process. D. base of the nose, around the ear, to the area between the xiphoid and umbilicus.

C. tip of the nose, to the earlobe, to the epigastric area below the xiphoid process.

A single intubation attempt in the adult patient should not exceed: A. 20 seconds. B. 30 seconds. C. 40 seconds. D. 45 seconds.

D. 45 seconds.

The proper size ET tube for the average size adult male ranges from: A. 6.0-7.5 mm. B. 6.5-8.0 mm. C. 7.5-8.5 mm. D. 8.0-9.0 mm.

D. 8.0-9.0 mm.

In the prehospital setting, gastric tubes are used primarily to: A. remove gastric toxins. B. administer medications. C. provide gastric nutrition. D. decompress the stomach.

D. decompress the stomach.

A properly placed endotracheal tube will facilitate all of the following, EXCEPT: A. complete protection of the airway. B. direct suctioning of gastric contents. C. the delivery of certain medications. D. delivery of higher minute volume.

D. delivery of higher minute volume.

You respond to a construction site where a steel girder collapsed on a 22-year-old male's chest. Coworkers removed the girder prior to your arrival. Your assessment reveals that he is unconscious and apneic. You should: A. open his airway with the jaw-thrust maneuver, maintain his head in a neutral in-line position, and insert a Combitube. B. apply a cervical collar, maintain an open airway with the jaw-thrust maneuver, and insert a multilumen airway device. C. ensure that his spine is fully immobilized, maintain his airway with an airway adjunct, and perform endotracheal intubation. D. maintain stabilization of his head, open his airway with the jaw-thrust maneuver, ventilate with a BVM, and prepare to intubate him.

D. maintain stabilization of his head, open his airway with the jaw-thrust maneuver, ventilate with a BVM, and prepare to intubate him.

The MOST reliable indicator of successful endotracheal intubation is: A. the presence of bilaterally clear and equal breath sounds. B. visualization of the tube passing between the vocal cords. C. when the paper in the end-tidal CO2 detector turns yellow. D. the presence of mist or vapor in the tube during exhalation.

D. the presence of mist or vapor in the tube during exhalation.

You have inserted an ET tube but are unable to hear breath sounds on the left side of the chest. You should: A. treat the patient for a pneumothorax and transport immediately. B. extubate the patient and preoxygenate for at least 2 to 3 minutes. C. advance the tube as you are auscultating the patient's breath sounds. D. withdraw the tube approximately 1 inch and reassess breath sounds.

D. withdraw the tube approximately 1 inch and reassess breath sounds.