Volume 1 Chapter 15

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What category of the Mallampati classification system would indicate the most difficult airway to​ manage?

Class IV

Which of the following devices is known as a dual lumen​ airway?

Combitube

Which of the following airway adjuncts requires the use of specialized​ equipment?

ET tube

Which of the following demonstrates a proper way to document​ end-tidal carbon dioxide level if the numeric display reads​ 38?

ETCO2 38 mmHg

You are called to an elder care facility for a resident who has arrested. Upon​ arrival, you are told by the nursing staff that the patient was found in the bed in cardiac​ arrest, and that he has no DNR orders. You immediately note the patient has a stoma with no tracheostomy tube​ placed, secondary to previous neck surgery from cancer. What is the best way to manage this​ patient's airway and ventilatory​ needs?

Gently insert an appropriately sized and lubricated endotracheal tube into the​ stoma, inflate the​cuff, and begin ventilations.

You and your partner are caring for a patient who requires a​ bag-valve mask, and ventilation is difficult. You are bagging the​ patient, and your partner is holding the mask in place and performing external laryngeal manipulation. If another provider becomes​ available, what should you have her​ do?

Hold the mask in place.

Which of the following is not a potential complication of extubation in the​ field?

Hypertension

Which of the following is not a component of the primary​ assessment?

Identifying sensation and motor function threats.

Why should a patient not be extubated in the field unless absolutely​ necessary?

If the patient deteriorates​ again, the family could sue the paramedic.

Failure to properly position the head and airway when attempting positive pressure ventilation will likely lead to what​ problem?

Inflation of the stomach

You have intubated and are currently ventilating a COPD patient with chronic bronchitis. During​ ventilations, you notice the high airway pressure alarm keeps​ sounding, despite your knowledge that the ET tube is placed properly and you have bilateral breath sounds. Given​ this, what can be done while suctioning the trachea of this patient to help extract the heavy​ mucus?

Inject​ 3-5 mL of sterile water into the ET tube first

You are ventilating a patient with a​ bag-valve mask, and the oxygen saturation levels remain lower than ideal. You already have one oropharyngeal airway in the mouth and a nasopharyngeal airway in the left nostril. What should be your next step if you are following the rule of​ threes?

Insert a nasopharyngeal airway in the right nostril.

What is the best method for treating gastric insufflation in an intubated​ patient?

Inserting a gastric tube into the stomach via the​ mouth, nose, or EGA.

Which of the following is true regarding the Esophageal Tracheal​ Combitube?

It does not require complete removal to accommodate an ET tube insertion.

Which of the following is NOT a disadvantage of the nasopharyngeal​ airway?

It isolates the trachea.

In order to minimize tooth breakage and soft tissue laceration during ET​ intubation, you should perform which of the​ following?

Keep your wrist straight and apply gentle traction up and toward the feet with your shoulder

What medical procedure is performed that often results in the patient having a stoma permanently​placed?

Laryngectomy

What does the​ "L" in LEMONS stand​ for?

Look externally

You are called to the home of a patient with a home ventilator. Upon your​ arrival, the family states that the​ventilator's high pressure alarm keeps going off. What is the most likely​ cause?

Mucus plugging the stoma

You are caring for an​ 8-year-old child who does not have a patent airway. Which option for securing the airway do you not have for this child that you would have for an​ adult?

Nasopharyngeal airway

When monitoring oxygen saturation in an​ infant, where should the sensor be​ placed?

On the heel

In which of the following conditions is insertion of the nasogastric tube contraindicated when performing gastric​ decompression?

Patient with facial fractures

Which of the following is a contraindication for the insertion of an Esophageal Tracheal Combitube​ (ETC) airway?

Patients under four feet tall

What step in the RSI procedure allows the patient to tolerate longer than normal periods of​ apnea?

Preoxygenation

You are caring for an unconscious patient who requires​ bag-valve mask ventilation. The patient is obese. What position should you place the patient​ in?

Ramped position

What is a potential result of overly aggressive or improper tube placement when performing a nasotracheal​ intubation?

Significant bleeding

What is visualized with a Class III Mallampati​ score?

Soft and hard palate

Why have the incidences of cricothyrotomy procedures being performed in the EMS setting fallen significantly over the last​ decade?

The effectiveness of RSI and EGAs.

What is the most common reason that an intubated patient becomes intolerant of the endotracheal​ tube?

The patient awakens after rapid sequence intubation.

Why should paralytics never be given alone to a patient undergoing endotracheal​ intubation?

The patient is still fully aware but cannot move.

When auscultating a​ patient, you hear gurgling sounds over the right and left apex. How would you interpret this​ finding?

The patient may have​ blood, vomitus or other secretions that could obstruct the upper airway.

When auscultating a patient after ET tube​ placement, what do epigastric sounds​ indicate?

The tube has been placed in the esophagus.

Which of the following statements about manual airway maneuvers is​ TRUE?

They are often neglected by EMTs and paramedics.

Why are video laryngoscope devices anticipated to completely replace direct laryngoscopes in the​ future?

They have proven to be more effective and prices are dropping.

Which of the following statements regarding the​ 3-3-2 rule is incorrectly​ worded?

The​ 3-2-2 rule uses the​ paramedic's finger measurements.

Which statement does not follow the rule of threes when using​ bag-valve mask​ ventilation?

Three masks

Explain how ET tube misting is an effective means of confirming tracheal placement.

Tube condensation is not an effective way to verify proper ETT placement.

​Shallow, slow, or infrequent​ breathing, indicating severe ICP buildup and brain​ anoxia, is:

agonal breathing.

All of the following are indications for​ RSI, ​EXCEPT:

an anticipated difficult airway.

Endotracheal intubation is particularly effective​ for:

anaphylaxis and airway burns.

You are called to the scene of an automobile accident to treat a​ 39-year-old male complaining of chest pain and difficulty breathing. On​ arrival, you note that the car was hit on the right side. You apply cervical immobilization and​ high-flow O2​, then begin your initial​ assessment, noting that the​ patient, still sitting in the passenger​ seat, is cyanotic and displays no obvious sign of bleeding. His respirations are 34 and​ labored, and you can palpate a radial pulse of 132. While you are conducting your​ exam, he tells you his right side hurts and he​ can't catch his breath. Your next step would be​ to:

auscultate his lungs.

The bifurcation of the trachea is called​ the:

carina.

A​ fine, bubbling sound heard on inspiration and associated with fluid in the alveoli and terminal bronchioles is​ called:

crackles.

There is accumulating evidence that mechanical ventilation is superior to manual ventilation EXCEPT in​_______ patients.

crashing

What type of transport ventilator allows for less patient​ sedation?

critical care

The AirTraq​® laryngoscope is unique because it is​ a(n):

disposable​ video-based device.

​A(n) ________ may be used to facilitate nasotracheal intubation.

endotrol tube

The purpose of the first step in the primary assessment of a​ non-cardiac arrest patient is​ to:

ensure a patent airway.

When swallowing​ occurs, the structure that occludes the tracheal opening to prevent aspiration of food and liquid is​ the:

epiglottis.

When observing the movement of the chest wall during assessment of a​ patient's breathing, asymmetrical​ movement, or paradoxical​ breathing, may be an indicator​ of:

flail chest.

Transport ventilators with enhanced monitoring and alarm features​ are:

generally used in critical care transport settings.

The reading obtained by the use of a pulse oximeter reflects​ the:

hemoglobin oxygen saturation in peripheral tissues.

Video laryngoscopy is considered​ a(n) __________ technique.

indirect

When using a laryngoscope with a curved​ blade, the blade tip should be​ advanced:

into the vallecula.

Using a laryngoscope equipped with a video camera would be considered superior to traditional intubation when a​ patient:

is in cardiac arrest and in a prone position.

After taking Standard Precautions and ventilating the patient with a BVM as well as possible while preparing the​ equipment, the next step in performing an open cricothyrotomy​ is:

locate the thyroid cartilage and the cricoid cartilage.

The hypoxic drive is stimulated​ by:

low PaO2.

You arrive at the scene of a single car​ accident; the sole patient is lying on the​ ground, slightly cyanotic with sonorous respirations and no other obvious injuries. You immediately perform the​ jaw-thrust procedure, which seems to immediately relieve the respiratory compromise. Your partner applies a nonrebreather mask with​ high-flow oxygen and wants you to move aside so he can apply a cervical collar and continue the primary exam. You​ should:

maintain your position and hold​ in-line immobilization until an alternative airway adjunct can be applied.

One indication for a cricothyrotomy​ is:

massive facial trauma.

Reassessment of a​ patient's airway should be​ conducted:

on a​ minute-by-minute basis.

A drop in blood pressure of greater than 10 torr during inspiration is​ called:

pulsus paradoxus.

Which of the following paralytics would have the fastest onset​ time?

succinylcholine

You are ventilating an intubated​ 68-year-old male COPD patient with a​ bag-valve mask. You note that while his SpO2 remains​ stable, there is poor compliance during ventilation. What is this poor compliance likely attributable​ to?

the chronic pulmonary disease process

Insertion of an endotracheal tube too far in a pediatric patient is likely to result in ventilation​ of:

the right lung only.

One way to improve airway management and ventilation is to make sure​ that:

the​ ear-to-sternal notch axis is aligned.

When performing a retrograde​ intubation, the guidewire should be​ inserted:

through the cricoid membrane and withdrawn through the mouth.

When intubating using a lighted​ stylet, you see a bright glow in the midline of the anterior neck. You have MOST likely intubated​ the:

trachea.

When correctly placed for a pediatric​ patient, the tip of a straight laryngoscope blade should​ be:

under the epiglottis.

You arrive at a​ restaurant, and as you approach your​ 58-year-old male​ patient, you note that he is sitting at a​ table, panicked and laboring to breathe. As you get​ closer, you note audible​ stridor, and the patient is cyanotic. You feel very little movement of air from his mouth or​ nose; your initial impression would​ be:

upper airway obstruction from food.

During a continuing education class you are helping to teach at your EMS​ service, you notice that all of the paramedics want to practice​ intubation, but none want to practice with the simple mechanical airways and ventilating with a​ bag-valve mask because​ "they are basic​ skills." What should be your response to your​ colleagues' comments?

​"Intubation is just one way to secure an airway. You need to remember that the whole goal is to provide effective​ ventilation."

During a continuous quality improvement​ (CQI) audit of one of your patient care​ reports, the quality assurance officer asks you for more clarification regarding the use of sedation and paralysis on a patient with an upper airway burn. Which of the following would be the best response to​ this?

​"It was best to do the RSI so we could secure the airway prior to it swelling​ shut."

How much air is required to inflate the distal cuff in an Esophageal Tracheal Combitube​ (ETC)?

​10-15 mL

The rule of threes should be followed when using which type of​ mask?

​Bag-valve mask

Progressively​ deeper, faster breathing alternating gradually with​ shallow, slower breathing is​ called:

​Cheyne-Stokes respirations.

During spontaneous​ breathing, which of the following reflexes prevents overinflating of the​ lungs?

​Hering-Breuer

In which order should the paramedic typically assess for immediate threats to a​ patient's life?

​airway, breathing, circulation

When you are intubating a stoma​ site, how far beyond the distal cuff​ (in cm) should you insert the endotracheal​ tube?

1 to 2

When performing tracheobronchial​ suctioning, what should be the maximum amount of suction​ time?

10 seconds

For standard transport​ ventilators, the oxygen concentration is usually fixed at​ ______ percent.

100

Which of the following is not a sign of adequate​ ventilation?

15 cm H2O expiratory pressure

A portable suction device should generate a flow rate of​ ______ liters per minute when the tube is open.

30

What would be the appropriate size ET tube to use for a​ two-year-old toddler you intend on​ intubating?

4

Open cricothyrotomy is contraindicated in children under the age of​ ________ because the cricothyroid membrane is small and underdeveloped.

8

You are caring for a patient who suddenly vomits a large volume. What type of suction catheter should you​ use?

A hard catheter

Which structure is relatively larger in the child compared to an​ adult?

Adenoids

You are treating a patient who was initially complaining of shortness of breath and chest pain. After stabilizing the​ patient, you note that the pulse​ ox, which initially indicated a SpO2 of​ 87%, has now risen to​ 100%. What should you do​ now?

Adjust FiO2 to maintain SpO2 of​ 95-100%.

You are treating an intubated patient and notice that the abdomen is becoming distended. What is the most likely cause of​ this?

Air accumulation in the stomach

You are performing an RSI on a​ 5-year-old patient, and you plan to use succinylcholine as your paralytic. What should you administer first to prevent​ bradycardia?

Atropine

Why would you not want to administer succinylcholine during an RSI procedure on a patient who was injured when he was crushed between two pieces of heavy equipment while at​ work?

Because of the risk of hyperkalemia

Where does the lower airway​ begin?

Below the larynx

What is considered the​ "gold standard" for verifying proper ETT​ placement?

Capnography

Which noninvasive respiratory monitoring device is preferred when immediate visibility to hypoventilation is​ needed?

Capnometer


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