CH 11- Airway Management

The partial pressure of oxygen in the alevoli is ____ mm Hg; the partial pressure of carbon dioxide in the alveoli is ____ mm Hg

104, 40

An adult at rest should have a respiratory rate that ranges between

12 and 20 breaths/min

The pressure of gas in a full cylinder of oxygen is approximately ____ pounds per square inch (psi)

2,000

When testing a mechanical suctioning unit, you should turn on the device, clamp the tubing, and ensure that it generates a vacuum pressure of more than

300 mm Hg

At a flow rate of 6L/min, nasal cannula can deliver an approximate oxygen concentration of up to:

44%

What is the alveolar minute volume of a patient with a tidal volume of 500 mL, a dead space volume of 150 mL, and a respiratory rate of 16 breaths/min?

5,600 mL

An oxygen cylinder should be taken out of service and refilled when the pressure inside it is less than

500 psi

With a good mask-to-face seal and an oxygen flow rate of 15 L/min, the nonrebreathing mask is capable of delivering up to ____ % inspired oxygen

90

The nasal cannula is MOST appropriately used in the prehospital setting

when the patient cannot tolerate a nonrebreathing mask

Which of the following statements regarding normal gas exchange in the lungs is correct?

Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries

Which of the following statements regarding breathing adequately is correct?

Patients breathing shallowly may require assisted ventilation despite a normal respiratory rate

A conscious and aler 28-year-old male complains of difficulty breathing. His respirations are 30 with accessory muscle use. His tidal volumes appear adequate. What should you do?

Provide oxygen via nonrebreathing mask

Intrapulmonary shunting occurs when

blood coming from the right side of the hear bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state

Which of the following oxygen flowmeters is NOT affected by gravity and can be used in any position when attatched to an oxygen cylinder?

bourdon-gauge flowmeter

You are responding to a 9-year-old female having an asthma attack. On arrival, the school nurse informs you that she gave the patients 2 puffs from her albuterol inhaler. You recall that this medication causes smooth muscle relaxation and dilation of the airways. In what portion of the lower airway does this medication act?

bronchioles

Which of the following structures is NOT found in the upper airway

bronchus

Which of the following would cause an increase in the amount of exhaled carbon dioxide?

increased cardiac output

Tidal volume is defined as the volume of air that

moves into or out of the lungs in a single breath

Which of the following organs or tissues can survive the longest without oxygen?

muscle

A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a

nonrebreathing mask

Your patient is showing signs of severe respiratory distress. Which of the following would be the best choice for providing oxygen to the patient?

nonrebreathing mask with reservoir

Prior to applying a nonrebreathing mask to a patient, you must ensure that the

the reservior bag is fully inflated

What is the MOST common cause of airway obstruction in an unconscious patient?

the tongue

Which of the following patients should you place in the recovery position?

A 31-year-old semiconscious male with low blood sugar and adequate breathing

In which of the following patients would the head tilt-chin lift maneuver be the MOST appropriate method of opening the airway?

A 37-ear-old female who is found unconscious in her bed

Which of the following patients would MOST likely require insertion of an oropharyngeal airway?

A 40-year-old unconscious patient with slow, shallow respirations

Which of the following patients is breathing adequately?

A conscious malel with respirations of 19 breaths/ min and pink skin

What occurs when a patient is breathing very rapidly and shallowly?

Air moves primarly in the anatomic dead space and does not participate in pulmonary gas exchange

An alert 62-year-old male complains of respiratory distress. He speaks in two-to three-word sentences and has a history of heart failure and hypertension. Vital signs are BP 180/110, P 88, R 28 with rales, SpO2 82%. What should you do?

Assist ventilations with a bag-valve mask

For which of the following conditions would the EMT most liekly administer humidified oxygen?

Croup

Based on current guidelines, in which of the following situations should supplemental oxygen be administered?

Exposure to carbon monoxide and an oxygen saturation of 94%

Which of the following statements regarding oxygenation and ventilation is correct?

In mines or confined places, where oxygen levels are low, ventilation may continue despite inadequate oxygenation

You are dispatched to an apartment complex where a 21-year-old female has apparently overdosed on several narcotic medications. She is semiconscious and has slow, shallow respirations. What should you do?

Insert a nasopharyngeal airway and begin assisted ventilation

How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?

It forces the alveoli open and increases the concentration of oxygen in the alveoli

How does positive-pressure ventilation affect cardiac output?

It increases intrathoracic pressure, which decreases venous returns to the heart and causes a decrease in cardiac output

You are performing bag-mask ventilations with oxygen connected and set at a flow rate of 15 L/min. What percentage of xygen are you delivering?

Nearly 100%

While providng CPAP to a patient in severe respiratory distress, you note that his heart rate has increased by 20 beats/min. He is conscious but is not longer following verbal commands. You should

Remove the CPAP device and ventilate him with a bag-mask device

You arrive at the scene of a bike accident. A 45-year-old man is lying on the ground. He is unresponsive and has multiple scrapes and cuts on his arms and legs. You note that the patient has strong pulses but labored, snoring respirations. What should you do?

Use the jaw-thrust maneuver to open the patient's airway

Which of the following regarding positive-pressure ventilation is correct?

With positive-pressure ventilation, more volume is required to have the same effects as normal breathing

A ventilation/perfusion (V/Q ratio) mismatch occurs when

a disruption in blood flow inhibits the exchange of oxygen and carbon dioxide in the lungs, even though the alveoli are filled with fresh oxygen

During your assessment of a patient with respiratory distress, you hear wheezing when listening to breath sounds. This indicates

a lower airway obstruction

Which of the following is the MOST reliable indicator of adequately performed bag-mask ventilations in an apneic adult with a pulse?

adequate rise of the chest when squeezing the bag

Which of the following is a sign of abnormal breathing?

accessory muscle use

Gas exchange in the lungs is facilitated by

adequate amounts of surfactant

Which of the following statements regarding the one-person bag-mask technique is correct?

adequate tidal volume is often difficult to achieve when one EMT is operating the bag-mask device

A 51-year-old female presents with a sudden onset of difficulty breathing. She is conscious and alert and able to speak in complete sentences. Her respirations are 22 breaths/min and regular. You should

administer oxygen via a nonrebreathing mask

In the prescence of oxygen, the cells convert glucose into energy through a process called

aerobic metabolism

Your protocols state that during the first few minutes of working on a cardiac arrest patient, you should provide passive ventilation. This means that you will

allow recoil of the chest between compressions to draw air into the lungs

A 23-year-old male experienced severe head trauma after his motorcycle collided with an oncoming truck. He is unconscious, has agonal gasps, and has copious bloody secretions in his mouth. How should you manage his airway?

alternative oropharyngeal suctioning and ventilation with a bag-mask device

The actual exchange of oxygen and carbon dioxide occurs in the

alveolar sacs

High-flow oxygen with a nasal cannula during the preoxugenation phase of endotracheal intubation is called

apneic oxygenation

You and your partner are treating a 66-year-old man who experienced a sudden onset of respiratory distress. He is conscious but is unable to follow simple verbal commands. Further assessment reveals that his breathing is severely labored and his oxygen saturation is 80%. You should

assist his ventilations with a bag-mask device

The nasopharyngeal airway is MOST beneficial because it

can maintain a patent airway in a semiconscious patient with a gag reflex

The primary waste product of aerobic metabolism is

carbon dioxide

A man was found unresponsive in his bed at home. There is no evidence of injury, and the patient's medical history is not known. The patient's face is cherry red, yet the pulse oximeter reads 98%. Which of the following would MOST likely explain this?

carbon monoxide poisoning

Oxygen toxicity is a condition in which

cellular tissue damage occurs from excessive oxygen levels in the blood

The jaw-thrust maneuver is used to open the airway of patients with suspected

cervical spine injuries

Irregular respirations characterized by an increasing rate and depth of breathing followed by periods of apnea are called

cheyne-stokes respirations

To select the proper size oropharyngeal airway, you should measure from the

corner of the mouth to the earlobe

The ____ cartilage is a firm ring that forms the inferior part of the larynx

cricoid

Which of the following is a late sign of hypoxia

cyanosis

Which of the following would NOT cause a decrease in tidal volume?

deep respirations

Inhalation occurs when the

diaphragm and intercostal muscles contract and cause a decrease in intrathoracic pressure

A 37-year-old male has an apparent foreign body airway obstruction. He is conscious and alert and is coughing forcefully. His skin is pink, warm, and moist. The MOST appropriate treatment for this patient includes

encouraging him to cough and transporting

The purpose of the pin-indecing system for compressed gas cynlinders is to

ensure that the correct regulator is used for the cylinder

Structures of the lower airway include all of the following except: bronchioles epiglottis trachea alveoli

epiglottis

The structure located superior to the larynx is called the

epiglottis

Which of the following structures is contained within the mediastinum?

esophagus

The exchange of carbon dioxide and oxygen in the alveli is know as

external respiration

The process of exchanging oxgen and carbon dioxide between the alveoli and the blood of the capillaries is called

external respiration

CPAP is indicated for patients who

have pulmonary edema and can follow verbal commands

The presence of elevated carbon dioxide levels in the blood is called

hypercarbia

The MOST significant complication assosciated with oropharyngeal suctioning is

hypoxia due to prolonged suction attempts

Hypoxia is MOST accurately defined as

inadequate oxygen to the tissues and cells

Without adequate oxygen, the body's cells

incompletely convert glucose into energy, and lactic acid accumulates in the blood

All of the following will help minimize the risk of gastric distention when ventilating an apneic patient with a bag-mask device EXCEPT

increasing the amount of delivered tidal volume

You and your partner are caring for a critically injured patient who is unresponsive and apneic. Your partner is controlling severe bleeding from the patient's lower extremities as you attmept ventilations with a bag-mask device. After repositioning the mask several times, you are unable to effectively ventilate the patient. You should

insert an oropharyngeal airway and reattempt ventilations

In contrast to inhalation, exhalation

is a passive process caused by increased intrathoracic pressure

You are dispatched to a residence where a middle-aged man was found unconscious in his front yard. There are no witnesses who can tell you what happened. You find him in a prone position; his eyes are closed and he is not moving. Your FIRST action should be to

log roll him as a unit to a supine position

The hypoxic drive is influenced by

low blood oxygen levels

Each cell of the body combines nutrients and oxygen and produces energy and waste products through a process called

metabolism

As the single EMT managing an apneic patient's airway, the preferred initial method of providing ventilations is the

mouth-to-mask technique with a one-way valve

Which of the following statements regarding oxygen is correct?

oxygen supports the combustion process and may cause a fire

The MOST serious complication associated with using a nasopharyngeal airway in a patient with trauma to the head or face is

penetrating the cranium

A 71-year-old male is semiconscious following a sudden, severe headache. There is vomitus on his face, and his respirations are slow and shallow. The EMT must immediately

perform oropharyngeal suctioning

The diaphragm is innervated by the ____ nerve, which allows it to contract

phrenic

You have inserted an oral airway and are ventilating an apneic woman with a bag-mask device. She suddenly begins regurgitating large amounts of vomit. You should

roll her onto her side and remove the oral airway

You are ventilating a 40-year-old uninjured man who is apneic but has a pulse. When your partner reassesses his blood pressure, he notes that it has decreased significantly from previous readings. You elevate the patient's legs, but this action has no effect. You should

reduce the rate or volume of the ventilations you are delivering

You are ventilating an apneic woman with a bag-mask device. She has dentures, which are tight-fitting. Adequate chest rise is present with each ventilation, and the patient's oxygen saturation reads 96%. When you reassess the patency of her airway, you note that her dentures are now loose, although your ventilations are still producing adequate chest rise. You should

remove her dentures, resume ventilations, and assess for adequate chest rise

A 19 year old female is found unconscious by her roomate. Your primary assessment reveals that her breathing is inadequate. As you insert an oropharyngeal airway, she begins to gag violenty. You should

remove the airway and be prepared to suction her oropharynx

An unconscious patient found in a prone position must be placed in a supine position in case he or she

requires CPR

You are ventilating a patient with a stoma; however, air is escaping from the mouth and nose. To prevent this, you should

seal the mouth and nose

Which of the following factors will cause a reduction in minute volume in an adult?

shallow breathing

Central chemoreceptors located in the medulla provide feedback to increase the rate and depth of breathing when they sense

slight increases in carbon dioxide or a decrease in the pH of the cerebrospinal fluid

While eating dinner, your partner suddenly grabs his throat and has a panicked look on his face. He has a weak cough, faint inspiratory stridor, and cyanosis around the lips. You should

stand behind him and administer abdominal thrusts

Proper technique for suctioning the oropharynx of an adult patient includes

suctioning while withdrawing the catheter from the oropharynx

What is the most common airway obstruction in the unresponsive patient?

tongue

The physical act of moving air into and out of the lungs

ventilation

A nasopharyngeal airway is inserted

with the bevel facing the septum if inserted into the right nare