Volume 1 Chapter 15
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 thecuff, 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 permanentlyplaced?
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 theventilator'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
