Airway, Respiration, and Ventilation - EMTPREP

You have successfully inserted a supraglottic airway into your 71-year-old unresponsive patient. How many ventilations should you deliver to you patient per minute via BVM?

10-12 A patient with an intermediate airway in place should be ventilated once every 5 to 6 seconds, or 10 to 12 times per minute.

What minute volume is needed to maintain sufficient gas exchange in a healthy person at baseline?

7 L/minute Minute volume is the volume of gas inhaled/exhaled from a person's lungs in one minute. Trauma patients with abnormal respiratory rates or inadequate ventilation can very easily dip below the needed minute volume.

You are transporting an adult patient with a suspected traumatic brain injury. The patient's GCS on scene was 6 and you intubated them. What should the current ventilatory rate be for the intubated patient?

10 breaths/minute When ventilating or assisting ventilations in an adult patient with a suspected traumatic brain injury, the rate should be 10 breaths/minute. Hyperventilating the patient can cause cerebral vasoconstriction which decreases the amount of oxygen available for the brain. The pediatric ventilatory rate for suspected TBI is 20 breaths/minute. The infant ventilatory rate for suspected TBI is 25 breaths/minute.

Which would be plausible values of PEEP pressure in the prehospital setting (select the 3 answer options which are correct)?

10 cm/H2O 20 cm/H2O 5 cm/H2O

You arrive on scene to discover a 21-year-old male in the tripod position. The patient's family states that he suffers from asthma, this attack began three hours ago, and his rescue inhaler has failed to help him. You notice some improvement after the administration of a Duo-Neb, but still hear wheezes on auscultation. Which of the following IV medications could be administered next to treat his respiratory distress?

125 mg Solu-Medrol The main indication for this drug is that the respiratory distress has been present in excess of two hours. Diphenhydramine would be correct only if this was an allergic or anaphylactic reaction. While a fluid challenge can sometimes be administered with asthma, 1000 mL could not be correct given that no other data is available.

You have a patient with an SpO2 reading of 92% and you apply supplemental oxygen via nasal cannula. Protocol states that the flow rate should be set between 1-6 liters per minute. What is the oxygen concentration in this range?

24 - 44% The concentration for a nasal cannula is 24-44%. A non-rebreather at 6-15 lpm is 60-90%. The concentration for a bag valve mask is 100%.

As an induction dose for RSI, what is the maxium amount of IV midazolam given?

5 mg Versed is typically given IV at 2.5 - 5 mg in most protocols during RSI.

The average tidal volume of an adult is?

5-7 mL/kg Tidal volume is the volume of gas inhaled or exhaled during normal respiration, and is most accurately determined based on ideal body weight.

What is the estimated total lung capacity in a healthy adult male?

6,000 mL In a healthy adult male, the estimated total lung capacity is 6,000 mL of air

During a one second ventilation in a patient who is experiencing respiratory arrest, approximately how many mL of air will a bag-mask device deliver?

600 mL To produce a 1 second ventilation with good chest rise and fall in an adult patient, a bag-mask device will deliver roughly 600 mL of air

Your newborn patient is going to be receiving blow-by oxygen. The proper rate and delivery of this should be?

5 L through NRB mask Any higher concentration is likely to dry out the oral and nasal mucosa in infants.

You decide to place your patient on CPAP due to hypoxemic respiratory failure secondary to CHF exacerbation. What should your initial settings be and how much should you increase it by?

5 cm/H2o, increasing by 2.5 cm/H2o as needed

You are transporting an intubated patient who is currently being ventilated through a ventilator. What should the initial PEEP setting be?

5 cmH20 PEEP should be initially set to 5 cmH20. This maintains PEEP at levels found in a normal, healthy person.

If your patient's tidal volume is approximately 500 mL and their anatomical dead space is 150 mL, what is the minute volume if they are breathing 16 bpm?

8000 ml Using the Minute volume formula : (Tidal volume [Vt] x respiratory rate) = Minute volume. The anatomical dead space is not a pertinent piece of information for this question... (500 ml X 16 bpm = 8000 ml

Which of the following is a V/Q with too much perfusion, and not enough ventilation?

<.8 Something like atelectasis would prevent air from reaching regions of the lung that are otherwise perfused.

What does the V represent in the V/Q relationship?

Alveolar minute ventilation The V stands for ventilation, or the air moving in and out of the lungs while the Q, stands for perfusion, which refers to blood (in this case, that which is reaching the lungs and participating in gas exchange).

Surfactant is produced by?

Alveolar type II cells Surfactant is produced by the alveolar type II cells and works to prevent alveoli from collapsing.

Which of the following is true regarding acid-base balance?

An inverse relationship exists between hydrogen ions and pH As hydrogen ion concentration increases, pH decreases. As hydrogen ion concentration decreases, pH increases. Normal body pH is between 7.35 and 7.45.

What is the lung sound referred to as "crackles" indicative of?

Air being forced through airways that are narrowed by fluid, mucus, or pus Crackles are caused by fluid in the small airways. They are popping sounds that are heard when air is forced through the small airways that are being narrowed by the accumulation of fluid, mucus, or pus.

Your patient is experiencing an abnormal respiratory pattern characterized by long, deep inspiration and short, ineffective expiration. What is this respiratory pattern called and what is it caused by?

Apneustic; damage to the upper pons Apneustic breathing is characterized by prolonged inspiratory effort and short, ineffective expiratory effort. Apneustic breathing is a result of damage to the upper pons. The apneustic center is located in the lower pons - therefore, damage above it (upper pons) would result in alteration of the function of the apneustic center.

A decrease in tidal volume would most likely occur from which two of the following?

Atelectasis, Paralysis of the diaphragm Atelectasis refers to complete or partial lung collapse, which will interfere with tidal volume. Paralysis of the diaphragm will also prevent air movement. While increased anatomic dead space will interfere with available oxygen, it does not change the overall volume of air moving into or our of the lungs.

Which medication blocks the parasympathetic system?

Atrovent Atrovent is a form of Atropine. Atrovent (Ipratropium bromide) is an anticholinergic bronchodilator and parasympatholytic. It antagonizes muscarininc cholinergic receptors in the bronchi, producing bronchodilation.

You and your partner arrive on scene to a patient who has been involved in an MVA. As you approach, you notice the patient breathing in sequences of uniformly deep gasps, apnea, then more gasps. What is the name of the respiratory pattern?

Biot's respirations As you answer questions like this, picture the waveform that the description would create. Compare that mental picture to the ones you've see in your textbooks. Biot's respirations are caused by damage to the pons of the brain stem and in this case, secondary to what we can safely assume is head/facial trauma.

What is the main goal in administering epinephrine for Asthma?

Bronchodilation by stimulating Beta 2 receptors The Alpha response triggers vasoconstriction, but that's not why we administer it to someone with asthma. Our goal is smooth muscle relaxation of the bronchioles or bronchodilation. This is caused by triggering Beta 2 receptors. Remember that this is different from the Beta 1 receptors, which act on the heart to increase contractile force and heart rate.

Of the following, which is not a reliable indicator of correct ET tube placement?

Condensation in the ET tube It is important to use multiple methods to determine correct tube placement. Condensation can sometimes occur if the tube is placed in the epigastrium.

You are obtaining medical history from an 82-year-old male patient at a care home. Care home staff called 911 after the patient reported having difficulty breathing and his oxygen saturations were dropping despite being on home oxygen. The patient tells you he has atrial fibrillation and COPD. He could have any of the following respiratory diseases, except?

CHF Chronic obstructive pulmonary disease, or COPD, is a term that encompasses asthma, bronchitis, and emphysema.

Why is using a pulse oximeter unreliable when you suspect CO poisoning?

CO has a greater affinity for hemoglobin than oxygen does All that an oxygen saturation monitor is going to tell you is the percentage of hemoglobin that have a bound iron molecule within them. Since CO binds to those iron molecules much stronger than just plain oxygen, your oxygen saturation readings will not be accurate.

During respiration, as blood from the right side of the heart circulates past the lungs, it drops off _____ and picks up _____?

CO2 and oxygen

Why are CPAP and BiPAP beneficial in pulmonary edema (select the 2 answer options which are correct)?

CPAP and BIPAP will help reduce preload, afterload, and venous return reducing the amount of fluid into the lungs. CPAP and Bipap also help force the edema out of the alveoli and into the vascular space. BIPAP is preferred in Asthma patients due to the control of the EPAP (pressure patient will breathe against). CPAP can cause breath stacking which can be detrimental to asthma patients. CPAP can still be used in asthma patients, but not for prolonged periods of time. You can control PEEP on both CPAP and BiPAP.

In regards to the carbonic acid-bicarbonate buffering system, hydrogen ions are to bicarbonate ions as water is to __________?

Carbon dioxide In the carbonic acid-bicarbonate buffering system, carbonic acid can be broken down into hydrogen ions and bicarbonate ions or it can carbon dioxide and water. It is all dependent on the body's pH and what it needs at that moment.

What is the correct order of acid-base buffer systems from fastest to respond, to slowest to respond?

Carbonic, protein, renal The carbonic buffering system is the fastest, almost immediate to respond to a change in pH. The protein buffering system is not as fast to respond as the carbonic buffering system. The renal buffering system can take hours to days to respond.

During inspiration, the diaphragm ___________ and ___________ the volume of the thoracic cavity?

Contracts/increases During inspiration the diaphragm contracts, increasing the thoracic volume, which causes air to enter the lungs. In addition, the intercostal muscles will contract, also causing an increase in the volume of the thoracic cavity.

You are called to a 20-year-old male that hit his head on an overhead shelf while walking. You arrive and find the patient is conscious and lying supine. Your partner takes C-spine precautions. As you perform a rapid assessment, there are no obvious injuries, but you notice the patient's hands are locked up in a claw-like position and the patient is breathing deep and fast at 36 breath/min. The patient appears anxious and says his hands are tingling and he is unable to straighten them. What is most likely the cause of his claw-like, locked up hands?

Carpopedal spasms Hyperventilation is characterized by rapid deep breathing, which can lead to a drop in carbon dioxide levels. Anxiety can increase hyperventilation and if carbon dioxide levels continue to drop, it will lead to a rise in pH. This rise in pH results in respiratory alkalosis that causes numbness or tingling in hands and feet and around mouth. This can lead to carpopedal spasms, which cause the hands and feet to lock up in a "claw-like" position.

What informs the respiratory system of changes in PH levels and advises for changes in the respiratory cycle?

Chemoreceptors

This type of abnormal respiratory pattern is characterized by oscillation of ventilation with equal intervals of apnea?

Cheyne-Stokes Cheye-Stokes respirations grow deeper and faster and then decrease with periods of apnea. This breathing pattern continues to oscillate.

You are dispatched to a report of a child struck by a motor vehicle. Upon arrival, you find a 5-year-old male who was riding his bike when he was struck. Bystanders report that he wasn't wearing a helmet and witnessed his head striking the pavement. He is unconscious, unresponsive, and you notice that the patient has an irregular breathing pattern. Which of the following breathing patterns is the patient likely exhibiting?

Cheyne-Stokes Cheyne-Stokes respirations are indicative of a head injury. The presence of apnea would mean the patient is not breathing. The presence of eupnea would indicate that the patient has normal breathing. The presence of Kussmaul respirations would indicate the patient is likely in a state of metabolic acidosis, or diabetic ketoacidosis.

You arrive on scene with family members who tell you their grandma was eating a steak dinner when she began choking. Family states they did abdominal thrusts until the patient became unconscious. The patient has a weak, slow radial pulse, and no respiratory effort. You attempt to provide ventilation via BVM, with no compliance. Compressions are initiated. You visualize the airway with a laryngoscope and pull out chunks of food with the Magill forceps, but still no compliance with BVM. The best method for managing this patient's airway is?

Cricothyrotomy Cricothyrotomy is the best choice for this patient. The carina is the narrowest part of the airway. If intubation is attempted and the obstruction is pushed down the airway, it may get stuck at the carina, therefore eliminating any hope of obtaining any possible airway with this patient.

When a person hyperventilates, their minute volume?

Decreases, due to decreased air volume reaching the alveoli Gas exchange cannot take place in the trachea and bronchi, which is why they are collectively called dead space. The alveoli (of the lungs) are where gas exchange takes place. Hyperventilation will create less tidal volume for each breath.

A rise in pH happens when which of the following occurs?

H+ ions decrease Hydrogen ions determine the pH level of the body. H+ ions and pH levels have an inverse relationship - as one increases, the other decreases. CO2 is acidic and would cause the pH to drop if CO2 ions increased. Bicarbonate ions, HCO3-, help to buffer H+ ions. A reduction of bicarbonate ions would also cause the pH to drop.

Which of the following describes the way stretch receptors help limit the amount of stretch by the lungs, preventing overinflation?

Hering-Breuer reflex

You and your partner are assessing a 12-year-old patient who is experiencing a sudden onset of difficulty breathing. Your partner states the patient has stridorous lung sounds. Stridor is described by which of the following two characteristics?

High-pitched inspiratory sound This is a life-threatening finding. Ensure you act quickly to avoid a complete obstruction of the airway.

Blood plasma is forced into the alveoli and interstitial space when which of the following becomes too high?

Hydrostatic pressure

What respiratory changes would you expect to see in a patient with alkalosis?

Hypoventilation In a patient with an alkalotic pH, you would expect to see hypoventilation in an effort to retain carbon dioxide (increasing the number of hydrogen ions) in the body in order to return the body's pH closer to normal.

Which of the following complications is most closely associated with V/Q mismatch?

Hypoxemia V/Q mismatch refers to any discrepancy between ventilation and perfusion at the lungs. When this occurs, the blood will have inadequate levels of oxygen (hypoxemia).

How does interstitial pneumonia differ from other types of pneumonia?

Inflammation occurs in the tissue between the air sacs of the lungs instead of in the air sacs of the lungs Interstitial pneumonia leads to long term scarring and thickening of the lung tissues Inflammation occurs throughout the entire lung tissue and is not localized to one area Bronchopneumonia and Lobar pneumonia generally affect parts of the lung but not the entire lung. In most other types of pneumonia inflammation occurs in the air sacs of the lungs instead of in the tissue surrounding the air sacs. As a result of the damage to the interstitial tissue scarring and thickening take place which causes the lungs to be less pliable making breathing more difficult.

What is your first-line therapy when managing a patient with metabolic acidosis?

Intravenous fluids If the patient slowed their breathing, that would decrease the rate they could blow off CO2, which is the opposite of what you want. High flow O2 is not going to have an affect on the body's decreased pH level (acidosis). Intravenous fluids are your first-line therapy to increase intra and extracellular volume and restoration of renal perfusion.

Pursed (or puckered) lip breathing is a sign of respiratory distress that patients will exhibit in an attempt to do which of the following?

Keep the bronchioles from collapsing during exhalation Pursed lip breathing is a true sign of respiratory distress. It should be noted while you are placing oxygen on them.

The breathing pattern characterized by hyperpnea and tachypnea is known as?

Kussmaul breathing Kussmaul breathing is characterized by periods of increased rate and depth. It is most often seen with metabolic acidosis in an attempt to blow off CO2.

You have been dispatched for a male reportedly "choking." Your patient is a 22-year-old male in obvious respiratory distress. His girlfriend tells you he has chronic dental problems, but doesn't have the money to take care of it. Your patient has had a sore throat for several days now and is extremely anxious and drooling. Visualization of his oral cavity reveals swelling and redness of the throat region. What life-threatening condition do you suspect your patient has?

Ludwig's Angina Ludwig's Angina is a life-threatening condition that most often occurs due to infections caused by dental problems. The infection causes swelling of the throat which begins to close the airway. Previous dental problems, fever, drooling, and sore throat are all common symptoms. These patients require rapid intervention that may include intubation. Do not delay aggressive airway management.

Which of the following is not a routine use of waveform capnography in the cardiac arrest patient?

Measuring percent of Hgb saturated with oxygen Waveform capnography is a great tool that can help you monitor all of the following pieces of a cardiac arrest scenario, except for measuring oxygen saturation. That would be measured by a pulse oximeter.

Your patient is a 21-year-old male who fell 15 feet from a ladder. He has a GCS of 8 on arrival. The MOST appropriate way to manage this patient's airway is?

Nasotracheal intubation Nasotracheal intubation will allow you to secure an airway and is not contraindicated by facial trauma in this scenario.

You notice that your 10-month-old patient is performing belly breathing. This signifies which of the following?

Normal breathing Don't assume anything with this patient, EXCEPT the information it has provided you. In the absence of sternal or intercostal retractions, belly breathing is completely normal.

Chemoreceptors are responsible for monitoring and maintaining proper levels of?

O2, CO2, pH Chemoreceptors are receptors responsible for maintaining proper levels of O2, CO2, pH. Baroreceptors are responsible for detecting changes in BP.

What is the main benefit of using a supraglottic airway (King LT airway, Combitube) instead of an ET tube?

Supraglottic airways can be placed regardless of patient position Supraglottic airways are a good back-up airway if endotracheal intubation cannot be achieved. They can easily be placed and do not require a patient to be in a easily accessible position (endotracheal intubation requires room to perform laryngoscopy).

You are on scene at the airport with a patient complaining of difficulty breathing. Your patient is a 26-year-old female who just landed after a 13-hour flight. She went outside to smoke a cigarette when she experienced sudden, extreme difficulty breathing. Your patient has no medical history, has smoked for 12 years, and takes an oral contraceptive. She is pale, sweaty, and is laying on the ground with her feet propped up on her luggage. Vitals: HR 124 BP 92/54 SpO2 90% RR 36, diminished lung sounds on the left side, equal chest rise and fall. Your immediate treatment of this patient should include?

Oxygen, ventilatory assistance, transport In patients with suspected pulmonary embolism (a cause of obstructive shock), oxygenation and ventilatory assistance, as needed, are the most important prehospital interventions. Early transport is important because the hospital will be able to provide the highest level of care for these patients. A history of smoking, long periods of inactivity, and the use of birth control should give you a very high index of suspicion for a pulmonary embolism.

All of the following are contraindications for the use of the Combitube except?

Patient has severe facial trauma A patient less than 16 years of age, a patient that has a gag reflex, and a patient that ingested a caustic substance are all contraindications of the Combitube

Who are un-cuffed endotracheal tubes normally recommended for?

Pediatrics up to 1 year of age Un-cuffed endotracheal tubes typically are used in pediatrics < 1-year-old due to the development of the trachea. In newborn patients into their first year of life, the trachea is shaped more in a "tapered" manner which allows for un-cuffed tubes to seat into the tapering of the trachea allowing for adequate tube sealant. The other reasoning behind the usage of an un-cuffed tube is due to the fear of causing damage to the fragile pediatric trachea. If a cuff ETT is used in this age group, it could result in potentially life-threatening tissue edema, mucosal injury, or fibrosis of the trachea.

A 2-year-old child is choking on a piece of her mother's jewelry and her airway is severely obstructed. The proper maneuver to relieve the obstruction is to?

Perform a series of abdominal thrusts Abdominal thrusts are the appropriate maneuver for children over 1 year of age. The series of back blows and chest thrusts is appropriate for infants. You should never check a pediatric patient's mouth with blind finger sweeps.

You arrive on scene for a 24-year-old pregnant female who began choking during lunch. You find the patient to be conscious, but unable to speak or take a breath. Family tells you she is about 7-months pregnant. You would treat this patient by?

Performing chest thrusts If unable to speak or breathe, this patient has a full airway obstruction and chest thrusts would be used to clear the obstruction. We're not performing abdominal thrusts on the overly obese or pregnant females.

You're called to a private residence for a 72-year-old male who has an altered mental status. Vital signs are BP: 102/58, HR: 104, RR: 6/min, SpO2: 88%. What should be your first intervention?

Place an appropriately sized NPA First things first. If you're going to ventilate the patient using a BVM you need to first place an appropriately sized OPA or NPA or both.

After suctioning the airway of your patient, you should?

Place the catheter in sterile water After use, the catheter should be placed in sterile water to remove any foreign matter or fluid, to ensure that it is ready to be used again, if needed.

Which part of the brain stem is responsible for regulating your respiratory rate and depth?

Pons Medulla oblongata controls blood pressure and heart rate. Pons regulates respiratory pace & depth. Reticular activating system- a part of the midbrain controls arousal and sleep-wake transitions. Midbrain regulates the level of consciousness.

Which of these characteristics is least associated with emphysema?

Productive cough throughout the day Simply because a person has a cough does not necessarily mean that they suffer from emphysema. Polycythemia is an increased production of red blood cells that can follow chronic pulmonary disease (i.e. emphysema) because of the resultant hypoxemia from the disease.

You are called to a 43-year-old female with shortness of breath and chest pain. The patient states that it hurts when she takes a deep breath and it came on suddenly last night. The patient had recent back surgery and is still recovering, but has never felt a pain like this before. 12-lead shows sinus tachycardia without ectopy. Which is most likely the cause for her chest pain?

Pulmonary Embolism Pulmonary embolism is the most likely cause due to patient history. With a negative 12-lead and recent back surgery the patient may have developed a blood clot that broke off and traveled to the pulmonary circulation causing and emboli.

While treating a pediatric patient with a broken femur, you notice the patient is breathing abnormally fast for her age. Despite the increased respiratory rate, the patient does not appear to be in respiratory distress. What is this respiratory condition called?

Quiet tachypnea Quiet tachypnea is present when a patient has a rapid (above normal for their age) respiratory rate, but is not in respiratory distress. Quiet tachypnea usually results from non-respiratory complications, such as pain. Bradypnea is an abnormally slow respiratory rate. Tachypnea is abnormally fast respirations.

You arrive on scene to a 10-year-old male who struck a tree while riding his skateboard. He has blood slowly oozing from his scalp, R 44, P 130, and has a GCS of 8. Your partner has taken C-spine. What is your next priority?

Rapid sequence intubation This patient is close to respiratory arrest and needs a patent airway as quickly as possible. We certainly want to control hemorrhage, but not initially. This patient will definitely need a trauma activation, but you have to treat the patient's life threats first. Lastly, don't talk yourself into rapid transport by thinking that if you were close to the hospital, it would be better to just 'load and go'. The question doesn't mention anything about distance to the hospital and this patient needs an airway.

You have been called to a chronic asthma patient who is having an asthma attack. The patient is working hard to breath and has minimal air movement. Your patient was at his doctor yesterday and has lab values from his visit: pH - 7.29, ETCO2 - 55 mmHg. What acid-base disturbance is occurring?

Respiratory acidosis A low pH with a high ETCO2 value indicates respiratory acidosis. Minimal air movement would also suggest inability to release excess CO2.

You respond on a 32-year-old female who tells you she has been partying with oxycodone and drinking alcohol for the past four days. What type of imbalance is this patient most likely experiencing?

Respiratory acidosis With a decreased respiratory rate due to the oxycodone and alcohol, the patient is going to have an increased amount of hydrogen ions building up in their system. You need to know the acid-base balance formula and memorizing it will make it much easier to answer these types of questions.

An increased pH, decreased PCO2 level, and low HCO3- levels indicate which of the following acid-base derangements?

Respiratory alkalosis An increased pH (alkalotic), with a decreased PCO2 level and low HCO3- levels would indicate respiratory alkalosis that has been going on for an extended period of time (more than a few hours).

Your 62-year-old male patient is in need of an inter-facility transfer. As you introduce yourself and get information from the ED team, you note he is breathing at 35 breaths/min. You check the latest ABG and note the following values: pH of 7.49, CO2 of 30, and a HCO3- of 23. Which of the following would best describe your patient's condition?

Respiratory alkalosis CO2 is being blown off by hyperventilation, resulting in a higher pH. Your CO2 is low so you have a known respiratory component.

Which of the following lung sounds would you MOST expect to hear with bronchitis?

Rhonchi Rhonchi most often indicate obstructions in the lower airways, typically as a result of mucus buildup, which is consistent with bronchitis. Rhonchi are best heard on exhalation when auscultated, though they are a continuous sound, and resembling snoring.

Your patient is a 24-year-old Chinese citizen on vacation in the United States. He is in moderate distress complaining of difficulty breathing and gives a 4-day history of runny nose, sore throat, fever, chills, and general malaise with a productive cough. His sputum production was significantly worse when he woke up this morning and he had developed difficulty breathing this afternoon. HR= 134, BP= 132/84, RR=26, SaO2= 90%. This presentation is consistent with?

Severe acure respiratory syndrome Severe Acute Respiratory Syndrome (SARS) is a viral respiratory illness that first appeared in southern China in November 2002. It became a global threat in March 2003 by spreading internationally via Hong Kong. Signs and symptoms are: sore throat, chills or rigors, runny nose, myalgias(muscle aches), headache, diarrhea. This will progress into a cough, sputum production, respiratory distress and eventually, respiratory failure.

Solu-Medrol is a medication that can be used for which of the following conditions?

Severe asthma Solu-medrol will work to reduce systemic inflammation and increase the sensitivity of beta-2 receptors.

You arrive on scene of a bar fight to find a 24-year-old male with an open head wound. As your partner maintains manual stabilization of his head, you perform an initial assessment. He is unconscious, has ineffective breathing, and bloody secretions in his mouth. You should next?

Suction his oropharynx A patient with ineffective breathing will need assisted ventilations, but because this patient has bloody secretions in his mouth, suctioning is necessary before using a BVM.

In respiratory acidosis, how does the buffer system deal with the retention of CO2?

The buffer system reaction is pushed in the opposite direction due to the increased availability of CO2

Which of the following is not a sign of severe respiratory distress in a pediatric patient?

Wheezing Although wheezing indicates less-than-adequate air movement, it could be normal for an asthma patient. See-saw breathing, nasal flaring, and retractions are all last ditch efforts by the body to optimize oxygenation and ventilation.

Which of the following is not a component of the triad that suggests fracture of the larnyx?

Tracheal deviation Hoarseness, subcutaneous emphysema, and laryngeal crepitus make up a triad that can indicate fracture of the larynx.

You are on scene attempting to intubate your patient. You instruct your partner to apply cricoid pressure so you can have a better view of the glottic opening. Which direction should your partner apply pressure?

Upward, right When applying cricoid pressure, you should "BURP" the cricoid cartilage. BURP is an acronym for "Backwards, Upwards, Rightward, Pressure".

You are called to a nursing home to assist a 92-year-old male patient with emphysema. When listening for abnormal breath sounds in this patient, you will most likely hear?

Wheezing Emphysema is a disease characterized by decreased alveolar surface tension. It is a lower airway disorder and patients will most often exhibit wheezing during periods of breathing difficulty. Stridor and crowing describe a high pitched sound that is characteristic of an upper airway blockage. Pleural friction rubbing sounds like grating or squeaking and occurs when the pleural layers are inflamed. Pleural friction rubbing is often a sign of pneumonia.