1 - NREMT Airway, Respiration and Ventilation
Your patient is a 33 year old female who fell off the back of a motorcycle going approximately 20 MPH. Her respirations are irregular at 8 a minute. An OPA has been inserted and ventilations are being assisted with a BVM and 100% O2 at a rate and tidal volume of________________________. C-Spine precautions have been taken and she is packaged and moved to the ambulance where she stops breathing and there is no palpable pulse. CPR is started and the lead paramedic does a rapid sequence intubation. The BVM is attached to the ET tube and ventilations are restarted at a rate of ______________________________________________. 10 breaths per minute. Tidal volume of just enough air to give adequate chest rise. / 8 to 10 breaths per minute without pauses in compressions. 10 breaths per minute. Tidal volume of approximately 800 ml. / 5-6 breaths per minute with pauses for ventilation delivery over 1 second. 12 to 20 breaths per minute. Tidal volume of just enough air to make the chest rise with each ventilation. / 10 breaths per minute with no interruption of compressions to deliver ventilations. 5 to 6 breaths per minute. Tidal volume of approximately 600 ml. / 8-10 breaths per minute with pauses to deliver compressions.
10 breaths per minute. Tidal volume of just enough air to give adequate chest rise. / 8 to 10 breaths per minute without pauses in compressions. Rationale: With an OPA in, this woman should be receiving assisted ventilations at a rate of 10 breaths per minute, according to the newest AHA Guidelines, with a tidal volume of just enough air to give adequate chest rise. Milliliters of volume were found to be difficult if not impossible to estimate while delivering rescue breaths. Once the CPR starts with the advanced airway in place, the rate changes to 8 to 10 breaths per minute WITHOUT pauses in compressions.
You arrive on scene with your partner Zelda to a restaurant where a woman is apparently having a reaction to the seafood from the buffet. She is having trouble breathing and her lips are swollen. Zelda hands you an adult EPI pen and you inject the patient into the thigh and hold it there for about 3 seconds. How long will the injection likely be effective? 30-60 minutes 1-2 hours 10-20 minutes 24 hours
10-20 minutes Rationale: Plan for it lasting only 10-20 minutes. Having additional dosages on hand during transport is a necessity.
An adult with a respiration rate of ______per minute would be considered within normal limits. A child aged 3-5 with a respiration rate of_______per minute would be considered within normal limits and an infant who is breathing at________per minute would be considered within normal limits. 22, 32, 42 11, 6, 15 20, 40, 60 16, 25, 40
16, 25, 40 Rationale: According to NES guidelines -normal adult respiratory rates are from 16-20 - preschool aged children (3-5)children are 20-30 and -infants are 40-60 initially and drop to 30-40 after a few minutes.
A BVM with no supplemental oxygen delivers approximately? 16% oxygen 21% oxygen 50% oxygen 27% oxygen
21% oxygen Rationale: Ambient air without supplemental O2 attached will provide 21% oxygen.
Which patient is most viable? 9-month-old infant found apneic, pulseless, cool, blue, and stiff after a nap 96-year-old female with a valid DNR who is not breathing but has a pulse of 38 38-year-old male whose had both legs torn off from a railway incident. He has agonal respirations and no palpable pulse 5-year-old who fell through the ice and was submerged for 10 minutes before being brought to your ambulance. She is not breathing and doesn't have a pulse
5-year-old who fell through the ice and was submerged for 10 minutes before being brought to your ambulance. She is not breathing and doesn't have a pulse Rationale: Drowning victims should be treated even if they have been submerged for a long time. The rule "no patient should be pronounced dead until warm and dead" applies. Children in particular have a good chance of survival in water up to 3 minutes, or 10 minutes in cold water (10 to 15 °C or 50 to 60 °F). The infant has rigor mortis and should not be worked. The DNR negates the need to begin CPR on the elderly patient. The 38-year-old male has suffered major trauma, and while all efforts will be given, the odds of surviving a traumatic arrest are very small.
Dispatch has contacted your unit in response to a 911 call from a person at a nearby lake. The reporting party says a boat ran ashore throwing several people into a wooded area. You and your partner Zeek arrive to find 3 people with minor cuts and lacerations doing CPR on a woman in her 30's. They tell you that the patient was thrown into some trees when the boat hit ground. Zeek takes a quick pulse check and does not find a carotid pulse. The two of you begin CPR. You should deliver approximately ______________ per minute via BVM as you load the patient into the ambulance. During the 30 minute transport, a simple oral adjunct is inserted and an additional pulse check reveals that the woman now has a good palpable pulse. At what rate should you now ventilate this patient? ______________ 6 breaths / 10 to 12 breaths per minute 10 to 12 breaths / 12 to 20 breaths per minute 8 to 10 breaths / 10 to 12 breaths per minute 12 to 20 / 12 to 20 breaths per minute
6 breaths / 10 to 12 breaths per minute Rationale: According to the AHA CPR and rescue breathing guidelines, the woman should have CPR performed on her at a 30:2 compression to ventilation ratio. This ratio should yield approximately 6 breaths over a period of one minute. Once the woman has a pulse, the ventilation rate would change to the rescue breathing rate of 10 to 12 ventilations per minute.
The approximate minute volume for a healthy adult breathing 12 times a minute is? 1,200 mL/min 10,000 mL/min 12,000 mL/min 6000 mL/min
6000 mL/min Rationale: Minute volume (or minute ventilations) is the tidal volume times the number of breaths in a minute. This question assumes you know the average tidal volume for an adult is 500 mL - 600 mL. Even given any variation of tidal volume that texts may provide, all other choices are way out of range. TV x breaths/min = Minute Volume or 500-600ml x breaths/min = Minute Volume
You and your partner Lenny arrive on scene to find a 50 year old man complaining of shortness of breath. He is lying in bed with his eyes closed and opens them when you call, "Sir". He is oriented to person, place, and time, but has no response to your command or to pain. This man has a GCS of...? 9 10 11 12
9 Rationale: He gets 3 points for opening his eyes to voice, 5 points for giving oriented verbal responses, and only 1 point for no motor response to command or pain, for a total of 9.
You and your partner Lola arrive on scene to a multiple patient emergency. Which of the following patients would you and Lola consider a priority patient? A 45 year old female with a blood pressure of 169/92 A 19 year old male who has a broken ulna A 29 year old pregnant patient who is having contractions 12 minutes apart A 24 year old woman who was stung by two or three wasps
A 45 year old female with a blood pressure of 169/92 Rationale: A blood pressure of 169/92 would be considered a priority patient. Contractions that are 12 minutes apart, a simple fracture, and wasp stings in and of themselves are secondary to the blood pressure.
Describe what cheyne-stokes respirations are and what type of patients will present with them? Cheyne-stokes are the respirations just before a pt. goes apneic. These breaths are from pts that have become deceased. Breathing rapidly causing tingling in the fingers and cyanosis around the lips. Pts. that are hyperventilating present with these types of respirations. Breathing where the pt takes long deep breaths far apart. The PT is usually breathing about 3 to 6 times per minute. Pts. with head injuries often breath like this because their medulla oblongata has been damaged. A breathing pattern with periods of rapid and slow respirations alternating with periods of apnea. Often associated with pts who have head injuries.
A breathing pattern with periods of rapid and slow respirations alternating with periods of apnea. Often associated with pts who have head injuries. Rationale: Cheyne-stokes respirations are characterized by a breathing pattern with periods of rapid and slow respirations alternating with periods of apnea. Often associated with pts that have head injuries, the cause is due to damage of the respiratory centers. The respiratory centers are located in the medulla oblongata which controls the rate and depth of respiratory movement of the diaphragm and other respiratory muscles.
The contraindications for the Oropharyngeal airway include ____________________ and _____________________. An unresponsive patient without an intact gag reflex and an apneic patient being ventilated with a bag-mask device A conscious patient and an apneic patient being ventilated with a bag-mask device A patient with an intact gag reflex and an apneic patient being ventilated with a bag-mask device. A conscious patient and a patient with an intact gag reflex
A conscious patient and a patient with an intact gag reflex Rationale: The contraindications for the Oropharyngeal airway include: A conscious patient and a patient with an intact gag reflex. A conscious patient doesn't require an airway adjunct, and an intact gag reflex could stimulate vomiting. Vomiting would further complicate airway management.
Which of these items should you use during resuscitation of a child while using a BVM? AED BIRQ A folded towel under the child's shoulders Nasal cannula at 12 lpm
A folded towel under the child's shoulders Rationale: National registry requires the use of a folded towel during testing. By doing so, it allows you to place the patients airway into proper positioning for airway management.
Which is a complication of the use of a nasal cannula? A nasal cannula can cause dampness in the nasal cavity The patient can get too much oxygen The patient re-breathes his/her exhaled air A nasal cannula can cause dryness in the nasal cavity
A nasal cannula can cause dryness in the nasal cavity Rationale: A nasal cannula can cause dryness or irritation in the nasal cavity. One solution to this problem is to humidify the oxygen delivered by the cannula.
You and your partner Wakim are informed by dispatch that the shooting scene where you had been ordered to stand by, is now safe to enter, according to law enforcement. When you arrive on scene, there is only one patient, he has a sucking chest wound as a result of being shot with a 45 caliber hand gun. What treatment would you include? Removing the embedded bullet with Magill forcepts A three sided or occlusive dressing based on protocols C-spine for possible spinal injury and a nasal canula at 7 lpm Compression of chest with large size trauma dressing
A three sided or occlusive dressing based on protocols Rationale: A sucking chest wound needs to be dressed with a 3 sided or an occlusive dressing, based on local protocols. The patient is pushing air out of the hole in their chest. The 3 sided dressing allows that air to escape but not enter.
You have an unconscious patient. What do you do? Start CPR immediately Baseline vitals, primary assessment, and secondary assessment ABCs, History taking, Rapid full body scan ABC, Baseline vitals, Transport decision
ABCs, History taking, Rapid full body scan Rationale: According to the NES, the ABCs are part of the primary survey, which is then followed by history taking, and then the secondary assessment. A rapid full body scan is the first step of the secondary assessment. The rapid full body scan may be incorporated into the primary survey in order to determine life threats. You would not start CPR as the patient is only unconscious. They may be breathing with a pulse. Baseline vitals come after the primary and secondary assessments. Transport decision also comes before vital signs.
You are dispatched for a report of breathing difficulty. Upon arrival you find an 80 year old male being held upright in a chair at the table. Family members relate that he began coughing, then couldn't talk after that. The patient is breathing normally when you assess him. He is unable to speak, and appears to be unable to stand. What would you consider as causes of his condition? Foreign Body Airway Obstruction Bronchospasms Sudden Onset of Congestive Heart Failure Acute Stroke
Acute Stroke Rationale: An active fit of coughing can produce a lot of pressure in the cerebral cavity. An elderly patient who has a sudden onset of inability to speak, gait disturbances, and has clear lung sounds should be suspected of a Stroke. An FBAO would not cause all these signs and symptoms. Bronchospasms are in the lungs and would affect the ability to move air. CHF is a disease process.
Gastric distention may interfere with ventilations while in the field and can cause? Decreased lung expansion Gastric rupture Increased resistance to BVM ventilations All of the above
All of the above Rationale: All are complications of gastric distention. As gastric distention occurs, the diaphragm pushes up on the base of the lungs causing a decrease in lung expansion. When lung expansion is decresed, BVM ventilations will become more resistant.
The following are signs of potentially life threatening respiratory problems in adults. Which is the most ominous sign? 1 or 2 word dyspnea Altered mental status Audible stridor Diaphoresis
Altered mental status Rationale: From ominous to least severe: Altered mental status, severe cyanosis, absent breath sounds, audible stridor, 1-2 word dyspnea, tachycardia >130, diaphoresis, and accessory muscle use. Altered mental status shows that the respiratory comprise has in fact impeded oxygen levels in the brain.
Oxygenation includes which two processes? Cell/capillary gas exchange and high ATP production Alveolar/capillary gas exchange and low ATP production Alveolar/capillary gas exchange and cell/capillary gas exchange High ATP production and low ATP production
Alveolar/capillary gas exchange and cell/capillary gas exchange Rationale: Oxygenation includes Alveolar/capillary gas exchange and cell/capillary gas exchange.
AHA CPR Guidelines for treating a patient with a foreign body airway obstruction include which of the following? Blind finger sweep after opening airway Tongue jaw lift Asking the patient if they can speak Asking the patient if they are choking
Asking the patient if they are choking Rationale: The first 2 answer choices are now eliminated from AHA FBAO guidelines. The only question asked now is "Are you choking".
A 20-year-old male has injured his back at a local swimming hole. You and your partner Missy arrive to find the man moaning and lying partially in the water next to a pile of rocks. Witnesses say he slipped while climbing a tree over the swimming hole and fell onto the rocks from about 30 ft up. The man is breathing at 12 breaths per minute and his respirations are very shallow with periods of apnea. His pulse is 72 beats per minute and his skin is slightly moist and pale. After taking c-spine precautions, what would be the most appropriate course of action? Assist ventilations and elevate the man's legs High flow O2 at 12-15LMP and a detailed physical exam Perform a focused physical exam looking for life threats and then transport Assess airway, high flow O2 via NRB, assess circulation, and transport
Assist ventilations and elevate the man's legs Rationale: This man is in need of ventilatory support as his respiration rate AND depth are not sufficient. Treatment should include slight elevation of the legs in order to help treat for shock as well as blankets and possibly heat packs for warmth.
If a Paramedic instructs you to hyperventilate the patient prior to intubation, what would you do? Coach the patient to breath faster Assist ventilations with 100% oxygen for several minutes Nothing, because that would be dangerous and constitute negligence Turn the O2 up to 25 lpm and adjust the mask
Assist ventilations with 100% oxygen for several minutes Rationale: Paramedics were taught for many years to hyperventilate (meaning to give the patient more breaths with a BVM or other artificial ventilation device) for the purpose of preparing for intubation. Research has now shown that there is only a need to pre-oxygenate the patient. You may still have paramedics use the term Hyperventilate, but understand the intent of the procedure. You don't need to ventilate faster, just provide 100% oxygen for a few minutes of normal ventilations.The reason for doing pre-oxygenation is that it buys more time to perform the intubation. The idea is that we replace all the air in the respiratory system with 100% oxygen, and since there is about 2.4 liters of air that are in the functional reserve capacity (FRC) of the lungs (average) we are trying to turn all of it into 100% oxygen and replace all that Nitrogen that is normally present. If we do some simple math we can see how effective this is. If room air is at 21% oxygen and the FRC is 2.4 liters then there are about 500 ml of oxygen in the patient. If we replace all that 2.4 liters with 100% oxygen we now have nearly 5 times the available oxygen just sitting there. This oxygen will still diffuse into the patient while the paramedic is attempting the intubation. This gives a little bit of padding to allow the intubation and prevent the patient from becoming hypoxic.
A two year old boy was pulled from a house fire and handed to you. His weak shallow breathing necessitates assisted ventilations. You put him on high flow oxygen assisted with a BVM at approximately 18 breaths per minute. After 10 minutes of transport, the child's pulse is 50 bpm. What should you do next? Begin chest compressions Increase breaths per minute to 28 Dress his burns and continue transport Call medical control to ask for instructions
Begin chest compressions Rationale: A child that is not perfusing well despite assisted ventilations with high flow oxygen and who has a pulse rate below 60 beats per minute, should have chest compressions initiated by the rescuer.
Which of the following would you expect to find in an infant who is breathing adequately? Use of accessory muscles Belly breathing Respirations of 15 a minute Retraction of the intercostal muscles
Belly breathing Rationale: Belly breathing is normal for infants and young children. Accessory muscle use, retractions of the intercostals, and respirations of 15 breaths per minute, are signs that the child is not breathing adequately.
The functions of the respiratory system include all of the following except: Ventilation Respiration Bronchiole/venous gas exchange Alveolar/capillary gas exchange
Bronchiole/venous gas exchange Rationale: The functions of the respiratory system include: -ventilation, -respiration, -alveolar/capillary gas exchange, and buffer.
What is one of the complications with using cricoid pressure? Unable to visualize cords during intubation Can obstruct the airway if done improperly Cause collapse of the esophagus Cause gastric distention
Can obstruct the airway if done improperly Rationale: If cricoid pressure is done improperly it can occlude the trachea and block passage of air.
Hyperventilation lowers the levels of: Carbon Dioxide in the body Hemoglobin in the body Ketones in the body Oxygen in the body
Carbon Dioxide in the body Rationale: Breathing too fast blows off too much CO2, resulting in respiratory alkalosis.
An elderly female patient has adequate respiratory depth with good quality and rate, but her SPO2 reading is at 90%. Which of the following is the most likely cause of this low reading? How are you going to treat her? Chemoreceptors slowing down because of advanced age. / Put her on a nasal canula at 5 LPM She has an FBAO or COPD. / Administer O2 via NRB at 15 LPM She is anemic and does not have the volume of hemoglobin necessary to adequately transport oxygen. / Transport in a fowler's position with 02 administered by a flow restricted oxygen powered ventilation device. She has a reduced capacity in her alveoli as a result of lost elasticity in the tissue. / Administer O2 via BVM and transport.
Chemoreceptors slowing down because of advanced age. / Put her on a nasal canula at 5 LPM Rationale: Even healthy elderly patients may show a reduced SPO2 reading. The chemoreceptors in the vasculature that measure amounts of oxygen and CO2 in the blood become less efficient. Treatment in this case would include O2 administered via a nasal canula.
Rapid breathing is first seen in what stage of shock? Compensated Decompensated Irreversible Both A and B
Compensated Rationale: A person may breath rapidly in compensated and decompensated shock, but it is FIRST seen in compensated shock.
Epinephrine _________________. Constricts vessels and relaxes airway passages Dilates vessels and increases pulse rate Is administered by autoinjector only Is not produced naturally by the body
Constricts vessels and relaxes airway passages Rationale: It constricts vessels and relaxes airway passages along with speeding up the pulse. It is administered in several different ways including IV and ET tube and it is produced naturally by the body.
Which of the following is a rare cause of respiratory failure in children? Upper airway obstruction Epiglottitis Anaphylaxis Croup
Croup Rationale: Croup is a relatively common condition that affects about 15% of children at some point, most often between 6 months and 5-6 years of age. The other choices are dire emergencies that can lead to respiratory failure and require immediate care and transport.
You have a conscious patient who is having problems breathing. As a precautionary measure, you insert an OPA. This will likely result in the? Patient being able to breath better Patient's respiratory center to relax Demonstration of the patient's gag reflex Patient having a more comfortable transport
Demonstration of the patient's gag reflex Rationale: Stimulating the soft palate of the mouth will often get a gag reflex in a conscious patient. Use an NPA if they are conscious and not contraindicative.
All the following conditions can adversely affect respiration at the cellular level except: Hypoxia Diaphoresis Infection Hypoglycemia
Diaphoresis Rationale: Conditions that can adversely affect respiration at the cellular level include: Hypoxia, hypoglycemia, and Infection. Diaphoresis or sweating and doesn't influence cellular respiration.
A person who is in anaphylaxis will have blood vessels that are ________________. Constricted Dilated Titrated Clogged
Dilated Rationale: A person in anaphylaxis will have dilated vessels which will cause a drop in blood pressure. The dilation is caused by a mediator release of histamine which causes among other things, smooth muscle tone in the blood vessels.
Which of the following would not be a sign of poor perfusion? Cyanosis Pallor Erythema Mottling
Erythema Rationale: Poor perfusion can cause pallor, cyanosis, and mottling. Erythema occurs when the blood vessels dilate causing increased blood flow to the tissue of the skin causing redness of the skin like a rash. This can be caused by an allergic or anaphylactic reaction.
Cells require chemicals in order to function, namely oxygen, glucose, and electrolytes. All of the following are cell functions requiring chemicals except: Excretion of oxygen Excretion of water Excretion of waste products Excretion of carbon dioxide
Excretion of oxygen Rationale: Cells require chemicals in order to function, namely oxygen, glucose, and electrolytes. Cell functions requiring chemicals include: Excretion of water, excretion of carbon dioxide, and aerobic versus anaerobic respiration.
You and your partner Tony are assessing a patient who has suffered a blunt trauma to the chest. During visual inspection of the thorax, you notice paradoxical motion during exhalation. You suspect this patient has what type of injury? Hemothorax Flail chest Scapula break Hemopneumothorax
Flail chest Rationale: A loose segment of ribs known as flail chest allows the lung to protrude from the open section causing the paradoxical or uneven movement. It is not very common but can occur during blunt force trauma to the chest.
Your patient is a 61 year old male who is complaining of dyspnea. He has no signs or history of trauma. What history and physical exam would you choose for this man and what is the most likely cause of his condition? Focused:Focused / He has an inflammation of the lower airway Rapid:Focused/ He has COPD Detailed:Detailed / He has a collapsed lung Rapid:Detailed / He just wants some attention
Focused:Focused / He has an inflammation of the lower airway Rationale: You know the man's chief complaint and potential life threat is the respiratory distress. You have determined that no trauma is involved so you can FOCUS on gathering history of his breathing difficulty as well as do a FOCUSED exam of the affected body system which in this case is the lungs and airway. Any one of the answers contained a possible explanation for his condition, but only one had the correct history and physical exam.
You arrive on scene to find a 35-year-old man lying prone in the bathroom. He is not alert and you log roll him with c-spine stabilization into a supine position. Your next course of action would be? AED - SAMPLE Manually open the airway Check pulse and apply AED Give him a sternal rub to check for consciousness
Give him a sternal rub to check for consciousness Rationale: According to the NREMT medical/trauma sheets you would want to check responsiveness (AVPU) before opening the airway.
A seven year old boy is having trouble breathing. His parents say he has never had any breathing problems before. The mother says the boy was sick for a few days and the breathing problems started this afternoon. During assessment, you notice the boy is flaring his nostrils and has a rough voice when answering your questions. What is this boy most likely suffering from and what should you do? He could have croup and I would put him on a nasal canula at 4 lpm because he is less than 40 lb. He could have tonsillitis and will require transport to the hospital in a position of comfort He could have epiglottitis and I would transport him with high flow O2 on a NRB Brescularous Syndrome, you should transport wearing a HEPA mask
He could have epiglottitis and I would transport him with high flow O2 on a NRB Rationale: Epiglotitis, although rare, is known to strike children in this age group. Croup is usually in younger children. Transporting with airway support is the best answer.
You are called to a home where a 91 year old man has had a syncopal episode and is vomiting. The caregiver who called 911 stated that the patient's bowel movements have been bright red since yesterday. The patient has not complained of any pain, but is nauseated. What is most likely wrong with this man and which choice includes appropriate treatment steps? He has an upper GI bleed and should be transported sitting up with high flow O2 administered via a non rebreather mask at 15 LPM. He has pancreatitis and should be given high flow O2 via NRB at 15 LPM. Rapid transport in a left lateral recumbent position while keeping him warm will help avoid shock. He has had a TIA and should be given high flow oxygen via NRB and transported on his effected side to the nearest hospital. He has a lower GI bleed and should be given O2 via nasal cannula at 4LPM and transported in a position of comfort while treating for shock
He has a lower GI bleed and should be given O2 via nasal cannula at 4LPM and transported in a position of comfort while treating for shock Rationale: The bright red blood in the bowel movements is indicative of a lower GI bleed. Answer 1,2, and 3 all utilize an NRB to deliver high flow O2. Given that the patient is vomiting and nauseated, it would be advisable to use a nasal cannula, rather than an NRB, to help avoid potential airway compromise if the patient continues to vomit.
It's 20 degrees outside and your unit has been called to an apartment complex where a man is having trouble breathing. You arrive to find the man sitting in a tripod position on a bench. He has a portable O2 tank and is receiving oxygen via a nasal cannula at 3 LPM. Your initial assessment reveals that his breathing is rapid with minimal chest rise and fall. Respiration rate is 20 breaths per minute and his pulse is 130. In a hoarse voice the man tells you he has a history of COPD and is on a new medication which he is unable to name. He denies any chest pain, but says he is getting a headache. Which of the following scenarios is most likely the cause for this man's breathing difficulties and how would you treat him? He is having an allergic reaction to the new COPD medication. Move him to the ambulance and administer high flow 02 via NRB His COPD medication is not the correct dosage and it is not clearing the surfactant from the alveolar walls. Move him to the ambulance and put him on high flow O2 via his cannula. He is going into anaphylaxis as a result of a bee sting. Inject him with an Epi pen and check his vitals in the back of the ambulance. He has pneumonia from his COPD and being out in the cold. Actively warm him in the back of the ambulance and transport him to the nearest hospital
He is having an allergic reaction to the new COPD medication. Move him to the ambulance and administer high flow 02 via NRB Rationale: Given the signs and symptoms, breathing difficulty, hoarse voice, tachycardia, increased respiration rate, new medication, and headache the most likely scenario is the allergic reaction to the new medication. Answer 2 is incorrect because COPD drugs are not designed to remove surfactant from the alveoli. Also, you would not give him high flow O2 via a cannula. Answer 3 is not likely correct as live bees are not found in 20 degree temperatures. Additionally, taking a blood pressure prior to administration of the Epi pen is recommended unless you are certain there is life threatening airway compromise due to an acute allergic reaction.
You arrive on scene with your partner to a restaurant where a man was reported to be choking. You enter and find an unconscious cyanotic male on the floor. He is supine with BBQ sauce on his mouth and a napkin in his hand. What would you do for this patient? Verify apnea, give two slow breaths with high flow O2, and administer back thrusts until the object has been removed. Ask the bystanders what happened. Verify no pulse, and attach the AED. Tell everyone to stand back, and hit analyze, following the prompts. Administer abdominal thrusts, followed by a finger sweep, and then administer high flow O2. Monitor patient while transporting. Head tilt, chin lift, verify apnea and begin Compressions. Upon completion of the compressions, give two slow breaths looking for chest rise and fall.
Head tilt, chin lift, verify apnea and begin Compressions. Upon completion of the compressions, give two slow breaths looking for chest rise and fall. Rationale: Open the airway and check to see if they are breathing, if not, begin compressions first. After completing the initial set of compressions, give two slow breaths looking for chest rise and fall. Continue this sequence until the object has been removed.
You and your partner Selena arrive on scene to find a boy with hives over much of his body. He is wheezing and complaining of shortness of breath. His mother says he was stung by a hornet and has no prior history of allergies. What would be the best course of action? High flow O2 and rapid transportation as the patient appears to be going into anaphylaxis Obtain BP, pulse, and respirations and then use the EpiPen injector even though it is expired Make sure blood pressure is above 100 mm hg and then give the patient an oral solution of benadryl Administer an EpiPen injector to the patient's thigh and then obtain a refusal
High flow O2 and rapid transportation as the patient appears to be going into anaphylaxis Rationale: Tending to the patient's ABC's and monitoring their vitals is important in determining the onset of anaphylaxis. Never use expired medications on a patient unless you contact medical control as a last ditch effort and they approve. Oral benadryl is not a medication approved for EMT's to administer under the national standards, however local protocol may allow it. You do not need to worry about the BP when administering benadryl for allergic reactions. It is likely a patient will have a low BP due to the reaction and the medication may help improve it as it starts acting. You should always transport a patient who you have administered epinephrine to. It is vital that the patient been seen by a physician as soon as possible
You and your partner Amy arrive on scene to find a woman with hives over much of her body. She is wheezing and complaining of difficulty breathing. Her husband says she was stung by a hornet and has no prior history of allergies. What would be the best course of action? Use an autoinject epinephrine pen and administer to the patient's thigh. Obtain signed transport refusal. Make sure blood pressure is above 100 mmHg and inject her with epinephrine 1/1000. Get her BP, pulse, and respirations and then inject her with epinephrine only if her vitals are within normal limits. High flow O2 and rapid transportation if the patient appears to be going into anaphylaxis.
High flow O2 and rapid transportation if the patient appears to be going into anaphylaxis. Rationale: Tending to the patient's ABC's and monitoring vitals is important in determining the onset of an anaphylactic reaction. If you administer epinephrine you would not have the patient sign a transport refusal. If you administer care, the patient needs to be transported. You do not need to make sure her BP is over 100 mmHg (that is for nitro). Having vital signs within normal limits is not a necessary criteria for giving epinephrine.
A patient is complaining of difficulty breathing after being struck in the ribs by a baseball, and is now cyanotic around the lips. Proper action would include: Sweeping the tongue out of the way to look for airway obstructions High flow oxygen via non-rebreather mask and rapid transport A bag-mask device with supplemental oxygen attached Advice on proper use of a mitt
High flow oxygen via non-rebreather mask and rapid transport Rationale: As long as the patient is able to talk and keep his/her respirations within range, then high flow Oxygen and transport would be the best choice.
Which statement best describes the Bronchi? Hollow tubes that further divide into the lower airways of the lungs and are supported by muscle. A hollow tube that passes air to the upper airway and is supported by cartilage. Hollow tubes that further divide into the lower airways of the lungs and are supported by cartilage. A hollow tube that passes air to the lower airway and is supported by muscle.
Hollow tubes that further divide into the lower airways of the lungs and are supported by cartilage. Rationale: The Bronchi are hollow tubes, which further divide in to lower airways of the lungs and are supported by cartilage. There are two main bronchi that are called the right and left bronchi.
Which of the following is not a typical disease process that would inhibit internal respiration? Pneumonia Pulmonary edema Hypertension Emphysema
Hypertension Rationale: Typical disease processes that can inhibit internal respiration include: -emphysema, -pulmonary edema, -pneumonia, -repeated environmental or occupational exposure. Hypertension is an inappropriate answer.
If the blood does not contain enough oxygen (PO2) to properly perfuse the tissues it is called? Hypothermia Tachemia Hypoxemia Decelerate dioxidation
Hypoxemia Rationale: Hypothermia is low temperature and the other two terms are made up. Hypoxemia is not to be confused with Hypoxia. Hypoxia is low O2 saturation and Hypoxemia is low partial pressure of oxygen in the arterial blood.
A 6 year old girl was found outside in her yard unconscious. She is breathing 6 breaths a minute and her pulse is 58 bpm with poor systematic perfusion. What should you do? Assist ventilations with high flow O2 and transport rapidly Initiate chest compressions and assist ventilations with high flow O2 Use an epinephrine auto injector to increase her heart rate Transport with high flow O2 and assist respirations if needed
Initiate chest compressions and assist ventilations with high flow O2 Rationale: AHA Guidelines for BLS include compressions for children with a pulse rate of less than 60 bpm who are perfusing poorly. Symptomatic bradycardia is a common terminal rhythm in infants and children. Don't wait for pulseless arrest to begin compressions.
A pediatric patient may need additional measures to maintain an open airway. Which of the following is an acceptable method to use? Insert an oral or nasal airway adjunct Place a rolled up towel under the child's neck to align the airway Put the child in a Trendelenburg position on high flow O2 at 15 liters a minute Use Magill forceps to keep the child's tongue from blocking the airway
Insert an oral or nasal airway adjunct Rationale: The only answer that is acceptable, is to utilize an oral or nasal airway adjunct. A rolled up towel (1 inch high) could be used under the shoulders, NOT the neck. The Trendelenburg position with high flow O2 will not aid in keeping the airway open. Magill forceps would not be the best choice for displacing the tongue.
You and your partner Bob have just arrived at a residence for a "slip and fall". When you enter the home a panicked father tells you that his 3 year old son has fallen down a flight of approximately 20 stairs and onto the basement floor. He has the child in his arms and hands him to you. The boy is unconscious with a slow, irregular breathing pattern and a pulse of 98 beats per minute. You and Bob gently place the child on the floor with manual c-spine stabilization and then: Insert an oropharyngeal airway and assist ventilations with a BVM while transporting rapidly. Give 2 short rescue breaths and then begin administration of high flow O2 via non rebreather mask if the child's airway is patent. Insert a nasopharyngeal airway and begin assisting ventilations at 15-30 breaths per minute with rapid transport. Begin CPR at 100 compressions per minute while delivering approximately 5-6 breaths per minute. Utilize 15:2 ratio with 2 EMTs.
Insert an oropharyngeal airway and assist ventilations with a BVM while transporting rapidly. Rationale: Possible head trauma is a contraindication for using a nasopharyngeal airway as it may increase intracranial pressure or cause additional trauma.
Status asthmaticus ____________. Increases chances of survival Is the stage before serious asthma sets in Responds well to traditional bronchodilators Is a life threatening condition
Is a life threatening condition Rationale: When the attack of asthma is severe, prolonged, and will not subside with the intervention of traditional bronchodilators, it is termed status asthmaticus.
A spontaneous pneumothorax: Is an uncommon cause of sudden onset breathing difficulties Is often caused by a ruptured bleb or air sac on the lung Can be caused by menstruation Will cause the trachea to deviate and the jugular veins to distend
Is often caused by a ruptured bleb or air sac on the lung Rationale: Sudden onset breathing difficulties are often caused by a spontaneous pneumothorax and is more common in men than women. Unless it develops into a tension pneumothorax, there will not be any tracheal deviation or JVD.
All of the following are disadvantages of a manually triggered ventilation device except: It is difficult to maintain adequate ventilation without assistance It is typically used on adult patients only High ventilation pressures may damage lung tissue It increases fatigue during extended transport times
It increases fatigue during extended transport times Rationale: The disadvantages of using a manually triggered ventilation device include: It is difficult to maintain adequate ventilation without assistance, typically used on adult patients only, requires special unit and additional training for use in pediatric patients, the rescuer is unable to easily assess lung compliance, and high ventilation pressure may damage lung tissue
Which best describes oxygenation? It It is the process of loading oxygen molecules onto hemoglobin molecules in the blood stream and is not required for internal respiration. It is the process of loading oxygen molecules onto hemoglobin molecules in the blood stream and is required for internal respiration. It is the process of loading hemoglobin molecules onto oxygen molecules in the blood stream and is required for internal respiration. It is the process of loading hemoglobin molecules onto oxygen molecules in the blood stream and is not required for internal respiration.
It is the process of loading oxygen molecules onto hemoglobin molecules in the blood stream and is required for internal respiration. Rationale: Oxygenation is the process of loading oxygen molecules onto hemoglobin molecules in the blood stream and is required for internal respiration. External respiration is a mechanical process, and Internal respiration is a chemical process.
Which of the following is a function of the Nasopharynx? Keeps dust and other small particles out of the respiratory system Cools and dehumidifies air Prevents food from entering the larynx Helps produce speech
Keeps dust and other small particles out of the respiratory system Rationale: The Nasopharynx functions include: warming and humidifying air and preventing dust and other small particles from entering the respiratory system.
Which of the answer choices is not an aspect of positive pressure ventilation? Amount of blood pumped out of heart is reduced Negative intrathoracic pressure Venous return is decreased during lung inflation Airway walls are pushed out of normal anatomical shape
Negative intrathoracic pressure Rationale: Aspects of positive pressure ventilation include: Amount of blood pumped out of heart is reduced, venous return is decreased during lung inflation, airway walls are pushed out of normal anatomical shape, and more volume is required to have the same effect as normal breathing.
You are dispatched to an electronics manufacturing plant where a woman has reportedly collapsed. As you enter the assembly area, you see the woman lying supine on the floor with several of her co-workers attempting aid. As you approach, you can see she is unresponsive. One of the co-workers says "She was standing next to me and I think she just fainted. I caught her when she fell toward me and I laid her down here". What would be the best course of action? Open her airway Assess her respirations Take her pulse Assess her skin
Open her airway Rationale: Opening the patient's airway would be first priority. She may or may not be breathing. She may or may not have a pulse. With no associated or apparent trauma, use the head tilt chin lift maneuver to open the airway. With suspected trauma, use the Jaw Thrust maneuver. If jaw thrust is not effective, move to head tilt chin lift.
The irritant gas that primarily affects the upper airway is? Insoluble Partially water-soluble Non-soluble Highly water soluble
Partially water-soluble Rationale: Gases such as Ammonia, Sulfur dioxide, and Hydrogen chloride have chemical properties that readily dissolve in the water covering the mucous membranes. This then allows them to produce an aqueous solution.
Pertinent negatives are often used when documenting patient conditions on a PCR. Which of the following is a pertinent negative for a patient experiencing an MI? Patient denies chest pain Patient complains of shortness of breath Lungs sounds are clear bilaterally Patient does not have any prior history of heart problems
Patient denies chest pain Rationale: A pertinent negative is a symptom or condition you would expect to see under certain circumstances, but is not present with a particular patient.
You are dispatched to a possible cardiac arrest. You arrive 10 minutes from the time of the call. You and your partner enter the residence to find a man in his 50's lying supine on the living room floor. His wife says that he "just collapsed" while eating dinner. Which of the following treatment choices is most appropriate at this time according to AHA Guidelines? Immediately analyze his rhythm and defibrillate with a monophasic manual defibrillator at 360 J if necessary Perform 30 compressions and then look inside the mouth before attempting to ventilate Use a biphasic defibrillator to analyze and shock the patient at 200 J if you do not know the type of biphasic waveform in use. Do 5 cycles or 2 minutes of CPR before attempting defibrillation
Perform 30 compressions and then look inside the mouth before attempting to ventilate Rationale: When a patient collapses while eating you should always suspect a possible Foreign Body Airway Obstruction (FBAO). A visual check of the mouth with each airway opening/ventilation cycle is now recommended by AHA. AHA guidelines now recommend attaching the AED and attempting to defibrillate as soon as you have one available.
You and your partner whom you have been working with for two years are called to a house where a woman is having chest pain and complaining of shortness of breath. She is diaphoretic and has a pulse of 110, respirations of 22, and a blood pressure of 140/80. She says she has no cardiac or respiratory history. You should? Put her in the ambulance and transport as rapidly as possible Call medical control and ask permission to administer some of her husband's nitro Perform your assessment, put her on O2 at 15 lpm, and transport Get her sample history and try to determine the cause of the respiratory problem
Perform your assessment, put her on O2 at 15 lpm, and transport Rationale: The best thing you could do in this case is to give her oxygen and get her to the hospital.
When assisting a patient with ventilation, there are five steps that need to be followed. Which is the second step in the process? Place the mask over the patient's nose and mouth Squeeze the bag each time the patient begins to inhale Explain the procedure to the patient Initially assist at the rate at which the patient is breathing
Place the mask over the patient's nose and mouth Rationale: The steps in ventilating a patient include: 1st - Explain the procedure to the patient. 2nd - Place mask over the patient's nose and mouth. 3rd - Initially assist at a rate at which the patient is breathing. 4th - Squeeze the bag each time the patient begins to inhale. 5th - Over the next 5-10 breaths, slowly adjust the rate and volume.
Air that becomes trapped between the visceral pleura and the parietal pleura is called? Pneumatic emphysema Pleural edema Pneumothorax Subcutaneous emphysema
Pneumothorax Rationale: Air may leak into the space between the visceral and parietal pleura from the lungs or from the environment with an open chest wound. This is a pneumothorax.
Your patient is an 86-year-old female who is complaining of difficulty breathing. She says it has been getting worse for the last few hours. She has a cough that she says, "has been..(breath) a companion(breath) for years." During your assessment you find that she has a rapid pulse and diminished breath sounds on her right side. She also says her chest hurts every time she coughs. What is the likely cause of this woman's complaint? COPD Pneumothorax Pulmonary Effusions Anaphylaxis
Pneumothorax Rationale: This woman likely has COPD, but the absence of breath sounds and the pain when she coughs is a sign that she has a spontaneous pneumothorax. Pulmonary Effusions is a made up term (it's pulmonary EMBOLISM and Pleural Effusion). People with weakened lung tissue can cough and cause a spontaneous pneumothorax.
When assessing the breathing of an infant or child, you should look for_________________? Normal breathing Adequate breathing Presence or absence of breathing Inadequate breathing
Presence or absence of breathing Rationale: AHA Guidelines specify that with children, you should verify the presence or absence of breathing. Also ALS continues to look for adequate breathing.
Of the following answers, which often causes dyspnea? Pulmonary Thromboembolism Asperger's Lymphoma Cat dander
Pulmonary Thromboembolism Rationale: Pulmonary Thromboembolism is where there is a passage of a blood clot formed in a vein that breaks off and circulates through the venous system. The large clot moves through the right side of the heart and into a pulmonary artery, where it becomes lodged, significantly decreasing or completely blocking blood involved in inhalation and exhalation of air. No exchange of oxygen or carbon dioxide takes place in the areas of blocked blood flow because there is no effective circulation. Over time, this condition can cause cyanosis.
You and your partner Luke are assessing a patient who is having difficulty breathing. After auscultation of the lungs, you determine that the alveoli are collapsing when the patient exhales. What type of breath sounds would this result in? Ronchi Cheyne-Stokes Rales Vesicular
Rales Rationale: Ronchi are not associated with collapsing alveoli. Cheyne-Stokes is associated with head injury. Rales or crackles, as they are often called, is the most likely breath sounds you would hear.
Reassessment consists of: Vitals, repeat secondary assessment, check interventions Repeat primary survey, check vitals, review chief complaint, check interventions Repeat vitals, repeat primary survey, repeat secondary survey Repeat initial assessment, check interventions, repeat vital signs
Repeat primary survey, check vitals, review chief complaint, check interventions Rationale: According to the NES the reassessment should consist of redoing the primary survey followed by taking vital signs, re-evaluating the patient's chief complaint and then checking any interventions that you may have made.
Your patient is an unconscious adult male who is not able to maintain his airway. You determine that his gag reflex is not intact. What is the first step when inserting an oropharyngeal airway? Select the proper size airway by measuring from the corner of his mouth to the earlobe Select the proper size airway by measuring from the center of his mouth to the earlobe Select the proper size airway by measuring from the base of his nose to the earlobe Select the proper size airway by measuring from the tip of his nose to the earlobe
Select the proper size airway by measuring from the corner of his mouth to the earlobe Rationale: The first step for inserting an oropharyngeal airway is to select the proper size by measuring from the corner of his mouth to the earlobe.
Something very simple can be done to assist your partner in visualizing the glottic opening during intubation. What is it? Presic maneuver Hilscot pressure Sellick maneuver Magnum Move
Sellick maneuver Rationale: Pressure to the cricoid cartilage, known as the Sellick maneuver, can help visualize the cords.
Your unit is called to a youth summer camp for an unknown illness of a 14-year-old girl. The counselor who called 911 stated that the girl started vomiting while playing basketball and is now complaining of stomach pain. You arrive to find the girl sitting in the camp office clutching her stomach. She is very overweight and slightly diaphoretic with pink skin that feels like a normal temperature. When you take her pulse she starts complaining of "feeling weak". She is AOX3. What is most likely wrong with this girl and which answer contains the most appropriate treatment? She is suffering from heat exhaustion and should be moved to a cool area and given small sips of cold water if her level of consciousness is not altered. Passively cool her with cold water. Administer high flow O2 and give a fluid bolus if protocols allow. Transport to the hospital for further evaluation. She is suffering from heat cramps and should be given small sips of cool water if her LOC is not impaired. Move her to a cool area and actively cool her by misting her with tepid water and then fanning her to allow for evaporation. Apply high flow O2, administer IV fluids if scope of practice allows, and transport. She is suffering from heat stroke and should be immediately cooled with ice and given 4 81mg salt pills if she does not have an altered LOC. Administer O2 via non rebreather mask and support airway during transport. She has a lower GI bleed and should have high flow O2 administered via NRB and transported to the hospital with her legs elevated. Treat for shock and be prepared to suction if she vomits or loses consciousness.
She is suffering from heat cramps and should be given small sips of cool water if her LOC is not impaired. Move her to a cool area and actively cool her by misting her with tepid water and then fanning her to allow for evaporation. Apply high flow O2, administer IV fluids if scope of practice allows, and transport. Rationale: Heat cramps are characterized by vomiting, sweating, stomach pain, and weakness. Heat exhaustion usually causes pale skin and profuse sweating and is the result of more extreme salt and fluid loss than heat cramps. Additionally, only COOL water should be administered orally and only with heat cramps. Cold water may increase nausea. Nothing should be given by mouth for heat exhaustion and cooling should be done with tepid or cool water as cold water may cause reflex vasoconstriction and shivering. The patient is not likely suffering heat stroke as she does not have an altered LOC and does not have an increased body temperature.
You are dispatched to the report of a choking. A 2-year-old girl has attempted to swallow a penny which has become lodged in her throat, causing a partial airway obstruction. Which of the following breath sounds would you most likely hear with this child? Cheyne-Stokes Crackles Rales Stridor
Stridor Rationale: Stridor is a high pitched inspiratory and or expiratory sound indicating an obstruction in the upper airway. This can be caused by a foreign body airway obstruction or medical conditions like croup. Wheezing is usually associated with lower respiratory problems like asthma. Rales are associated with the lower portions of the airway being partially blocked by fluid or swelling which result in a popping sound during inhalation as the alveoli pop open. Cheyne-Stokes is a respiratory pattern characterized by a crescendo from apnea to hyperpnea.
Which list includes only abnormal breath sounds? Retractions, nasal flare, abdominal breathing, and diaphoresis Abdominal breathing, stridor, retractions, and silent chest Wheezing, nasal flare, crackles, and diaphoresis Stridor, wheezing, crackles, and silent chest
Stridor, wheezing, crackles, and silent chest Rationale: Abnormal breath sounds include: -stridor, -wheezing, -crackles, -silent chest, and -unequal breath sounds. Any of these conditions would be cause for concern and would require a further evaluation of your patient.
Which is the correct description for calculating the duration of flow for oxygen cylinders? Subtract the safe residual pressure from the gauge pressure, then multiply by the flow rate in L/min, lastly, divide by the cylinder constant Subtract the flow rate in L/min from the gauge pressure, then multiply by the cylinder constant, lastly, divide by the safe residual pressure Subtract the safe residual pressure from the gauge pressure, then multiply by the cylinder constant, lastly, divide by the flow rate in L/min Subtract the gauge pressure from the safe residual pressure, then multiply by the oxygen constant, lastly, divide by the flow rate in L/min
Subtract the safe residual pressure from the gauge pressure, then multiply by the cylinder constant, lastly, divide by the flow rate in L/min [(Gauge Pressure - Safe Residual Pressure) x Cylinder constant] / Flow Rate in L/min Rationale: The correct formula for calculating the duration of flow for oxygen cylinders is: Subtract the safe residual pressure from the gauge pressure, then multiply by the cylinder constant, lastly, divide by the flow rate in L/min. Some formulas do not include a safe residual pressure, but a residual pressure should always be included as a margin for patient safety.
The cricothyroid membrane is ___________ to the ______________. Anterior / thyroid cartilage Inferior to the cricoid cartilage A solid ring connected / esophagus Superior / cricoid cartilage
Superior / cricoid cartilage Rationale: The cricothyroid membrane is above (superior) the cricoid cartilage and below the thyroid cartilage.
You and your partner Larry are dispatched for a call to a man with severe stomach pain. When you arrive on scene you find him lying on the floor of the kitchen in the fetal position. There is vomit on his face and he says he is going to throw up again. He denies falling and says the only thing wrong is that his stomach is killing him. Assessing his abdomen you find it to be very tender to the touch and he moans when you palpate his stomach. He is also breathing very fast at 30 a minute. What other signs and symptoms might you find with this patient? Tachycardia - hypotension - fever Bottle of poison, cyanosis, and crepitus Broken ribs, hypertension, and deep, rapid breathing Rebound tenderness - metabolic acidosis
Tachycardia - hypotension - fever Rationale: The patient is not likely to have crepitus, having no pain and denying that they fell. A person with broken ribs is unlikely to be breathing fast and deep and if a person has been vomiting copious amounts it is likely they would be in metabolic alkalosis rather than acidosis.
What happens when levels of CO2 in the blood become too high? The body produces more sodium bicarbonate to counteract respiratory alkalosis The patient begins to enter into metabolic acidosis The brain increases rate of respiration There is increased intracranial pressure due to increased CO2 in the CSF
The brain increases rate of respiration Rationale: The respiratory control center will increase both rate and depth of breathing to get rid of the CO2. When a patient retains CO2 in the blood, they experience respiratory acidosis.
Use of an SpO2 monitor on a person suffering from carbon monoxide poisoning will be inaccurate because ___________. The oxygen has stronger bonding properties than the CO2 molecule CO2 is odorless and tasteless so the monitor cannot detect it Carbon monoxide has a weaker bond with the hemoglobin The carbon monoxide molecule displaces the oxygen molecule inhibiting oxygen delivery
The carbon monoxide molecule displaces the oxygen molecule inhibiting oxygen delivery Rationale: The carbon monoxide molecule has a stronger bond to the hemoglobin and displace oxygen molecules leaving them essentially stranded in the blood. While the monitor may show a number in the mid 90's?it does not mean that oxygen is reaching the tissue and perfusing correctly.
Which of the following statements is correct with regard to inhalation physiology? The intercostal muscles and diaphragm contract, increasing the size of the thoracic cavity Air enters the trachea then passes the vocal cords and into the carina where it enters the lungs The diaphragm draws down creating a negative pressure while the lower rib cage moves down and in Carbon dioxide moves from the arteries into the alveoli and oxygen moves from the alveoli into the veins
The intercostal muscles and diaphragm contract, increasing the size of the thoracic cavity Rationale: The first answer is the only choice without something listed incorrectly about the process of inhalation. The second answer incorrectly states, air goes by the trachea before the vocal cords. The third answer says the lower rib cage moves down and in when it is the exact opposite. The fourth answer has the diffusion process backwards.
Anatomically, a child's airway is just like a little adult's, EXCEPT? The tongue is smaller and the adenoids are not present The tongue is larger in proportion to the child's body and the cricoid cartilage is smaller The vallecula is not developed yet The tongue is larger in proportion to the child's body and the uvula is not developed yet
The tongue is larger in proportion to the child's body and the cricoid cartilage is smaller Rationale: Pediatric patients have larger tongues in proportion to their bodies, and their cricoid cartilage is the smallest structure.
Which of the following descriptions best depicts the Bronchioles? They are thin hollow tubes that lead to the alveoli and remain open through smooth muscle tone. They are thin hollow tubes that lead to the alveoli and remain open through cartilage support.. They are the end of the airway and are the site where oxygen and carbon dioxide are exchanged. They are the end of the airway and have millions of thin walled sacs.
They are thin hollow tubes that lead to the alveoli and remain open through smooth muscle tone. Rationale: The bronchioles are thin hollow tubes that lead to the alveoli and remain open through smooth muscle tone.
During inspiration, the air enters the nose and then proceeds: Through the oropharynx and into the vocal cords passing the bronchi then the trachea into the alveoli Through the larynx and then through the trachea passing the bronchi and into the carina and finally the alveoli Through the nasopharynx and then the larynx into the trachea then the bronchi and alveoli Through the larynx and then through the oropharynx passing the bronchi and finally the alveoli
Through the nasopharynx and then the larynx into the trachea then the bronchi and alveoli Rationale: The 3rd answer contains an order of airway structures that is correct. There are additional landmarks that could be added, but the overall order is correct where the other answers are incorrect in order or passage.
What is the major function of the lower airway? To warm, filter, and humidify air To protect from foreign objects To exchange oxygen and carbon dioxide To increase metabolism
To exchange oxygen and carbon dioxide Rationale: The major function of the lower airway is to exchange oxygen and carbon dioxide through a process called diffusion.
Which of the following is NOT a purpose of the Oropharyngeal airway? To make it easier to suction the oropharynx To keep the tongue from blocking the upper airway To keep the tongue from blocking the lower airway To allow the passage of air to the lungs
To keep the tongue from blocking the lower airway Rationale: The purposes of an Oropharyngeal airway include: Make it easier to suction oropharynx, keep the tongue from blocking the upper airway, and allow the passage of air to the lungs. It has no impact on the lower airway.
Which of the following choices would be included in the lower airway? Trachea - alveoli - uvula Epiglottis - oropharynx - vestibular fold Trachea - bronchial tree - alveoli Vocal cords - pharynx - epiglottis
Trachea - bronchial tree - alveoli Rationale: The lower airway is the trachea, bronchial tree, and alveoli. Everything above the trachea is considered upper airway.
Cheyne-Stokes breathing is characterized by __________. Uneven breaths with periods of apnea Deep rapid breaths Bradypnea Rapid breathing very shallow
Uneven breaths with periods of apnea Rationale: Cheyne-Stokes is often seen in head injuries and is characterized by uneven or progressive breaths with periods of apnea.
Your patient is a 61-year-old male who has fallen from a step ladder while hanging Christmas lights. He fell approximately 5 feet onto a deck railing and has a contusion on the left side of his neck and head. He is not breathing. Suspecting a possible c-spine injury you attempt to open his airway with the jaw thrust maneuver, but are not successful. How will you next try to open his airway? Use the jaw tilt maneuver Use the new head tilt jaw thrust maneuver Use the head tilt chin lift maneuver Use the jaw thrust maneuver again
Use the head tilt chin lift maneuver Rationale: AHA Guidelines state that after an unsuccessful attempt at opening the patient's airway with the jaw thrust maneuver, you should use the head tilt chin lift maneuver. Opening the airway is priority.
What would you do if a newborn infant has a heart rate lower than 100 beats a minute? Ventilate at 40-60 breaths a minute Begin chest compressions Ventilate at 100 respirations a minute None of the above
Ventilate at 40-60 breaths a minute Rationale: You should ventilate at 40 to 60 breaths a minute. If the infant is below 60 beats a minute, you should do chest compressions as well for a total of 120 events per minute(90 compressions and 30 breaths).
The most important treatment when caring for a patient with an irritant gas exposure is? Needle thoracentesis Oxygen Ventilation CPR
Ventilation Rationale: Although oxygen is always important, you need to treat the underlying problem. Irritant gases restrict the lungs ability to ventilate, therefore, the need for ventilation is priority.
You arrive on scene with your partner Mark to find your patient, a 68-year-old man who is unconscious and has a pulse of 140. He is cyanotic around his mouth and down his neck and appears to be breathing very shallowly at 6 per minute. Your actions would include? Determining the cause of respiratory problems High flow O2 via NRB and transport Preparation for suction Ventilation with a BVM with attached O2 at 15 lpm
Ventilation with a BVM with attached O2 at 15 lpm Rationale: An unconscious patient who is cyanotic would benefit most from positive pressure ventilations with high flow O2 and a call to ALS.
The amount of air that can be forcibly expelled from the lungs after breathing deeply is called: Dead space Residual volume Minute volume Vital capacity
Vital capacity Rationale: The amount of air that can be forcibly expelled from the lungs after breathing deeply is called vital capacity. Dead space is the amount of tidal volume not reaching the alveoli during ventilation. Residual volume is the volume of air remaining in the lungs after maximum exhalation. Minute volume is the volume of air inhaled and exhaled by the lungs over a minute.
All of the following are functions of the mouth and oral cavity except: Alternative airway Entrance to digestive system Warms and humidifies air Involved in speech production
Warms and humidifies air Rationale: The mouth and oral cavity functions include: alternative airway, especially in emergency; entrance to digestive system; involved in production of speech; contains the tongue. The nose is the primary functionary in warming and humidifying air.
You have just arrived at the scene to find a 27-year-old female complaining of anxiety and breathing difficulties. Which of the following questions would be most appropriate to ask first? What is your name? What day is today? Do you have a history of panic attacks? How long have you been having trouble breathing?
What is your name? Rationale: When performing patient assessment, the first thing, after your scene size-up, is to do the primary survey (also called primary assessment). The first step of the primary survey is to form a general impression, followed by level of consciousness, then Airway, Breathing, and Circulatory status, and finally identify life threats during that process. While all of those questions are proper to ask at some point during an assessment, the best choice is to ask the patient her name first. This is critical information because it allows you to know who you are interacting with. It also helps to determine a general impression of the patient according to their proper or improper response, and then determine airway status. This sets the stage for the rest of your assessment. You should always introduce yourself and ask for your patient's name at the beginning of your assessment. The other questions come during the history taking part of your assessment.
When administering oxygen to a patient with COPD experiencing diffuse chest pain and shortness of breath, you should? Place a mask on the patient but do not turn on the oxygen You do not administer oxygen any differently than you would to any other patient Reduce oxygen from the usual 85-100% to between 25-35% You must deliver higher percentage of oxygen because the patient has COPD
You do not administer oxygen any differently than you would to any other patient Rationale: For the average person, the trigger that respirations and/or perfusion is inadequate is an increase of CO2 in the cerebral spinal fluid. In the COPD patient it is increased O2. You should never withhold oxygen from a patient with this
Respiratory physiology includes cellular respiration, the process that exchanges oxygen and carbon dioxide within the lungs. Oxygen that is inhaled________________________________________. Carbon dioxide _______________________________________________. moves by osmosis from the alveoli into the lungs where it is absorbed into the blood stream / moves by osmosis through the cell wall of the alveoli and into the veins where it is transported to the heart is diffused through the capillary cell wall and into the venules where it moves into the alveoli / is diffused from the alveoli into the veins where it is cleaned diffuses from the alveoli into the capillaries where it moves into the arterioles and arteries / diffuses from the capillaries into the alveoli and is expelled from the lungs during exhalation is actively transported by the arteries to the alveoli where cellular respiration occurs / is passively transported from the veins and capillaries through the alveoli and finally the lungs
diffuses from the alveoli into the capillaries where it moves into the arterioles and arteries / diffuses from the capillaries into the alveoli and is expelled from the lungs during exhalation Rationale: Cellular respiration is the exchange of gases within the alveoli. Inhaled oxygen moves from the alveoli into the arteries by diffusion. CO2 moves from the veins, venules, and then capillaries into the alveoli by diffusion as well. It then moves into the lungs to be expelled during exhalation.
When inserting a nasopharyngeal airway, the airway should be placed in the ____________ nostril, with the curvature of the device following the curve of the __________ of the nose. larger, roof smaller, roof larger, floor smaller, floor
larger, floor Rationale: When inserting a nasopharyngeal airway, the airway should be placed in the larger nostril, with the curvature of the device following the curve of the floor of the nose.
Respiratory systems assessment findings for anaphylaxis include _____________________ and __________________________. decreased mental status and wheezing to diminished lung sounds wheezing to diminished lung sounds and increased heart rate severe respiratory distress and wheezing to diminished lung sounds rapid pulse and hypotension
severe respiratory distress and wheezing to diminished lung sounds Rationale: Respiratory systems assessment findings for anaphylaxis include severe respiratory distress and wheezing to diminished lung sounds. Due to the bronchoconstriction and angioedema associated with anaphylaxis, patients can experience severe respiratory distress. The lung sounds can range from wheezes indicating constriction, to diminished or even absent, indicating profound constriction.
You and your partner arrive at the home of a 59 year old male with a history of acute pulmonary edema. The patient is conscious and breathing at a rate of 28 breaths/min. Which treatment is best indicated? Begin mouth-to-mask rescuscitation. insert an Oropharyngeal airway insert a Nasopharygeal airway use a Continous Positive Airway Pressure (CPAP) device.
use a Continous Positive Airway Pressure (CPAP) device. Rationale: Research is showing that CPAP has better results with fewer problems than the more traditional methods used in the past. While this device may not be in use in many parts of the country yet, it is now included in the National EMS Education Standards as a recommended treatment at the EMT level.
