Airway

a 7 year old presents conscious with a partial foreign body airway obstruction. She suddenly becomes unresponsive. You should: A. Administer 30 chest compressions B. Perform five back blows C. Check pulse D. Deliver abdominal thrusts.

A. Administer 30 chest compressions Chest compressions should be started in an unconscious child of any age with suspected airway obstruction. Back blows followed by chest compression is performed in conscious choking infants while abdominal thrust can be attempted in a conscious child beyond infancy. A pulse should be checked once the foreign body airway obstruction has be relieved.

A patient presents with agonal breathing. While ventilating this patient with a bag-valve-mask, you should: A. Give one breath every 5 seconds B. Math his respiratory rate and "assist" ventilations C. Give each breath over 3 seconds

A. Give one breath every 5 seconds. Patients with atonal breathing have an inadequate respiratory rate, making choice 2 a poor choice. Ventilations should be administered over 1 second, not 3 seconds as in choice 3. Raising the chest 3 inches with each breath, choice 4 can only occur when too much tidal volume is administered and should be avoided

A patient presents conscious and alert with a respiratory rate of 22 breaths per minute. You osculate crackles up to the middle lobes of both lungs, and her skin is clammy with peripheral cyanosis. She has a medical history of asthma and left sides heart failure. The best way to correct the patient's underlying problem is too: A. Initiate non-invasive positive pressure ventilation B. Initiate bag-valve mask ventilation C. Administer oxygen via a nonrebreather mask D. Assist the patient with her metered-dose inhaler.

A. Initiate non-invasive positive pressure ventilation Patient's presentation is concerning for heart failure exacerbation causing pulmonary edema. CPAP will decrease the work of breathing and provide additional positive pressure at the end of expiration, keeping the alveoli from collapsing, this improving oxygenation. It also can decrease preload which is helpful in cariogenic pulmonary edema. A bad valve mask device, choice 2, or a nonrebreather mask, choice 3, won't provide this. The patient isnt experiencing bronchospasm, making choice 4 incorrect.

You are ventilation a patient with a bag-valve-mask. An oropharyngeal airway is in place, and you are performing a head tilt, chin lift. You notice that ventilation is becoming harder. You should: A. Lay the patient on her left side. B. Perform another head-tilt, chin lift. C. Suction the airway D. Increase the oxygen flow rate

B. Perform another head-tilt, chin-lift. If airway or ventilation problems occur while performing bag-valve-mask ventilation, the procedure should be started from the beginning, making choice 2 the best answer.

You are ventilating a patient in respiratory failure with a bag-valve-mask when you notice that his abdomen is being distended. You should: A. Increase tidal volume B. Increase the oxygen concentration C. Decrease the ventilation volume D. Increase the ventilatory rate

C. Decrease the ventilation volume Ventilation with a bag valve mask device can sometime cause air to inflate the stomach due to relaxed esophageal sphincter or if the build up pressure in the esophagus opens the esophageal sphincter. The incidence of gastric distention can be minimized by limiting ventilation volume to the point that the chest rises. Increasing the ventilatory rate or pressure of airway during ventilation will worsen the problem. None of the other choices would result in decreased gastric distention.

All of the following can results in bradycardia in pediatric patients EXCEPT: A. Toxic ingestion B. Hypoxia C. Fever D. Head trauma

C. Fever Hypoxia is the most common cause of pediatric bradycardia and should be immediately corrected when identified. Other causes include increase intracranial pressure, toxic ingestion, vasovagal stimulation, and hypothermia. Fever usually presents along with tachycardia.

A conscious 6 month old is moving around, turning blue, and not making any sounds or moving any air. You should: A. check her pulse B. deliver abdominal thrusts. C. Perform five back blow (slaps) D. Administer 30 chest compressions.

C. Perform five back blows In a conscious infant with suspected choking, five back slaps followed by five chest compressions should be performed. Afterwards, mouth should be checked for foreign body. If seen, it should be removed with a finger sweep. Abdominal thrusts, choice 2, should never be performed on an infant< 1 year of age. Chest compressions should be immediately performed on an unconscious infant with choking.

Where should vehicles be parked in relation to a fuel leak or hazardous materials release A. downwind B. At least 50 feet away C. Upwind D. None of the above

C. upwind Vehicles should be parked upwind from a fuel leak or hazardous materials release

A patient has rapid, shallow respirations, obtunded after being trapped in a house fire. You should: A. Suction the airway B. Obtain a set of vital signs C. Administer oxygen via a non breather mask D. Assist ventilations with a bag-valve mask

D. Assist ventilations with a bag-valve-mask The patient's shallow breathing suggest ventilation is inadequate, making choice 4 the correct one. Theres no indication for the need to suction, choice 1 and a non breather mask, choice 3, would be right if patient's breathing is adequate. A set of vital signs, choice 2, should be obtained after taking care of issues found in the primary exam.

A 6 month old make with no medical history has two day history of low grade fever, tachypnea, and wheezing. Auscultation of lung sounds reveals inspiratory and expiratory wheezes to all lobes bilaterally. This is most consistent with: A. epiglottis B. Pneumonia C. Croup D. Bronchiolitis

D. Bronchiolitis Bronchiolitis is an inflammation of small airways that can cause fever, diffuse wheezing. Croup, choice 3, is a viral infection characterized by a barking cough and clear lung sounds. Epiglottis causes inflammation of the tissue around the supraglottis, which results in fever, odynophagia, drooling and stridor in severe cases. It would be unusual for pneumonia to present with diffuse wheezing.

A 65 year old female describes waking up from sleep because she says "I felt like I was being smothers while I was laying down" Lung auscultation reveals rales (crackles) to the bases bilaterally. Based on this information, she is more likely suffering from: A. Pulmonary Edema B. Pneumonia C. Emphysema D. Pulmonary embolism

D. Pulmonary embolism The presence of rales (crackles) and orthopnea or shortness of breath associated with laying supine suggest pulmonary edema. Pneumonia can also have rales on exam but the bibasalar distribution is more specific to pulmonary edema.

Your patient is fully immobilized on a back board when he starts to vomit into his airway. You should: A. Suction the airway with a portable suction unit. B. Ventilate the patient with 100% oxygen C. Unstrap the patient and roll him on his side D. Roll the backboard, and the patient on its side.

D. Roll the backboard, and the patient on its side. The most immediate way to clear the airway is to roll the patient on the backboard onto his side. Ventilation, choice 2 isnt indicated in this situation, and unstrapping the patient from the background. Choice 3, is unnecessary because the board actually helps you roll the patient while still maintaining spinal precautions. Suctioning with a portable suction unit, choice 1, may seem like a good idea, but its not as effective at clearing the airway of copious amounts of large, chunky stomach contents.