Ch. 15
When performing nasotracheal intubation, you should use an ET tube that is: A) equipped with a stylet in order to make the tube formfitting. B) uncuffed so as to avoid unnecessary damage to the nasal mucosa. C) slightly larger than the nostril into which the tube will be inserted. D) 1 to 1.5 mm smaller than you would use for orotracheal intubation.
D) 1 to 1.5 mm smaller than you would use for orotracheal intubation.
What size ET tube would be MOST appropriate to use for a 4-year-old child? A) 3.5 mm B) 4.0 mm C) 4.5 mm D) 5.0 mm
D) 5.0 mm
Which of the following medications is safest to use in patients with borderline hypotension or hypovolemia? A) Brevital B) Pentothal C) Sublimaze D) Etomidate
D) Etomidate
You should be MOST suspicious of tube misplacement following an open cricothyrotomy if: A) bleeding from the subcutaneous tissues is observed. B) there is minimal rise of the chest during ventilations. C) progressive redness is noted around the insertion site. D) a crackling sensation is noted when palpating the neck.
D) a crackling sensation is noted when palpating the neck.
Cuffed ET tubes are generally not used in the field until the child is 8 to 10 years old because: A) the cuff would apply pressure and obstruct the airway. B) the high-pressure cuff would likely rupture the trachea. C) most children are only intubated for short periods of time. D) a cuff at the cricoid ring is not necessary to obtain a seal.
D) a cuff at the cricoid ring is not necessary to obtain a seal.
You are attempting to intubate a 5-year-old girl when you note that her heart rate has fallen from 120 beats/min to 80 beats/min. A patent IV line has been established. The MOST appropriate action is to: A) administer 0.02 mg/kg of atropine to increase her heart rate. B) abort the intubation attempt and begin chest compressions at 100/min. C) give a 20 mL/kg normal saline bolus and continue your intubation attempt. D) abort the attempt and ventilate with a bag-mask device and 100% oxygen.
D) abort the attempt and ventilate with a bag-mask device and 100% oxygen.
If intubation of a child is unsuccessful after two attempts, your MOST appropriate action is to: A) have your partner attempt to intubate as you apply gentle posterior pressure to the cricoid cartilage. B) insert a multilumen airway device and confirm placement by means of auscultation of breath sounds and capnography. C) turn the child on his or her side, apply manual pressure to the epigastrium to relieve distension, and reattempt intubation. D) discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately.
D) discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately.
The major advantage of the multilumen airway is that: A) it can be used in children and adults as an alternative airway device. B) no mask seal is required to ventilate with either of the multilumen airways. C) intubating the trachea with the multilumen airway in place is extremely easy. D) effective ventilation is possible if the tube enters the esophagus or the trachea.
D) effective ventilation is possible if the tube enters the esophagus or the trachea.
If ventilation is difficult after inserting a King LT airway, you should: A) deflate both of the cuffs, withdraw the device 2 cm, and reattempt ventilation. B) remove the King LT and immediately resume ventilation with a bag-mask. C) attach a manually triggered ventilator and observe for adequate chest rise. D) gently withdraw the device, without deflating the cuffs, until ventilation is easier.
D) gently withdraw the device, without deflating the cuffs, until ventilation is easier.
Once you have confirmed that the lighted stylet-ET tube combination has entered the trachea, you should: A) secure the tube manually, remove the stylet, and attach a bag-mask device. B) slightly withdraw the stylet and tube to ensure placement above the carina. C) remove the lighted stylet and inflate the distal cuff with 5 to 10 mL of air. D) hold the stylet in place and advance the tube about 2 to 4 cm into the trachea.
D) hold the stylet in place and advance the tube about 2 to 4 cm into the trachea.
Proper insertion of the LMA involves: A) inserting the LMA into the patient's mouth by following the curvature of the patient's tongue. B) lifting the patient's jaw upward and blindly inserting the LMA until you meet resistance. C) flexing the patient's neck, depressing the tongue with a tongue blade, and blindly inserting the LMA. D) inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.
D) inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.
Before securing the ET tube in place with a commercial device, you should: A) remove the bag-mask device from the ET tube. B) hyperventilate the patient for 30 seconds to 1 minute. C) move the ET tube to the center of the patient's mouth. D) note the centimeter marking on the ET tube at the patient's teeth.
D) note the centimeter marking on the ET tube at the patient's teeth.
A 36-year-old man experienced significant burns to his face, head, and chest following an incident with a barbeque pit. Your assessment of his airway reveals severe swelling. After administering medications to sedate and paralyze the patient, you are unable to intubate him. Furthermore, bag-mask ventilations are producing minimal chest rise. The quickest way to secure a patent airway in this patient is to: A) ventilate with a demand valve. B) insert a LMA. C) perform a needle cricothyrotomy. D) perform an open cricothyrotomy.
D) perform an open cricothyrotomy.
After tracheobronchial suctioning is complete, you should: A) visualize the vocal cords to ensure the tube is still in the correct position. B) hyperventilate the patient at 24 breaths/min for approximately 3 minutes. C) instill 3 to 5 mL of saline down the tube to loosen any residual secretions. D) reattach the bag-mask device, continue ventilations, and reassess the patient.
D) reattach the bag-mask device, continue ventilations, and reassess the patient.
If you must insert the ET tube into the patient's left nostril, you should: A) insert the tube straight back without rotating it. B) insert the tube with the beveled tip facing upward. C) ensure that the bevel is facing away from the septum. D) rotate the tube 180° as its tip enters the nasopharynx.
D) rotate the tube 180° as its tip enters the nasopharynx.
Nondepolarizing neuromuscular blocking agents include all of the following, EXCEPT: A) vecuronium bromide. B) rocuronium bromide. C) pancuronium bromide. D) succinylcholine chloride.
D) succinylcholine chloride.
The MOST significant disadvantage associated with needle cricothyrotomy is: A) air leakage around the insertion site. B) the inability to exhale via the glottis. C) local infection due to poor technique. D) the potential for pulmonary aspiration.
D) the potential for pulmonary aspiration.
Rigorous tube confirmation protocol must be followed after performing digital intubation because: A) inadvertent extubation of the patient is very common. B) capnography is unreliable in digitally intubated patients. C) ET tubes that are placed digitally do not have a pilot balloon. D) the procedure of digital intubation is truly a blind technique.
D) the procedure of digital intubation is truly a blind technique.
Proper insertion of the needle into the cricothyroid membrane involves a ___ angle toward the ________. A) 45°, feet B) 90°, posterior trachea C) 45°, posterior trachea D) 90°, feet
A) 45°, feet
Which of the following statements regarding the King LT airway is correct? A) In the prehospital setting, the King LTS-D is only used in adults. B) The King LT airway provides better airway protection than the ET tube. C) The King LT airway has two lumens that effectively seal the esophagus. D) In contrast to the King LT-D, the LTS-D is closed at the distal end.
A) In the prehospital setting, the King LTS-D is only used in adults.
Which of the following statements regarding field extubation is correct? A) It is generally better to sedate the patient rather than extubate. B) The patient should be extubated if spontaneous breathing occurs. C) The risk of laryngospasm following extubation is relatively low. D) Extubation should be performed with the patient in a supine position.
A) It is generally better to sedate the patient rather than extubate.
Using the DOPE mnemonic, which of the following interventions would you MOST likely have to perform if you suspect "O" as the cause of acute deterioration in the intubated child? A) Tracheobronchial suctioning B) Immediate extubation of the child C) Needle decompression of the chest D) Checking the bag-mask device for defects
A) Tracheobronchial suctioning
Several attempts to orotracheally intubate an unresponsive, apneic young man have failed. You resume bag-mask ventilations and begin transport to a hospital located 25 miles away. En route, you begin having difficulty maintaining an adequate mask-to-face seal with the bag-mask device. Assuming that you have the proper equipment, which of the following techniques to secure a patent airway would be MOST appropriate? A) Transillumination intubation B) Blind nasotracheal intubation C) An open or needle cricothyrotomy D) Further attempts at orotracheal intubation
A) Transillumination intubation
An intubated 33-year-old man is becoming agitated and begins moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should: A) administer a sedative medication. B) suction his airway and carefully extubate. C) chemically paralyze him with vecuronium. D) physically restrain his head to the stretcher.
A) administer a sedative medication.
Compared with an open cricothyrotomy, needle cricothyrotomy: A) allows for subsequent attempts to intubate the patient. B) requires the paramedic to manipulate the patient's cervical spine. C) is technically more difficult and takes longer to perform. D) is associated with a higher risk of damage to adjacent structures.
A) allows for subsequent attempts to intubate the patient.
The MOST common complication associated with nasotracheal intubation is: A) bleeding. B) aspiration. C) hypoxemia. D) regurgitation
A) bleeding.
When determining whether transillumination-guided intubation should be attempted, you should: A) consider the amount of soft tissue that is overlying the trachea. B) avoid the procedure if the patient is thin or is greater than 6 ft tall. C) ensure the airway is clear of secretions by suctioning for 30 seconds. D) recall that patients with short necks are often easy to transilluminate.
A) consider the amount of soft tissue that is overlying the trachea.
The main disadvantage of the LMA is that it: A) does not provide protection against aspiration. B) spontaneously dislodges in the majority of patients. C) is associated with significant upper airway swelling. D) is technically more difficult to perform than intubation.
A) does not provide protection against aspiration.
Multilumen airways are contraindicated in patients with: A) esophageal cancer. B) cervical spine trauma. C) traumatic cardiac arrest. D) a history of gastric ulcers.
A) esophageal cancer.
Drugs such as vecuronium bromide (Norcuron) and pancuronium bromide (Pavulon) are MOST appropriate to administer when: A) extended periods of paralysis are needed. B) longer-acting paralytics are contraindicated. C) you have a transport time of less than 15 minutes. D) intubation of the patient is anticipated to be difficult.
A) extended periods of paralysis are needed.
Appropriate insertion of a soft-tip (whistle-tip) suction catheter down the ET tube involves: A) gently inserting the catheter until resistance is felt. B) inserting the catheter until secretions are observed. C) inserting the catheter no farther than 6 to 8 in. D) applying suction while gently inserting the catheter.
A) gently inserting the catheter until resistance is felt.
When a patient is given a paralytic without sedation: A) he or she is fully aware and can hear and feel. B) you should only give one tenth of the standard dose. C) placement of an ET tube is less traumatic. D) paralysis is not achieved and intubation is not possible.
A) he or she is fully aware and can hear and feel.
The MOST significant complication associated with digital intubation is: A) hypoxia. B) dental trauma. C) airway swelling. D) vocal cord damage.
A) hypoxia.
You are intubating a 60-year-old man in cardiac arrest and have visualized the ET tube passing between the vocal cords. After removing the laryngoscope blade from the patient's mouth, manually stabilizing the tube, and removing the stylet, you should: A) inflate the distal cuff with 5 to 10 mL of air. B) attach an ETCO2 detector to the tube. C) secure the ET tube with a commercial device. D) begin ventilations and auscultate breath sounds.
A) inflate the distal cuff with 5 to 10 mL of air.
Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because: A) it must be performed on spontaneously breathing patients. B) the procedure should be performed in less than 10 seconds. C) it does not involve direct visualization of the vocal cords. D) patients requiring nasotracheal intubation are usually stable
A) it must be performed on spontaneously breathing patients.
The MOST effective way to minimize the risk of hypoxia while intubating a child is to: A) limit your intubation attempt to 20 seconds. B) monitor the child's cardiac rhythm at all times. C) premedicate the child with 0.02 mg/kg of atropine. D) not allow the oxygen saturation to fall below 100%.
A) limit your intubation attempt to 20 seconds.
Incising the cricothyroid membrane vertically will: A) minimize the risk of damaging the thyroid gland. B) facilitate insertion of an 8.0- to 9.0-mm ET tube. C) completely eliminate the risk of any external bleeding. D) increase the risk of damaging the external jugular veins.
A) minimize the risk of damaging the thyroid gland.
Fentanyl (Sublimaze) is a: A) narcotic analgesic. B) benzodiazepine sedative. C) sedative-hypnotic drug. D) butrophenone sedative.
A) narcotic analgesic.
The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because: A) no important structures lie between the skin covering the cricothyroid membrane and the airway. B) the tough cartilage that comprises the cricothyroid membrane can easily be incised with a scalpel. C) there are no major blood vessels or other structures that lie adjacent to the cricothyroid membrane. D) the cricoid cartilage helps prevent accidental perforation through the back of the airway and into
A) no important structures lie between the skin covering the cricothyroid membrane and the airway.
During ventilation with the LMA, the paramedic should: A) observe the patient for signs of inadequate ventilation. B) maintain the patient's head in a slightly flexed position. C) suction the patient's oropharynx at least every 2 minutes. D) hyperventilate the patient to maximize tidal volume delivery.
A) observe the patient for signs of inadequate ventilation.
When preoxygenating an uninjured child prior to ET intubation, you should: A) place the child's head in the sniffing position, insert an oral airway if needed, and ventilate with a bag-mask for at least 2 minutes. B) hyperextend the child's head, insert an oral airway if needed, and hyperventilate the child at 40 breaths/min for at least 2 to 3 minutes. C) maintain the child's head in a neutral position, insert an oral airway if needed, and deliver 1 breath every 10 seconds for at least 3 minutes. D) place the child's head in the sniffing position, insert an oral airway if needed, and moderately hyperventilate the child at 24 breaths/min for 30 seconds.
A) place the child's head in the sniffing position, insert an oral airway if needed, and ventilate with a bag-mask for at least 2 minutes.
The use of phenylephrine hydrochloride (Neo-Synephrine) during nasotracheal intubation will: A) reduce the likelihood and severity of nasal bleeding. B) sedate the patient and facilitate his or her compliance. C) dilate the nasal vasculature and facilitate tube insertion. D) anesthetize the nasopharynx and reduce patient discomfort.
A) reduce the likelihood and severity of nasal bleeding.
Undersedation of a patient during airway management would likely result in all of the following, EXCEPT: A) respiratory depression. B) trauma to the airway. C) poor patient compliance. D) tachycardia and hypertension.
A) respiratory depression.
When intubating a 3-year-old child, you would MOST likely use a: A) size 2 straight blade. B) 6.5-mm uncuffed ET tube. C) 5.0-mm cuffed ET tube. D) size 1 curved blade.
A) size 2 straight blade.
Digital intubation can be performed on trauma patients because: A) the head does not have to be placed in a sniffing position. B) most trauma patients have distortion of the airway anatomy. C) orotracheal intubation is unsafe to perform on trauma patients. D) the technique is easier to perform than other forms of intubation.
A) the head does not have to be placed in a sniffing position.
Digital intubation should be performed only on a patient who has a bite block inserted in his or her mouth and who is_______ and _______. A) unconscious, apneic B) stuporous, bradypneic C) comatose, breathing inadequately D) semiconscious, tachypneic
A) unconscious, apneic
The external jugular veins run ____________ and are located ____________ to the cricothyroid membrane. A) vertically, lateral B) vertically, medial C) horizontally, lateral D) horizontally, medial
A) vertically, lateral
The King airway should NOT be used in patients: A) with known esophageal disease. B) with prolonged cardiac arrest. C) with a traumatic brain injury. D) who weigh less than 25 kg.
A) with known esophageal disease.
To prevent muscular fasciculations associated with the use of succinylcholine, you should administer: A) 0.5 mg of atropine sulfate via rapid IV push. B) 10% of the usual dose of a nondepolarizing paralytic. C) an infusion of potassium chloride set at 5 mEq per hour. D) 1 to 1.5 mg/kg of lidocaine over 10 to 15 minutes.
B) 10% of the usual dose of a nondepolarizing paralytic.
Approximately how far should you insert a 5.0-mm ET tube in a 4-year-old child? A) 12 cm B) 15 cm C) 17 cm D) 19 cm
B) 15 cm
In which of the following situations would ET intubation of a pediatric patient be LEAST necessary? A) Traumatic brain injury with unconsciousness B) Administration of certain resuscitative medications C) Cardiopulmonary arrest due to respiratory failure D) Difficulty effectively ventilating with a bag-mask
B) Administration of certain resuscitative medications
Which of the following is NOT an appropriate method for confirming proper ET tube placement in a 15-kg child? A) Waveform capnography B) Esophageal bulb or syringe C) Bilateral auscultation of breath sounds D) Assessment of skin color and oxygen saturation
B) Esophageal bulb or syringe
Which of the following represents the MOST correct technique for performing transillumination-guided intubation? A) Place the patient's head in a hyperflexed position and insert the tube-stylet combination into the left side of the mouth. B) Grasp the lower jaw with your thumb and forefinger, displace it forward, and insert the tube-stylet combination in the midline of the patient's mouth. C) Hyperextend the patient's head, pull the jaw down, and insert the tube-stylet combination into the right side of the patient's mouth. D) Place the patient's head in a neutral position, displace the tongue with a tongue blade, and insert the tube-stylet combination in the midline of the mouth.
B) Grasp the lower jaw with your thumb and forefinger, displace it forward, and insert the tube-stylet combination in the midline of the patient's mouth.
While transporting an intubated 8-year-old boy, he suddenly jerks his head and becomes cyanotic shortly thereafter. His oxygen saturation and capnometry readings are both falling, and he is becoming bradycardic. You attempt to auscultate breath sounds, but are unable to hear because of the drone of the engine. What has MOST likely happened? A) Tension pneumothorax B) Inadvertent extubation C) Obstruction of the tube D) Right mainstem intubation
B) Inadvertent extubation
Which of the following medications has been shown to blunt the increase in intracranial pressure associated with suctioning and laryngeal stimulation? A) Atropine B) Lidocaine C) Amiodarone D) Furosemide
B) Lidocaine
Which of the following is NOT a contraindication for nasotracheal intubation? A) Apnea B) Spinal injury C) Frequent use of cocaine D) Patients taking an anticoagulant
B) Spinal injury
Which of the following clinical findings is LEAST suggestive of a pneumothorax in an intubated child? A) Decreased ventilation compliance B) Stronger breath sounds on the right side C) Persistent cyanosis despite ventilations D) Stronger breath sounds on the left side
B) Stronger breath sounds on the right side
Which of the following is NOT characteristic of a depolarizing neuromuscular blocking agent? A) Bradycardia B) Tachycardia C) Muscle fasciculations D) Short duration of action
B) Tachycardia
If the patient's oxygen saturation drops at any point during rapid-sequence intubation, you should: A) stop and hyperventilate the patient at a rate of 24 breaths/min. B) abort the intubation attempt and ventilate with a bag-mask device. C) apply posterior cricoid pressure and continue the intubation attempt. D) continue the intubation attempt and monitor the cardiac rhythm closely.
B) abort the intubation attempt and ventilate with a bag-mask device.
The LMA is: A) a suitable airway device for use in morbidly obese patients. B) an alternative to bag-mask ventilation when intubation is not possible. C) associated with a higher risk of damage to the vocal cords than intubation. D) especially effective for CHF patients who require high pulmonary pressures.
B) an alternative to bag-mask ventilation when intubation is not possible
Diazepam and midazolam provide all of the following therapeutic effects, EXCEPT: A) sedation. B) analgesia. C) anxiolysis. D) retrograde amnesia.
B) analgesia.
Open cricothyrotomy is generally contraindicated in all of the following situations, EXCEPT: A) tracheal tumors or subglottic stenosis. B) any patient who is younger than 16 years of age. C) crushing laryngeal injuries or tracheal transection. D) inability to identify the correct anatomic landmarks.
B) any patient who is younger than 16 years of age
Because the high-pressure ventilator used with needle cricothyrotomy would cause an increase in intrathoracic pressure, ___________ and ___________ may result. A) hypercarbia, hypoxia B) barotrauma, pneumothorax C) hypoventilation, hypocarbia D) esophageal rupture, hemorrhage
B) barotrauma, pneumothorax
You have just inserted a Combitube in a 59-year-old cardiac arrest patient. You attach the bag-mask device to the pharyngeal (blue) tube, begin ventilations, and note the presence of bilaterally equal breath sounds, absent epigastric sounds, and visible chest rise. You should: A) perform laryngoscopy to visualize placement of the Combitube. B) continue to ventilate and use additional confirmation techniques. C) continue ventilating the patient at a rate of 10 to 12 breaths/min. D) ventilate through the clear tube and auscultate all four lung fields.
B) continue to ventilate and use additional confirmation techniques.
Neuromuscular blocking agents: A) are most commonly used as the sole agent to facilitate placement of an ET tube. B) convert a breathing patient with a marginal airway into an apneic patient with no airway. C) induce total body paralysis within 10 to 15 minutes following administration via IV push. D) have a negative effect on both cardiac and smooth muscle and commonly cause dysrhythmias.
B) convert a breathing patient with a marginal airway into an apneic patient with no airway.
If used properly, and under the correct circumstances, sedation during airway management: A) chemically paralyzes the patient, thus facilitating placement of an advanced airway device. B) effectively increases patient compliance, thus making definitive airway management safer to perform. C) significantly reduces the pain and discomfort associated with laryngoscopy and ET intubation. D) minimizes the risks of bradycardia and hypotension that occasionally occur during advanced airway management.
B) effectively increases patient compliance, thus making definitive airway management safer to perform.
In contrast to a needle cricothyrotomy, an open cricothyrotomy: A) involves the use of a high-pressure jet ventilator. B) enables the paramedic to provide greater tidal volume. C) is the preferred technique in patients with short, fat necks. D) is easier to perform in children younger than 8 years of age.
B) enables the paramedic to provide greater tidal volume.
After confirming that an intubated patient remains responsive enough to maintain his or her own airway, you should first: A) fully deflate the distal cuff on the ET tube. B) have the patient sit up or lean slightly forward. C) suction the oropharynx to remove any secretions. D) insert an orogastric tube to ensure the stomach is empty.
B) have the patient sit up or lean slightly forward.
When correctly placed, the distal tip of the Cobra perilaryngeal airway (CobraPLA): A) enters the esophagus and provides complete obturation. B) is proximal to the esophagus and seals the hypopharynx. C) is in almost perfect alignment with the esophageal opening. D) rests against the arytenoid cartilage and enters the glottis.
B) is proximal to the esophagus and seals the hypopharynx.
Digital intubation is absolutely contraindicated if the patient: A) has copious airway secretions. B) is unconscious but breathing. C) is trapped in a confined space. D) is extremely obese or has a short neck.
B) is unconscious but breathing.
The King LT airway can be used to: A) administer certain cardiac medications directly into the trachea. B) maintain a patent airway in spontaneously breathing patients. C) establish a patent airway in patients of any age and body size. D) suction pulmonary secretions from the tracheobronchial tree.
B) maintain a patent airway in spontaneously breathing patients.
Needle cricothyrotomy is contraindicated in patients with: A) uncontrolled oropharyngeal bleeding. B) obstruction above the catheter insertion site. C) massive maxillofacial trauma and trismus. D) a suspected injury to the cervical spine.
B) obstruction above the catheter insertion site.
The MOST obvious risk associated with extubation is: A) moderate airway swelling as the ET tube is removed. B) overestimating the patient's ability to protect his or her own airway. C) patient retching and gagging as you remove the ET tube. D) stimulation of the parasympathetic nervous system with resulting bradycardia.
B) overestimating the patient's ability to protect his or her own airway.
You are caring for a 69-year-old man with congestive heart failure. His breathing is profoundly labored, his oxygen saturation reads 79% on oxygen via nonrebreathing mask, and he is showing signs of physical exhaustion. Considering that your protocols do not allow you to perform rapid-sequence intubation, you should: A) insert an oral airway, assist ventilations with a bag-mask device, and transport at once. B) preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation. C) give him Valium for sedation, perform orotracheal intubation, and transport to the hospital at once. D) insert a nasopharyngeal airway and ensure that the nonrebreathing mask is tightly secured to his face.
B) preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation.
Proper placement of the King LT airway is performed by all of the following techniques, EXCEPT: A) auscultation of bilateral breath sounds. B) the esophageal detector device. C) quantitative waveform capnography. D) observation for symmetrical chest rise.
B) the esophageal detector device.
The MOST significant complication associated with the use of multilumen airways is: A) laryngospasm or vomiting during insertion of the tube. B) unrecognized displacement of the tube into the esophagus. C) vocal cord damage if the tube inadvertently enters the trachea. D) pharyngeal or esophageal trauma secondary to poor technique.
B) unrecognized displacement of the tube into the esophagus.
When nasally intubating a patient, the ET tube is advanced: A) as the patient exhales. B) when the patient inhales. C) when the patient swallows. D) in between the patient's breaths.
B) when the patient inhales.
In general, a multilumen airway should not be used in patients who are: A) greater than 6 ft tall. B) younger than 16 years of age. C) older than 65 years of age. D) less than 4 ft 5 in tall.
B) younger than 16 years of age.
In some cases, atropine sulfate, in a dose of ______, may be given to children to prevent vagal-induced bradycardia during ET intubation. A) 0.5 mg B) 1 to 2 mg C) 0.02 mg/kg D) at least 0.01 mg
C) 0.02 mg/kg
Which of the following medications does NOT possess hypnotic properties? A) Versed B) Brevital C) Alfentanil D) Etomidate
C) Alfentanil
Which of the following statements regarding pediatric ET intubation in the prehospital setting is correct? A) An average-sized toddler would require a 4.5-mm cuffed ET tube to secure the airway adequately. B) When intubating an infant or small child, it is important to remember that the epiglottis is less floppy. C) Bag-mask ventilation can be as effective as intubation for EMS systems that have short transport times. D) Because the pediatric airway is smaller than an adult's, paramedics should routinely intubate children in the field.
C) Bag-mask ventilation can be as effective as intubation for EMS systems that have short transport times.
Which of the following is NOT a step that is performed during nasotracheal intubation? A) Advancing the ET tube as the patient inhales B) Preoxygenating with a bag-mask as necessary C) Ensuring that the patient's head is hyperflexed D) Placing the patient's head in a neutral position
C) Ensuring that the patient's head is hyperflexed
Which of the following statements regarding multilumen airways is correct? A) Multilumen airways can be used safely in pediatric patients if ET intubation is unsuccessful. B) To ensure proper placement, multilumen airways should be inserted under direct laryngoscopy. C) Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal. D) Compared with esophageal airways, multilumen airway devices have not been shown to provide better ventilation.
C) Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal
Which of the following indicates that the lighted stylet has entered the trachea? A) Dim, diffuse light at the anterior part of the neck B) Bulging of the soft tissue above the thyroid cartilage C) Tightly circumscribed light below the thyroid cartilage D) Absent illumination at the midline of the patient's neck
C) Tightly circumscribed light below the thyroid cartilage
You have intubated a 70-year-old man with chronic bronchitis and are en route to the hospital. During transport, you note that ventilations are becoming increasingly difficult and the digital capnometry reading is falling. Your partner tells you that she can still hear bilaterally equal breath sounds, but they are faint. She further tells you that there are no sounds over the epigastrium. What intervention is MOST likely indicated for this patient? A) Immediate extubation B) Withdrawing the tube 2 cm C) Tracheobronchial suctioning D) Hyperventilation at 24 breaths/min
C) Tracheobronchial suctioning
Which of the following statements regarding translaryngeal catheter ventilation is correct? A) It is more difficult to perform than an open cricothyrotomy. B) It provides a more definitive airway than an open cricothyrotomy. C) Ventilation is achieved by the use of a high-pressure jet ventilator. D) The technique uses the tracheal wall as an entry point to the airway.
C) Ventilation is achieved by the use of a high-pressure jet ventilator.
Before intubating a patient who has been chemically sedated and paralyzed, it is MOST important for the paramedic to: A) administer 0.5 mg of atropine sulfate. B) hyperventilate the patient at 24 breaths/min. C) adequately preoxygenate with 100% oxygen. D) suction the oropharynx to clear any secretions.
C) adequately preoxygenate with 100% oxygen.
The King LT-D airway features a: A) straight tube with two inflatable cuffs that hold an equal amount of air. B) port through which gastric contents can be suctioned from the stomach. C) curved tube with ventilation ports located between two inflatable cuffs. D) universal size with two inflation ports and is used for patients of any age.
C) curved tube with ventilation ports located between two inflatable cuffs.
Paralytic medications exert their effect by: A) blocking the release of epinephrine and norepinephrine from the sympathetic nervous system. B) competitively binding to the motor neurons in the brain, thus blocking their ability to send messages. C) functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine. D) blocking the function of the autonomic nervous system and impeding the action of acetylcholinesterase.
C) functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine.
The paramedic should be especially diligent when confirming tube placement following blind nasotracheal intubation because: A) the ET tube cannot be secured effectively when it is in the nose. B) most patients who are intubated nasally are extremely combative. C) he or she did not visualize the tube passing between the vocal cords. D) most nasotracheal intubation attempts result in esophageal placement.
C) he or she did not visualize the tube passing between the vocal cords.
Transillumination-guided intubation can be difficult or impossible to perform: A) in any patient with dentures. B) if the patient has oral secretions. C) in a brightly lit environment. D) in patients over 70 years of age.
C) in a brightly lit environment.
After inserting the Combitube to the proper depth, you should next: A) inflate the distal cuff with 5 mL of air. B) ventilate through the pharyngeal tube. C) inflate the pharyngeal cuff with 100 mL of air. D) apply a cervical collar to minimize head movement.
C) inflate the pharyngeal cuff with 100 mL of air.
After inserting the needle into through the cricothyroid membrane, you should next: A) change your angle to 90° and advance the catheter over the needle. B) aspirate with the syringe and then insert the needle about 2 cm farther. C) insert the needle about 1 cm farther and then aspirate with the syringe. D) advance the catheter over the needle until the hub is flush with the skin.
C) insert the needle about 1 cm farther and then aspirate with the syringe.
During tracheobronchial suctioning, it is MOST important to: A) apply suction for no longer than 5 seconds in the adult. B) avoid rotating the catheter as you are suctioning the trachea. C) monitor the patient's cardiac rhythm and oxygen saturation. D) inject 10 mL of saline down the ET tube to loosen secretions.
C) monitor the patient's cardiac rhythm and oxygen saturation.
When performing an open cricothyrotomy, you should FIRST: A) maintain aseptic technique as you cleanse the area with iodine. B) slide your index finger between the thyroid and cricoid cartilages. C) palpate for the V notch of the thyroid cartilage and stabilize the larynx. D) hyperextend the patient's neck and then palpate the cricoid cartilage.
C) palpate for the V notch of the thyroid cartilage and stabilize the larynx.
You should turn the jet ventilator release valve off when: A) the audible alarm sounds. B) wide chest expansion is noted. C) the patient's chest visibly rises. D) you can auscultate breath sounds.
C) the patient's chest visibly rises.
When intubating a 3-year-old child, you should insert the ET tube until: A) the distal cuff is 1 to 2 cm beyond the vocal cords. B) you meet resistance, and then withdraw the tube 2 cm. C) the vocal cord mark is 2 to 3 cm beyond the vocal cords. D) the cm marking on the tube reads 15 cm at the child's lips.
C) the vocal cord mark is 2 to 3 cm beyond the vocal cords.
A size 3 or 4 LMA: A) is most suitable for use in morbidly obese patients. B) is less likely to become dislodged than smaller sizes. C) will accommodate the passage of a 6.0-mm ET tube. D) is appropriate to use in children younger than 6 years of age.
C) will accommodate the passage of a 6.0-mm ET tube.
Open cricothyrotomy is indicated when: A) ET intubation is unsuccessful after three attempts. B) all other methods of advanced airway management have failed. C) you are unable to secure a patent airway with less invasive means. D) the patient has a head injury that precludes nasotracheal intubation.
C) you are unable to secure a patent airway with less invasive means.
If you see a soft-tissue bulge on either side of the airway when performing nasotracheal intubation: A) inadvertent esophageal intubation has likely occurred. B) you should completely remove the tube and reoxygenate. C) you have probably inserted the tube into the pyriform fossa. D) the tube is positioned correctly just above the glottic opening.
C) you have probably inserted the tube into the pyriform fossa.
