Chapter 11 Airway Management

The EMT should assess a patient's tidal volume by: A. observing for adequate chest rise. B. assessing the facial area for cyanosis. C. counting the patient's respiratory rate. D. measuring the patient's oxygen saturation.

Answer: A Rationale: Tidal volume—the volume of air that is moved into or out of the lungs in a single breath—is assessed by observing for adequate chest rise. If shallow chest rise is noted, the patient's tidal volume is likely reduced.

During insertion of an oropharyngeal airway into an unconscious patient, she begins to vomit. The first thing you should do is: A. turn the patient on her side. B. remove the airway at once. C. suction the patient's mouth. D. use a smaller-sized oral airway.

Answer: A Rationale: Whenever an unconscious patient begins to vomit—whether you are inserting an oropharyngeal airway or not—you should immediately turn the patient onto his or her side; this will allow drainage of vomit from the mouth and prevent aspiration. After the patient is on his or her side, remove the oral airway and suction the mouth.

You and your partner are ventilating an apneic adult when you notice that his stomach is becoming distended. You should: A. suction his airway for up to 15 seconds. B. reposition his head. C. increase the rate and volume of your ventilations. D. decrease your ventilation rate but use more volume.

Answer: B Rationale: Gastric distention occurs when air enters the stomach. Severe gastric distention can result in vomiting and aspiration if not recognized and treated. To minimize the amount of air that enters the stomach during ventilations, you should reposition the patient's head.

Signs of adequate breathing in the adult include all of the following, EXCEPT: A. pink, warm, dry skin. B. shallow chest rise. C. symmetrical chest movement. D. a respiratory rate of 16 breaths/min.

Answer: B Rationale: Signs of inadequate breathing in the adult include a respiratory rate less than 12 breaths/min or greater than 20 breaths/min, shallow chest rise (reduced tidal volume), cyanosis, and asymmetrical chest movement (both sides of the chest do not move equally).

Breathing is controlled by an area in the: A. lungs. B. brainstem. C. spinal cord. D. diaphragm.

Answer: B Rationale: The pons and the medulla are the respiratory centers in the brainstem that control breathing.

You are delivering oxygen to a patient with a nasal cannula at 4 L/min when he begins to complain of a burning sensation in his nose. You should: A. remove the nasal cannula. B. apply a nonrebreathing mask. C. attach an oxygen humidifier. D. increase the flow rate to 6 L/min.

Answer: C Rationale: Administering "dry" oxygen through a nasal cannula—especially over a prolonged period of time—can result in drying of the nasal membranes, in which case the patient might complain of a burning sensation in the nose. Humidified oxygen will serve to keep the nasal membranes moist.

In which of the following patients would a nasopharyngeal airway be contraindicated? A. A semiconscious patient with a gag reflex B. An unconscious patient with an intact gag reflex C. A patient who fell 20 feet and landed on his or her head D. An unconscious patient who gags when you insert an oral airway

Answer: C Rationale: Nasopharyngeal (nasal) airways are contraindicated in patients with severe head or facial injuries and should be used with caution in patients who have delicate nasal membranes or are prone to nosebleeds. The nasal airway is better tolerated in patients who are semiconscious and/or those with a gag reflex.

In an otherwise healthy individual, the primary stimulus to breathe is a(n): A. increased level of oxygen in the blood. B. decreased level of oxygen in the blood. C. increased level of carbon dioxide in the blood. D. decreased level of carbon dioxide in the blood.

Answer: C Rationale: Under control of the brainstem, rising levels of carbon dioxide in arterial blood normally stimulate breathing in an otherwise healthy patient.

A patient is found unconscious after falling from a third-floor window. His respirations are slow and irregular. You should: A. place him in the recovery position. B. apply oxygen via a nonrebreathing mask. C. suction his airway for up to 15 seconds. D. assist his breathing with a bag-mask device.

Answer: D Rationale: The patient is not breathing adequately. Slow, irregular respirations will not result in adequate oxygenation. You should assist the patient's breathing with a bag-mask device attached to 100% oxygen. Suctioning is indicated if the patient has blood or other liquids in the airway; there is no evidence of this in the scenario.

When ventilating an apneic adult with a bag-mask device, you should squeeze the bag: A. until it is empty. B. over a period of 2 seconds. C. at a rate of 20 breaths/min. D. until visible chest rise is noted.

Answer: D Rationale: When ventilating any apneic patient with a bag-mask device, you should squeeze the bag over a period of 1 second and observe for visible chest rise. Ventilate the apneic adult at a rate of 10 breaths/min (one breath every 6 seconds). Ventilate infants and children at a rate of 20 to 30 breaths/min (one breath every 2 to 3 seconds).

For which of the following conditions would the EMT most likely administer humidified oxygen? a. Croup b. Blood loss c. Hypoxia d. Apnea

a. Croup

The nasopharyngeal airway is MOST beneficial because it: a. can maintain a patent airway in a semiconscious patient with a gag reflex. b. effectively maintains the airway of a patient in cardiopulmonary arrest. c. can effectively stabilize fractured nasal bones if it is inserted properly. d. is generally well tolerated in conscious patients with an intact gag reflex.

a. can maintain a patent airway in a semiconscious patient with a gag reflex.

The presence of elevated carbon dioxide levels in the blood is called: a. hypercarbia. b. acidosis. c. hypoxia. d. hypoxemia.

a. hypercarbia.

The MOST serious complication associated with using a nasopharyngeal airway in a patient with trauma to the head or face is: a. penetrating the cranium. b. causing severe bleeding. c. damaging the turbinates. d. fracturing the septum.

a. penetrating the cranium.

A man was found unresponsive in his bed at home. There is no evidence of injury, and the patient's medical history is not known. The patient's face is cherry red, yet the pulse oximeter reads 98%. Which of the following would MOST likely explain this? a. Increased body temperature b. Carbon monoxide poisoning c. Severe pulmonary edema d. Cold extremities

b. Carbon monoxide poisoning

Which of the following statements regarding normal gas exchange in the lungs is correct? a. The oxygen content in the alveoli is highest during the exhalation phase. b. Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries. c. The actual exchange of oxygen and carbon dioxide occurs in the capillaries. d. Blood that returns to the lungs from the body has low levels of carbon dioxide.

b. Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries.

High-flow oxygen with a nasal cannula during the preoxygenation phase of endotracheal intubation is called: a. active ventilation. b. apneic oxygenation. c. denitrogenation. d. passive ventilation.

b. apneic oxygenation.

You and your partner are treating a 66-year-old man who experienced a sudden onset of respiratory distress. He is conscious but is unable to follow simple verbal commands. Further assessment reveals that his breathing is severely labored and his oxygen saturation is 80%. You should: a. administer continuous positive airway pressure. b. assist his ventilations with a bag-mask device. c. apply high-flow oxygen via nonrebreathing mask. d. attempt to insert an oropharyngeal airway.

b. assist his ventilations with a bag-mask device.

Which of the following statements regarding the one-person bag-mask technique is correct? a. The C-clamp method of holding the mask to the face is not effective when ventilating a patient with a bag-mask device. b. Bag-mask ventilations should be delivered every 2 seconds when the device is being operated by one person. c. Adequate tidal volume is often difficult to achieve when one EMT is operating the bag-mask device. d. The bag-mask device delivers more tidal volume and a higher oxygen concentration than the mouth-to-mask technique.

c. Adequate tidal volume is often difficult to achieve when one EMT is operating the bag-mask device.

The actual exchange of oxygen and carbon dioxide occurs in the: a. pulmonary capillaries. b. apex of the lung. c. alveolar sacs. d. bronchioles.

c. alveolar sacs.

Each cell of the body combines nutrients and oxygen and produces energy and waste products through a process called: a. ventilation. b. oxygenation. c. metabolism. d. respiration.

c. metabolism.

Proper technique for suctioning the oropharynx of an adult patient includes: a. suctioning for up to 1 minute if the patient is well oxygenated. b. continuously suctioning patients with copious oral secretions. c. suctioning while withdrawing the catheter from the oropharynx. d. removing large, solid objects with a tonsil-tip suction catheter.

c. suctioning while withdrawing the catheter from the oropharynx.

The nasal cannula is MOST appropriately used in the prehospital setting: a. if long-term supplemental oxygen administration is required. b. when the patient breathes primarily through his or her mouth. c. when the patient cannot tolerate a nonrebreathing mask. d. if the patient's nasopharynx is obstructed by secretions.

c. when the patient cannot tolerate a nonrebreathing mask.

With a good mask-to-face seal and an oxygen flow rate of 15 L/min, the nonrebreathing mask is capable of delivering up to ______% inspired oxygen. a. 80 b. 70 c. 100 d. 90

d. 90

Which of the following patients should you place in the recovery position? a. A 24-year-old unconscious female who overdosed and has a reduced tidal volume b. A 40-year-old conscious female with a possible neck injury and regular respirations c. A 19-year-old conscious male with a closed head injury and normal respirations d. A 31-year-old semiconscious male with low blood sugar and adequate breathing

d. A 31-year-old semiconscious male with low blood sugar and adequate breathing

Based on current guidelines, in which of the following situations should supplemental oxygen be administered? a. Any diabetic patient whose oxygen saturation is less than 98% b. Signs of myocardial infarction and an oxygen saturation of 97% c. Any elderly patient whose oxygen saturation is less than 95% d. Exposure to carbon monoxide and an oxygen saturation of 94%

d. Exposure to carbon monoxide and an oxygen saturation of 94%

Which of the following statements regarding oxygenation and ventilation is correct? a. Oxygenation without adequate ventilation can occur in climbers who quickly ascend to an altitude of lower atmospheric pressure. b. Oxygenation is the movement of air into and out of the lungs, whereas ventilation is the exchange of gases. c. In carbon monoxide (CO) poisoning, ventilation is impaired because CO binds to oxygen very quickly. d. In mines or confined places, where oxygen levels are low, ventilation may continue despite inadequate oxygenation.

d. In mines or confined places, where oxygen levels are low, ventilation may continue despite inadequate oxygenation.

A 51-year-old female presents with a sudden onset of difficulty breathing. She is conscious and alert and able to speak in complete sentences. Her respirations are 22 breaths/min and regular. You should: a. assist her ventilations with a bag-mask device. b. perform a secondary assessment and then begin treatment. c. insert a nasal airway in case her mental status decreases. d. administer oxygen via a nonrebreathing mask.

d. administer oxygen via a nonrebreathing mask.

In contrast to inhalation, exhalation: a. is an active process caused by decreased intrathoracic pressure. b. requires muscular effort to effectively expel air from the lungs. c. occurs when the diaphragm lowers and expels air from the lungs. d. is a passive process caused by increased intrathoracic pressure.

d. is a passive process caused by increased intrathoracic pressure.

You are ventilating an apneic woman with a bag-mask device. She has dentures, which are tight fitting. Adequate chest rise is present with each ventilation, and the patient's oxygen saturation reads 96%. When you reassess the patency of her airway, you note that her dentures are now loose, although your ventilations are still producing adequate chest rise. You should: a. leave her dentures in place, but carefully monitor her for an airway obstruction. b. attempt to replace her dentures so that they fit tightly and resume ventilations. c. leave her dentures in place and increase the rate and volume of your ventilations. d. remove her dentures, resume ventilations, and assess for adequate chest rise.

d. remove her dentures, resume ventilations, and assess for adequate chest rise.