CH 11- Airway Management
The partial pressure of oxygen in the alevoli is ____ mm Hg; the partial pressure of carbon dioxide in the alveoli is ____ mm Hg
104, 40
An adult at rest should have a respiratory rate that ranges between
12 and 20 breaths/min
The pressure of gas in a full cylinder of oxygen is approximately ____ pounds per square inch (psi)
2,000
When testing a mechanical suctioning unit, you should turn on the device, clamp the tubing, and ensure that it generates a vacuum pressure of more than
300 mm Hg
At a flow rate of 6L/min, nasal cannula can deliver an approximate oxygen concentration of up to:
44%
What is the alveolar minute volume of a patient with a tidal volume of 500 mL, a dead space volume of 150 mL, and a respiratory rate of 16 breaths/min?
5,600 mL
An oxygen cylinder should be taken out of service and refilled when the pressure inside it is less than
500 psi
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
90
The nasal cannula is MOST appropriately used in the prehospital setting
when the patient cannot tolerate a nonrebreathing mask
Which of the following statements regarding normal gas exchange in the lungs is correct?
Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries
Which of the following statements regarding breathing adequately is correct?
Patients breathing shallowly may require assisted ventilation despite a normal respiratory rate
A conscious and aler 28-year-old male complains of difficulty breathing. His respirations are 30 with accessory muscle use. His tidal volumes appear adequate. What should you do?
Provide oxygen via nonrebreathing mask
Intrapulmonary shunting occurs when
blood coming from the right side of the hear bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state
Which of the following oxygen flowmeters is NOT affected by gravity and can be used in any position when attatched to an oxygen cylinder?
bourdon-gauge flowmeter
You are responding to a 9-year-old female having an asthma attack. On arrival, the school nurse informs you that she gave the patients 2 puffs from her albuterol inhaler. You recall that this medication causes smooth muscle relaxation and dilation of the airways. In what portion of the lower airway does this medication act?
bronchioles
Which of the following structures is NOT found in the upper airway
bronchus
Which of the following would cause an increase in the amount of exhaled carbon dioxide?
increased cardiac output
Tidal volume is defined as the volume of air that
moves into or out of the lungs in a single breath
Which of the following organs or tissues can survive the longest without oxygen?
muscle
A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a
nonrebreathing mask
Your patient is showing signs of severe respiratory distress. Which of the following would be the best choice for providing oxygen to the patient?
nonrebreathing mask with reservoir
Prior to applying a nonrebreathing mask to a patient, you must ensure that the
the reservior bag is fully inflated
What is the MOST common cause of airway obstruction in an unconscious patient?
the tongue
Which of the following patients should you place in the recovery position?
A 31-year-old semiconscious male with low blood sugar and adequate breathing
In which of the following patients would the head tilt-chin lift maneuver be the MOST appropriate method of opening the airway?
A 37-ear-old female who is found unconscious in her bed
Which of the following patients would MOST likely require insertion of an oropharyngeal airway?
A 40-year-old unconscious patient with slow, shallow respirations
Which of the following patients is breathing adequately?
A conscious malel with respirations of 19 breaths/ min and pink skin
What occurs when a patient is breathing very rapidly and shallowly?
Air moves primarly in the anatomic dead space and does not participate in pulmonary gas exchange
An alert 62-year-old male complains of respiratory distress. He speaks in two-to three-word sentences and has a history of heart failure and hypertension. Vital signs are BP 180/110, P 88, R 28 with rales, SpO2 82%. What should you do?
Assist ventilations with a bag-valve mask
For which of the following conditions would the EMT most liekly administer humidified oxygen?
Croup
Based on current guidelines, in which of the following situations should supplemental oxygen be administered?
Exposure to carbon monoxide and an oxygen saturation of 94%
Which of the following statements regarding oxygenation and ventilation is correct?
In mines or confined places, where oxygen levels are low, ventilation may continue despite inadequate oxygenation
You are dispatched to an apartment complex where a 21-year-old female has apparently overdosed on several narcotic medications. She is semiconscious and has slow, shallow respirations. What should you do?
Insert a nasopharyngeal airway and begin assisted ventilation
How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?
It forces the alveoli open and increases the concentration of oxygen in the alveoli
How does positive-pressure ventilation affect cardiac output?
It increases intrathoracic pressure, which decreases venous returns to the heart and causes a decrease in cardiac output
You are performing bag-mask ventilations with oxygen connected and set at a flow rate of 15 L/min. What percentage of xygen are you delivering?
Nearly 100%
While providng CPAP to a patient in severe respiratory distress, you note that his heart rate has increased by 20 beats/min. He is conscious but is not longer following verbal commands. You should
Remove the CPAP device and ventilate him with a bag-mask device
You arrive at the scene of a bike accident. A 45-year-old man is lying on the ground. He is unresponsive and has multiple scrapes and cuts on his arms and legs. You note that the patient has strong pulses but labored, snoring respirations. What should you do?
Use the jaw-thrust maneuver to open the patient's airway
Which of the following regarding positive-pressure ventilation is correct?
With positive-pressure ventilation, more volume is required to have the same effects as normal breathing
A ventilation/perfusion (V/Q ratio) mismatch occurs when
a disruption in blood flow inhibits the exchange of oxygen and carbon dioxide in the lungs, even though the alveoli are filled with fresh oxygen
During your assessment of a patient with respiratory distress, you hear wheezing when listening to breath sounds. This indicates
a lower airway obstruction
Which of the following is the MOST reliable indicator of adequately performed bag-mask ventilations in an apneic adult with a pulse?
adequate rise of the chest when squeezing the bag
Which of the following is a sign of abnormal breathing?
accessory muscle use
Gas exchange in the lungs is facilitated by
adequate amounts of surfactant
Which of the following statements regarding the one-person bag-mask technique is correct?
adequate tidal volume is often difficult to achieve when one EMT is operating the bag-mask device
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
administer oxygen via a nonrebreathing mask
In the prescence of oxygen, the cells convert glucose into energy through a process called
aerobic metabolism
Your protocols state that during the first few minutes of working on a cardiac arrest patient, you should provide passive ventilation. This means that you will
allow recoil of the chest between compressions to draw air into the lungs
A 23-year-old male experienced severe head trauma after his motorcycle collided with an oncoming truck. He is unconscious, has agonal gasps, and has copious bloody secretions in his mouth. How should you manage his airway?
alternative oropharyngeal suctioning and ventilation with a bag-mask device
The actual exchange of oxygen and carbon dioxide occurs in the
alveolar sacs
High-flow oxygen with a nasal cannula during the preoxugenation phase of endotracheal intubation is called
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
assist his ventilations with a bag-mask device
The nasopharyngeal airway is MOST beneficial because it
can maintain a patent airway in a semiconscious patient with a gag reflex
The primary waste product of aerobic metabolism is
carbon dioxide
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?
carbon monoxide poisoning
Oxygen toxicity is a condition in which
cellular tissue damage occurs from excessive oxygen levels in the blood
The jaw-thrust maneuver is used to open the airway of patients with suspected
cervical spine injuries
Irregular respirations characterized by an increasing rate and depth of breathing followed by periods of apnea are called
cheyne-stokes respirations
To select the proper size oropharyngeal airway, you should measure from the
corner of the mouth to the earlobe
The ____ cartilage is a firm ring that forms the inferior part of the larynx
cricoid
Which of the following is a late sign of hypoxia
cyanosis
Which of the following would NOT cause a decrease in tidal volume?
deep respirations
Inhalation occurs when the
diaphragm and intercostal muscles contract and cause a decrease in intrathoracic pressure
A 37-year-old male has an apparent foreign body airway obstruction. He is conscious and alert and is coughing forcefully. His skin is pink, warm, and moist. The MOST appropriate treatment for this patient includes
encouraging him to cough and transporting
The purpose of the pin-indecing system for compressed gas cynlinders is to
ensure that the correct regulator is used for the cylinder
Structures of the lower airway include all of the following except: bronchioles epiglottis trachea alveoli
epiglottis
The structure located superior to the larynx is called the
epiglottis
Which of the following structures is contained within the mediastinum?
esophagus
The exchange of carbon dioxide and oxygen in the alveli is know as
external respiration
The process of exchanging oxgen and carbon dioxide between the alveoli and the blood of the capillaries is called
external respiration
CPAP is indicated for patients who
have pulmonary edema and can follow verbal commands
The presence of elevated carbon dioxide levels in the blood is called
hypercarbia
The MOST significant complication assosciated with oropharyngeal suctioning is
hypoxia due to prolonged suction attempts
Hypoxia is MOST accurately defined as
inadequate oxygen to the tissues and cells
Without adequate oxygen, the body's cells
incompletely convert glucose into energy, and lactic acid accumulates in the blood
All of the following will help minimize the risk of gastric distention when ventilating an apneic patient with a bag-mask device EXCEPT
increasing the amount of delivered tidal volume
You and your partner are caring for a critically injured patient who is unresponsive and apneic. Your partner is controlling severe bleeding from the patient's lower extremities as you attmept ventilations with a bag-mask device. After repositioning the mask several times, you are unable to effectively ventilate the patient. You should
insert an oropharyngeal airway and reattempt ventilations
In contrast to inhalation, exhalation
is a passive process caused by increased intrathoracic pressure
You are dispatched to a residence where a middle-aged man was found unconscious in his front yard. There are no witnesses who can tell you what happened. You find him in a prone position; his eyes are closed and he is not moving. Your FIRST action should be to
log roll him as a unit to a supine position
The hypoxic drive is influenced by
low blood oxygen levels
Each cell of the body combines nutrients and oxygen and produces energy and waste products through a process called
metabolism
As the single EMT managing an apneic patient's airway, the preferred initial method of providing ventilations is the
mouth-to-mask technique with a one-way valve
Which of the following statements regarding oxygen is correct?
oxygen supports the combustion process and may cause a fire
The MOST serious complication associated with using a nasopharyngeal airway in a patient with trauma to the head or face is
penetrating the cranium
A 71-year-old male is semiconscious following a sudden, severe headache. There is vomitus on his face, and his respirations are slow and shallow. The EMT must immediately
perform oropharyngeal suctioning
The diaphragm is innervated by the ____ nerve, which allows it to contract
phrenic
You have inserted an oral airway and are ventilating an apneic woman with a bag-mask device. She suddenly begins regurgitating large amounts of vomit. You should
roll her onto her side and remove the oral airway
You are ventilating a 40-year-old uninjured man who is apneic but has a pulse. When your partner reassesses his blood pressure, he notes that it has decreased significantly from previous readings. You elevate the patient's legs, but this action has no effect. You should
reduce the rate or volume of the ventilations you are delivering
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
remove her dentures, resume ventilations, and assess for adequate chest rise
A 19 year old female is found unconscious by her roomate. Your primary assessment reveals that her breathing is inadequate. As you insert an oropharyngeal airway, she begins to gag violenty. You should
remove the airway and be prepared to suction her oropharynx
An unconscious patient found in a prone position must be placed in a supine position in case he or she
requires CPR
You are ventilating a patient with a stoma; however, air is escaping from the mouth and nose. To prevent this, you should
seal the mouth and nose
Which of the following factors will cause a reduction in minute volume in an adult?
shallow breathing
Central chemoreceptors located in the medulla provide feedback to increase the rate and depth of breathing when they sense
slight increases in carbon dioxide or a decrease in the pH of the cerebrospinal fluid
While eating dinner, your partner suddenly grabs his throat and has a panicked look on his face. He has a weak cough, faint inspiratory stridor, and cyanosis around the lips. You should
stand behind him and administer abdominal thrusts
Proper technique for suctioning the oropharynx of an adult patient includes
suctioning while withdrawing the catheter from the oropharynx
What is the most common airway obstruction in the unresponsive patient?
tongue
The physical act of moving air into and out of the lungs
ventilation
A nasopharyngeal airway is inserted
with the bevel facing the septum if inserted into the right nare