chapter 15

After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then:

inflate the distal cuff with 5 to 10 mL of air.

All of the following are complications associated with orotracheal intubation, EXCEPT:

necrosis of the nasal mucosa.

The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because:

no important structures lie between the skin covering the cricothyroid membrane and the airway.

Which of the following interventions is NOT appropriate when treating an unresponsive patient whose airway is obstructed by a dental appliance?

Abdominal thrusts

Which of the following is NOT an appropriate method for confirming proper ET tube placement in a 15-kg child?

Esophageal bulb or syringe

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?

Inadvertent extubation

Which of the following conditions would MOST likely cause laryngeal spasm and edema?

Inhalation injury

Which of the following statements regarding field extubation is correct?

It is generally better to sedate the patient rather than extubate.

Typically, ETCO2 is approximately:

2 to 5 mm Hg lower than the arterial PaCO2

The average depth of ET tube insertion for adult patients is:

21 to 25 cm.

The normal alveolar volume in a healthy adult is:

350 ml

Murphy's eye, an opening on the distal side of an ET tube, allows ventilation to occur:

even if the tip of the tube is occluded by blood or mucus.

The function of the lower airway is to:

exchange oxygen and carbon dioxide.

When a patient's respirations are too rapid and too shallow:

inhaled air may only reach the anatomic dead space before being exhaled.

The __________ is an anatomic space located between the base of the tongue and the epiglottis.

vallecula

The process of moving air into and out of the lungs is called:

ventilation.

The BEST way to be certain that the ET tube has passed through the vocal cords is to:

visualize the tube passing between the vocal cords.

The upper airway of an adult consists of all the structures above the:

vocal cords.

The nasal cannula is of MOST benefit to patients:

with mild hypoxemia and claustrophobia.

When a patient is given a paralytic without sedation:

he or she is fully aware and can hear and feel.

The condition in which the body's tissues and cells do not receive enough oxygen is called:

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:

inflate the distal cuff with 5 to 10 mL of air.

The dorsal respiratory group is primarily responsible for:

initiating respiration based on information received from the chemoreceptors.

You have been providing bag-mask ventilations to an unresponsive, apneic patient with facial trauma for approximately 10 minutes. After intubating the patient, you should:

insert an orogastric tube to relieve gastric distention.

A 19-year-old woman ingested a large quantity of Darvon. She is responsive to pain only and has slow, shallow respirations. The MOST appropriate airway management for this patient involves:

inserting a nasal airway and assisting ventilations with a bag-mask device.

It would NOT be appropriate to place a patient in the recovery position if he or she:

is breathing shallowly

The nasal cavity:

is extremely delicate and has a rich blood supply

Decreased ventilation compliance following intubation is LEAST suggestive of:

left bronchus intubation.

The MOST effective way to minimize the risk of hypoxia while intubating a child is to:

limit your intubation attempt to 20 seconds

During sleep, the metabolic rate is ________ and the number of respirations _________.

low, decreases

When two paramedics are ventilating an apneic patient with a bag-mask device, the paramedic not squeezing the bag should:

maintain an adequate mask-to-face seal.

You respond to a residence for a possible overdose. The patient, a young man, is unresponsive with slow, snoring respirations. There are obvious needle track marks on his arms. Your FIRST action should be to:

manually open his airway.

The anterior portion of the palate is formed by the:

maxilla and palatine bones

All of the following factors would increase a person's respiratory rate, EXCEPT:

narcotic analgesic use

Fentanyl (Sublimaze) is a:

narcotic analgesic.

Asymmetric chest wall movement is characterized by:

one side of the chest moving less than the other.

The MOST obvious risk associated with extubation is:

overestimating the patient's ability to protect his or her own airway.

Changes in the rate and depth of breathing are regulated primarily by the:

pH of the CSF

When administering oxygen via a nonrebreathing mask, you must ensure that the:

patient has adequate tidal volume

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:

perform a needle cricothyrotomy.

If chest compressions and repositioning of the airway are unsuccessful in removing a severe airway obstruction in an unconscious patient, you should:

perform laryngoscopy and use Magill forceps

When preoxygenating an uninjured child prior to ET intubation, you should:

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 involuntary control of breathing originates in the:

pons and medulla.

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:

preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation

The major advantage of ET intubation is that it:

protects the airway from aspiration.

You should insert the ET tube between the vocal cords until the:

proximal end of the cuff is 1 to 2 cm past the vocal cords.

After inserting an oropharyngeal airway in an unresponsive woman, the patient begins to gag. You should:

remove the airway and have suction ready.

You are dispatched to the residence of a 19-year-old man who has a tracheostomy tube and is on a mechanical ventilator. According to the patient's mother, he began experiencing difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally diminished breath sounds, and his oxygen saturation is 90%. You disconnect the patient from the mechanical ventilator and begin bag-mask ventilations; however, you meet significant resistance. You should:

remove the bag-mask and suction his tracheostomy tube.

An airway obstruction secondary to a severe allergic reaction:

requires specific and aggressive treatment.

You are assessing a young woman who was struck in the head with a baseball bat. The patient is semiconscious and has slow, irregular respirations. Further assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood in her mouth, but clenches her teeth and becomes combative when you attempt to suction her oropharynx. The MOST appropriate airway management for this patient involves:

sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea.

If an unresponsive patient does not have a gag reflex, an oropharyngeal airway:

should be inserted whether the patient is breathing or not

CPAP is NOT appropriate for patients with:

slow, shallow respiratory effort

The MOST significant complication associated with the use of an oropharyngeal airway is:

soft-tissue trauma with oral bleeding.

Laryngospasm is defined as:

spasmodic closure of the vocal cords.

When replacing a dislodged tracheostomy tube, it is MOST important that you:

take appropriate standard precautions.

You are transporting an intubated patient and note that the digital capnometry reading has quickly fallen below 30 mm Hg. You should:

take immediate measures to confirm proper placement of the ET tube.

The Hering-Breuer reflex is a protective mechanism that:

terminates inhalation and prevents lung overexpansion.

When performing an open cricothyrotomy, you will MOST likely avoid damage to the jugular veins if:

the cricothyroid membrane is incised vertically.

When administering CPAP therapy to a patient, it is important to remember that:

the increased intrathoracic pressure caused by CPAP can result in hypotension.

When inserting a stylet into an ET tube, you must ensure that:

the stylet rests at least ½ in back from the end of the tube.

Anatomically, the ________ is directly anterior to the glottic opening.

thyroid cartilage

The volume of air that is moved into or out of the respiratory tract in one breath is called:

tidal volume.

When using a straight blade, a major mistake of new paramedics is to:

try to pass the ET tube down the barrel of the blade.

You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see:

two white fibrous bands that lie vertically within the glottic opening.

Which of the following patients may benefit from CPAP?

Alert patient with respiratory distress following submersion in water

Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading?

Carboxyhemoglobin

Atelectasis occurs when:

a deficiency of surfactant causes alveolar collapse.

Surfactant is:

a phospholipid compound that decreases surface tension on the alveolar walls.

Which of the following represents the correct sequence for managing a patient's airway?

Open, clear, assess, intervene

Which of the following statements regarding oxygen is correct?

Oxygen supports the process of combustion.

When ventilating a patient with a bag-mask device, you note increased compliance. This means that:

air can be forced into the lungs with relative ease.

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:

abort the attempt and ventilate with a bag-mask device and 100% oxygen.

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?

Tracheobronchial suctioning

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?

Tracheobronchial suctioning

All of the following conditions will cause an increase in the circulating levels of carbon dioxide in the blood, EXCEPT:

acute hyperventilation.

Indications for CPAP include:

acute pulmonary edema

You should be MOST suspicious of tube misplacement following an open cricothyrotomy if:

a crackling sensation is noted when palpating the neck.

A young woman experienced massive facial trauma after being ejected from her car when it struck a tree. She is semiconscious, has blood draining from her mouth, and has poor respiratory effort. The MOST appropriate initial airway management for this patient involves:

alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2 minutes until you can definitively secure her airway.

The LMA is:

an alternative to bag-mask ventilation when intubation is not possible.

Biot respirations are characterized by:

an irregular pattern of breathing with intermittent periods of apnea.

The trachea and mainstem bronchi:

are lined with beta-2 receptors that result in bronchodilation when stimulated

Most of the complications caused by intubation-induced hypoxia:

are subtle and occur gradually.

When ventilating a patient with facial injuries, it is MOST important to:

be alert for changes in ventilation compliance

Capnography is a reliable method for confirming proper ET tube placement because:

carbon dioxide is not present in the esophagus.

A 40-year-old man fell 20 ft from a tree while trimming branches. Your assessment reveals that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver. You should:

carefully open his airway with the head tilt-chin lift maneuver.

Capnography can serve as an indicator of:

chest compression effectiveness.

The hypoxic drive stimulates breathing in patients with:

chronically decreased PaO2 levels.

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:

continue to ventilate and use additional confirmation techniques.

Neuromuscular blocking agents:

convert a breathing patient with a marginal airway into an apneic patient with no airway

An 8-year-old child in cardiac arrest has been intubated. When ventilating the child, the paramedic should:

deliver 8 to 10 breaths per minute.

When ventilating an apneic adult with a pulse with a bag-mask device, you should:

deliver each breath over 1 second at a rate of 10 to 12 breaths/min.

The pulse oximeter would be LEAST useful when:

determining if a patient should receive oxygen.

A 66-year-old woman is found to be unresponsive and apneic. Her carotid pulse is weak and rapid. When ventilating this patient, you should deliver:

each breath over 1 second at a rate of 10 to 12 breaths/min.

With regard to intubation difficulty, neck mobility problems are MOST commonly associated with:

elderly patients.

A 50-year-old woman presents with acute respiratory distress while eating. Upon your arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals that her skin is pink and moist. In addition to transporting her to the hospital, you should:

encourage her to cough and closely monitor her condition.

Complications of aspiration include all of the following, EXCEPT:

excess surfactant production.

After correctly positioning the laryngoscope blade in the patient's mouth, you should:

exert gentle traction at a 45° angle to the floor as you lift the patient's jaw.

The oropharynx:

forms the posterior portion of the oral cavity.

In contrast to the right lung, the left lung:

has two lobes.

It would be appropriate to insert a nasopharyngeal airway in patients who:

have an altered mental status with an intact gag reflex