EMT chapter 10 airway
When using a bag-mask device, the proper ventilation rate for a child with a pulse is:
12 to 20 times a minute.
What is the approximate amount of oxygen in a G cylinder?
5,300 liters
During a cardiac arrest, what is the proper ventilation rate while doing compressions on an adult that does not have an advanced airway in place?
Give 2 ventilations after 30 compressions.
Why is the provision of hyperventilation to a cardiac arrest patient MOST detrimental?
It can worsen cardiac preload and cardiac output
You have an EMT student riding with you one day when you have a patient in acute pulmonary edema. Along with oxygen, and positioning, you elect to place the patient on CPAP. At the hospital, your student asks you why you did not just call ALS to intubate the patient so you could control the airway better, rather than using CPAP. What should be your answer?
cpap has been shown to lower intubation rates and ventilator use when used at the proper time during the course of patient management
The narrowest part(s) of an infant's upper airway is (are) the:
cricoid cartilage
Which of the following is typically a part of the on-board, permanently mounted equipment in the ambulance?
fixed suction unit
A fixed on-board suction unit should have a variable flow control knob to allow the EMT to do what with the volume of suctioning?
. Be able to adjust the volume of suctioning at the tip.
When a nasal cannula is used, the flow rate should be NO more than:
6 lpm
You are ventilating a patient manually, which of the following changes to the vital signs would you
A decrease in the systolic pressure.
You are called to a residence for a 19-year-old female who had a grand mal seizure and is now postictal with gurgling respirations. Which of the following devices should you utilize FIRST?
A portable suction unit
Which of the following may lead to over ventilation of an apneic adult patient with a pulse?
A rate of 22/min
Why should the EMT prohibit anyone from smoking around oxygen that is in use?
Oxygen is an accelerant.
Which of the following differences between the airways in the adult and pediatric is correct?
Pediatrics have a proportionally larger tongue
You are inserting an OPA into a small child's airway. What is the preferred insertion technique that you should employ?
Straight insertion technique with a tongue depressor
The removal of a heavy liquid from the upper airway in an unresponsive patient with gurgling would necessitate what type of equipment?
Suction unit
You are treating a patient who has taken too much of his pain-relieving narcotic. He is breathing very slowly and barely causing the chest to rise with inhalation. The BEST device to administer oxygen to this patient would be the:
bag-mask device with oxygen reservoir system.
A harsh, high-pitched sound heard during inspiration, characteristic of an upper airway obstruction due to swelling, is called:
stridor
You are treating a patient who needs supplemental oxygen but will NOT tolerate the nonrebreather mask you would like to use. What should you do?
switch to a nasal cannula at 6 lpm
Why would an EMT select a nasopharyngeal airway (NPA) instead of an OPA?
the patient still has a gag reflex.
Steps in performing a head-tilt, chin-lift maneuver for opening the airway of a non-trauma patient include:
tilting the head backward with one hand.
Which of the following patients, in the absence of disease or injury, will use oxygen at the highest rate, and thus, must always be adequately oxygenated and ventilated?
A patient who is 3-years-old
When using a soft catheter to suction the mouth and oropharynx, you should:
. measure the catheter from the corner of the mouth to the tip of the ear.
You are caring for an adult who was seen by a family member to become unconscious on the couch, and then slid to the carpeted floor. He appears to have taken an overdose of a medication. What is the proper technique used to open his airway?
. Head-tilt, chin-lift maneuver
When ventilating an adult with a pulse using a bag-mask device, the EMT should ventilate the patient:
10 to 12 times a minute.
You are called to transport a 48-year-old female who has been previously diagnosed with pneumonia and is complaining of shortness of breath. Your patient is normotensive and somewhat apprehensive, and you opt to start her on oxygen via a nasal cannula. What is the maximum flow rate you should administer with this oxygenation device?
6 lpm
Regardless of the size of the oxygen tank or what the tank is made of (steel or aluminum), what is the universal color denoting an oxygen tank?
Green
Which of the following is a known disadvantage to providing mechanical ventilation to an apneic patient with a pulse?
It may cause a drop in blood pressure.
Regardless of the size of the oxygen tank the EMT is using, which of the following statements is TRUE?
No matter what size it is, an oxygen tank is full at a pressure of 2,000 psi.
You are suctioning the airway of a patient with a copious amount of vomiting with a rigid-tip catheter. What can you do to help ensure that the maximum amount of liquid will be removed during the suctioning procedure without inserting the tip farther than recommended?
Place the tip of the rigid catheter so that the convex side is against the roof of the mouth.
Which of the following statements is CORRECT when comparing a wall-mounted suction unit in the back of the ambulance with a portable suction unit?
Both the portable and wall-mounted units should perform equally well with regard to the amount of suction they can provide.
Which of the following vital sign changes is consistent with pediatric hypoxia that may necessitate airway and/or ventilatory assistance?
Bradycardia
Which of the following would indicate to you that your patient may NOT be breathing adequately?
Breathing limited to abdominal movement.
Of the following influences on breathing, which one has the MOST significant impact on the moment-to-moment regulation of breathing?
Carbon dioxide levels
Which of the following patients are particularly sensitive to the detrimental effects of overventilation?
Cardiac arrest patients
Which of the following statements is TRUE regarding the oropharyngeal airway?
Even with the airway inserted, it is necessary to maintain the position of the head.
Which of the following ventilatory devices has the greatest risk of causing gastric inflation in the patient?
FROPVD
What is another airway-clearing maneuver that an EMT could use on a patient with profuse vomiting that cannot be easily controlled with suctioning?
Roll the patient onto her side.
Which of the following is recommended when using a one-person BVM technique for ventilating an apneic patient?
Use your ring and little finger to bring the patient's jaw up to the mask.
Of the following that are present in a patient with respiratory distress, which is the MOST reliable indicator that the patient needs mechanical ventilation despite breathing spontaneously?
absence of alveolar breath sounds
Blood, vomitus, or other substances that occlude the nasopharynx may drain and lead to:
airway occlusion
An infant who is conscious with a pulse has an obstructed airway, the EMT should:
alternate back blows and chest thrusts
NEVER use adhesive tape on a pressurized oxygen tank, as it may cause:
an explosion.
While working with a Paramedic, you are on scene assessing a patient with COPD. As you are evaluating the patient's breathing status, you know to assess for each of the following EXCEPT:
assessing the patient's pulse pressure.
If a patient needs to be ventilated for a long period of time with a constant rate and volume, the EMT should consider using a/an:
automatic transport ventilator.
For which of the following patients will the EMT most likely use high-flow oxygen?
cardiac arrest patient being resuscitated
External respiration is best described as the:
exchange of gases between the alveoli and the surrounding capillary bed.
Compared to the adult patient, an infant's ventilation rate is:
faster and with a lower tidal volume
A common problem caused by overly aggressive manual ventilation by the EMT is:
gastric distention
If you will be transporting a patient from a local hospital to a hospital hours away for specialized services and the patient needs to be administered oxygen, the patient should be on:
humidified oxygen
If oxygen is being delivered to a patient over a long period of time, it should be:
humidified.
Just because a patient is attempting to breathe against a partially occluded airway, if they do NOT move enough air to reach the alveoli, what secondary complication might they experience?
hypoxia and hypercapnia
If a gurgling sound is heard during the provision of artificial ventilation with a bag valve mask (BVM), the EMT should:
immediately apply suction to remove the liquid from the airway.
Which patient population is most likely to become hypoxic from poor oxygen reserves during periods of hypoventilation or apnea?
infants
The use of a rigid suction catheter, or "tonsil tip" catheter, is:
more effective for heavy particulate matter than a soft catheter.
The preferred method of artificial ventilation that EMTs are recommended to use is:
mouth-to-mask.
You are treating a patient who was seriously injured in an automobile accident. You decide to start as high a concentration of oxygen as you can. You therefore select which oxygenation delivery adjunct?
nonrebreather mask
The reservoir bag on a nonrebreather mask should:
not completely empty during inhalation.
For safety purposes, in what position should the oxygen tank valve be between patient contacts?
off
The oxygenation principle behind mouth-to-mouth (or barrier) ventilation is:
our exhaled breath is 16 percent oxygen.
If a humidifier is going to be used in the ambulance for a long trip, the EMT should:
partially fill the humidifier container with sterile water.
Principal procedures by which life-threatening respiratory or ventilatory problems are treated include all of the following, EXCEPT:
providing chest compressions if the patient has no pulse.
You are reviewing your partner's PCR on a dyspnea patient whom you just transported. Your partner used the word tachypnea in the report. You know that this means:
rapid breathing rate.
Each of the following would be considered an advantage of the ATV, EXCEPT:
the ATV allows the rescuer to feel lung compliance, much like a BVM.
As a general guideline, the best type of portable suction unit is:
the one that is charged and ready to go at the patient's side.
During skills testing at an EMS service you have applied to work at, the preceptor asks you about your decision to ventilate a patient who is still breathing on his own. Which of the following answers BEST defends your decision?
the patient did not have good alveolar breath sounds
The signs that an adult may have a completely or partially blocked airway with poor airway exchange include each of the following, EXCEPT:
the patient's skin is pale and clammy.
The most common cause of airway obstruction in the patient who is found supine and unresponsive is:
tongue
When opening the airway of a patient with a suspected spinal injury:
use the jaw-thrust maneuver.
What is the negative pressure that the suction unit should be set at when performing suctioning with a soft catheter?
-80 mmHg
You are called to a residence for a 19-year-old female who had a grand mal seizure and is now postictal with sonorous respirations. Which of the following devices should you utilize FIRST if all of them could be inserted?
. An oropharyngeal airway
If there is only one EMT to dedicate to the airway and ventilation, which device would make the MOST sense for a long trip to the hospital?
The manually triggered ventilator
You are caring for a two-week-old who reportedly is having trouble breathing. Which of the below findings BEST supports the suspicion the patient is truly hypoxic?
The heart rate is 60 per minute.
You respond to the scene of a witnessed opiate overdose. On your arrival, the patient is unconscious and supine with labored, sonorous respirations and cyanotic lips. What would be the cause of the sonorous airway sounds?
Airway occlusion from the tongue
What is the primary difference between a CPAP machine and a BiPAP (or Bilevel PAP) machine?
CPAP provides a constant back pressure, while a BiPAP provides alternating pressures.
A fixed on-board suction unit should be able to provide an airflow of how many liters per minute (lpm)?
>40
Not only will excessive gastric inflation cause an increased risk of vomiting in a pediatric patient, what other problem may it cause?
Decreased lung compliance
You are managing a patient who is suffering from a right ventricular infarction. If the patient is also complaining of mild dyspnea, how could the MI contribute to the perception of dyspnea?
Decreased perfusion to the lungs
Which of the following would have the least contributory effect on reducing tidal volume in a patient?
Diabetes or high blood sugar
Your unit is on the scene of a call for a 19-year-old female who is having an asthma attack. Her pulse ox is in the mid-90s, and you hear bilateral wheezing with auscultation. What is your initial concern for this conscious patient with respiratory distress?
Diminishing pulmonary function until respiratory failure occurs.
You have a patient with an altered mental status following exacerbation of COPD. The patient is breathing spontaneously at a rate of 40/min with absent alveolar breath sounds. The skin is dusky in color, the pulse ox reads 74 percent, and you are awaiting your Paramedic backup to provide advanced airway management. While waiting, what intervention must the EMT do?
Provide assisted ventilations synchronized with the patient's spontaneous effort.
Which of the following patients is a candidate for CPAP?
Pulmonary edema patient who is normotensive but struggling to breathe
Which of the following is the MOST important airway concern for any patient who displays an altered mental status?
The tongue will relax into the back of the throat and cause a partial or complete airway obstruction.
How does the mental status of a patient change in light of an airway occlusion from a foreign body trapped in the trachea?
The patient can rapidly become unresponsive.
Which of the following disturbances could occur when an EMT provides too great an airway pressure during PPV?
The patient may develop gastric distension.
You are caring for a patient with severe shortness of breath. The patient currently has a respiratory rate of 42/min, has obvious retractions, cannot speak in full sentences, and is becoming sleepy. Why is this patient going into respiratory inadequacy despite the fast respiratory rate?
The tidal volume typically diminishes as the rate becomes more rapid.
You are managing a patient with damage to the brainstem due to a stroke. How can this have a detrimental effect on the patient's breathing status?
There can be a change in both the breathing rate and regularity.
What is the common disadvantage of both the NPA and the OPA?
They do not isolate the trachea or prevent aspiration.