Chapter 9 Airway Management

A 23-year-old male experienced severe head trauma after his motorcycle collided with an oncoming truck. He is unconscious, has rapid and shallow breathing, and has copious bloody secretions in his mouth. How should you manage his airway? A. Provide continuous ventilations with a bag-mask device to minimize hypoxia. B. Insert a nasopharyngeal airway and provide suction and assisted ventilations. C. Suction his oropharynx with a rigid catheter until all secretions are removed. D. Alternate 15 seconds of oral suctioning with 2 minutes of assisted ventilation.

The correct answer is: Alternate 15 seconds of oral suctioning with 2 minutes of assisted ventilation.

Irregular respirations characterized by an increasing rate and depth of breathing followed by periods of apnea are called: A. eupneic respirations. B. agonal respirations. C. Cheyne-Stokes respirations. D. ataxic respirations.

The correct answer is: Cheyne-Stokes respirations.

How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems? A. It prevents alveolar collapse by pushing air into the lungs during the inhalation phase. B. It forces the alveoli open and pushes more oxygen across the alveolar membrane. C. It pushes thick, infected pulmonary secretions into isolated areas of the lung tissue. D. It decreases intrathoracic pressure, which allows more room for the lungs to expand.

The correct answer is: It forces the alveoli open and pushes more oxygen across the alveolar membrane.

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

The correct answer is: Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries.

Which of the following patients is breathing adequately? A. an unconscious 52-year-old female with snoring respirations and cool, pale skin B. a conscious female with facial cyanosis and rapid, shallow respirations C. a conscious male with respirations of 19 breaths/min and pink skin D. a conscious male with respirations of 18 breaths/min and reduced tidal volume

The correct answer is: a conscious male with respirations of 19 breaths/min and pink skin

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. perform a secondary assessment and then begin treatment. B. assist her breathing with a bag-mask device and 100% oxygen. C. insert a nasal airway in case her mental status decreases. D. administer 100% oxygen via a nonrebreathing mask.

The correct answer is: administer 100% oxygen via a nonrebreathing mask.

In the presence of oxygen, the mitochondria of the cells convert glucose into energy through a process called: A. aerobic metabolism. B. respiration. C. perfusion. D. anaerobic metabolism.

The correct answer is: aerobic metabolism.

The actual exchange of oxygen and carbon dioxide occurs in the: A. bronchioles. B. apex of the lung. C. pulmonary capillaries. D. alveolar sacs.

The correct answer is: alveolar sacs.

You and your partner are caring for a critically injured patient. Your partner is controlling severe bleeding from the patient's lower extremities as you attempt ventilations with a bag-mask device. After repositioning the mask several times, you are unable to effectively ventilate the patient. You should: A. suction the patient's airway for 30 seconds and reattempt ventilations. B. begin ventilations using the mouth-to-mask technique. C. hyperextend the patient's head and reattempt ventilations. D. continue attempted ventilations and transport immediately.

The correct answer is: begin ventilations using the mouth-to-mask technique.

Intrapulmonary shunting occurs when: A. the presence of pulmonary surfactant causes a decrease in alveolar surface tension, thus impairing the exchange of gases in the lungs. B. a decrease in respiratory rate and depth causes carbon dioxide accumulation in the alveoli and an overall decrease in blood oxygen levels. C. blood coming from the right side of the heart bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state. D. any impairment in circulatory function causes a reduced ability for oxygen and carbon dioxide to diffuse across the alveolar-capillary membrane.

The correct answer is: blood coming from the right side of the heart bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state.

The jaw-thrust maneuver is used to open the airway of patients with suspected: A. mandibular fractures. B. upper airway swelling. C. cervical spine injuries. D. copious oral secretions.

The correct answer is: cervical spine injuries.

To select the proper size oropharyngeal airway, you should measure from the: A. corner of the mouth to the superior ear. B. center of the mouth to the posterior ear. C. angle of the jaw to the center of the mouth. D. corner of the mouth to the earlobe.

The correct answer is: corner of the mouth to the earlobe.

Which of the following would NOT cause a decrease in tidal volume? A. agonal respirations B. deep respirations C. shallow breathing D. irregular breathing

The correct answer is: deep respirations

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: A. a series of back blows and chest thrusts. B. finger sweeps to remove the obstruction. C. encouraging him to cough and transporting. D. performing a series of abdominal thrusts.

The correct answer is: encouraging him to cough and transporting.

Which of the following structures is contained within the mediastinum? A. esophagus B. bronchioles C. larynx D. lungs

The correct answer is: esophagus

Despite your attempts to coach a conscious young female's respirations, she continues to hyperventilate with a marked reduction in tidal volume. You should: A. ventilate her at the rate at which she is breathing. B. restrain her and provide ventilatory assistance. C. insert a nasopharyngeal airway and give oxygen. D. explain to her that you will assist her ventilations.

The correct answer is: explain to her that you will assist her ventilations.

CPAP is indicated for patients who: A. have pulmonary edema and can follow verbal commands. B. are unresponsive and have signs of inadequate ventilation. C. are hypotensive and have a marked reduction in tidal volume. D. have signs of pneumonia but are breathing adequately.

The correct answer is: have pulmonary edema and can follow verbal commands.

If ventilation is impaired, carbon dioxide levels in the bloodstream will increase. This condition is called: A. hypoxia. B. acidosis. C. hypoxemia. D. hypercarbia.

The correct answer is: hypercarbia.

In contrast to inhalation, exhalation: A. is a passive process caused by increased 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 an active process caused by decreased intrathoracic pressure.

The correct answer is: is a passive process caused by increased intrathoracic pressure.

The hypoxic drive—the primary stimulus to breathe for patients with certain chronic respiratory diseases—is influenced by: A. high blood carbon dioxide levels. B. low blood oxygen levels. C. high blood oxygen levels. D. low blood carbon dioxide levels.

The correct answer is: low blood oxygen levels.

Which of the following organs or tissues can survive the longest without oxygen? A. kidneys B. muscle C. liver D. heart

The correct answer is: muscle

A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a: A. nonrebreathing mask. B. bag-mask device. C. nasal cannula. D. mouth-to-mask device.

The correct answer is: nonrebreathing mask.

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: A. perform a head-to-toe assessment to look for bleeding. B. increase the volume of your ventilations and reassess his blood pressure. C. ensure that you are delivering one breath every 3 to 5 seconds. D. reevaluate the rate and volume of your ventilations.

The correct answer is: reevaluate the rate and volume of your ventilations.

A 19-year-old female is found unconscious by her roommate. Your primary assessment reveals that her breathing is inadequate. As you insert an oropharyngeal airway, she begins to gag violently. You should: A. select a smaller oropharyngeal airway and attempt to insert it. B. remove the airway and be prepared to suction her oropharynx. C. continue to insert the airway as you suction her oropharynx. D. insert the airway no further but leave it in place as a bite block.

The correct answer is: remove the airway and be prepared to suction her oropharynx.

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: A. perform a finger sweep of her mouth. B. roll her onto her side and remove the oral airway. C. ask your partner to apply cricoid pressure. D. remove the oral airway and suction her oropharynx.

The correct answer is: roll her onto her side and remove the oral airway

The diaphragm functions as an involuntary muscle when a person: A. takes a deep breath. B. sleeps. C. holds his or her breath. D. coughs.

The correct answer is: sleeps.

Central chemoreceptors located in the medulla provide feedback to increase the rate and depth of breathing when they sense: A. increased levels of oxygen in the blood and a decrease in the pH of the cerebrospinal fluid. B. decreased levels of oxygen in the blood and an increase in the pH of the cerebrospinal fluid. C. slight decreases in carbon dioxide and an increase in the pH of the cerebrospinal fluid. D. slight elevations in carbon dioxide or a decrease in the pH of the cerebrospinal fluid.

The correct answer is: slight elevations in carbon dioxide or a decrease in the pH of the cerebrospinal fluid.

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. removing large, solid objects with a tonsil-tip suction catheter. C. continuously suctioning patients with copious oral secretions. D. suctioning while withdrawing the catheter from the oropharynx.

The correct answer is: suctioning while withdrawing the catheter from the oropharynx.

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

The correct answer is: when the patient cannot tolerate a nonrebreathing mask.

A nasopharyngeal airway is inserted: A. with the bevel pointing downward if inserted into the left nare. B. into the smaller nostril with the tip following the roof of the nose. C. into the larger nostril with the tip pointing away from the septum. D. with the bevel facing the septum if inserted into the right nare.

The correct answer is: with the bevel facing the septum if inserted into the right nare.