CH 16 Flashcards
(200 cards)
1
Q
Most of the complications caused by intubation-induced hypoxia:
are dramatic and occur immediately.
are subtle and occur gradually.
are easily reversible.
can be predicted with pulse oximetry.
A
are subtle and occur gradually.
2
Q
The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because:
the tough cartilage that comprises the cricothyroid membrane can easily be incised with a scalpel.
the cricoid cartilage helps prevent accidental perforation through the back of the airway and into the esophagus.
no important structures lie between the skin covering the cricothyroid membrane and the airway.
there are no major blood vessels or other structures that lie adjacent to the cricothyroid membrane.
A
no important structures lie between the skin covering the cricothyroid membrane and the airway.
3
Q
Face-to-face intubation may be performed in which of the following situations?
When you see a soft-tissue bulge on either side of the airway
When the patient is in the supine position and weighs more than 200 pounds
When the patient has blood-clotting abnormalities or they are taking anticoagulation medications
When a seated patient suddenly becomes unconscious and apneic
A
When a seated patient suddenly becomes unconscious and apneic
4
Q
The most significant complication associated with the use of an oropharyngeal airway is:
mild bradycardia in pediatric patients.
significant bruising of the hard palate.
soft-tissue trauma with oral bleeding.
a tachycardic response in adult patients.
A
soft-tissue trauma with oral bleeding.
5
Q
Capnography can serve as an indicator of:
chest compression effectiveness.
proper ventilatory depth.
coronary perfusion pressure.
cerebral perfusion pressure.
A
chest compression effectiveness.
6
Q
If the patient’s oxygen saturation drops at any point during rapid sequence intubation, you should:
abort the intubation attempt and ventilate with a bag-mask device.
apply posterior cricoid pressure and continue the intubation attempt.
continue the intubation attempt and monitor the cardiac rhythm closely.
stop and hyperventilate the patient at a rate of 24 breaths/min.
A
abort the intubation attempt and ventilate with a bag-mask device.
7
Q
Proper insertion of the needle into the cricothyroid membrane involves which angle toward the patient’s feet?
30 degrees
90 degrees
45 degrees
60 degrees
A
45 degrees
8
Q
Which of the following statements regarding the automatic transport ventilator (ATV) is correct?
The paramedic can control an apneic patient’s minute volume with accuracy when using an ATV.
The ATV should not be used to ventilate a patient who is intubated and in cardiac arrest.
Most ATVs are large and cumbersome and are therefore impractical to use in the prehospital setting.
Inadvertent variations in the rate and duration of ventilations often occur when the ATV is used.
A
The paramedic can control an apneic patient’s minute volume with accuracy when using an ATV.
9
Q
When properly positioned, the tip of the laryngeal mask airway is at the:
piriform fossae.
base of the tongue.
glottis opening.
entrance of the esophagus.
A
entrance of the esophagus.
10
Q
Which of the following medications is a dissociative anesthetic that produces anesthesia through hallucinogenic, amnesic, analgesic, and sedative effects?
Diazepam
Versed
Ketamine
Fentanyl
A
Ketamine
11
Q
A disadvantage of ET intubation is that it:
bypasses the upper airway’s physiologic functions of warming, filtering, and humidifying.
does not eliminate the incidence of gastric distention and can result in pulmonary aspiration.
is associated with a high incidence of vocal cord damage and bleeding into the oropharynx.
is only a temporary method of securing the patient’s airway until a more definitive device can be inserted.
A
bypasses the upper airway’s physiologic functions of warming, filtering, and humidifying.
12
Q
A patient with orthopnea:
has blood-tinged sputum.
is breathing through pursed lips.
has dyspnea while lying flat.
awakens at night with dyspnea.
A
has dyspnea while lying flat.
13
Q
Reemergence phenomenon is characterized by:
a drop in blood pressure as medication wears off.
the incomplete recollection of previous events.
pleasant dreams or vivid nightmares.
a transient, but significant, drop in heart rate
A
pleasant dreams or vivid nightmares.
14
Q
You should be suspicious of tube misplacement following a surgical cricothyrotomy if:
bleeding from the subcutaneous tissues is observed.
there is minimal rise of the chest during ventilations.
progressive redness is noted around the insertion site.
a crackling sensation is noted when palpating the neck.
A
a crackling sensation is noted when palpating the neck.
15
Q
The process of delayed sequence intubation involves:
administering a sedative in order to facilitate oxygenation of the patient.
administering a paralytic only, followed by intubation in 2 to 3 minutes.
administering a sedative only, followed by intubation in 3 to 5 minutes.
avoiding the need to intubate a patient through the use of CPAP or BPAP.
A
administering a sedative in order to facilitate oxygenation of the patient.
16
Q
In contrast to negative-pressure ventilation, positive-pressure ventilation occurs when:
air is drawn into the lungs.
air is forced into the lungs.
intrathoracic pressure falls.
the diaphragm contracts.
A
air is forced into the lungs.
17
Q
Which of the following medications is a sedative-hypnotic drug?
Alfentanil
Fentanyl
Etomidate
Ketamine
A
Etomidate
18
Q
Before performing orotracheal intubation, it is most important for the paramedic to:
apply a pulse oximeter to the patient.
monitor the patient’s cardiac rhythm.
wear gloves and facial protection.
preoxygenate with a bag-mask device.
A
wear gloves and facial protection.
19
Q
In contrast to the nasogastric tube, the orogastric tube:
can be used in patients who require gastric lavage.
should only be used in patients who are conscious.
is not necessary in patients who have been intubated.
is safer to use in patients with severe facial trauma.
A
is safer to use in patients with severe facial trauma.
20
Q
When ventilating a patient with facial injuries, it is most important to:
ventilate with a higher-than-normal volume.
ensure that a cervical collar has been applied.
be alert for changes in ventilation compliance.
suction the oropharynx every 2 to 3 minutes.
A
be alert for changes in ventilation compliance.
21
Q
Which of the following is a step that is performed during nasotracheal intubation?
Preoxygenating with a bag-mask device as necessary
Ensuring that the patient’s head is hyperflexed
Advancing the tub as the patient exhales
Inserting the tube into the right side of the patient’s mouth
A
Preoxygenating with a bag-mask device as necessary
22
Q
Appropriate insertion of a soft-tip (whistle-tip) suction catheter down the ET tube involves:
gently inserting the catheter until resistance is felt.
inserting the catheter no farther than 6 to 8 inches.
inserting the catheter until secretions are observed.
applying suction while gently inserting the catheter.
A
gently inserting the catheter until resistance is felt.
23
Q
The incidence of bleeding associated with nasotracheal intubation can be reduced by:
lubricating the tip of the tube with a water-soluble gel.
aiming the tip of the tube up toward the patient’s eye.
advancing the tube as the patient exhales.
manipulating the patient’s head in a hyperextended position.
A
lubricating the tip of the tube with a water-soluble gel.
24
Q
Regardless of the internal diameter, all ET tubes have:
a pilot balloon on the proximal end.
a 15/22-mm proximal adaptor.
black millimeter markings on the side.
an inflatable cuff at the distal tip.
A
a 15/22-mm proximal adaptor.
25
Incising the cricothyroid membrane horizontally will:
increase the risk of damaging the external jugular veins.
completely eliminate the risk of any external bleeding.
minimize the risk of damaging the thyroid gland.
facilitate insertion of an 8.0- to 9.0-mm ET tube.
minimize the risk of damaging the thyroid gland.
26
When a patient is given a paralytic without sedation:
they are fully aware and can hear and feel.
placement of an ET tube is less traumatic.
paralysis is not achieved and intubation is not possible.
you should only give one-tenth of the standard dose.
they are fully aware and can hear and feel.
27
When performing nasotracheal intubation, you should preform the nasotracheal tube by bending it in a:
straight line.
half-circle.
circle.
U-shape.
circle.
28
You are transporting an intubated patient and note that his ETCO2 reading has fallen below 30 mm Hg. You should:
hyperventilate the patient to see if the ETCO2 reading decreases.
promptly extubate the patient and ventilate with a bag-mask device.
slow your ventilation rate to see if the ETCO2 reading increases.
take immediate measures to confirm proper placement of the ET tube.
slow your ventilation rate to see if the ETCO2 reading increases.
29
Endotracheal (ET) intubation is defined as:
inserting an ET tube through the glottic opening via the patient's nose.
inserting an ET tube through the vocal cords via the patient's mouth.
passing an ET tube through the glottic opening and sealing off the trachea.
passing an ET tube through an opening in the cricothyroid membrane.
passing an ET tube through the glottic opening and sealing off the trachea.
30
Which of the following is an indicator of inadequate artificial ventilation when ventilating an apneic, tachycardic adult with a bag-mask device?
Each ventilation is delivered over 1 second.
One breath is given every 10 to 12 seconds.
The patient's heart rate slows down.
About 20 breaths per minute are being delivered.
About 20 breaths per minute are being delivered.
31
Which of the following conditions will cause an increase in the circulating levels of carbon dioxide in the blood?
Hypertension
Lactic acidosis
Diabetes
Acute hyperventilation
Lactic acidosis
32
Normally, an adult male will require an ET tube that ranges from:
7.5 to 8.5 mm.
8.5 to 9.0 mm.
6.5 to 7.0 mm.
7.0 to 7.5 mm.
7.5 to 8.5 mm.
33
When the King LT airway is properly placed, the distal cuff seals the:
esophagus.
larynx.
oropharynx.
nasopharynx.
esophagus.
34
Which of the following dosing regimens for ketamine would likely be used to induce sedation prior to administering a neuromuscular blocker?
0.2 to 0.3 mg/kg
0.5 to 1 mg/kg
25 to 50 mg
2 mg/kg
2 mg/kg
35
After properly positioning the head for intubation, you should open the patient's mouth and insert the laryngoscope blade:
in the midline of the mouth and gently lift upward on the tongue.
into the right side of the mouth and sweep the tongue to the left.
into the left side of the mouth and move the blade to the midline.
in the midline of the mouth and gently sweep the tongue to the left.
into the right side of the mouth and sweep the tongue to the left.
36
Which of the following patient characteristics can help you determine which size King LT airway to use?
Gender
Age
Height and weight
Level of consciousness
Height and weight
37
Supplemental oxygen is indicated for any patient with:
a syncopal episode.
ischemic stroke.
respiratory distress.
cardiac chest pain.
respiratory distress.
38
Signs of clinical improvement during CPAP therapy include:
increased ease of speaking.
increased end-tidal CO2.
a decrease in systolic BP.
an increase in the heart rate.
increased ease of speaking.
39
Oxygen that is entirely devoid of moisture:
is less combustible than humidified oxygen.
should be given in conjunction with bronchodilators.
will dry the patient's mucous membranes quickly.
is optimum for patients requiring long-term oxygen.
will dry the patient's mucous membranes quickly.
40
Two attempts to ventilate an unconscious 10-year-old boy have been unsuccessful. You should next:
perform chest compressions.
intubate his trachea.
deliver abdominal thrusts.
look inside his mouth.
perform chest compressions.
41
The main disadvantage of the LMA is that it:
spontaneously dislodges in the majority of patients.
is technically more difficult to perform than intubation.
is associated with significant upper airway swelling.
does not provide protection against aspiration.
does not provide protection against aspiration.
42
An airway obstruction secondary to a severe allergic reaction:
requires specific and aggressive treatment.
often responds well to humidified oxygen.
is usually the result of pulmonary aspiration.
is treated effectively with abdominal thrusts.
requires specific and aggressive treatment.
43
The King LT-D airway features a:
curved tube with a ventilation port located between two inflatable cuffs.
port through which gastric contents can be suctioned from the stomach.
universal size with two inflation ports and is used for patients of any age.
straight tube with two inflatable cuffs that hold an equal amount of air.
curved tube with a ventilation port located between two inflatable cuffs.
44
Paramedics must use extreme caution when accessing the airway via the cricothyroid membrane because:
the cricothyroid membrane is highly vascular and tends to bleed profusely when it is incised.
cricothyrotomy is associated with a high incidence of inadvertent laceration of a carotid artery.
the cricothyroid membrane is bordered laterally and inferiorly by the highly vascular thyroid gland.
the thyroid cartilage is smaller than the cricoid cartilage and makes the cricothyroid membrane difficult to locate.
the cricothyroid membrane is bordered laterally and inferiorly by the highly vascular thyroid gland.
45
Which of the following findings is most significant in a patient with acute respiratory distress?
A family history of pulmonary embolism
Low-grade fever and flulike symptoms
Prior ICU admission for the same problem
A regular heart rate of 110 beats/min
Prior ICU admission for the same problem
46
Which of the following abnormal respiratory patterns suggest brain injury or cerebral anoxia?
Vesicular breath sounds
Tracheal breath sounds
Kussmaul respirations
Agonal respirations
Agonal respirations
47
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:
ventilate the patient at a rate of 12 to 20 breaths/min.
insert an orogastric tube to relieve gastric distention.
hyperventilate the patient with 100% oxygen.
insert a nasogastric tube to decompress the stomach.
insert an orogastric tube to relieve gastric distention.
48
Which of the following is a contraindication for nasotracheal intubation?
Acetaminophen use
Frequent use of heroine
Spinal injury
Apnea
Apnea
49
In order for a tracheostomy tube to be compatible with a mechanical ventilator or bag-mask device:
it should have a stylet that can be removed easily.
the patient's head must be in a hyperextended position.
it must be equipped with a 15/22-mm proximal adaptor.
it should have an internal diameter of at least 6.0 mm.
it must be equipped with a 15/22-mm proximal adaptor.
50
Which of the following is a complication of aspiration?
Severe bradycardia
Damage to the vocal cords
Excess surfactant production
Airway obstruction
Airway obstruction
51
Which of the following medications is safest to use in patients with borderline hypotension or hypovolemia?
Sublimaze
Etomidate
Pentothal
Brevital
Etomidate
52
Decreased ventilation compliance following intubation may suggest:
gastric distention.
low oxygen saturation.
bronchial obstruction.
left bronchus intubation.
gastric distention.
53
An increasing peak expiratory flow reading in a patient with respiratory distress suggests that the patient is:
responding to bronchodilator therapy.
experiencing worsened hypoxemia.
in need of further bronchodilator therapy.
no longer experiencing bronchospasm.
responding to bronchodilator therapy.
54
Diazepam and midazolam provide which of the following therapeutic effects?
Dissociative anesthetic
Analgesic
CNS depressant
Sedative
Sedative
55
Removal of a dental appliance after intubating a patient is:
acceptable only if the device is an upper or lower bridge.
dangerous and may cause dislodgement of the tube.
mandatory in the event the patient will require surgery.
generally preferred but should be performed carefully.
dangerous and may cause dislodgement of the tube.
56
Drugs such as vecuronium bromide (Norcuron) and pancuronium bromide (Pavulon) are appropriate to administer when:
you have a transport time of less than 15 minutes.
intubation of the patient is anticipated to be difficult.
extended periods of paralysis are needed.
longer-acting paralytics are contraindicated.
extended periods of paralysis are needed.
57
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.
gain airway access via the cricothyroid membrane.
alternate chest compressions and abdominal thrusts.
perform a blind finger sweep of the mouth.
perform laryngoscopy and use Magill forceps.
58
The use of phenylephrine hydrochloride (Neo-Synephrine) during nasotracheal intubation may:
dilate the nasal vasculature and facilitate tube insertion.
sedate the patient and facilitate his or her compliance.
reduce the likelihood and severity of nasal bleeding.
anesthetize the nasopharynx and reduce patient discomfort.
reduce the likelihood and severity of nasal bleeding.
59
A patient with a suppressed cough mechanism:
is at serious risk for aspiration.
often requires ventilation support.
should have continuous airway suctioning.
should be intubated at once.
is at serious risk for aspiration.
60
When performing surgical cricothyrotomy, you should first:
maintain aseptic technique as you cleanse the area with iodine.
hyperextend the patient's neck and then palpate the cricoid cartilage.
palpate for the V notch of the thyroid cartilage and stabilize the larynx.
slide your index finger between the thyroid and cricoid cartilages.
palpate for the V notch of the thyroid cartilage and stabilize the larynx.
61
Placing a suction catheter past the base of the tongue:
is effective in thoroughly clearing the airway.
may cause the patient to gag or vomit.
will result in aspiration of gastric contents.
commonly causes bradycardia in adult patients.
may cause the patient to gag or vomit.
62
If a patient has a stoma and no tracheostomy tube in place:
suctioning of the stoma must be performed before ventilating.
you must perform a head tilt–chin lift maneuver before ventilating.
ventilations can be performed by placing a mask over the stoma.
you should not seal the nose and mouth when ventilating.
ventilations can be performed by placing a mask over the stoma.
63
A decrease in which of which of the following decreases carbon dioxide elimination, resulting in a building of carbon dioxide in the blood?
Partial pressure of carbon dioxide
Minute volume
Intrapulmonary shunting
Carboxyhemoglobin
Minute volume
64
Which of the following would likely cause a prolonged alveolar plateau?
Shock
Tachypnea
Diabetic ketoacidosis
Heroin overdose
Heroin overdose
65
Whether you are providing ventilations to a patient with a stoma using a resuscitation mask or bag-mask device, you must first:
adequately cleanse the stoma site with iodine.
place the patient's head in a neutral position.
suction the stoma for no longer than 10 seconds.
perform a head tilt–chin lift maneuver.
place the patient's head in a neutral position.
66
Which of the following structures is most critical to visualize during orotracheal intubation?
Epiglottis
Tonsils
Tongue
Uvula
Epiglottis
67
After inserting an oropharyngeal airway in an unresponsive woman, the patient begins to gag. You should:
remove the airway and have suction ready.
spray an anesthetic medication into her mouth.
suction her oropharynx for up to 15 seconds.
turn the patient on her side in case she vomits
remove the airway and have suction ready.
68
When a patient's respirations are too rapid and too shallow:
minute volume increases because a larger amount of air reaches the lungs.
the increase in tidal volume will compensate for a rapid respiratory rate.
the majority of inhaled air lingers in areas of physiologic dead space.
inhaled air may only reach the anatomic dead space before being exhaled.
inhaled air may only reach the anatomic dead space before being exhaled.
69
Intrapulmonary shunting is defined as:
the return of unoxygenated blood to the left side of the heart.
a decrease in the surface area of the alveoli caused by damage.
failure of blood to bypass an obstruction in a pulmonary artery.
a condition in which too much carbon dioxide is eliminated.
the return of unoxygenated blood to the left side of the heart.
70
Assessment of a patient in respiratory distress reveals capnographic waveforms that resemble a shark fin. What should you suspect?
Pneumonia
Hyperventilation
Heart failure
Bronchospasm
Bronchospasm
71
When nasally intubating a patient, the ET tube is advanced:
as the patient exhales.
in between the patient's breaths.
when the patient swallows.
when the patient inhales.
when the patient inhales.
72
When performing surgical cricothyrotomy, you can avoid damage to the jugular veins if:
the cricothyroid membrane is incised vertically.
the patient's head is hyperextended.
the patient's head is in a neutral position.
you incise the cricothyroid membrane at a transverse angle
the cricothyroid membrane is incised vertically.
73
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. Appropriate initial airway management for this patient involves:
suctioning her airway until it is clear of blood and other secretions, administering a sedative and paralytic, and performing endotracheal intubation.
vigorously suctioning her oropharynx for no longer than 30 to 45 seconds and then inserting a supraglottic airway device.
suctioning her oropharynx and performing direct laryngoscopy to assess the amount of upper airway damage or swelling that is present.
providing positive pressure ventilatory support with a bag-mask device and making preparations to perform an open cricothyrotomy.
suctioning her airway until it is clear of blood and other secretions, administering a sedative and paralytic, and performing endotracheal intubation.
74
A study using data from 40 states demonstrated an overall prehospital ET intubation success rate of:
73.5%.
85.3%.
91.7%.
68.2%.
85.3%.
75
A mouth-opening width of less than how many inches indicates a potentially difficult airway?
2
3
5
4
2
76
Paralytic medications exert their effect by:
blocking the function of the autonomic nervous system and impeding the action of acetylcholinesterase.
blocking the release of epinephrine and norepinephrine from the sympathetic nervous system.
competitively binding to the motor neurons in the brain, thus blocking their ability to send messages.
functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine.
functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine.
77
It would not be appropriate to place a patient in the recovery position if they:
are tachycardic.
have not been injured.
are semiconscious.
are breathing shallowly.
are breathing shallowly.
78
Before securing the ET tube in place with a commercial device, you should:
remove the bag-mask device from the ET tube.
hyperventilate the patient for 30 seconds to 1 minute.
note the centimeter marking on the ET tube at the patient's teeth.
move the ET tube to the center of the patient's mouth.
note the centimeter marking on the ET tube at the patient's teeth.
79
A 6.0-mm ET tube can be passed through which size LMA?
3 or 4
1 or 2
5 or 6
7 or 8
3 or 4
80
Which of the following is proper procedure when inserting a nasogastric tube in a responsive patient?
Advancing the tube along the roof of the mouth
Administering a topical alpha agonist to constrict the nasal vasculature
Injecting 40 to 50 mL of air into the tube
Keeping the patient's head in an extended position while inserting the tube
Administering a topical alpha agonist to constrict the nasal vasculature
81
Asymmetric chest wall movement is characterized by:
a part of the chest wall that bulges during exhalation.
one side of the chest moving less than the other.
chest rise that is minimally visible.
alternating movement of the chest and abdomen.
one side of the chest moving less than the other.
82
Several cycles of basic life support maneuvers have failed to relieve a severe airway obstruction in an unresponsive 44-year-old woman. You should:
perform direct laryngoscopy and attempt to remove the obstruction with Magill forceps.
intubate the patient and attempt to push the foreign body into one of the mainstem bronchi.
continue basic life support maneuvers and transport the patient to the hospital immediately.
place the patient's head in a neutral position and perform an emergency cricothyrotomy.
perform direct laryngoscopy and attempt to remove the obstruction with Magill forceps.
83
When using the King LT airway, too much air in the oropharyngeal cuff could result in:
pneumothorax.
gagging.
hyperventilation.
increased intracranial pressure.
increased intracranial pressure.
84
The procedure in which the vocal cords are visualized for placement of an ET tube is called direct:
laryngoscopy.
tracheostomy.
pharyngoscopy.
bronchoscopy.
laryngoscopy.
85
An adult patient with an abnormal respiratory rate should:
be given oxygen at 4 L/min with a nasal cannula.
be evaluated for other signs of inadequate ventilation.
be assessed immediately for heart rate abnormalities.
receive ventilatory assistance with a bag-mask device.
be evaluated for other signs of inadequate ventilation.
86
A patient with respiratory splinting:
is holding their arm against the chest.
is often tachypneic with deep breathing.
is breathing shallowly to alleviate chest pain.
has an increased tidal volume due to a chest injury.
is breathing shallowly to alleviate chest pain.
87
Which of the following statements regarding field extubation is correct?
The patient should be extubated if spontaneous breathing occurs.
Extubation should be performed with the patient in a supine position.
It is generally better to sedate the patient than to extubate.
The risk of laryngospasm following extubation is relatively low.
It is generally better to sedate the patient than to extubate.
88
After obtaining a peak expiratory flow reading of 200 mL, you administered one bronchodilator treatment to a 21-year-old woman with an acute episode of expiratory wheezing. The next peak flow reading is 400 mL. You should:
assist ventilations and be prepared to intubate her.
recognize that the patient's condition has improved.
try another treatment modality to treat her wheezing.
give another bronchodilator treatment and reassess.
recognize that the patient's condition has improved.
89
Fentanyl (Sublimaze) is a:
sedative-hypnotic drug.
butyrophenone sedative.
narcotic analgesic.
benzodiazepine sedative.
narcotic analgesic.
90
Which of the following conditions would likely cause laryngeal spasm and edema?
Viral pharyngitis
Inhalation injury
Croup
Mild asthma attack
Inhalation injury
91
When replacing a dislodged tracheostomy tube, it is most important that you:
insert the tube 2 cm beyond the cuff.
lubricate the tube before insertion.
use a tracheostomy tube of the same size.
take appropriate standard precautions.
take appropriate standard precautions.
92
Which of the following clinical findings would be significant in a patient experiencing respiratory distress?
End-tidal carbon dioxide of 40 mm Hg
Heart rate of 90 beats/min
Fever of 102.5 degrees Fahrenheit
BP of 148/94 mm Hg
Fever of 102.5 degrees Fahrenheit
93
After placing an ET tube, you suspect that the filter line from the capnography adaptor is occluded by blood or other secretions. What should you do in this situation?
Replace the in-line ETCO2 detector.
Slowly retract the tube while simultaneously listening for breath sounds over the left side of the chest.
Remove half the amount of air from the distal cuff.
Use suctioning to remove the blood or other secretions.
Replace the in-line ETCO2 detector.
94
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 80%. You disconnect the patient from the mechanical ventilator and begin bag-mask ventilations; however, you meet significant resistance. You should:
remove his tracheostomy tube and replace it with a new one.
ventilate with a demand valve and transport at once.
remove the bag-mask device and suction his tracheostomy tube.
suspect that he has bilateral pneumothoraces.
remove the bag-mask device and suction his tracheostomy tube.
95
If several attempts to open a patient's airway with the jaw-thrust maneuver are unsuccessful, you should:
insert an oropharyngeal airway and reattempt the jaw-thrust maneuver.
suction the mouth for 15 seconds and then reattempt to open the airway.
maintain the patient's head in a neutral position and intubate at once.
carefully tilt the patient's head back while lifting up on the chin.
carefully tilt the patient's head back while lifting up on the chin.
96
Complications associated with the one-person bag-mask ventilation technique are often related to:
improper manual head positioning.
unrecognized rescuer fatigue.
inadequate tidal volume delivery.
hyperinflation of the lungs.
inadequate tidal volume delivery.
97
Which of the following capnography findings indicates that a patient is rebreathing previously exhaled carbon dioxide?
Decreasing ETCO2 value and waveforms that fall well below the baseline
Intermittent loss of a capnographic waveform, especially during inhalation
Increasing ETCO2 value and waveforms that never return to the baseline
Small capnographic waveforms with a complete loss of alveolar plateau
Increasing ETCO2 value and waveforms that never return to the baseline
98
In contrast to a needle cricothyrotomy, a surgical cricothyrotomy:
involves the use of a high-pressure jet ventilator.
is the preferred technique in patients with short, fat necks.
enables the paramedic to provide greater tidal volume.
is easier to perform in children younger than 8 years of age.
enables the paramedic to provide greater tidal volume.
99
The BURP maneuver usually involves applying backward, upward, and rightward pressure to the:
lower third of the thyroid cartilage.
lower third of the cricoid cartilage.
upper third of the thyroid cartilage.
upper third of the cricoid cartilage.
lower third of the thyroid cartilage.
100
After the laryngoscope blade has been placed during face-to-face intubation, you may slightly adjust the patient's head to ensure better visualization by:
tilting the head to the left side.
sweeping the tongue to the patient's left and moving their head to the right.
pulling the mandible forward by pressing down.
pushing their chin up while the second paramedic holds the patient's head still.
pulling the mandible forward by pressing down.
101
To prevent muscular fasciculations associated with the use of succinylcholine, you should administer:
an infusion of potassium chloride set at 5 mEq per hour.
10% of the usual dose of a nondepolarizing paralytic.
1 to 1.5 mg/kg of lidocaine over 10 to 15 minutes.
0.5 mg of atropine sulfate via rapid IV push.
10% of the usual dose of a nondepolarizing paralytic.
102
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 no chest rise. The quickest way to secure a patent airway in this patient is to:
ventilate with a demand valve.
perform a needle cricothyrotomy.
perform an open cricothyrotomy.
insert a supraglottic airway device.
perform a needle cricothyrotomy.
103
Typically, ETCO2 is approximately:
2 to 5 mm Hg higher than the arterial PaCO2.
5 to 10 mm Hg lower than the arterial PaCO2.
5 to 10 mm Hg higher than the arterial PaCO2.
2 to 5 mm Hg lower than the arterial PaCO2.
2 to 5 mm Hg lower than the arterial PaCO2.
104
Surgical cricothyrotomy is generally contraindicated in which of the following situations?
Tracheal tumors or subglottic stenosis
A patient who is younger than 16 years of age
When you can't secure a patient airway by any other means
Severe foreign body obstruction of the upper airway
Tracheal tumors or subglottic stenosis
105
If you see a soft-tissue bulge on either side of the airway when performing nasotracheal intubation:
you have probably inserted the tube into the piriform fossa.
the tube is positioned correctly just above the glottic opening.
inadvertent esophageal intubation has likely occurred.
you should completely remove the tube and reoxygenate.
you have probably inserted the tube into the piriform fossa.
106
Inserting a nasopharyngeal airway in a patient with CSF drainage from the nose following head trauma may:
result in acute hypertension and decreased cerebral perfusion pressure.
result in ventricular dysrhythmias secondary to intracranial pressure.
cause acute herniation of the brainstem through the foramen magnum.
cause the device to enter the brain through a hole caused by a fracture.
cause the device to enter the brain through a hole caused by a fracture.
107
What point(s) on the capnographic waveform represent(s) a mixture of alveolar gas and dead space gas?
A-B
D
B-C
B
B
108
The most common complication associated with nasotracheal intubation is:
regurgitation.
hypoxemia.
bleeding.
aspiration.
bleeding
109
If you insert the ET tube into the patient's left nostril, you should:
insert the tube straight back without rotating it.
rotate the tube 180 degrees as its tip enters the nasopharynx.
insert the tube with the beveled tip facing upward.
ensure that the bevel is facing away from the septum.
rotate the tube 180 degrees as its tip enters the nasopharynx.
110
Patients with laryngectomies commonly develop mucus plugs in their stoma because:
their swallowing mechanism is suppressed.
they are at higher risk for pneumonia.
they do not possess an efficient cough.
the diameter of the stoma is small.
they do not possess an efficient cough.
111
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:
secure the ET tube with a commercial device.
begin ventilations and auscultate breath sounds.
attach an ETCO2 detector to the tube.
inflate the distal cuff with 5 to 10 mL of air.
inflate the distal cuff with 5 to 10 mL of air.
112
Therapeutic effects of CPAP include:
increased alveolar surface tension.
forcing of fluid into the alveoli.
opening of collapsed alveoli.
increased intrathoracic pressure.
opening of collapsed alveoli.
113
A 19-year-old woman ingested a large quantity of Darvon. She is responsive to pain only and has slow, shallow respirations. Appropriate airway management for this patient involves:
inserting an oral airway and assisting ventilations with a bag-mask device.
inserting an oral airway and administering oxygen via nonrebreathing mask.
suctioning her airway, inserting an oral airway, and administering 100% oxygen.
inserting a nasal airway and assisting ventilations with a bag-mask device.
inserting a nasal airway and assisting ventilations with a bag-mask device.
114
Undersedation of a patient during airway management would likely result in:
loss of airway reflexes.
respiratory depression.
severe hypotension.
pulmonary aspiration.
pulmonary aspiration.
115
The most significant disadvantage associated with needle cricothyrotomy is:
the potential for pulmonary aspiration.
the inability to exhale via the glottis.
local infection due to poor technique.
air leakage around the insertion site.
the potential for pulmonary aspiration.
116
After confirming that an intubated patient remains responsive enough to maintain their airway, you should first:
fully deflate the distal cuff on the ET tube.
insert an orogastric tube to ensure that the stomach is empty.
have the patient sit up or lean slightly forward.
suction the oropharynx to remove any secretions.
have the patient sit up or lean slightly forward.
117
When determining the correct-sized nasogastric tube for a patient, you should measure the tube:
from the mouth to the chin and to the xiphoid process.
from the nose to the chin and to the epigastric region.
from the nose to the chin to the xiphoid process.
from the nose to the ear and to the xiphoid process.
from the nose to the ear and to the xiphoid process.
118
While ventilating an intubated patient, you note a complete loss of capnographic waveform and numeric value, yet the patient's chest rises with ventilations and you are able to hear bilateral breath sounds. What should you do?
Increase the rate of ventilation.
Replace the ETCO2 inline adaptor.
Decrease the rate of ventilation.
Extubate and ventilate with a bag-mask device.
Replace the ETCO2 inline adaptor.
119
Which of the following statements regarding anemia is correct?
Anemic patients typically present with flushed skin and bradycardia.
Anemia results in a decreased ability of the blood to carry oxygen.
Anemia is a condition caused exclusively by a deficiency of iron.
Patients with anemia have a chronically high level of hemoglobin.
Anemia results in a decreased ability of the blood to carry oxygen.
120
You have intubated a 70-year-old woman with chronic bronchitis and are en route to the hospital. During transport, you note that ventilations are becoming increasingly difficult and her ETCO2 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 indicated for this patient?
Withdrawing the tube 2 cm
Immediate extubation
Hyperventilation at 24 breaths/min
Tracheobronchial suctioning
Tracheobronchial suctioning
121
After opening an unresponsive patient's airway, you determine that his respirations are rapid, irregular, and shallow. You should:
intubate him at once.
suction his mouth for 15 seconds.
apply a nonrebreathing mask.
begin positive-pressure ventilations.
begin positive-pressure ventilations.
122
Which of the following patients may benefit from CPAP?
Trauma patient with labored breathing and extensive chest wall bruising
Comatose patient with shallow breathing after overdosing on heroin
Alert patient with respiratory distress following submersion in water
Patient with pulmonary edema who is unable to follow verbal commands
Alert patient with respiratory distress following submersion in water
123
Which of the following interventions is not appropriate when treating an unresponsive patient whose airway is obstructed by a dental appliance?
Direct laryngoscopy
Abdominal thrusts
Use of Magill forceps
Chest compressions
Abdominal thrusts
124
The pyramid-like structures that form the posterior attachment of the vocal cords are called:
piriform fossae.
hypoepiglottic ligaments.
arytenoid cartilages.
palatine tonsils.
arytenoid cartilages.
125
After tracheobronchial suctioning is complete, you should:
visualize the vocal cords to ensure that the tube is still in the correct position.
reattach the bag-mask device, continue ventilations, and reassess the patient.
instill 3 to 5 mL of saline down the tube to loosen any residual secretions.
hyperventilate the patient at 24 breaths/min for approximately 3 minutes.
reattach the bag-mask device, continue ventilations, and reassess the patient.
126
Proper placement of the King LT airway is performed by using which of the following techniques?
Use of the jaw-thrust maneuver
Observation of esophageal disease
The esophageal detector device
Auscultation of bilateral breath sounds
Auscultation of bilateral breath sounds
127
When performing tracheobronchial suctioning, take care not to exceed how many seconds of suctioning in an adult?
10
5
15
20
10
128
Because the high-pressure ventilator used with needle cricothyrotomy would cause an increase in intrathoracic pressure, which of the following could result?
Hypercarbia
Hypoventilation
Esophageal rupture
Barotrauma
Barotrauma
129
Which of the following patients would require positive-pressure ventilation?
Semiconscious 39-year-old man with shallow chest wall movement, cyanosis, and bradypnea
Conscious 46-year-old woman with wheezing and rhonchi
Conscious 41-year-old woman with early inspiratory crackles
Conscious 36-year-old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin
Semiconscious 39-year-old man with shallow chest wall movement, cyanosis, and bradypnea
130
A 40-year-old man fell 20 feet 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:
suction his oropharynx and reattempt the jaw-thrust maneuver.
assist his ventilations and prepare to intubate him immediately.
insert a nasopharyngeal airway and assess his respirations.
carefully open his airway with the head tilt–chin lift maneuver.
carefully open his airway with the head tilt–chin lift maneuver.
131
An intubated 33-year-old man is becoming agitated and begins moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should:
administer a sedative medication.
chemically paralyze him with vecuronium.
physically restrain his head to the stretcher.
suction his airway and carefully extubate.
administer a sedative medication.
132
The 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.
whether the tube is in the trachea or in the esophagus.
even if the ET tube does not enter the patient's trachea fully.
if the tube is inserted into the right mainstem bronchus.
even if the tip of the tube is occluded by blood or mucus.
133
If ventilation is difficult after inserting a King LT airway, you should:
deflate both of the cuffs, withdraw the device 2 cm, and reattempt ventilation.
gently withdraw the device, without deflating the cuffs, until ventilation is easier.
attach a manually triggered ventilator and observe for adequate chest rise.
remove the King LT and immediately resume ventilation with a bag-mask device.
gently withdraw the device, without deflating the cuffs, until ventilation is easier.
134
An 8-year-old child in cardiac arrest has been intubated. When ventilating the child, the paramedic should:
deliver 10 breaths per minute.
deliver one breath every 15 seconds.
observe for full chest expansion.
allow partial exhalation between breaths.
deliver 10 breaths per minute.
135
You should turn the jet ventilator release valve off when:
wide chest expansion is noted.
the audible alarm sounds.
the patient's chest visibly rises.
you can auscultate breath sounds.
the patient's chest visibly rises.
136
When using a stethoscope with the head removed to determine maximum airflow during nasotracheal intubation, place the stethoscope tubing in the proximal end of the ET tube at approximately:
1 inch.
3 inches.
4 inches.
2 inches.
1 inch
137
During ventilation with the LMA, the paramedic should:
observe the patient for signs of inadequate ventilation.
suction the patient's oropharynx at least every 2 minutes.
hyperventilate the patient to maximize tidal volume delivery.
maintain the patient's head in a slightly flexed position.
observe the patient for signs of inadequate ventilation.
138
You should insert the ET tube between the vocal cords until the:
centimeter marking reads 15 cm at the patient's teeth.
distal end of the cuff is 1 to 2 cm past the vocal cords.
proximal end of the cuff is 1 to 2 cm past the vocal cords.
tube meets resistance as it makes contact with the carina.
proximal end of the cuff is 1 to 2 cm past the vocal cords.
139
You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see:
the epiglottis lift when the tip of the curved blade is resting underneath it.
two white fibrous bands that lie vertically within the glottic opening.
the thyroid cartilage bulge anteriorly as you lift up on the laryngoscope.
the tip of the straight blade touching the posterior wall of the pharynx.
two white fibrous bands that lie vertically within the glottic opening.
140
Proper insertion of the LMA involves:
inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.
inserting the LMA into the patient's mouth by following the curvature of the patient's tongue.
lifting the patient's jaw upward and blindly inserting the LMA until you meet resistance.
flexing the patient's neck, depressing the tongue with a tongue blade, and blindly inserting the LMA.
inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.
141
CPAP is not appropriate for patients with:
slow, shallow respiratory effort.
an oxygen saturation less than 90%.
acute or chronic bronchospasm.
evidence of congestive heart failure.
slow, shallow respiratory effort.
142
Which of the following is a nondepolarizing neuromuscular blocking agent?
Atropine sulfate
Vecuronium bromide
Succinylcholine chloride
Midazolam
Succinylcholine chloride
143
Intubation of the trauma patient is effectively performed:
with a cervical collar in place.
by two paramedics.
with the patient's head elevated.
with a curved blade.
by two paramedics.
144
How does the i-gel differ from the LMA?
The i-gel comes in only two sizes.
The i-gel mask holds more air than the LMA.
The lumen of the i-gel is smaller than the LMA.
The i-gel has a noninflatable mask.
The i-gel has a noninflatable mask.
145
When administering CPAP therapy to a patient, it is important to remember that:
the head straps must be secured immediately in order to achieve an adequate seal.
SpO2 of 100% must be achieved within the first 5 minutes of CPAP application.
the increased intrathoracic pressure caused by CPAP can result in hypotension.
acute symptomatic bradycardia has been directly linked to CPAP therapy.
the increased intrathoracic pressure caused by CPAP can result in hypotension.
146
A Cormack-Lehane Class 3 airway is characterized by:
visualization of the epiglottis only.
a partial view of the arytenoid cartilage.
a full view of the glottic opening.
an inability to see the epiglottis or glottis.
visualization of the epiglottis only.
147
You should confirm that the ET tube has passed through the vocal cords by:
visualizing the tube passing between the vocal cords.
feeling the ridges of the tracheal wall with the ET tube.
ensuring the presence of bilaterally equal breath sounds.
noting the appropriate color change on the carbon dioxide detector.
visualizing the tube passing between the vocal cords.
148
The most obvious risk associated with extubation is:
moderate airway swelling as the ET tube is removed.
patient retching and gagging as you remove the ET tube.
overestimating the patient's ability to protect their airway.
bradycardia from stimulation of the parasympathetic nervous system.
overestimating the patient's ability to protect their airway.
149
What phase of the capnographic waveform is called the expiratory upslope?
C-D
A-B
B-C
D-E
B-C
150
Which of the following statements regarding translaryngeal catheter ventilation is correct?
The technique uses the tracheal wall as an entry point to the airway.
Ventilation is achieved by the use of a high-pressure jet ventilator.
It provides a more definitive airway than an open cricothyrotomy.
It is more difficult to perform than an open cricothyrotomy.
Ventilation is achieved by the use of a high-pressure jet ventilator.
151
Orotracheal intubation should be performed with the patient's head:
in the sniffing position.
slightly flexed.
in a neutral position.
hyperextended.
in the sniffing position.
152
Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because:
it does not involve direct visualization of the vocal cords.
the procedure should be performed in less than 10 seconds.
patients requiring nasotracheal intubation are usually stable.
it must be performed on spontaneously breathing patients.
it must be performed on spontaneously breathing patients.
153
If an unresponsive patient does not have a gag reflex, an oropharyngeal airway:
should only be inserted if the patient is not breathing.
must be inserted by depressing the tongue with a tongue blade.
should be inserted whether the patient is breathing or not.
will effectively prevent aspiration if the patient vomits.
should be inserted whether the patient is breathing or not.
154
The pressure relief valve on an automatic transport ventilator may lead to unrecognized hypoventilation in patients with which of the following conditions?
Bronchospasm
Flat nasal bridge
Prolonged apnea
Airway obstruction
Airway obstruction
155
If the ET tube has been positioned properly in the trachea:
breath sounds should be somewhat louder on the right side and the epigastrium should be silent.
breath sounds should be loud at the apices of the lungs but somewhat diminished at the bases.
the bag-mask device should be easy to compress and you should see corresponding chest expansion.
you should not see vapor mist in the ET tube during exhalation when ventilating with a bag-mask device.
the bag-mask device should be easy to compress and you should see corresponding chest expansion.
156
The difficulty of intubation should be low if the distance between the hyoid bone and the thyroid notch is at least how many fingerbreadths wide?
3
2
1
4
2
157
The concept of apneic oxygenation is based on the fact that:
supplemental oxygen after chemical paralysis will not reduce a hypoxic event.
in the apneic patient, approximately 200 mL/min of carbon dioxide moves into the alveoli.
oxygen uptake by the alveoli will continue, even when the diaphragm is not moving.
the average healthy adult patient will not desaturate for 15 to 20 minutes.
oxygen uptake by the alveoli will continue, even when the diaphragm is not moving.
158
Product literature states that the LMA should only be used in patients who are:
responsive.
fasting.
conscious.
in critical condition.
fasting.
159
The lowest portion of the pharynx that opens into the larynx anteriorly and the esophagus posteriorly is the:
laryngopharynx.
oropharynx.
hyperpharynx.
nasopharynx.
laryngopharynx.
160
When performing nasotracheal intubation, you should use an ET tube that is:
uncuffed so as to avoid unnecessary damage to the nasal mucosa.
1 to 1.5 mm smaller than you would use for orotracheal intubation.
equipped with a stylet in order to make the tube formfitting.
slightly larger than the nostril into which the tube will be inserted.
1 to 1.5 mm smaller than you would use for orotracheal intubation.
161
If the ET tube is placed in the trachea properly, the colorimetric paper inside the carbon dioxide detector should:
turn yellow during inhalation.
turn yellow during exhalation.
remain purple during ventilations.
not change colors.
turn yellow during exhalation.
162
Needle cricothyrotomy is contraindicated in patients with:
uncontrolled oropharyngeal bleeding.
a suspected injury to the cervical spine.
obstruction above the catheter insertion site.
massive maxillofacial trauma and trismus.
obstruction above the catheter insertion site.
163
On a capnographic waveform, which point is the maximal ETCO2 and is the best reflection of the alveolar CO2 level?
E
D
C
B
D
164
Compared with surgical cricothyrotomy, needle cricothyrotomy:
requires the paramedic to manipulate the patient's cervical spine.
is associated with a higher risk of damage to adjacent structures.
is technically more difficult and takes longer to perform.
allows for subsequent attempts to intubate the patient.
allows for subsequent attempts to intubate the patient.
165
A construction worker fell approximately 15 feet and landed on his head. He is semiconscious. His respiratory rate is 14 breaths/min with adequate depth. Further assessment reveals blood draining from his nose. You should:
administer oxygen via nonrebreathing mask and continue your assessment.
insert a nasopharyngeal airway and assist ventilations with a bag-mask device.
suction his nasopharynx for up to 30 seconds and apply oxygen via nasal cannula.
insert a nasopharyngeal airway and administer oxygen via nonrebreathing mask.
administer oxygen via nonrebreathing mask and continue your assessment.
166
After inserting the needle into through the cricothyroid membrane, you should next:
advance the catheter over the needle until the hub is flush with the skin.
change your angle to 90 degrees and advance the catheter over the needle.
aspirate with the syringe and then insert the needle about 2 cm farther.
insert the needle about 1 cm farther and then aspirate with the syringe.
insert the needle about 1 cm farther and then aspirate with the syringe.
167
When suctioning a patient's stoma, you should:
ask the patient to inhale as you are suctioning.
insert the catheter no more than 15 cm.
provide suction for no longer than 20 seconds.
insert the catheter until resistance is felt.
insert the catheter until resistance is felt.
168
The King airway is contraindicated in patients:
with prolonged cardiac arrest.
with known esophageal disease.
who weigh less than 25 kg.
with a traumatic brain injury.
with known esophageal disease.
169
Which of the following is a complication associated with orotracheal intubation?
Laryngeal swelling
Necrosis of the nasal mucosa
Traumatic brain injury
Aspiration
Laryngeal swelling
170
The use of capnography in patients with prolonged cardiac arrest may be limited because:
of acidosis and minimal carbon dioxide elimination.
the paramedic often ventilates the patient too slowly.
of an excess buildup of nitrogen in the blood.
metabolic alkalosis causes reduced carbon dioxide.
of acidosis and minimal carbon dioxide elimination.
171
When checking the cuff of the LMA prior to insertion, you should:
inflate the cuff with 50% more air than is required.
gently pull on the cuff at the tube to ensure integrity.
inflate the cuff with 100 mL of air and then deflate.
stretch the cuff to check for tears or other damage.
inflate the cuff with 50% more air than is required.
172
The average peak expiratory flow rate in a healthy adult is approximately:
550 mL.
450 mL.
650 mL.
750 mL.
550 mL.
173
A length-based resuscitation tape measure can be used to determine the most appropriate size of bag-mask device for pediatric patients who weigh up to:
38 kg.
42 kg.
34 kg.
46 kg.
34 kg.
174
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.
perform abdominal thrusts until she becomes unconscious.
look in her mouth and attempt to visualize a foreign body.
deliver positive-pressure ventilations via bag-mask device.
encourage her to cough and closely monitor her condition.
175
In which of the following conditions would you likely encounter pulsus paradoxus?
Minor asthma attack
Pericardial tamponade
Compensated respiratory acidosis
Moderate asthma attack
Pericardial tamponade
176
If return of spontaneous circulation (ROSC) occurs, which of the following ETCO2 findings would you expect to encounter?
Complete loss of a capnographic waveform
A progressive decrease in the ETCO2 reading
Capnographic waveforms that get smaller
An abrupt and sustained increase in ETCO2
An abrupt and sustained increase in ETCO2
177
Hyperventilating an apneic patient:
may decrease venous return to the heart.
is beneficial if the pulse rate is too slow.
reduces the incidence of gastric distention.
is appropriate if the patient is an adult.
may decrease venous return to the heart.
178
When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of which Mallampati class?
II
I
III
IV
III
179
Poor lung compliance during your initial attempt to ventilate an unconscious, apneic adult should be treated by:
reopening the airway and reattempting to ventilate.
performing 30 chest compressions and reassessing.
administering 15 subdiaphragmatic thrusts at once.
sweeping the patient's mouth with your fingers.
reopening the airway and reattempting to ventilate.
180
When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should:
ensure that the patient is in a supine position to obtain an accurate reading.
perform the test three times and take the best rate of the three readings.
ask the patient to fully exhale before blowing into the mouthpiece.
administer one bronchodilator treatment before obtaining the first reading.
perform the test three times and take the best rate of the three readings.
181
When inserting a stylet into an ET tube, you must ensure that:
you use a petroleum-based gel to facilitate easy removal.
the stylet rests at least half an inch back from the end of the tube.
the tube is bent in the form of a U to facilitate placement.
the stylet is rigid and does not allow the ET tube to bend.
the stylet rests at least half an inch back from the end of the tube.
182
A size 3 or 4 LMA:
is most suitable for use in morbidly obese patients.
is appropriate to use in children younger than 6 years of age.
is less likely to become dislodged than smaller sizes.
will accommodate the passage of a 6.0-mm ET tube.
will accommodate the passage of a 6.0-mm ET tube.
183
The paramedic should be especially diligent when confirming tube placement following blind nasotracheal intubation because:
they did not visualize the tube passing between the vocal cords.
the ET tube cannot be secured effectively when it is in the nose.
most patients who are intubated nasally are extremely combative.
most nasotracheal intubation attempts result in esophageal placement.
they did not visualize the tube passing between the vocal cords.
184
What is the cuff volume of a King LT airway with a green connector?
40 to 45 mL
35 mL
10 mL
20 mL
35 mL
185
When performing face-to-face intubation, advance the ET tube until the cuff is about how many inches past the vocal cords?
0.25 to 0.5 inches
1 to 1.25 inches
0.5 to 0.75 inches
1.25 to 1.5 inches
0.5 to 0.75 inches
186
In contrast to a curved laryngoscope blade, a straight laryngoscope blade is designed to:
indirectly lift the epiglottis to expose the vocal cords.
move the patient's tongue to the left.
extend beneath the epiglottis and lift it up.
fit into the vallecular space at the base of the tongue.
extend beneath the epiglottis and lift it up.
187
An ET tube that is too large for a patient:
will make ventilating the patient more difficult.
will lead to an increased resistance to airflow.
is much more likely to enter the esophagus.
can be difficult to insert and may cause trauma.
can be difficult to insert and may cause trauma.
188
Which of the following factors increase a person's respiratory rate?
Narcotic analgesic use
Decreased metabolism
The use of benzodiazepines
The use of amphetamines
The use of amphetamines
189
It would be appropriate to insert a nasopharyngeal airway in patients who:
have an altered mental status with an intact gag reflex.
have CSF leakage from the nose and are semiconscious.
are semiconscious with active vomiting and cyanosis.
are unresponsive with multiple facial bone fractures.
have an altered mental status with an intact gag reflex.
190
Before intubating a patient who has been chemically sedated and paralyzed, it is most important for the paramedic to:
suction the oropharynx to clear any secretions.
adequately preoxygenate with 100% oxygen.
administer 0.5 mg of atropine sulfate.
hyperventilate the patient at 24 breaths/min.
adequately preoxygenate with 100% oxygen.
191
After you have intubated an apneic patient with chest trauma, your partner is auscultating breath sounds and tells you that breath sounds are faint on the right side of the chest. You should:
increase the force of your ventilations as your partner reauscultates the lungs.
immediately remove the ET tube and oxygenate the patient for 30 seconds.
slightly withdraw the tube as your partner auscultates breath sounds.
suspect that the patient has a pneumothorax on the right side of the chest.
suspect that the patient has a pneumothorax on the right side of the chest.
192
Which of the following findings is clinically significant in a 30-year-old woman with difficulty breathing and a history of asthma?
Prior ICU admission for her asthma
1 mm Hg drop in systolic BP during inhalation
Oral temperature of 97.9 degrees Fahrenheit
Expiratory wheezing on exam
Prior ICU admission for her asthma
193
When administering oxygen via a nonrebreathing mask, you must ensure that the:
one-way valves are disabled.
reservoir is half-filled first.
patient has adequate tidal volume.
flow rate is set to at least 6 L/min.
patient has adequate tidal volume.
194
Neuromuscular blocking agents:
induce total body paralysis within 10 to 15 minutes following administration via IV push.
are most commonly used as the sole agent to facilitate placement of an ET tube.
convert a breathing patient with a marginal airway into an apneic patient with no airway.
have a negative effect on both cardiac and smooth muscle and commonly cause dysrhythmias.
convert a breathing patient with a marginal airway into an apneic patient with no airway.
195
With regard to intubation difficulty, neck mobility problems are commonly associated with:
female patients.
tall, thin patients.
small children.
elderly patients.
elderly patients.
196
How should the patient's head by positioned during face-to-face intubation?
It should be manually stabilized.
It should be hyperextended.
It should be placed in the sniffing position.
It should be turned to the left side.
It should be manually stabilized.
197
The pulse oximeter is useful when:
assessing a patient with venous pulsations.
determining the patient's baseline respiratory rate.
monitoring a patient who takes ACE inhibitors.
identifying deterioration of the cardiac patient.
identifying deterioration of the cardiac patient.
198
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:
give him Valium for sedation, perform orotracheal intubation, and transport to the hospital at once.
preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation.
insert a nasopharyngeal airway and ensure that the nonrebreathing mask is tightly secured to his face.
insert an oral airway, assist ventilations with a bag-mask device, and transport at once.
preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation.
199
Biot respirations are characterized by:
an irregular pattern of breathing with intermittent periods of apnea.
deep, gasping respirations that are often rapid but may be slow.
increased respirations followed by apneic periods.
slow, shallow irregular respirations or occasional gasping breaths.
an irregular pattern of breathing with intermittent periods of apnea.
200
Surgical cricothyrotomy is indicated when:
ET intubation is unsuccessful after three attempts.
the patient has a head injury that precludes nasotracheal intubation.
all other methods of advanced airway management have failed.
you are unable to secure a patent airway with less invasive means.
you are unable to secure a patent airway with less invasive means.
