EMT-B Chapter 10 – Airway Management

On which of the following patients would it be MOST appropriate to use the flow-restricted, oxygen-powered ventilation device?
a 21-year-old male with traumatic cardiac arrest
After ___________ minutes without oxygen, brain damage is very likely.
6 to 10
Based on current guidelines, in which of the following situations should supplemental oxygen be administered?
a) Exposure to carbon monoxide and an oxygen saturation of 95%
b) Any elderly patient whose oxygen saturation is less than 95%
c) Signs of myocardial infarction and an oxygen saturation of 97%
d) Any diabetic patient whose oxygen saturation is less than 98%
a) Exposure to carbon monoxide and an oxygen saturation of 95%
Your protocols state that during the first few minutes of working on a cardiac arrest patient, you should provide passive ventilation. This means that you will:
allow recoil of the chest between compressions to draw air into the lungs
How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?
It forces the alveoli open and pushes more oxygen across the alveolar membrane.
You come upon an unresponsive patient who is not injured and is breathing on her own with a normal rate and an adequate tidal volume. What would be the advantage of placing her in the recovery position?
It helps to maintain a clear airway.
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:
begin ventilations using the mouth-to-mask technique
Which of the following oxygen flowmeters is NOT affected by gravity and can be used in any position when attached to an oxygen cylinder?
Bourdon-gauge flowmeter
During your assessment of a patient with respiratory distress, you hear wheezing when listening to breath sounds. This indicates:
a lower airway obstruction.
You are ventilating a patient with a stoma; however, air is escaping from the mouth and nose. To prevent this, you should:
seal the mouth and nose.
Complications associated with using a manually triggered ventilation device include
a) inadequate ventilation and hypercarbia.
b) reduced tidal volume delivery and hypoxia.
c) lung tissue injury and gastric distention.
d) inadequate oxygenation and tracheal injury.
c) lung tissue injury and gastric distention.
Which of the following is a late sign of hypoxia?
a) Anxiety
b) Restlessness
c) Cyanosis
d) Tachycardia
c) Cyanosis
In which of the following patients would the head tilt-chin lift maneuver be the MOST appropriate method of opening the airway?
a 37-year-old female who is found unconscious in her bed
Which of the following is the MOST reliable indicator of adequately performed bag-mask ventilations in an apneic adult with a pulse?
adequate rise of the chest when squeezing the bag
The pressure of gas in a full cylinder of oxygen is approximately _______ pounds per square inch (psi).
2,000
Which of the following patients is breathing adequately?
a conscious male with respirations of 19 breaths/min and pink skin
While eating dinner, your partner suddenly grabs his throat and has a panicked look on his face. He has a weak cough, faint inspiratory stridor, and cyanosis around the lips. You should:
stand behind him and administer abdominal thrusts.
The __________ cartilage is a firm ring that forms the inferior part of the larynx.
cricoid
In the presence of oxygen, the mitochondria of the cells convert glucose into energy through a process called:
aerobic metabolism.
What occurs when a patient is breathing very rapidly and shallowly?
Air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchange.
The MOST serious complication associated with using a nasopharyngeal airway in a patient with trauma to the head or face is:
penetrating the cranium.
The process of exchanging oxygen and carbon dioxide between the alveoli and the blood of the capillaries is called:
external respiration
Which of the following would cause an increase in the amount of exhaled carbon dioxide?
a) Excessive ventilation
b) Anaerobic metabolism
c) Increased cardiac output
d) Cardiopulmonary arrest
Anaerobic metabolism
Which of the following statements regarding oxygen is correct?
Oxygen supports the combustion process and may cause a fire.
An unconscious patient found in a prone position must be placed in a supine position in case he or she:
requires cardiopulmonary resuscitation (CPR)
The hypoxic drive—the primary stimulus to breathe for patients with certain chronic respiratory diseases—is influenced by:
low blood oxygen levels.
A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a:
nonrebreathing mask
Inhalation occurs when the:
diaphragm and intercostal muscles contract and cause a decrease in intrathoracic pressure
The diaphragm is innervated by the _________ nerve, which allows it to contract.
phrenic
The jaw-thrust maneuver is used to open the airway of patients with suspected:
cervical spine injuries.
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:
reevaluate the rate and volume of your ventilations
Which of the following statements regarding positive-pressure ventilation is correct?
With positive-pressure ventilation, more volume is required to have the same effects as normal breathing.
You have inserted an oral airway and are ventilating an apneic woman with a bag-mask device. She suddenly begins regurgitating large amounts of vomit. You should:
roll her onto her side and remove the oral airway.
What is the minute volume of a patient with a tidal volume of 500 mL, a dead space volume of 150 mL, and a respiratory rate of 16 breaths/min?
5,600 mL
Which of the following patients should you place in the recovery position?
a 31-year-old semiconscious male with low blood sugar and adequate breathing
Which of the following structures is NOT found in the upper airway?
bronchus
The primary waste product of aerobic metabolism is:
carbon dioxide
A 51-year-old female presents with a sudden onset of difficulty breathing. She is conscious and alert and able to speak in complete sentences. Her respirations are 22 breaths/min and regular. You should:
administer 100% oxygen via a nonrebreathing mask.
Tidal volume is defined as the volume of air that:
moves into or out of the lungs in a single breath.
Intrapulmonary shunting occurs when:
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.
A ventilation/perfusion (V/Q ratio) mismatch occurs when:
a disruption in blood flow inhibits the exchange of oxygen and carbon dioxide in the lungs, even though the alveoli are filled with fresh oxygen.
The MOST significant complication associated with oropharyngeal suctioning is:
hypoxia due to prolonged suction attempts
Gas exchange in the lungs is facilitated by:
adequate amounts of surfactant.
The partial pressure of oxygen in the alveoli is _______ mm Hg, while the partial pressure of carbon dioxide in the alveoli is _______ mm Hg.
104, 40
Which of the following patients would MOST likely require insertion of an oropharyngeal airway?
a 40-year-old unconscious patient with slow, shallow respirations
You and your partner are treating a 66-year-old man who experienced a sudden onset of respiratory distress. He is conscious but is unable to follow simple verbal commands. Further assessment reveals that his breathing is severely labored and his oxygen saturation is 80%. You should:
assist his ventilations with a bag-mask device.
At a flow rate of 6 L/min, a nasal cannula can deliver an approximate oxygen concentration of up to:
44%.
You are dispatched to a residence where a middle-aged man was found unconscious in his front yard. There are no witnesses who can tell you what happened. You find him in a prone position; his eyes are closed and he is not moving. Your FIRST action should be to:
log roll him as a unit to a supine position.
Structures of the lower airway include all of the following, EXCEPT the:
epiglottis
To select the proper size oropharyngeal airway, you should measure from the:
corner of the mouth to the earlobe.
With a good mask-to-face seal and an oxygen flow rate of 15 L/min, the nonrebreathing mask is capable of delivering up to ______% inspired oxygen.
90
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:
remove the airway and be prepared to suction her oropharynx.
An oxygen cylinder should be taken out of service and refilled when the pressure inside it is less than:
500 psi.
Which of the following organs or tissues can survive the longest without oxygen?
muscle
The actual exchange of oxygen and carbon dioxide occurs in the:
alveolar sacs.
A 71-year-old male is semiconscious following a sudden, severe headache. There is vomitus on his face and his respirations are slow and shallow. The EMT must immediately:
perform oropharyngeal suctioning.
The diaphragm functions as an involuntary muscle when a person:
sleeps.
Which of the following statements regarding oxygenation and ventilation is correct?
In mines or confined places, where oxygen levels are low, ventilation may continue despite adequate oxygenation.
Which of the following statements regarding normal gas exchange in the lungs is correct?
Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries
Without adequate oxygen, the body’s cells:
incompletely convert glucose into energy, and lactic acid accumulates in the blood.
The main advantage of the Venturi mask is:
the use of its fine adjustment capabilities in the long-term management of physiologically stable patients.
An adult at rest should have a respiratory rate that ranges between:
12 and 20 breaths/min.
You are ventilating an apneic woman with a bag-mask device. She has dentures, which are tight-fitting. Adequate chest rise is present with each ventilation, and the patient’s oxygen saturation reads 96%. When you reassess the patency of her airway, you note that her dentures are now loose, although your ventilations are still producing adequate chest rise. You should:
remove her dentures, resume ventilations, and assess for adequate chest rise.
The nasopharyngeal airway is MOST beneficial because it:
can maintain a patent airway in a semiconscious patient with a gag reflex.
Which of the following statements regarding the one-person bag-mask device technique is correct?
Adequate tidal volume is often difficult to achieve when one EMT is operating the bag-valve mask.
Irregular respirations characterized by an increasing rate and depth of breathing followed by periods of apnea are called:
Cheyne-Stokes respirations.
The physical act of moving air into and out of the lungs is called:
ventilation.
When testing a mechanical suctioning unit, you should turn on the device, clamp the tubing, and ensure that it generates a vacuum pressure of more than:
300 mm Hg
Central chemoreceptors located in the medulla provide feedback to increase the rate and depth of breathing when they sense:
slight elevations in carbon dioxide or a decrease in the pH of the cerebrospinal fluid.
If ventilation is impaired, carbon dioxide levels in the bloodstream will increase. This condition is called:
hypercarbia.
CPAP is indicated for patients who:
have pulmonary edema and can follow verbal commands.
While providing CPAP to a patient in severe respiratory distress, you note that his heart rate has increased by 20 beats/min. He is conscious, but is no longer following verbal commands. You should:
remove the CPAP device and ventilate him with a bag-valve mask.
As the single EMT managing an apneic patient’s airway, the preferred initial method of providing ventilations is the:
mouth-to-mask technique with a one-way valve.
Proper technique for suctioning the oropharynx of an adult patient includes:
suctioning while withdrawing the catheter from the oropharynx.
Which of the following structures is contained within the mediastinum?
esophagus
Which of the following is NOT a possible cause of airway obstruction?
shallow breathing
You are performing mouth-to-mask ventilations with oxygen connected and set at a flow rate of 15 L/min. What percentage of oxygen is your patient receiving?
55%
What is the MOST common cause of airway obstruction in an unconscious patient?
the tongue
The nasal cannula is MOST appropriately used in the prehospital setting:
when the patient cannot tolerate a nonrebreathing mask
All of the following will help minimize the risk of gastric distention when ventilating an apneic patient with a bag-mask device, EXCEPT:
increasing the amount of delivered tidal volume.
While assisting with respirations, you note gastric distention. In order to prevent or alleviate the distention, you should:
a) ensure that the patient’s airway is appropriately positioned.
b) ventilate the patient at the appropriate rate.
c) ventilate the patient at the appropriate volume.
d) All of these answers are correct.
d) All of these answers are correct.
Which of the following statements regarding breathing adequacy is correct?
Patients breathing shallowly may require assisted ventilation despite a normal respiratory rate.
A 37-year-old male has an apparent foreign body airway obstruction. He is conscious and alert and is coughing forcefully. His skin is pink, warm, and moist. The MOST appropriate treatment for this patient includes:
encouraging him to cough and transporting.
The purpose of the pin-indexing system that has been established for compressed gas cylinders is to:
ensure that the correct regulator is used for the cylinder.
Prior to applying a nonrebreathing mask on a patient, you must ensure that the:
reservoir bag is fully inflated.
The leaf-shaped structure located superior to the larynx is called the:
epiglottis.
A nasopharyngeal airway is inserted:
with the bevel facing the septum if inserted into the right nare
Each cell of the body combines nutrients and oxygen and produces energy and waste products through a process called:
metabolism.
Which of the following factors will cause a decreased minute volume in an adult?
shallow breathing
Which of the following would NOT cause a decrease in tidal volume?
deep respirations
How does positive-pressure ventilation affect cardiac output?
It increases intrathoracic pressure, which decreases venous return to the heart and causes a decrease in cardiac output.
In contrast to inhalation, exhalation:
is a passive process caused by increased intrathoracic pressure.
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?
Alternate 15 seconds of oral suctioning with 2 minutes of assisted ventilation.
You respond to a construction site and find a worker lying supine in the dirt. He has been hit by a heavy construction vehicle and flew more than 15 feet (4.6 m) before landing in his current position. There is discoloration and distention of his abdomen about the right upper quadrant. He is unconscious and his respirations are 10 breaths/min and shallow, with noisy gurgling sounds. What method will you use to keep his airway open?
c) Oropharyngeal airway