Emt-P Airway

Front 1

1. The muscular structure that divides the chest cavity from the abdominal cavity is called the:

Back 1

Diaphragm.

Remember that the diaphragm is a large muscle.

Front 2

The volume of air in a normal breath is called:

Back 2

Tidal volume.

Tidal Volume is the amount of gas inhaled or exhaled in a normal respiratory cycle. Approximately 500ml in an adult male.

Front 3

Most oxygen in the blood is transported

Back 3

As Oxyhemoglobin

Oxyhemoglobin is the make up of blood and oxygen that carries oxygen to the tissues

Front 4

A 60-year-old male has a long history of smoking and peripheral edema. He is complaining of extreme weakness and exhaustion from labored breathing. You determine he is hypoventilating. Your most likely assessment is:

Back 4

Right Heart Failure

Key s/s of RHF are peripheral edema, tachycardia, JVD and respiratory difficulties. RHF is usually follows Left heart failure.

Front 5

Your 38 year old male patient is sleepy and suffering from carbon monoxide poisoning. Your treatment includes:

Back 5

Administering Oxygen

Oxygen is your best choice. Paper bag breathing is usually for hyperventilation and carbon dioxide retention.

Front 6

Which of the following describes a correct order of structures in the respiratory passageways?

Back 6

pharynx, larynx, trachea, bronchi, bronchioles

Front 7

Your 34-year-old patient called 9-1-1 because he had a sudden onset of difficulty breathing and chest pain. You arrive to find a tall, thin male who appears very anxious. He splints his chest when he coughs. Your assessment reveals diaphoresis, tachypnea, tachycardia, and hypotension. You should most likely suspect:

Back 7

A spontaneous pneumothorax.

A spontaneous pneumothorax is correct. Some key points – thin patient, chest pain in young persons, tachypnea all of sudden onset often after a coughing episode.

Front 8

For any patient, whether it be an adult, child or infant, if the chest does not rise and fall with each artificial ventilation, or the pulse does not return to normal, the paramedic should

Back 8

Increase the volume of ventilations

If the chest is not rising. You may need to increase the volume of ventilatory assistance to get proper chest rise.

Front 9

The best method of administering oxygen to a distressed neonate who cannot be ventilated with a BVM is:

Back 9

Endotracheal intubation.

While intubation is not a priority if BVM ventilations are successful. If the neonate cannot be ventilated endotracheal intubation is your best choice.

Front 10

when blood levels of carbon dioxide or hydrogen ions increase above normal, the respiratory center of brain responds by

Back 10

increasing the rate and depth of respiration

Increases in PaC02 will stimulate the brain to increase respirations

Front 11

anatomical dead space is

Back 11

the volume of air in the trachea, bronchi and air passages that does not reach the alveoli during respiration

Front 12

The main respiratory center lies in the:

Back 12

Medulla

The medulla oblongata controls respirations, pulse rate and blood pressure.

Front 13

Which of the following does NOT belong to the conducting portion of the respiratory system?

Back 13

Alveoli

Alveoli is not part of “conducting” air in the respiratory system. They are the functional part of respiration.

Front 14

A 76-year-old female has rapid and labored breathing, diaphoresis, cyanosis, neck vein distension, agitation and confusion. Lungs sounds reveal rales. She has a rapid, irregular pulse and an elevated blood pressure. Your management should include ECG monitoring, and:

Back 14

Administer high flow oxygen, nitroglycerine, furosemide, and morphine sulfate.

While morphine and furosemide administration varies from region to region. This is the best answer given

Front 15

a high pitched noise associated with upper airway constriction is known as

Back 15

stridor

Stridor is an upper airway sound often heard in patients with croup

Front 16

You are transporting a severely anemic patient. Pulse oximetry in this setting can be very misleading because:

Back 16

Patients with severe anemia are often hypoxic even when fully saturated.

Anemic patients have a reduced capacity for blood to transport oxygen resulting in low Spo2 readings.

Front 17

which of the following is a true statement of a patient utilizing pursed lip breathing technique.

Back 17

it helps improve tidal volume

Usually seen in COPD patients. Pursed lip breathing helps to empty the lungs completely and allows for deeper inspirations.

Front 18

All of the following statements are true regarding the pediatric airway as compared to the adult airway, EXCEPT:

Back 18

The larynx is lower in the pediatric airway.

The larynx is NOT lower in the pediatric airay structure. Review pediatric airway anatomy vs. adult.

Front 19

In infants and children with respiratory difficulties a paramedic may observe

Back 19

A slight increase in pulse early, but soon the pulse will drop significantly

Remember that pediatric patients will compensate early on in a medical emergency but soon can rapidly deteriorate.

Front 20

Gas exchange in the lungs happens by the process of

Back 20

diffusion

Diffusion is a high to lower concentration exchange like oxygen to carbon dioxide.

Front 21

The passive process in which the rib muscles and the diaphragm relax causing the rib muscles to move downward and inward and the diaphragm to rise is known as

Back 21

expiration and exhalation

Expiration aka Exhalation defines this process. Check your airway chapter.

Front 22

A paramedic must not place anything in the mouth of an infant or child if he or she suspects a(n) _______. Doing this may set off spasms in the airway.

Back 22

Upper respiratory blockage

Upper respiratory blockage is the best choice.

Front 23

You should open the airway of a head trauma patient by using the

Back 23

jaw-thrust method

The jaw thrust is the preferred method for opening the airway of a trauma patient with suspected spinal injury.

Front 24

Correct placement of the endotracheal tube in an adult is confirmed by:

Back 24

Checking lung fields for equal and bilateral lung sounds.

Placement of ET tube placement is confirmed by equal lung sounds but also by direct visualization, ETCO2 readings and also Capnography.

Front 25

A patient who is having difficulty breathing, but breathing adequately should be positioned in the following manner

Back 25

Position of comfort, but preferably sitting up

If complaint is difficluty breathing but patient is breathing adequately, position of comfort is best to help keep patient calm but encourage siting up or semi fowlers.

Front 26

The volume of air that can be exhaled after normal exhalation is the

Back 26

expiratory reserve volume.

Front 27

Which of the following is a symptom of breathing difficulties?

Back 27

Restlessness or anxiety

Tachycardia, cyanosis and pale skin are signs. Restlessness and anxiety are symptoms.

Front 28

With the pediatric asthma patient which is considered the most critical sign/symptom

Back 28

silent chest

A silent chest is an ominous sign in the pediatric patient. Respiratory arrest may be imminent.

Front 29

Which of the following is a contraindication to the use of an oropharyngeal airway?

Back 29

the patient has a gag reflex

Patient with a gag reflex cannot tolerate a OPA.

Front 30

Your patient complains of shortness of breath, chest pain, fever, chills, general malaise and a productive cough with blood-streaked yellow sputum. You detect rhonci and wheezes in the right lower lung. The most likely diagnosis is:

Back 30

Pneumonia

CHF and pulmonary edema more often will present with rales and cool, pale diaphoretic skin and most will be a sudden onset. COPD patienst will have wheezing but usually not associated with fever, chills and productive cough. The best answer is pneumonia.

Front 31

All of the following are potential complications of nasotracheal intubation, EXCEPT:

Back 31

Fracture of the cribriform plate.

Fracture of the cribiform plate is not a concern in nasaltracheal intubation.

Front 32

When confronted with a patient who has hypoxic drive and who is having trouble breathing, you should

Back 32

Give the patient the oxygen he needs, but closely monitor the respirations of the patient

While patients with this type of respiratory drive may have negative effects with high concentration oxygen. In the prehospital setting there is no contraindication to high flow 02.

Front 33

a respiratory pattern described as an irregular pattern, rate and volume with intermittent periods of apnea is known as

Back 33

biots

Biots has an irregular pattern, rate and volume with epsiodes of apnea.

Front 34

a reason that a geriatric patients respiratory system becomes less effective is that

Back 34

there is decreased chest wall compliance

In addition to decreased chest wall complaince, elderly patients may also have loss of lung elasticity, increased air trapping in aveoli and other complications due to underlying pulmonary disease.

Front 35

Lack of oxygen in blood cells and tissues resulting from inadequate breathing or heart function will cause the skin to be:

Back 35

cyanotic

Cyanosis is that bluish color of the skin related to reduced hemoglobin in the blood.

Front 36

The use of accessory muscles and nasal flaring are all signs of

Back 36

labored breathing

These are signs of labored breathing. The patient is using additional muscles and attempts at getting more air and oxygen into their lungs.

Front 37

You are intubating a patient using a MacIntosh blade. This type of blade is designed to have the tip of the blade placed into the:

Back 37

Vallecula

MacIntosh blade is guided into the vellecula to indirectky ekeveate the epiglottis.

Front 38

Which one of the following statements is true regarding the peculiarities of the pediatric airway

Back 38

Pediatric patients are often obligate nose-breathers.

Pediatrics are nose breathers as well as have larger tongues, higher larynx and smaller croid rings.

Front 39

You are assessing a patient’s respiration’s. You find that the respiration’s are 14, normal, and regular. The word ‘normal’ is used to reflect

Back 39

the quality of the respiration

Normal relates to “quality” where 14 is the “rate” and regular is “Rhythm/time”.

Front 40

confirmation of ET tube placement should be evaluated

Back 40

immediately after insertion, each time the patient is moved, by at least two methods

All choices are correct. Using methods like EtC02 are now the standards in most EMS systems.

Front 41

Your patient is a 57-year-old female with a history of asthma. Her husband tells you she has been having an asthma attack that has lasted all morning. She is cyanotic, her chest is hyper resonant, she is using accessory muscles to breathe, and there are inaudible breath sounds bilaterally. Your management of her should include oxygenation, IV access and:

Back 41

Nebulized albuterol and ECG monitoring.

Albuterol via nebulaizer is the best choice along with ECG monitoring. Other options listed would take too long to take affect and this patient is in sever respiratory distress.

Front 42

Shortly after starting an IV on a 58-year-old female, she suddenly exhibits hypotension, cyanosis, rapid pulse and loss of consciousness. You suspect _______, therefore you place her_______:

Back 42

An air embolus/ in the Trendelenburg position.

While rare, the best choice is air embolus and position the patient Trendelenburg preferably left lateral.

Front 43

total lung capacity is

Back 43

the amount of gas contained in the lungs at the end of a maximal inspiration

After a maximal inspiration, the amount of gas that is in the lungs at that time is considered “total lung capacity”

Front 44

respiratory acidosis is caused by

Back 44

excess carbon dioxide retention

Too much carbon dioxide causes respiratory acidosis. Caused by conditions like COPD, chest trauma and other respiratory depression conditions

Front 45

Which of the following statements about a person with Cheyne-Stokes respirations is TRUE:

Back 45

excess carbon dioxide retention

Too much carbon dioxide causes respiratory acidosis. Caused by conditions like COPD, chest trauma and other respiratory depression conditions

Front 46

Which of the following statement is true regarding pediatric asthma

Back 46

Dehydration is common.

Dehydration can be common in pediatric asthma patients.

Front 47

The active process that uses the constriction of several muscles to increase the size of the chest cavity where the intercostal muscles contract and the diaphragm lowers is called

Back 47

Inspiration

When the diaphragm and intercostal muscles contract the patient will be taking a breath in (Inhalation).

Front 48

Normal parameters for an SP02 reading in a healthy person is

Back 48

90-100%

90-100% are normal parameters and will also depend on patient history. Smoking, COPD etc can make it more towards 90%.

Front 49

Your 42-year-old patient with a history of hypertension is found in moderate respiratory distress and presents with bilateral wheezing. His blood pressure is 210/126, heart rate is 122, and respiratory rate is 28 and labored. Which of the following medications is CONTRAINDICATED?

Back 49

Subcutaneous epinephrine 1:1000

Due to the patients history, vital signs and presentation. SQ Epi may exacerbate his condition. Moderate SOB with wheezing may be better treated with albuterol. Also consider CHF for this patient.

Front 50

nasal cannula use will deliver __ % of oxygen at a flow rate of 6lpm in optimal conditions

Back 50

40

40-44% is the most a nasal cannula will deliver at 6LPM. Any higher flow rates will not increase % since the anatomical reserve in the nasal cavity is already filled.

Front 51

When ventilating an infant or a child where the chest does not rise and fall with each ventilation, do all of the following except

Back 51

Perform blind fingers sweeps to detect airway blockages

Blind finger sweeps should not be performed in infants or children for fear of pushing a foriegn body deeper into the airway.

Front 52

A diagnostic sign that can help evaluate peripheral circulation is

Back 52

Capillary refill

Capillary refill using a capillary bed such a finger nails when compressed should take less than 2 seconds to return or “refill” after compressing.

Front 53

During airway management, pathological obstructions of the nares can preclude the use of a/an:

Back 53

Nasopharyngeal airway.

Since the nasopharyngeal airway enters via the nares, obstructions would not allow safe and effective use.

Front 54

if a patient can only speak in two to three words sentences, this usually indicates

Back 54

there is inadequate tidal volume

Patient that can only speak in short sentences indicates a lower than normal tidal volume or not enough air to speak normally.

Front 55

Adverse effects of beta-2 adrenergic bronchodilators include all of the following EXCEPT:

Back 55

lethargy

BETA 2 bronchodilators will have the opposite effect of lethargy such as agitation, increased heart rate and feeling nervous.

Front 56

complications of endotracheal intubation include all of the following except

Back 56

gastric distension

Gastric distention is a result of too much air entering the stomach, where the other choices are a direct complication of ETI.

Front 57

All of the following are potential side effects of inhalers except

Back 57

Decreased pulse rate

Many inhalers will have side affects of increased heart rate, nervouseness and tremors.

Front 58

Which of the following respiratory patterns indicates the highest degree of severity in head-injured patients?

Back 58

Cheyne-Stokes.

Chenye Stokes is seen in disturbance or injury to the respiratory center of the brain. It is an increase in rate and volume with periods of apnea.

Front 59

If you observe a pulse rate below the expected rates for infants and children, you should

Back 59

Make sure that the airway is open, Make sure that the chest rises and falls with each ventilation, Check to make sure that the oxygen tank has not run out or that there is not a kink in the airline

Remember ABC’s. Open airway, adequate respirations, equipment failure.

Front 60

A teenage male is suspected of a drug overdose. As you approach him, you see he is lying on his back and you can hear gurgling respiration’s. This gurgling is most likely being caused by:

Back 60

fluid or vomitus in his upper airway

The gurgling is from fluid in his upper airway which needs to be removed by suctioning so that he does not aspirate the fluid into his lungs.

Front 61

a respiratory pattern described as a gradually increasing rate and tidal volume followed by a gradual decrease with intermittent periods of apnea is

Back 61

cheyne-stokes

Cheyne-Stokes which is associated with a disturbance of the respiratory center in the brain.

Front 62

The primary reason for performing the Sellick’s maneuver during endotracheal intubation is to:

Back 62

Prevent regurgitation.

Sellick’s maneuver compresses trachea against cervical vertebra, occluding esophagus. Limiting regurgitation/aspiration.

Front 63

Factors which can alter oxygen levels in the blood include all of the following, EXCEPT:

Back 63

Hypertension

Hypertension will not alter levels. However hypertension is usually a result from other causes such as CHF or CVA, these can alter the 02 levels.

Front 64

A patient who is having difficulty breathing often positions himself in what is called the ‘tripod position’ Which of the following best describes this position?

Back 64

Patient is leaning forward with his hands resting on his knees or another surface

Patient will be leaning forward with hands on knees or another surface mimicking a “tripod effect”

Front 65

the phrenic nerve originates from which spinal nerves

Back 65

c3-c4-c5

Front 66

Signs of inadequate breathing in infants and children are

Back 66

Nasal flaring, Seesaw breathing or grunting and Retractions

Front 67

the volume of air in the alveoli that contributes to oxygen/carbon dioxide exchange during respiration

Back 67

A prolonged expiratory phase.

Airflow becomes restricted upon exhalation causing a longer expiratory phase.

Front 68

Beta-2 selective adrenergic agonists include all EXCEPT:

Back 68

Isoproterenol

Isoproterenol relies exclusively on beta receptors

Front 69

Normal breathing is determined by all of the following except

Back 69

Sound

Sound is not a determining sign for normal breathing.

Front 70

the presence of rhonci in a patient diagnosed with pneumonia indicates

Back 70

mucus in the airways

Mucus is what can cause the rhonci sounds heard in pneumonia patients.

Front 71

The exchange of gases between blood and cells is called

Back 71

internal respiration.

Internal respiration is where gas exchnage occurs between blood and cells.

Front 72

Which of the following respiratory disorders will NOT produce hypoxic drive

Back 72

Asthma

COPD includes Chronic Bronchitis and Emphysema. Asthma is not part of this disease process

Front 73

_______ is the patient’s sensation of difficult breathing while lying flat. It is commonly found in patients with ______.

Back 73

Orthopnea/ congestive heart failure.

Orthopnea is the change of respiratory difficult when positioning changes. Seen many times in developing CHF patients when lying flat.

Front 74

breath sounds such as crackles and rhonci that are not normally heard are defined as __________ breath sounds

Back 74

adventitious

Breath sounds that are abnormal or heard over normal breath sounds are referred to as adventitious.

Front 75

An infant or child suffering from a lower respiratory problem may exhibit all of the following signs except

Back 75

Rapid breathing with stridor (a harsh, high-pitched sound)

Stridor ( a harsh, high pitched sound) is an upper airway condition.

Front 76

The structure which closes off the larynx is the

Back 76

epiglottis

Front 77

An adult patient who is breathing at a rate of 6 breaths per minute needs to be treated by

Back 77

providing positive pressure ventilation with 100% oxygen

This patient requires high oxygen concentration at 100% via BVM 15-25 LPM. The average breathing rate for an adult is 12-16 breaths per minute.

Front 78

Early signs of progressive respiratory distress include:

Back 78

Tachycardia, irritability, and labored respiratory effort.

Irritability along with increased heart rate and labored breathing effort are signs of hypoxia and an increase in distress.

Front 79

The average breathing rate of an adult is

Back 79

12 – 20 breaths per minute

12-20 is the average range for an adult at rest. AHA rates are 8-10 rescue breaths.

Front 80

An infant will breathe approximately

Back 80

25 – 50 breaths per minute

While can vary ie 30-60 or 20-40 BPM. Of the choices given 25-50 is the best answer. Infant is Birth-1 year old.

Front 81

The primary chemical stimulus for breathing is the concentration of

Back 81

carbon dioxide in the blood.

In normal patients carbon dioxide levels trigger breathing.

Front 82

a nasopharyngeal airway is measured

Back 82

from the tip of the nose to the earlobe

Tip of the nose to earlobe and diameter should be approx size of “patients” pinky finger.

Front 83

You suspect that your nearly unconscious male patient has ingested sleeping pills and alcohol. He is breathing inadequately. You should immediately

Back 83

manage the airway

ABC’s – Airway management is the priority here and a nasal cannual wont do it.

Front 84

All of the following criteria are examples of when you can assist a patient with his prescribed inhaler except

Back 84

Patient is unconscious

An unconscious patient cannot use an inhaler since it requires them to inhale at a timed/specifc moment.

Front 85

A child will breathe approximately

Back 85

15 – 30 breaths per minute

15-30 is the best approximate respiratory rate for a child.

Front 86

Over time, patients with severe emphysema or chronic bronchitis rely on _______ as the only remaining respiratory drive.

Back 86

Hypoxemia

COPD patients have the hypoxic drive and rely on changes in Pa02 levels to regulate respirations.

Front 87

For which of the following patients would rapid sequence intubation be the next intervention of choice?

Back 87

An unresponsive victim of head and chest trauma with clenched teeth.

The unresponsive patient is your best choice. While the CHF and pediatric seizure may be candidates for RSI, there are still other interventions you can try first.

Front 88

The skin color of a patient who is having difficulty breathing is often

Back 88

Blue and/or pale

Blue and pale skin color are signs of lack of perfusion to the skin.

Front 89

Which of the following are lower airway problems?

Back 89

Rales

Rales are sounds auscultated in the lower airways.

Front 90

Sighing is a slow, deep inspiration followed by a prolonged expiration is thought to be a protective reflex to prevent:

Back 90

Atelectasis

This hyperinflates the lungs and re expands alveoli.

Front 91

the thoracic cavity is covered by a smooth, moist epithelial layer called the

Back 91

parietal pleura

Parietal pleura covers the thoracic cavity.

Front 92

A 60-year-old female has a long history of smoking and chronic bronchitis with subsequent chronic hypoxemia, chronic hypercarbia, pulmonary vascular hypertension with ventricular dysfunction. She is complaining of extreme weakness and exhaustion from labored breathing. Your most likely assessment is:

Back 92

Right heart failure.

Considering the patients history and chief complaint, right sided heart failure is the most likely emergency.

Front 93

what sign and symptom would lead you to believe a patient is decompensating significantly in respiratory distress

Back 93

decreased level of consciousness

Change in mental status in respiratory distress is significant since it indicates a severe lack of oxygenated blood getting to the brain. This occurs after prolonged respiratory distress.

Front 94

Since the chest wall is softer in infants and children, they tend to

Back 94

Depend more heavily on their diaphragms for respirations

Infants are belly breathers. Depending more on their diaphragm for respirations.

Front 95

The LEAST invasive way to secure a patient’s airway when intubation is unsuccessful is to:

Back 95

Place an pharyngeal esophageal airway device.

A pharyngeal esophageal airway device is the least invasive method from these choices.

Front 96

A patient with breathing difficulties, but is breathing adequately, should receive

Back 96

Nonrebreather mask at 12 – 15 liters/minute oxygen

The best choice is the NRB at high flow 02.

Front 97

A contraindication to endotracheal tube placement is when the:

Back 97

Patient is conscious and has adequate respirations.

ET tube placement is an advanced airway procedure for patients in respiratory arrest, imminent arrest and other conditions that would require you to manage the airway and beath for the patient.

Front 98

The exchange of gases occurs in the

Back 98

alveoli.

Gas is exchanged at the alveoli with the capilliaries by “DIFFUSION”

Front 99

an advantage of using the combi tube include all of the following except

Back 99

it can be used with pediatric patients

Combitubes cannot be used for pediatric patients.

Front 100

While assessing a patient with a history of COPD, you note a drop in the systolic blood pressure of 10mmHg or more with each respiratory cycle. This finding is referred to as:

Back 100

Pulsus paradoxus

Pulsus paradoxus is an abnormal decrease in systolic BP that drops > 10-15mmHg during inspiration.