Exam (elaborations)
EMT AIRWAY QUESTIONS AND ANSWERS
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EMT AIRWAY QUESTIONS AND ANSWERS
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EMT AIRWAY QUESTIONS AND ANSWERSWhich of the following is the preferred initial method for providing artificial ventilations to
an apneic adult?
A: Two-person bag-valve-mask technique with 100% oxygen
B: Mouth-to-mask technique with supplemental oxygen
C: One-person bag-valve-mask technique with 100% oxygen
D: Flow-restricted, oxygen-powered ventilation device - Answers -B: Mouth-to-mask
technique with supplemental oxygen
Reason:The preferred initial method for providing artificial ventilations is the mouth-to-
mask technique with one-way valve and supplemental oxygen attached. Evidence has
shown that rescuers who ventilate patients infrequently have difficulty maintaining an
adequate seal with a bag-mask device. Because both of the rescuer's hands are freed
up when using a pocket face mask, it is easier to maintain an adequate seal, thus
providing more effective ventilations. Of course, if two rescuers are available to manage
the airway, the two-person bag-mask device technique should be used. The flow-
restricted, oxygen-powered ventilation device, also referred to as the manually-triggered
ventilator or demand valve, requires an oxygen source to function and would thus not
be practical as an initial device for providing artificial ventilations.
The MOST effective way to determine if you are providing adequate volume during
artificial ventilation is:
A:assessing the pulse for an improving heart rate.
B:checking the skin for improvement of cyanosis.
C:checking the pupils for increased reactivity.
D:assessing the chest for adequate rise. - Answers -D:assessing the chest for
adequate rise.
Reason:The goal of providing artificial ventilation is to provide adequate tidal volume to
the patient so that enough oxygen is delivered to the lungs, and ultimately, the cells of
the body. The most effective way to determine if adequate tidal volume is being
delivered is to watch for the chest to rise during each ventilation. Other signs of
adequate artificial ventilation include improvement in skin color, the return of the heart
rate to a normal range, and ensuring that you are ventilating the patient at the
appropriate rate. If the adult is apneic but has a pulse, provide 10 to 12 breaths/min. If
the adult is apneic and pulseless, provide 8 to 10 breaths/min after an advanced airway
device (ie, ET tube, multilumen airway, supraglottic airway) has been inserted.
Which of the following processes occurs during inhalation?
A: The diaphragm descends and the intercostal muscles relax.
B: The intercostal muscles and diaphragm both contract.
C: The diaphragm contracts and the intercostal muscles relax.
D: The intercostal muscles relax and the diaphragm descends. - Answers -B: The
intercostal muscles and diaphragm both contract.
Reason: During the active process of inhalation, the diaphragm contracts, causing it to
descend. This increases the vertical dimensions of the chest. At the same time, the
,intercostal muscles (muscles between the ribs) contract, increasing the horizontal
dimensions of the chest. These two processes cause intrathoracic pressure to fall, and
air rushes in to fill the lungs. The drawing of air into the lungs by the actions of these
muscles is called negative-pressure ventilation.
A 22-year-old man crashed his motorcycle into a tree. He is found approximately 20 feet
away from his bike and is responsive to pain only. He is not wearing a helmet. You are
unable to effectively open his airway with the jaw-thrust maneuver. What should you
do?
A: Insert an oral airway and assess his breathing.
B: Apply high-flow oxygen and assess his carotid pulse.
C: Suction his oropharynx and reattempt the jaw-thrust.
D: Carefully tilt his head back and lift up on his chin. - Answers -D: Carefully tilt his
head back and lift up on his chin.
Reason: Regardless of the situation, you MUST be able to establish and maintain a
patent airway. Without a patent airway, the patient will die. If you are unable to
effectively open a trauma patient's airway with the jaw-thrust maneuver, you should
carefully perform the head tilt-chin lift maneuver. You cannot assess, not to mention
treat, a patient's airway if it is not open and clear of secretions or foreign bodies.
If the level of CO2 in the arterial blood increases:
A: the respiratory rate slows significantly.
B: the respiratory rate and depth decrease.
C: a reduction in tidal volume will occur.
D: the respiratory rate and depth increase. - Answers -D: the respiratory rate and depth
increase.
Reason: Special receptors, called chemoreceptors, sense the levels of oxygen and
carbon dioxide in the arterial blood. The central chemoreceptors are located in the
brain; the peripheral chemoreceptors are located in the aorta and carotid arteries. The
level of carbon dioxide in the arterial blood stimulates the healthy patient to breathe
(primary respiratory drive). If the carbon dioxide level rises above normal, the
chemoreceptors send messages to respiratory centers in the brain, resulting in an
increase in respiratory rate and depth (tidal volume). Conversely, if the level of carbon
dioxide is too low, respiratory rate and depth decrease accordingly.
You are assessing an elderly man with respiratory distress. He is coughing up bloody
sputum and has an oxygen saturation of 85%. You auscultate his breath sounds and
hear coarse crackles in all lung fields. This patient MOST likely has:
A: severe bacterial pneumonia.
B: congestive heart failure.
C: acute onset emphysema.
D: decompensated asthma. - Answers -B: congestive heart failure. Reason: This
patient's signs and symptoms are classic for left-sided congestive heart failure and
pulmonary edema. As the left side of the heart weakens, in which case it can no longer
effectively pump blood, blood backs up into the lungs, resulting in pulmonary edema. As
pulmonary edema gets worse, the patient begins coughing up pink, frothy sputum
,(hemoptysis). The presence of fluid in the lungs impairs the exchange of oxygen and
carbon dioxide, resulting in hypoxemia and a low oxygen saturation (SpO2).
Auscultation of the patient's lungs often reveals coarse crackles, which indicates the
presence of fluid. Emphysema is a chronic respiratory disease, not an acute one.
Furthermore, hemoptysis is not a common finding with emphysema. Likewise, patients
with decompensated asthma often have markedly diminished lung sounds owing to
severe bronchospasm; hemoptysis and crackles are not common. Bacterial pneumonia
can cause respiratory distress; however, it usually presents with fever and diminished
breath sounds to a localized area of a lung (for example, the left lower lobe).
Which of the following patients has signs of inadequate breathing?
A: A 30-year-old man with respirations of 12 breaths/min with adequate depth
B: A 50-year-old woman with respirations of 12 breaths/min and pink, dry skin
C: A 60-year-old man with clear and equal breath sounds bilaterally
D: A 41-year-old woman with shallow respirations of 14 breaths/min - Answers -D: A
41-year-old woman with shallow respirations of 14 breaths/min Reason: Although the
41-year-old woman has a respiratory rate that falls within the normal range for an adult,
the depth of her breathing is shallow (reduced tidal volume). Signs of inadequate
breathing in the adult include a slow (less than 12 breaths/min) or fast (greater than 20
breaths/min) respiratory rate, shallow depth (reduced tidal volume), altered level of
consciousness, tachycardia, an irregular pattern of inhalation and exhalation,
diminished breath sounds during auscultation, and cyanosis. It is important to assess
ALL components of a patient's breathing: rate, regularity, depth, and quality. Do not rely
solely on one parameter.
Which of the following injuries or conditions should be managed FIRST?
A:Fluid drainage from both ears
B:Bleeding within the oral cavity
C:Bilateral fractures of the femurs
D:A large open abdominal wound - Answers -B: Bleeding within the oral cavity
Reason: Any injury or condition that jeopardizes the airway has priority over all else. If
blood or other secretions within the mouth are not suctioned immediately, aspiration
may occur; this significantly increases mortality. After securing a patent airway, control
any external bleeding. Ideally, you and your partner should treat airway problems and
external bleeding at the same time.
You are assessing a middle-aged male who is experiencing respiratory distress. The
patient has a history of emphysema and hypertension. He appears fatigued; has weak
retractions; and labored, shallow breathing. Your MOST immediate action should be to:
A: administer oxygen with a nonrebreathing mask.
B: assist his ventilations with a bag-mask device.
C: assess his oxygen saturation with a pulse oximeter.
D: auscultate his breath sounds to detect wheezing. - Answers -B: assist his
ventilations with a bag-mask device.
Reason:Your patient is NOT breathing adequately. He is fatigued; has weak retractions;
and labored, shallow breathing. If you do not treat him immediately, he may stop
, breathing altogether. You should begin assisting his ventilations with a bag-mask device
and high-flow oxygen. After initiating ventilatory assistance, attach the pulse oximeter to
assess his oxygen saturation and auscultate his breath sounds. A nonrebreathing mask
is appropriate for patients with difficulty breathing who are moving air adequately; this
patient is not!
When ventilating an apneic patient, you note decreased ventilatory compliance. This
means that:
A: the upper airway is blocked.
B: the lungs are difficult to ventilate.
C: fluid is occupying the alveoli.
D: you meet no resistance when ventilating. - Answers -B: the lungs are difficult to
ventilate.
Reason: As it applies to artificial ventilation, compliance is the ability of the lungs to
expand during ventilation. Increased ventilatory compliance means that no resistance is
met when you ventilate the patient; you can ventilate the lungs with ease. Decreased
ventilatory compliance means that significant resistance is met when you ventilate the
patient; the lungs are difficult to ventilate. Conditions such as upper airway obstruction,
widespread bronchospasm, fluid in the alveoli (eg, pulmonary edema), and COPD can
all cause decreased ventilatory compliance.
You are dispatched to a residence for an elderly female who has possibly suffered a
stroke. You find her lying supine in her bed. She is semiconscious; has vomited; and
has slow, irregular breathing. You should:
A: manually open her airway and suction her oropharynx.
B: Insert a nasal airway and begin assisting her breathing.
C: perform a head tilt-chin lift and insert an oral airway.
D: administer high-flow oxygen and place her on her side. - Answers -A: manually open
her airway and suction her oropharynx.
Reason: This patient's airway is in immediate jeopardy! The first step in caring for any
semi- or unconscious patient is to manually open the airway (eg, head tilt-chin lift, jaw-
thrust) and ensure it is clear of obstructions or secretions. Because the patient has
vomited, she likely has vomitus in her mouth, which must be removed with suction
before she aspirates it into her lungs. Mortality increases significantly if aspiration
occurs. After opening her airway and removing any vomitus or secretions from her
oropharynx with suction, you should insert an airway adjunct (a nasal airway in this
case; the patient is semiconscious and likely has an intact gag reflex) and begin
assisting her breathing with a bag-mask device. Her respiratory effort is inadequate and
should be treated with some form of positive-pressure ventilation, not a nonrebreathing
mask. Placing a semi- or unconscious patient on his or her side (recovery position) is
only appropriate if he or she is breathing adequately; this patient is not.
An unresponsive apneic patient's chest fails to rise after two ventilation attempts. You
should:
A: reposition the head and reattempt to ventilate.
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