COPR Airway Management and Respiratory Emergencies 1 — Questions and Answers
Question 1: A patient is unresponsive and apneic. After opening the airway with a head-tilt chin-lift, you attempt bag-valve-mask ventilation but notice significant resistance and chest does not rise. What is your FIRST priority?
- Perform a blind finger sweep
- Reposition the airway and attempt ventilation again (Correct answer)
- Insert a nasopharyngeal airway immediately
- Begin chest compressions
Correct answer: Reposition the airway and attempt ventilation again
Airway repositioning is the first corrective step when BVM ventilation fails, as improper positioning is the most common cause of ineffective ventilation.
Question 2: Which of the following is the MOST reliable indicator that endotracheal tube placement is correct?
- Bilateral breath sounds on auscultation
- Visualization of the tube passing through the vocal cords (Correct answer)
- Absence of epigastric sounds
- Chest rise with ventilation
Correct answer: Visualization of the tube passing through the vocal cords
Direct visualization of the tube passing through the vocal cords is the gold standard for confirming correct ETT placement.
Question 3: A patient presents with severe respiratory distress, absent breath sounds on the left, hypotension, and tracheal deviation to the right. What condition should be suspected?
- Massive hemothorax
- Left tension pneumothorax (Correct answer)
- Right-sided pneumonia
- Cardiac tamponade
Correct answer: Left tension pneumothorax
Absent breath sounds, tracheal deviation away from the affected side, and hemodynamic compromise are classic signs of tension pneumothorax.
Question 4: When performing nasotracheal intubation, which patient condition is a contraindication?
- Trismus
- Suspected cervical spine injury
- Suspected mid-face or basilar skull fracture (Correct answer)
- Gag reflex intact
Correct answer: Suspected mid-face or basilar skull fracture
Mid-face fractures and suspected basilar skull fractures are contraindications to nasotracheal intubation due to the risk of intracranial tube placement.
Question 5: A patient with acute severe asthma is not responding to initial bronchodilator therapy and is becoming increasingly fatigued. Which finding MOST suggests impending respiratory failure?
- Expiratory wheeze
- SpO2 of 93% on room air
- Decreasing level of consciousness and a silent chest (Correct answer)
- Use of accessory muscles
Correct answer: Decreasing level of consciousness and a silent chest
A silent chest (absence of wheeze due to minimal airflow) combined with decreasing consciousness indicates critical, life-threatening asthma requiring immediate intervention.
Question 6: Which of the following is the correct procedure for performing needle decompression for tension pneumothorax?
- 2nd intercostal space, mid-clavicular line, over the top of the rib
- 3rd intercostal space, anterior axillary line, below the rib
- 2nd intercostal space, mid-clavicular line, below the rib (Correct answer)
- 4th intercostal space, mid-axillary line, over the top of the rib
Correct answer: 2nd intercostal space, mid-clavicular line, below the rib
Needle decompression is performed at the 2nd ICS mid-clavicular line just over the top of the 3rd rib to avoid the neurovascular bundle running beneath each rib.
Question 7: A 60-year-old COPD patient presents with worsening dyspnea, productive cough, and SpO2 of 82%. After applying supplemental oxygen, his SpO2 rises to 92% but his respiratory rate decreases significantly and he becomes more somnolent. What is the MOST likely explanation?
- The patient has developed a pulmonary embolism
- High-flow oxygen has suppressed his hypoxic respiratory drive (Correct answer)
- The patient is experiencing a myocardial infarction
- Oxygen toxicity has developed rapidly
Correct answer: High-flow oxygen has suppressed his hypoxic respiratory drive
Some severe COPD patients rely on hypoxic drive to breathe; administering high-flow oxygen can suppress this drive, causing hypoventilation and CO2 retention.
COPR Airway Management and Respiratory Emergencies 1
A patient is unresponsive and apneic.
After opening the airway with a head-tilt chin-lift, you attempt bag-valve-mask ventilation but notice significant resistance and chest does not rise.
What is your FIRST priority?