CPR - Certified Paramedic Response Advanced Airway Management Questions and Answers 1 — Questions and Answers
Question 1: A paramedic is treating a 58-year-old male in cardiac arrest. After endotracheal intubation, waveform capnography shows a persistent, flat waveform with an ETCO2 value of 0 mmHg despite effective chest compressions. What is the MOST likely cause of this finding?
- Severe bronchoconstriction
- The endotracheal tube is correctly placed in the trachea
- Esophageal intubation (Correct answer)
- Return of spontaneous circulation (ROSC)
Correct answer: Esophageal intubation
A persistent, flat waveform on capnography with a value of 0 mmHg is the most reliable indicator of esophageal intubation. During cardiac arrest, even with effective CPR, some CO2 should be detected if the tube is in the trachea. The absence of CO2 indicates that the tube is in the esophagus, and no gas exchange is occurring.
Question 2: You are preparing for a Rapid Sequence Intubation (RSI) on a patient with a suspected head injury and increasing intracranial pressure. Which of the following induction agents is often preferred in this scenario due to its hemodynamic stability and potential for neuroprotection?
- Propofol
- Etomidate (Correct answer)
- Diazepam
- Midazolam
Correct answer: Etomidate
Etomidate is often favored for RSI in patients with head injuries as it maintains hemodynamic stability (minimal effect on blood pressure) and does not increase intracranial pressure. In contrast, Propofol can cause significant hypotension, and benzodiazepines like Diazepam and Midazolam may also lower blood pressure.
Question 3: A 45-year-old female with massive facial trauma is unable to be ventilated with a bag-valve-mask, and multiple attempts at endotracheal intubation have failed. The patient is now hypoxic and bradycardic. What is the most appropriate next step in airway management?
- Insert a supraglottic airway
- Perform a needle cricothyrotomy
- Attempt nasotracheal intubation
- Perform a surgical cricothyrotomy (Correct answer)
Correct answer: Perform a surgical cricothyrotomy
In a "can't intubate, can't ventilate" (CICV) scenario, especially with massive facial trauma that precludes the use of other airways, a surgical cricothyrotomy is the definitive emergency procedure to secure an airway. A needle cricothyrotomy is an option but provides only temporary oxygenation and is not a definitive airway. A supraglottic airway would likely be ineffective due to the trauma, and nasotracheal intubation is contraindicated with severe facial injuries.
Question 4: Which of the following is considered the GOLD STANDARD for confirming correct endotracheal tube placement in a patient with a perfusing rhythm?
- Bilateral breath sounds on auscultation
- Visualization of the tube passing through the vocal cords
- Condensation in the endotracheal tube
- Continuous waveform capnography (Correct answer)
Correct answer: Continuous waveform capnography
While direct visualization, auscultation, and tube condensation are all used as part of the assessment, continuous waveform capnography is the most reliable, non-invasive method to confirm and continuously monitor endotracheal tube placement in patients with adequate circulation. It provides real-time physiological feedback that the tube is in the trachea and gas exchange is occurring.
Question 5: A paramedic is managing the airway of a patient in respiratory distress using a supraglottic airway (SGA) device. Which of the following is a known potential complication associated with the use of SGAs?
- Decreased risk of aspiration compared to endotracheal intubation
- Inability to ventilate against high airway pressures (Correct answer)
- Requirement for neuromuscular blockade for insertion
- Guaranteed protection against laryngospasm
Correct answer: Inability to ventilate against high airway pressures
Supraglottic airways do not provide a definitive seal of the trachea like an endotracheal tube. Therefore, they may not be effective in patients with poor lung compliance or high airway resistance, as air can leak around the cuff instead of entering the lungs. They do not guarantee protection from aspiration, do not require paralysis for insertion, and cannot prevent laryngospasm.
Question 6: During CPR on an intubated adult patient, the quantitative waveform capnography reading has been consistently between 8-12 mmHg. Suddenly, the reading jumps to 40 mmHg. What is the most likely interpretation of this change?
- The quality of chest compressions has significantly improved
- The endotracheal tube has been displaced into the esophagus
- Return of Spontaneous Circulation (ROSC) has occurred (Correct answer)
- The patient is developing severe acidosis
Correct answer: Return of Spontaneous Circulation (ROSC) has occurred
A sudden, significant increase in the end-tidal CO2 (ETCO2) value during CPR is a strong indicator of the Return of Spontaneous Circulation (ROSC). The restored cardiac output circulates more CO2 to the lungs for exhalation, causing the sharp rise in the ETCO2 reading. While improved compressions may slightly increase the value, a jump of this magnitude is most commonly associated with ROSC.
CPR - Certified Paramedic Response Advanced Airway Management Questions and Answers 1
A paramedic is treating a 58-year-old male in cardiac arrest.
After endotracheal intubation, waveform capnography shows a persistent, flat waveform with an ETCO2 value of 0 mmHg despite effective chest compressions.
What is the MOST likely cause of this finding?