EMS EMS Cardiac & Respiratory Emergencies 2 — Questions and Answers
Question 1: A patient with known COPD is in severe respiratory distress with SpO2 of 82%. What oxygen delivery device is MOST appropriate?
- Nasal cannula at 2 L/min
- Non-rebreather mask at 15 L/min
- Venturi mask titrated to 88–92% SpO2 (Correct answer)
- Bag-valve mask at room air
Correct answer: Venturi mask titrated to 88–92% SpO2
COPD patients require controlled oxygen via Venturi mask targeting SpO2 of 88–92% to avoid suppressing their hypoxic drive.
Question 2: Which breath sounds are characteristic of acute pulmonary edema?
- Absent breath sounds bilaterally
- Bilateral crackles (rales) in the lung bases (Correct answer)
- Unilateral wheezing
- Pleural friction rub
Correct answer: Bilateral crackles (rales) in the lung bases
Acute pulmonary edema causes fluid in the alveoli, producing bilateral basilar crackles (rales) due to fluid-filled air sacs re-opening.
Question 3: What position should a patient with acute pulmonary edema be placed in to improve respiratory effort?
- Supine (flat)
- Trendelenburg (head-down)
- High Fowler's (sitting upright) (Correct answer)
- Left lateral recumbent
Correct answer: High Fowler's (sitting upright)
High Fowler's position (sitting upright, legs dangling) reduces venous return and relieves cardiac workload, improving breathing in pulmonary edema.
Question 4: A patient has tracheal deviation to the right, absent breath sounds on the left, and severe respiratory distress after a motor vehicle crash. What condition should be suspected?
- Left-sided hemothorax
- Left-sided tension pneumothorax (Correct answer)
- Right-sided pneumothorax
- Cardiac tamponade
Correct answer: Left-sided tension pneumothorax
Tracheal deviation away from the affected side, absent breath sounds, and hemodynamic instability indicate tension pneumothorax requiring immediate needle decompression.
Question 5: Where is needle decompression performed for a tension pneumothorax using the traditional approach?
- 5th intercostal space, anterior axillary line
- 2nd intercostal space, midclavicular line (Correct answer)
- 4th intercostal space, midaxillary line
- 3rd intercostal space, sternal border
Correct answer: 2nd intercostal space, midclavicular line
Traditional needle decompression is performed at the 2nd intercostal space, midclavicular line, just above the 3rd rib to avoid neurovascular structures.
Question 6: A patient with asthma is unresponsive to two bronchodilator treatments and has silent chest on auscultation. What does this indicate?
- Resolving bronchospasm
- Severe bronchospasm with near-total airway obstruction (status asthmaticus) (Correct answer)
- Pulmonary embolism
- Pneumothorax
Correct answer: Severe bronchospasm with near-total airway obstruction (status asthmaticus)
Silent chest in an asthmatic indicates severe airflow limitation — air movement is so minimal that wheezing disappears, signaling impending respiratory failure.
EMS EMS Cardiac & Respiratory Emergencies 2
A patient with known COPD is in severe respiratory distress with SpO2 of 82%.
What oxygen delivery device is MOST appropriate?