EMS Clinical Procedures & Protocols 2 — Questions and Answers
Question 1: When performing endotracheal intubation, the cuff should be inflated to what pressure range to minimize tracheal mucosal damage?
- 10–15 mmHg
- 20–30 cmH2O (Correct answer)
- 40–50 cmH2O
- 5–10 cmH2O
Correct answer: 20–30 cmH2O
ETT cuff pressure should be maintained between 20–30 cmH2O to seal the airway while preventing mucosal ischemia.
Question 2: A patient in PEA arrest has bilateral absent breath sounds after intubation. What is the FIRST action?
- Confirm tube placement with waveform capnography
- Remove the ETT and BVM ventilate (Correct answer)
- Increase ventilation rate
- Administer epinephrine 1 mg IV
Correct answer: Remove the ETT and BVM ventilate
Absent bilateral breath sounds after intubation indicates esophageal intubation; immediately remove the tube and resume BVM ventilation.
Question 3: Which needle decompression landmark is used in the anterior approach for tension pneumothorax?
- 2nd intercostal space, midclavicular line (Correct answer)
- 4th intercostal space, anterior axillary line
- 3rd intercostal space, midaxillary line
- 5th intercostal space, midclavicular line
Correct answer: 2nd intercostal space, midclavicular line
The standard anterior landmark is the 2nd intercostal space at the midclavicular line, just above the 3rd rib.
Question 4: During IV cannulation, you advance the catheter and get a flashback but cannot flush. What is the most likely cause?
- Catheter is kinked or the vein has been blown (Correct answer)
- Gauge is too small for the fluid rate
- The tourniquet was released too early
- Air embolism has occurred
Correct answer: Catheter is kinked or the vein has been blown
A flashback followed by inability to flush usually means the catheter tip has blown the vein or the catheter is kinked against the vessel wall.
Question 5: When applying a tourniquet for hemorrhage control, it should be placed how far proximal to the wound?
- Directly over the wound
- 2–3 inches proximal to the wound (Correct answer)
- 6–8 inches proximal to the wound
- At the nearest joint
Correct answer: 2–3 inches proximal to the wound
Tourniquets should be applied 2–3 inches proximal to the bleeding wound to effectively compress the supplying vessel.
Question 6: Which waveform on capnography indicates CPR compressions are providing adequate perfusion during cardiac arrest?
- Flat line at 0 mmHg
- ETCO2 consistently ≥ 10 mmHg (Correct answer)
- ETCO2 > 45 mmHg
- Irregular waveform with peaks > 60 mmHg
Correct answer: ETCO2 consistently ≥ 10 mmHg
An ETCO2 of ≥ 10 mmHg during CPR suggests adequate cardiac output is being generated by compressions.
Question 7: A patient requires IO access. After successful insertion, which finding BEST confirms correct placement?
- Needle does not wobble when released
- Absence of subcutaneous infiltration and easy fluid flow (Correct answer)
- Blood aspirated is bright red
- Patient reports pain on aspiration
Correct answer: Absence of subcutaneous infiltration and easy fluid flow
Correct IO placement is confirmed by the needle standing firm, easy aspiration of marrow contents, and fluid flowing without subcutaneous swelling.
EMS Clinical Procedures & Protocols 2
When performing endotracheal intubation, the cuff should be inflated to what pressure range to minimize tracheal mucosal damage?