FP-C Ventilator Management and Respiratory Support 3

Question 1

At altitude (e.g., 8,000 ft cabin altitude), which change in a ventilated patient's gas volumes should the flight paramedic anticipate?

Accepted Answer

Gas volumes will expand due to decreased atmospheric pressure (Boyle's Law)

Answer

Delivered tidal volumes will decrease due to increased atmospheric pressure

Answer

Oxygen partial pressure increases, improving oxygenation

Answer

PEEP levels automatically increase to compensate

Question 2

Which of the following is a recognized criterion for initiating non-invasive positive pressure ventilation (NIPPV) during transport?

Accepted Answer

Acute hypercapnic respiratory failure with intact airway reflexes

Answer

GCS of 8 or less with inability to protect airway

Answer

Hemoptysis with SpO2 less than 80%

Answer

Bilateral flail chest with tension pneumothorax

Question 3

CPAP differs from BiPAP primarily in that CPAP:

Accepted Answer

Delivers a single continuous pressure throughout the respiratory cycle

Answer

Provides higher pressure during inhalation than exhalation

Answer

Can only be used with a face mask, not a nasal interface

Answer

Is contraindicated in patients with hypoxemic respiratory failure

Question 4

When ventilating a patient with chronic obstructive pulmonary disease (COPD) exacerbation, which ventilator adjustment is MOST important to prevent air trapping?

Accepted Answer

Prolonging expiratory time by using a lower I:E ratio (e.g., 1:3 to 1:4)

Answer

Increasing respiratory rate to 20-24 breaths/min

Answer

Increasing tidal volume to 10 mL/kg IBW

Answer

Using 100% FiO2 throughout transport

Question 5

A patient intubated for respiratory failure has an ETCO2 waveform that shows a rising baseline (capnographic 'shark fin' pattern with elevation). This most likely indicates:

Accepted Answer

Air trapping and incomplete exhalation (obstructive pattern)

Answer

Esophageal intubation

Answer

Hyperventilation with low CO2

Answer

Pulmonary edema causing washout effect

Question 6

During critical care transport, a ventilated patient develops sudden hypotension, rising peak airway pressures, and absent breath sounds on the left side. The PRIORITY intervention is:

Accepted Answer

Needle thoracostomy on the left chest at the 2nd intercostal space, midclavicular line

Answer

Administer 1 L IV crystalloid bolus immediately

Answer

Increase PEEP to 15 cmH2O to recruit the left lung

Answer

Obtain 12-lead ECG to rule out MI

Question 7

Which parameter is considered the most reliable indicator that a patient is ready for extubation during transport preparation?

Accepted Answer

Negative inspiratory force (NIF) more negative than -20 cmH2O with GCS ≥ 10

Answer

SpO2 greater than 90% on FiO2 of 1.0

Answer

Absence of secretions for more than 2 hours

Answer

Heart rate less than 100 beats per minute