Free Paramedics Airway, Respiration, and Ventilation Questions and Answers — Questions and Answers
Question 1: A 58-year-old male is in cardiac arrest. After endotracheal intubation, you begin ventilation and monitor waveform capnography. The initial ETCO2 is 8 mmHg. Despite high-quality CPR and appropriate ALS interventions, the ETCO2 remains below 10 mmHg for 20 minutes. What is this finding most indicative of?
- Effective chest compressions and good pulmonary blood flow.
- A misplaced endotracheal tube in the esophagus.
- A low likelihood of achieving Return of Spontaneous Circulation (ROSC). (Correct answer)
- Hyperventilation of the patient.
Correct answer: A low likelihood of achieving Return of Spontaneous Circulation (ROSC).
In cardiac arrest, ETCO2 is an indirect measure of pulmonary blood flow, which is generated by chest compressions. Persistently low ETCO2 values (<10 mmHg) during resuscitation suggest that chest compressions are not generating adequate circulation. The failure to achieve an ETCO2 greater than 10 mmHg after 20 minutes of high-quality CPR is associated with a very low probability of achieving ROSC.
Question 2: You are ventilating an intubated 70-year-old female with a history of COPD. The ventilator suddenly sounds a high-pressure alarm. Which of the following is the MOST likely cause?
- A leak in the ventilator circuit.
- Disconnection of the endotracheal tube from the ventilator.
- Bronchospasm or a mucus plug. (Correct answer)
- Development of hypotension.
Correct answer: Bronchospasm or a mucus plug.
A high-pressure alarm indicates an obstruction to airflow, which increases airway resistance. In a patient with COPD, bronchospasm or the presence of a mucus plug are common causes of increased airway resistance, leading to the ventilator needing higher pressure to deliver the set volume. A leak or disconnection would cause a low-pressure alarm. Hypotension is not a direct cause of a high-pressure alarm.
Question 3: A paramedic is managing the airway of an 18-month-old in respiratory distress. Which anatomical difference in a pediatric patient is most critical to consider when positioning the airway?
- The trachea is narrower and more flexible.
- The tongue is proportionally smaller than in an adult.
- The epiglottis is less flexible and U-shaped.
- The occiput is proportionally larger, causing neck flexion. (Correct answer)
Correct answer: The occiput is proportionally larger, causing neck flexion.
In infants and young children, the occiput (back of the head) is proportionally larger than in adults. When lying supine, this causes the neck to flex, which can obstruct the airway. To achieve a neutral or 'sniffing' position for airway management, padding should be placed under the shoulders to align the airway axes.
Question 4: Which of the following is the most reliable sign of adequate artificial ventilation with a bag-valve-mask (BVM)?
- The patient's skin color improves from cyanotic to pink.
- Gastric distention is noted.
- Equal and visible chest rise and fall with each ventilation. (Correct answer)
- The heart rate returns to a normal range.
Correct answer: Equal and visible chest rise and fall with each ventilation.
The most direct and reliable indicator that air is entering the lungs during BVM ventilation is observing the chest rise and fall with each breath delivered. While skin color and heart rate may improve with effective ventilation, they are less immediate and can be influenced by other factors. Gastric distention indicates air is entering the stomach, which is a complication of, not a sign of, adequate ventilation.
Question 5: You respond to a 45-year-old male with massive facial trauma after an assault. He is unconscious, breathing agonally, and has significant bleeding in the oropharynx that suctioning cannot control. You are unable to intubate or ventilate with a BVM. What is the most appropriate next step?
- Insert a laryngeal mask airway (LMA).
- Perform a surgical cricothyrotomy. (Correct answer)
- Attempt a nasotracheal intubation.
- Place the patient in the recovery position and transport rapidly.
Correct answer: Perform a surgical cricothyrotomy.
This patient is in a 'can't intubate, can't ventilate' situation. A surgical cricothyrotomy is indicated when other, less invasive, methods of securing an airway have failed or are impossible due to conditions like massive facial trauma, clenched jaw, or severe airway swelling. An LMA would likely be ineffective due to the bleeding, and nasotracheal intubation is often contraindicated in severe facial trauma. The patient requires an immediate definitive airway.
Question 6: Use of a laryngeal mask airway (LMA) is relatively contraindicated in which of the following patients?
- A patient in cardiac arrest after an unwitnessed collapse.
- A patient with a known difficult airway who requires ventilation.
- A morbidly obese patient who has not fasted. (Correct answer)
- An elderly patient with a history of asthma.
Correct answer: A morbidly obese patient who has not fasted.
The LMA does not protect the airway from aspiration as effectively as an endotracheal tube. Patients who are morbidly obese or have not fasted are at a significantly higher risk for regurgitation and aspiration. Therefore, using an LMA in this population is a relative contraindication.
Free Paramedics Airway, Respiration, and Ventilation Questions and Answers
A 58-year-old male is in cardiac arrest.
After endotracheal intubation, you begin ventilation and monitor waveform capnography.
The initial ETCO2 is 8 mmHg.
Despite high-quality CPR and appropriate ALS interventions, the ETCO2 remains below 10 mmHg for 20 minutes.
What is this finding most indicative of?