Free Paramedics Airway, Respiration, and Ventilation 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?

Accepted Answer

A low likelihood of achieving Return of Spontaneous Circulation (ROSC).

Answer

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?

Accepted Answer

Bronchospasm or a mucus plug.

Answer

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?

Accepted Answer

The occiput is proportionally larger, causing neck flexion.

Answer

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)?

Accepted Answer

Equal and visible chest rise and fall with each ventilation.

Answer

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?

Accepted Answer

Perform a surgical cricothyrotomy.

Answer

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.

Paramedics Exam Practice Test

Paramedics Exam Practice Test

Free Paramedics Airway, Respiration, and Ventilation Questions and Answers