Paramedics Airway, Respiration & Ventilation Questions and Answers

Question 1

A 68-year-old male with a history of COPD is being ventilated with a bag-valve mask. Quantitative waveform capnography shows a prolonged Phase II and a 'shark fin' appearance. What is the most likely cause of this finding?

Accepted Answer

Bronchospasm

Answer

The 'shark fin' waveform on a capnogram, characterized by a sloping and prolonged Phase II (expiratory upstroke) and a less distinct alveolar plateau, is a classic sign of bronchoconstriction or airway obstruction. [1] This shape indicates that alveoli are emptying at different rates due to the obstruction, leading to a slower rise in expired CO2.

Question 2

You are transporting a 5-year-old child in respiratory distress. Which anatomical difference in a pediatric airway, compared to an adult, is most critical to consider when positioning the patient for basic airway management?

Accepted Answer

The occiput is proportionally larger.

Answer

In infants and young children, the proportionally larger occiput causes the neck to flex when the child is laid supine. [31] This flexion can obstruct the airway. To achieve a neutral or 'sniffing' position for optimal airway alignment, padding should be placed under the shoulders and torso to elevate the chest. [26, 31]

Question 3

A paramedic is managing a mechanically ventilated patient following intubation. The high-pressure alarm on the ventilator sounds. After confirming the patient is not biting the tube and there are no kinks in the circuit, which of the following is the most appropriate next step?

Accepted Answer

Suction the endotracheal tube.

Answer

Common causes of a high peak airway pressure alarm include obstructions. [29] After ruling out external issues like a kinked tube or the patient biting it, an internal obstruction such as a mucus plug is a likely cause. [29] Suctioning the endotracheal tube is the appropriate intervention to clear such a blockage and resolve the high pressure.

Question 4

Which of the following is a primary indication for performing a needle cricothyrotomy in the prehospital setting?

Accepted Answer

A 'can't intubate, can't ventilate' situation with massive maxillofacial trauma.

Answer

A cricothyrotomy is an invasive, rescue airway procedure indicated only when all other methods of securing an airway have failed or are impossible. [22] A 'can't intubate, can't ventilate' scenario, such as one caused by massive facial trauma that prevents bag-mask ventilation or intubation, is a primary indication. [8, 22]

Question 5

You are setting up a ventilator for a 70 kg adult male patient diagnosed with Acute Respiratory Distress Syndrome (ARDS). According to the ARDSNet protocol, what should the initial tidal volume be set to?

Accepted Answer

6 mL/kg

Answer

The ARDSNet protocol recommends a lung-protective ventilation strategy that includes low tidal volumes to prevent ventilator-induced lung injury. The standard initial tidal volume is 6 mL/kg of predicted body weight. [10, 14, 21, 24]

Paramedics Exam Practice Test

Paramedics Exam Practice Test

Paramedics Airway, Respiration & Ventilation Questions and Answers