Paramedics Exam Airway, Respiration & Ventilation 3 — Questions and Answers
Question 1: A trauma patient has absent breath sounds on the left with tracheal deviation to the right and JVD. Blood pressure is 70/40. What intervention takes priority?
- Endotracheal intubation
- Bilateral large-bore IV access
- Needle decompression of the left chest (Correct answer)
- Immediate transport only
Correct answer: Needle decompression of the left chest
Absent breath sounds, tracheal deviation away, JVD, and hypotension are classic signs of tension pneumothorax, requiring immediate needle decompression.
Question 2: Which ETCO2 reading during CPR suggests good quality chest compressions and adequate perfusion?
- Less than 10 mmHg
- 10–20 mmHg
- 20–40 mmHg (Correct answer)
- Greater than 50 mmHg
Correct answer: 20–40 mmHg
ETCO2 of 20–40 mmHg during CPR correlates with adequate cardiac output and perfusion; values below 10 mmHg suggest poor compressions or futile resuscitation.
Question 3: A patient with a suspected C-spine injury requires intubation. Which technique is most appropriate?
- Nasotracheal intubation with hyperextension
- Orotracheal intubation with manual in-line stabilization (Correct answer)
- Blind digital intubation without any stabilization
- Defer intubation until CT imaging is complete
Correct answer: Orotracheal intubation with manual in-line stabilization
Orotracheal intubation with manual in-line cervical stabilization (MILS) maintains the airway while minimizing cervical spine movement.
Question 4: A patient with epiglottitis is in a 'sniffing position' and drooling. Which airway management approach is preferred in the prehospital setting?
- Immediate aggressive BVM ventilation
- Rapid sequence intubation with ketamine
- Allow patient to maintain position of comfort and prepare for surgical airway backup (Correct answer)
- Insert a nasopharyngeal airway immediately
Correct answer: Allow patient to maintain position of comfort and prepare for surgical airway backup
Epiglottitis can cause complete airway obstruction if agitated; the patient should be kept calm in position of comfort with surgical airway equipment on standby.
Question 5: During ventilation of a pediatric patient, you notice gastric distension. What is the most appropriate corrective action?
- Apply cricoid pressure immediately and insert an NG tube
- Increase tidal volume to overcome gastric pressure
- Reduce tidal volume and ensure proper head positioning (Correct answer)
- Switch to nasal cannula oxygen delivery
Correct answer: Reduce tidal volume and ensure proper head positioning
Gastric distension from over-ventilation is corrected by reducing tidal volume to 6–8 mL/kg and ensuring proper airway alignment; NG decompression may follow.
Question 6: Which of the following correctly describes the Sellick maneuver and its current evidence-based status?
- Cricoid pressure proven to reliably prevent aspiration, routinely recommended
- Anterior thyroid pressure to improve laryngoscopy view, routinely recommended
- Cricoid pressure that may impair laryngoscopy view; not routinely recommended by current guidelines (Correct answer)
- Lateral pressure on the larynx to improve intubation success, routinely recommended
Correct answer: Cricoid pressure that may impair laryngoscopy view; not routinely recommended by current guidelines
Sellick maneuver (cricoid pressure) has not been proven to reliably prevent aspiration and can worsen laryngoscopy view; current evidence does not support routine use.
Question 7: A patient presents with stridor after a bee sting. SpO2 is 91%. Which is the FIRST priority intervention?
- Albuterol nebulizer treatment
- Intubation via direct laryngoscopy
- Epinephrine 0.3 mg IM to the lateral thigh (Correct answer)
- High-flow oxygen via non-rebreather mask only
Correct answer: Epinephrine 0.3 mg IM to the lateral thigh
Anaphylaxis with stridor indicates impending airway closure from laryngeal edema; epinephrine 0.3 mg IM is the first-line treatment to reverse this process.
Paramedics Exam Airway, Respiration & Ventilation 3
A trauma patient has absent breath sounds on the left with tracheal deviation to the right and JVD.
Blood pressure is 70/40.
What intervention takes priority?