Airway and Ventilation Flashcards
21 cards from real PHTLS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 20 Airway and Ventilation flashcards as text
A trauma patient has a GCS of 8 and is breathing with an irregular pattern. What is the most appropriate airway intervention?
Answer: Definitive airway management via endotracheal intubation or supraglottic device
A GCS ≤8 with inadequate breathing indicates the need for a definitive airway to protect and control ventilation.
Which finding during airway assessment indicates immediate life-threatening airway obstruction?
Answer: Complete absence of breath sounds bilaterally with no chest rise
No breath sounds and no chest rise with ventilation attempts signals complete airway obstruction requiring immediate action.
When performing bag-valve-mask ventilation on a trauma patient, what tidal volume and rate are recommended to avoid iatrogenic harm?
Answer: Tidal volumes causing visible chest rise at 10-12 breaths/min
PHTLS recommends ventilations sufficient to produce visible chest rise at 10-12/min to prevent hyperventilation and gastric insufflation.
A patient with suspected cervical spine injury needs airway management. Which approach is preferred?
Answer: Use jaw thrust maneuver with in-line spinal stabilization
Jaw thrust with manual in-line stabilization opens the airway while minimizing cervical spine movement.
Which supraglottic airway device is considered acceptable for definitive airway management when endotracheal intubation is not feasible in PHTLS?
Answer: Laryngeal mask airway (LMA) or King LT
Supraglottic devices like the LMA or King LT are acceptable rescue airways when intubation cannot be performed.
During rapid sequence intubation (RSI) of a trauma patient, which complication most directly results from excessive ventilation rate?
Answer: Reduced venous return and decreased cardiac output
Hyperventilation raises intrathoracic pressure, reducing venous return and can cause or worsen hypotension in trauma patients.
A patient with a penetrating neck injury is maintaining their own airway but has progressive swelling and voice changes. What is the most appropriate prehospital action?
Answer: Initiate early definitive airway before complete obstruction occurs
Progressive airway compromise from expanding hematoma requires early airway intervention before complete obstruction makes it impossible.
Which assessment finding best distinguishes tension pneumothorax from a simple pneumothorax in a trauma patient?
Answer: Absent breath sounds plus hypotension and tracheal deviation
Tension pneumothorax produces absent breath sounds combined with hemodynamic compromise (hypotension) and possibly tracheal deviation.
When is a needle decompression indicated in the prehospital setting?
Answer: Suspected tension pneumothorax with deteriorating hemodynamics
Needle decompression is indicated for suspected tension pneumothorax causing hemodynamic or respiratory deterioration.
What is the preferred site for needle decompression according to current PHTLS guidelines?
Answer: 4th or 5th intercostal space, anterior axillary line
PHTLS and TCCC guidelines now recommend the 4th or 5th ICS at the anterior axillary line due to higher success rates in muscular patients.
A patient with an open chest wound is becoming hypoxic. What is the immediate intervention?
Answer: Apply a vented (3-sided) chest seal or commercial vented device
A vented chest seal allows air to escape on exhalation, preventing conversion to tension pneumothorax while sealing the wound.
Which of the following is a contraindication to nasopharyngeal airway (NPA) insertion in a trauma patient?
Answer: Suspected basilar skull fracture
Suspected basilar skull fracture is a relative contraindication to NPA because of the theoretical risk of intracranial placement.
End-tidal CO2 (ETCO2) monitoring after intubation in a trauma patient should target which range to avoid secondary brain injury?
Answer: 35-45 mmHg
Normal ETCO2 (35-45 mmHg) prevents both hypercapnia (increases ICP) and hypocapnia (causes cerebral vasoconstriction and ischemia).
Which clinical sign is the most reliable indicator of adequate ventilation in a prehospital trauma patient?
Answer: Symmetric chest rise with each breath
Symmetric chest rise with each ventilation confirms bilateral lung inflation and is the most direct assessment of adequate ventilation.
A trauma patient with severe facial injuries has an unsecurable airway via orotracheal intubation. What is the next definitive option?
Answer: Surgical cricothyrotomy
Surgical cricothyrotomy is the definitive rescue airway when oral and nasal intubation are not possible due to facial trauma.
In PHTLS, what does the mnemonic 'MOANS' help assess?
Answer: Anticipated difficulty of bag-valve-mask ventilation
MOANS (Mask seal, Obesity/Obstruction, Age, No teeth, Stiff) predicts difficulty with BVM ventilation before intubation.
What physiologic effect does hyperventilation cause in a trauma patient with TBI that makes it harmful?
Answer: Causes cerebral vasoconstriction reducing blood flow and oxygen delivery
Hyperventilation lowers CO2, causing cerebral vasoconstriction that reduces cerebral blood flow and worsens ischemia in the injured brain.
A patient has diminished breath sounds on the left with a deviated trachea to the right and a BP of 70/40. Which condition does this represent?
Answer: Left-sided tension pneumothorax
Left-sided absent breath sounds, rightward tracheal deviation, and shock are classic signs of left-sided tension pneumothorax.
When using a two-handed BVM technique during trauma resuscitation, why is it preferred over single-handed technique?
Answer: It achieves a better mask seal and reduces leak, improving ventilation
A two-person technique with two hands on the mask creates a superior seal, ensuring more consistent tidal volume delivery.
Which patient presentation is MOST consistent with a hemothorax requiring prehospital intervention?
Answer: Unilateral absent breath sounds, dull percussion, normal BP
Hemothorax produces absent or diminished breath sounds with dullness to percussion on the affected side, though BP may be maintained initially.
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