question

Which of the following statements regarding epiglottitis is correct

answer

Epiglottitis has become relatively rare in children due to vaccinations against haemophilus influenza type b bacterium

question

Frothy sputum that has a pink tinge to it is MOST suggestive of

answer

CHF

question

Patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she

answer

was previously intubated for his or her condition

question

Patient with respiratory distress who is willing to lie flat

answer

may be acutely deteriorating

question

Apneustic breathing is characterized by

answer

short, brisk inhalations with a long pause before exhalation

question

When replacing a dislodged tracheostomy tube, it is MOST important that you

answer

Take appropriate standard precautions

question

When administering oxygen via a nonrebreathing mask, you must ensure that the

answer

patient has adequate tidal volume

question

King LT airway can be used to

answer

Maintain a patent airway in spontaneously breathing patients

question

Young woman experiences massive facial trauma after being ejected from her car when it struck a tree. She is semiconscious, has blood draining from her mouth, and has poor respiratory effort. The MOST appropriate initial airway management for this patient involves

answer

alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2 minutes until you can definitively secure her airway

question

Person who experience sharp chest pain following an increasing dyspnea after her or she coughs most likely has

answer

a pneumothorax

question

Patient with quiet tachypnea is MOST likely experiencing

answer

shock

question

Bourdon gauge oxygen flowmeter

answer

Reduces the high pressure in the oxygen cylinder to a safe pressure

question

Would NOT be appropriate to place a patient in the recovery position if he or she

answer

Is breathing shallowly

question

Which of the following statements regarding orotracheal intubation is correct

answer

Orotracheal intubation is the most common method of performing ET intubation

question

Asymmetric chest wall movement is characterized by

answer

one side of the chest moving less than the other

question

Capnography is a reliable method for confirming proper ET tube placement because

answer

carbon dioxide is not present in the esophagus

question

Would be appropriate to insert a nasopharyngeal airway in patients who

answer

have an altered mental status with an intact gag reflex

question

Hepatomegaly and jugular venous distention are MOST suggestive of

answer

Right heart failure

question

Patent airway

answer

Does not equate to adequate ventilation

question

During sleep, the metabolic rate is____ and the number of respirations ____

answer

low, decreases.

question

Adult patient with an abnormal respiratory rate should

answer

Be evaluated for other signs of inadequate ventilation

question

Testing of the skin under the jaw often occurs when airway devices are inadvertently inserted into the

answer

pyriform fossae

question

Which of the following situations would ET intubation of pediatric patient be LEAST necessary?

answer

Administration of certain resuscitative medications

question

Which of the following patients is LEAST likely in need of positive pressure ventilation?

answer

Conscious 36 year old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin

question

Used properly, and under the correct circumstances, sedation during airway management

answer

Effectively increases patient compliance, thus making definitive airway management safer to perform

question

_____ breath sounds are the MOST commonly heard breath sounds and have a much more obvious inspiratory component

answer

vesicular

question

Pulse oximetry reading would be LEAST accurate in a patient

answer

with poor peripheral perfusion

question

When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of Mallampati Class

answer

III

question

By-product of cellular respiration

answer

Carbon dioxide

question

Pickwickian syndrome is a condition in which respiratory compromise results from

answer

Extreme obesity

question

After inserting the needle into the cricothyroid membrane, you should next

answer

insert the needle about 1 cm farther and then aspirate with the syringe

question

Which of the following represents the correct dequence for managing a patient's airway

answer

Open, clear, assess, intervene

question

Respond to a residence for a possible overdose. The patient, a young man, is unresponsive with slow, snoring respirations. There are obvious needle track marks on his arms. Your first action should be to

answer

Manually open his airway

question

Digital intubation can be performed on trauma patients because

answer

The head does not have to be placed in a sniffing position

question

Murphy's eye, an opening on the distal side of an ET tube, allows ventilation to occur

answer

Even if the tip of the tube is occluded by blood or mucus

question

Main disadvantage of the LMA is that it

answer

Does not provide protection against aspiration

question

Some cases, atropine sulfate, in a dose of ____, may be given to children to prevent vagal-induced bradycardia during ET intubation

answer

0.02 mg/kg

question

Which of the following statements regarding pediatric ET intubation in the prehospital setting is correct

answer

Bag mask ventilation can be as effective as intubation for EMS systems that have short transport times

question

Barrel chest appearance classically seen in emphysemic patients is secondary to

answer

Air trapping in the lungs

question

Involuntary control of breathing originates in the

answer

Pons and medulla

question

CPAP is NOT appropriate for patients with

answer

Slow, shallow respiratory effort

question

ET tube that is too large for a patient

answer

can be difficult to insert and may cause trauma

question

Retractions of the sternum or ribs during inhalation

answer

Are especially common in infants and small children

question

Either side of the glottis, tissue forms a pocket called the

answer

Piriform fossae

question

Reactive airway disease is characterized by

answer

Bronchospasm, edema, and mucus production

question

Hallmarks of a pulmonary embolism is

answer

Cyanosis that does not resolve with oxygen therapy

question

BURP maneuver usually involves applying backward, upward and rightward pressure to the

answer

Lower third of the thyroid cartilage

question

Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading

answer

Carboxyhemoglobin

question

While transporting an intubated 8 year old boy, he suddenly jerks his head and becomes cyanotic shortly thereafter. His oxygen saturation and capnometry readings are both falling, and he is becoming bradycardic. You attempt to auscultate breath sounds, but are unable to hear because of the drone of the engine. What has MOST likely happened

answer

Inadvertent extubation

question

Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because

answer

It must be performed on spontaneously breathing patients

question

Paradoxical respiratory movement is characterized by

answer

the epigastrium and thorax moving in opposite directions

question

Hyperventilating patient

answer

May be acidotic and is trying to decease his or her pH level

question

Cricothyroid membrane

answer

Is relatively avascular and is covered by skin and minimal subcutaneous tissue

question

Digital clubbing is MOST indicative of

answer

chronic hypoxia

question

Wheezing is resolved with medication that

answer

Relax the smooth muscle of the bronchioles

question

Mainstem bronchus ends at the level of the

answer

bronchioles

question

Intrapulmonary shunting occurs when

answer

Nonfuctional alveoli inhibit pulmonary gas exchange

question

Patients with pneumonia often experience a coughing fit when they roll from one side to the other because

answer

Pneumonia often occurs in the lung bases, typically on only one side

question

COPD is characterized by

answer

Changes in pulmonary structure and function that are progressive and irreversible

question

When intubating a 3 year old child, you would MOST likely use a

answer

Size 2 straight blade

question

When a patient is given a paralytic without sedation

answer

He or she is fully aware and can hear and feel

question

Compared with an open cricothyotomy, needle cricothyrotomy

answer

allows for subsequent attemts to intubate the patient

question

Most complications caused by intubation induced hypoxia

answer

are subtle and occur gradually

question

Fraction of inspired oxygen (FIO2) increases with

answer

supplemental oxygen

question

Anterior portion of the palate is formed by the

answer

Maxilla and palatine bones

question

Indications for CPAP include

answer

acute pulmonary edema

question

Suspect that an unconscious patient has experienced a spinal injury, you should open his or her airway by

answer

placing your fingers behind the angle of the jaw and lifting the jaw forward

question

Paralytic medications exert their effect by

answer

Functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine

question

What is the alveolar minute volume of a patient with a respiratory rate of 12 breaths/min, a tidal volume of 450 mL, and a deal space volume of 135 mL

answer

3,780 mL

question

Using the DOPE mnemonic, which of the following interventions would you MOST likely have to perform if you suspect "O" as the cause of acute deterioration in the intubated child?

answer

Tracheobronchial suctioning

question

Pressure relief valve on an automatic transport ventilator may lead to unregonized hypoventilation in patients with all the following conditions EXCEPT

answer

prolonged apnea

question

Which of the following medications has been shown to blunt the increase in intracranial pressure associated with suctioning and laryngeal stimulation?

answer

lidocaine

question

Unresponsive patient does not have a gag reflex, an oropharyngeal airway

answer

should be inserted whether the patient is breathing or not

question

Length based resuscitation tape measure can be used to determine the most appropriate size of bag mask device for pediatric patients who weigh up to

answer

34 kg

question

During forceful inhalation, the vocal cords

answer

Open widely to provide minimum resistance to air flow

question

What size ET tube would be MOST appropriate to use for a 4 year old child?

answer

5.0mm

question

Average peak expiratory flow rate in a healthy adult is approximately

answer

550ml

question

Contrast to needle cricothyrotomy, an open cricothyrotomy

answer

enables the paramedic to provide greater tidal volume

question

Approximately how far should you insert a 5.0 mm ET tube in a 4 year old child?

answer

15 cm

question

Using a bulb style esophageal detector device to assist you in confirmed proper ET tube placement, you should expect the bulb to

answer

Refill briskly in the tube is in the trachea

question

Transporting an intubated patient and note that the digital capnometry reading has quickly fallen below 30 mm Hg. You should

answer

Slow your ventilation rate to see if the ETC02 reading decreases.

question

Transillumination-guided intubation can be difficult or impossible to perform

answer

in a brightly lit environment

question

Once you have confirmed that the lighted stylet ET tube combination has entered the trachea, you should

answer

hold the stylet in place and advice the tube about 2-4 cm into the trachea

question

When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear

answer

crackles in the bases of the lungs at the end of inspiration

question

Sudden increase in end tidal C02 may be the earliest indicator of

answer

Return of spontaneous circulation

question

Hypoxic drive is a phenomenon in which

answer

bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance

question

Diaphragm of the stehoscope is designed to auscultate

answer

high pitched sounds

question

When administering a nebulized bronchodilator, the oxygen flow rate should be set to at least ____ liters per minute

answer

6

question

King LT-D airway features a

answer

curved tube with ventilation ports located between two inflatable cuffs

question

Factors would increase a person's respiratory rate, EXCEPT

answer

Narcotic analgesic use

question

Hering-Breur reflex is a protective mechanism that

answer

Terminates inhalation and prevents lung overexpansion

question

Which of the following is NOT an appropriate method for confirmed proper ET tube placement in a 15 kg child

answer

Esophageal bulb or syringe

question

Rigorous tube confirmation protocol must be following after performing digital intubation because

answer

the procedure of digital intubation is truly a blind technique

question

_____ is the lowest portion of the pharynx and opens into the larynx anteriorly and the esophagus posteriorly

answer

laryngopharynx

question

Before performing orotracheal intubation, it is MOST important for the paramedic to

answer

wear gloves and facial protection

question

MOST likely observe grossly low respiratory rate and volume in a patient who overdosed on

answer

Heroin

question

Patient with orthopnea

answer

seeks a sitting position when short of breath

question

50-year old woman presents with acute respiratory distress while eating. Upon your arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals that her skin is pink and moist. In addition to transporting her to the hospital, you should

answer

Encourage her to cough and closely monitor her condition

question

21-year old man experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. He is noticeably dyspneic, has an oxygen saturation of 93% on room air, and has diminished breath sounds to the upper right lobe. The MOST appropriate treatment for this patient involves

answer

Administering high-flow supplemental oxygen and transporting at once

question

Transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should

answer

Begin assisting his ventilations with a bag-mask and 100% oxygen

question

Children more prone to croup when they acquire a viral infection that adults infected with the same virus?

answer

A child's airway is narrower than an adult's and even minor swelling can result in obstruction

question

Polycythemia is a condition in which

answer

Excess red blood cells are produced in response to chronic hypoxia

question

Patient's hemoglobin level is only 10g/dL, ___% would have to be desaturated before he or she would appear cyanotic

answer

50

question

Respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically searching. You should

answer

Recognize that he is experiencing end stage COPD, begin assisting ventilations, and contact medical control as needed

question

Increase in the number of EMS calls for patients with chronic respiratory problems most commonly occurs

answer

During sudden weather changes

question

36 year old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should

answer

Assist his ventilations and establish vascular access

question

Pneumonitis is especially common in older patients with

answer

chronic food aspiration

question

Presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates

answer

Thick secretions in the large airways

question

What function do the nasal turbinates serve?

answer

Warming and humidifying inhaled air

question

Patient's initial presentation makes you suspicious about a particular respiratory condition, you must

answer

Confirm your suspicions with a thorough assessment

question

____ cartilage forms a complete ring and maintains the trachea in an open position

answer

Cricoid

question

Uncontrollable coughing and hemptysis in a cigarette smoker are clinical findings MOST consistent with

answer

Lung cancer

question

Otherwise healthy adult whose normal hemoglobing level is 12 to 14 g/dL typically will begin to exhibit cyanosis when

answer

about 5 g/dL of hemoglobin is desaturated

question

Hypoventilating patients

answer

Become hypercapneic and acidotic

question

MOST clinically significant finding when questioning a patient with a chronic respiratory disease is

answer

Prior intubation for the same problem

question

Transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should

answer

Remove the CPAP unit, assist his ventilations with a bag mask device and prepare to intubate him

question

76 year old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prlonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to

answer

place her in a position that facilitates breathing

question

Emphysema is caused by

answer

Chronic destruction of the alveolar walls

question

Morbidly obese man called 9-1-1 because of difficulty breathing. When you arrive, you find the 39 year old patient lying supine in his bed. He is in marked respiratory distress and is only able to speak in two-word sentences. He has a history of hypertension, but denies any respiratory conditions. What should you do FIRST?

answer

Sit him up or place him on his side

question

Inspiratory and expiratory _____ sounds are both loud, but the inspiratory sounds are shorter than the expiratory sounds

answer

bronchial

question

When regard to intubation difficulty, neck mobility problems are MOST commonly associated with

answer

Elderly patients

question

Endotracheal intubation is MOST accurately defined as

answer

passing an ET tube through the glottis opening and sealing off the trachea

question

Contrast to the nasogastric tube, the orogastric tube

answer

is safer to use in patients with severe facial trauma

question

Artificial airway adjust

answer

does not obviate the need for proper head positioning

question

Nondepolarizing neuromuscular blocking agents include all of the following EXCEPT

answer

succinylcholine chloride

question

Proper insertion of the LMA involves

answer

Inserting the LMA along the roof of the mouth and using your fingers to push the airway against the hard palate

question

Patients with a partial laryngectomy

answer

are called partial neck breathers because they breathe through both a stoma and the nose and mouth

question

Trachea and mainstem bronchi

answer

are lined with beta-2 receptors that result in bronchodilation when stimulated

question

Surfactant is

answer

A phospholipid compound that decreases surface tension on the alveolar walls

question

After tracheobronchial suctioning is complete, you should

answer

Reattach the bag-mask device, continue ventilations, and reassess the patient

question

MOST obvious risk associated with extubation is

answer

Overestimating the patient's ability to protect his or her own airway

question

66 year old woman is found to be unresponsive and apneic. Her carotid pulse is weak and rapid. When ventilating this patient, you should deliver

answer

Each breath over 1 second at a rate of 10 to 12 breaths/min

question

Intubated 33 year old man is becoming agitated and beings moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should

answer

administer a sedative medication

question

Complications associated with orotracheal intubation, EXCEPT

answer

necrosis of the nasal mucosa

question

Which of the following medications is safest to use in patients with borderline hypotension or hypovolemia?

answer

Etomidate

question

Disadvantage of ET intubation is that it

answer

Bypassess the upper airway's physiologic functions of warming, filtering and humidifying

question

Intubation of a child is unsuccessful after two attempts, your MOST appropriate action is to

answer

discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately

question

____ are formed by the cranial bones and prevent contaminants from entering the respiratory tract

answer

sinuses

question

Should be MOST suspicious of tube misplacement following an open cricothyrotomy if

answer

a crackling sensation is noted when palpating the neck

question

When performing an open circothyrotomy, you should FIRST

answer

palpate the V notch of the thyroid cartilage and stabilize the larynx

question

Contrast to a curved laryngoscope blade, a straight laryngoscope blade is designed to

answer

extend beneath the epiglottis and lift it up

question

Fentanyl (Sublimaze) is a

answer

narcotic analgesic

question

ET tube has been positioned properly in the trachea

answer

the bag-mask device should be easy to compress and you should see corresponding chest expansion

question

Anatomically, the _____ is directly anterior to the glottis opening

answer

vallecular space

question

Diazepam and midazolam provide all of the following therapeutic effects, EXCEPT

answer

analgesia

question

Placing a suction catheter past the base of the tongue

answer

may cause the patient to gag or vomit

question

After inserting the combitube to the proper depth, you should next

answer

Inflate the pharyngeal cuff with 100 mL of air

question

Oxygen that is entirely devoid of moisture

answer

Will dry the patient's mucous membranes quickly

question

Digital intubation is absolutely contraindicated if the patients

answer

is unconscious but breathing

question

After properly positioning the patient's head for intubation, you should open his or her mouth and insert the blade

answer

into the right side of the mouth and sweep the tongue to the left

question

Which of the following is NOT a contraindication for nasotracheal intubation

answer

Spinal injury

question

Which of the following interventions is NOT appropriate when treating an unresponsive patient whose airway is obstructed by a dental appliance

answer

Abdominal thrusts

question

When administering CPAP therapy to a patient, it is important to remember that

answer

the increased intrathoracic pressure caused by CPAP can result in hypotension

question

Unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have ____ respirations

answer

Bradypneic

question

Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD

answer

Fever and localized crackles

question

Most obvious external landmark of the larynx is the

answer

Thyroid cartilage

question

Hepatojugular reflex occurs when

answer

Mild pressure placed on the patient's liver further engorges the jugular veins

question

Colormetric ETC02 detector turns purple during exhalation phase through an ET tube, approximately how much carbon dioxide is being exhaled

answer

Less than 0.5%

question

____ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea

answer

Biot

question

Bedridden patients with excessive pulmonary secretions are MOST prone to developing

answer

Pneumonia

question

Difficulty with exhalation is MOST characteristic of

answer

Obstructive lung disease

question

Which of the following statements regarding anatomic dead space is correct

answer

Anatomic dead space is about 1 mL per pound of body weight

question

Known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow and his pulse is slow and weak. You should

answer

Assist ventilations with a bag mask device, administer naloxone, and reassess his ventilatory status

question

Unlike bronchodilator therapy, corticosteroid therapy

answer

Takes a few hours to reduce bronchial edema

question

____ cells are found in the lining of the airways and produce a blanket of mucus that covers the entire lining of the conducting airways

answer

Goblet

question

Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT

answer

a decreased expiratory phase

question

Which of the following statements regarding anemia is correct

answer

Anemia results in a decreased ability of the blood to carry oxygen

question

King airway should NOT be used in patients

answer

With known esophageal disease

question

When correctly placed, the distal tip of the Cobra perilaryngeal airway (CobraPLA)

answer

Is proximal to the esophagus and seals the hypopharynx

question

Capnographic waveform, point ___ is the maximal ETC02 and is the best reflection of the alveolar C02 level

answer

D

question

Which of the following medications does NOT possess hypnotic properties

answer

Alfentanil

question

Average depth of ET tube insertion for adult patients is

answer

21 to 25 cm

question

MOST effective way to minimize the risk of hypoxia while intubating a child is to

answer

Limit your intubation attempt to 20 seconds

question

Must insert the ET tube in the patient's left nostril, you should

answer

Rotate the tube 180 degrees as its tip enters the nasopharynx

question

Orotracheal intubation should be performed with the patient's head

answer

in the sniffing position

question

Normal alveolar volume in a healthy adult is

answer

350 mL

question

When using a straight blade, a major mistake of new paramedics is to

answer

Try to pass the ET tube down the barrel of the blood

question

Intrapulmonary shunting is defined as

answer

The return of unoxygenated blood to the left side of the heart

question

Several attempts to orotracheally intubate an unresponsive, apneic young man have failed. You resume bag mask ventilations and begin transport to a hospital located 25 miles away. En route, you begin having difficulty maintaining an adequate mask to face seal with the bag mask device. Assuming that you have the proper equipment, which of the following techniques to secure a patent airway would be MOST appropriate?

answer

Transillumination intubation

question

When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should

answer

Perform the test three times and take the best rate of the three readings

question

When determining the correct sized nasogastric tube for a patient, you should measure the tube

answer

From the nose to the ear and the xiphoid process

question

Contrast to negative pressure ventilation, positive pressure ventilation

answer

May impair blood return to the heart

question

____ are pyramid like structures that form the posterior attachment of the vocal cords

answer

Arytenoid cartilages

question

Order for a tracheostomy tube to be compatible with a mechanical ventilator or bag mask device

answer

It must be equipped with a 15/22 mm proximal adaptor

question

Negative pressure ventilation occurs when

answer

Air is drawn into the lungs when intrathoracic pressure decreases

question

Cor pulmonale is defined as

answer

Right heart failure secondary to chronic lung disease

question

Patient with status asthmaticus commonly presents with

answer

physical exhaustion and inaudible breath sounds

question

Patient who is coughing up purulent sputum is MOST likely experiencing

answer

An infection

question

CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases by

answer

improving patency of the lower airway through the use of positive and expiratory pressure

question

Classic presentation of chronic bronchitis is

answer

excessive mucus production and a chronic or recurrent productive cough

question

Patient who is coughing up thick pulmonary secretions should NOT take

answer

An antitussive

question

Amount of pulmonary surfactant is decreased

answer

Alveolar surface tension increases

question

Intubation of a patient with severe asthma

answer

Is often the last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces

question

Patient who is experiencing an allergic reaction states that his tongue "feels thick" and speaks at a low volume. You should immediately evaluate for

answer

Angioedema

question

Nasal cannula is of MOST benefit to patients

answer

With mild hypoxemia and claustrophobia

question

Undersedation of a patient during airway management would likely result in all of the following, EXCEPT

answer

Respiratory depression

question

After obtaining a peak expiratory flow reading of 200 mL, you administered one bronchodilator treatment to a 21 year old woman with an acute episode of expiratory wheezing. The next peak flow reading is 400 mL. You should

answer

Recognize that the patient's condition has improved

question

Needle cricothyrotomy is contraindicated in patients with

answer

Obstruction above the catheter insertion site

question

Complications of aspiration include all of the following, EXCEPT

answer

Excess surfactant production

question

Which of the following findings is MOST clinically significant in a 30 year old woman with difficulty breathing and a history of asthma

answer

Prior ICU admission for her asthma

question

Because the high pressure ventilator used with needle cricothrotomy would cause an increase in intrathoracic pressure, ____ and ____ may result

answer

Barotrauma, pneumothorax

question

Which of the following patients may benefit from CPAP?

answer

Alert patient with respiratory distress following submersion in water

question

Open cricothyrotomy is generally contraindicated in all of the following situations, EXCEPT

answer

any patient who is younger than 16 years of age

question

Spacer device in conjunction with a metered dose inhaler

answer

Collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment

question

Conditions will cause an increase in the circulating levels of carbon dioxide in the blood, EXCEPT

answer

Acute hyperventilation

question

Which of the following patients has the lowest minute volume

answer

Tidal volume of 350 mL; respiratory rate of 12 breaths/min

question

Elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a "water pill" and vasotec for high blood pressure. You should

answer

Suspect acute right heart failure and administer oxygen

question

Respiratory alkalosis is the result of

answer

Excess carbon dioxide elimination

question

Mouth opening width of less than ____ cm indicates a potentially difficult airway

answer

3

question

Contrast to decreased P02 levels, increased PC02 levels typically manifest as

answer

sedation or sleepiness

question

Assessing a young woman who was struck in the head with a baseball bat. The patient is semiconscious and has slow, irregular respirations. Further assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood in her mouth, but clenches her teeth and becomes combative when you attempt to suction her oropharynx. The MOST appropriate airway management for this patient involves

answer

sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea

question

Patient with orthopnea

answer

has dyspnea while lying flat

question

Patient with obvious respiratory failure require immediate

answer

Ventilation support

question

Primary treatment of bronchospasm is

answer

bronchodilator therapy

question

What type of medication dries secretions in the airway and prevents the cilia from removing them effectively

answer

Antihistamine

question

36 year old man experienced significant burns to his face, head, and chest following an incident with a barbeque pit. Your assessment of his airway reveals severe swelling. After administering medications to sedate and paralyze the patient, you are unable to intubate him. Furthermore, bag mask ventilations are producing minimal chest rise. The quickest way to secure a patent airway in this patient is to

answer

perform a needle cricothyrotomy

question

Phenylephrine hydrochloride ( Neo-Synephrine) during nasotracheal intubation will

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reduce the likelihood and severity of nasal bleeding

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After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then

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inflate the distal cuff with 5 to 10 mL of air

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Dispatched to a residence for a 59 year old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. The patient is MOST likely experiencing

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pneumonia

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Which of the following statements regarding translaryngeal catheter ventilation is correct?

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Ventilation is achieved by the use of a high pressure jet ventilator

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Which of the following medications is a parasympathetic bronchodilator

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ipratropium

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Which of the following conditions would LEAST likely present with an acute onset of respiratory distress?

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Pneumonia

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Process of moving air into and out of the lungs is called

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Ventilation

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When a patient's respirations are too rapid and too shallow

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Inhaled air may only reach the anatomic dead space before being exhaled

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MOST significant complication associated with the use of multilumen airways is

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Unrecognized displacement of the tube into the esophagus

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Contrast to the right lung, the left lung

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Has two lobes

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Supplemental oxygen given to a patient with an acute myocardial infarction

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Enhances the body's compensatory mechanisms during the cardiac event

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Digital intubation should be performed only on a patient who has a bite block inserted in his or her mouth and who is ____ and ____

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unconscious, apneic

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After opening an unresponsive patient's airway, you determine that his respirations are rapid, irregular, and shallow. You should

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Begin positive pressure ventilations

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Removal of a dental appliance after intubating a patient is

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Dangerous and may cause dislodgement of the tube

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40 year old man named Jose fell 20 ft from a tree while trimming branches. Your assessment reveals that he is unresponsive. you cannot open his airway effectively with the jaw thrust maneuver. You should

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Carefully open his airway with the head tilt chin lift maneuver

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Automated transport ventilator is NOT appropriate for patients who are

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Breathing spontaneously

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Stretch receptors in the lungs are responsible for the ___ reflex, which causes you to cough if you take too deep a breath

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Hering-Breuer

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Patients with COPD typically experience an acute exacerbation of their condition because of

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Environmental changes such as weather or the inhalation of trigger substances

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Drugs such as vecuronium bromide (Norcuron) and pancuronium bromide (Pavulon) are MOST appropriate to administer when

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Extended periods of paralysis are needed

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Major advantage of ET intubation is that it

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Protects the airway from aspiration

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Oxygen that is dissolved in the blood plasma

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Makes up the partial pressure of oxygen

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Which of the following conditions would MOST likely cause laryngeal spasm and edema

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Inhalation injury

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Physiologic effects of CPAP include

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Opening of collapsed alveoli

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Biot respirations are characterized by

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An irregular pattern of breathing with intermittent periods of apnea

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When checking the cuff of the LMA prior to insertion, you should

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Inflate the cuff with 50% more air than is required

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Venturi Mask is MOST useful in the prehospital setting when

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A COPD patient requires a long range transport

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During tracheobronchial suctioning, it is MOST important to

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Monitor the patient's cardiac rhythm and oxygen saturation

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After confirming that an intubated patient remains responsive enough to maintain his or her own airway, you should first

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have the patient sit up or lean slightly forward

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Size 3 or 4 LMA

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will accomodate the passage of a 6.0 mm ET tube

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MOST significant complication associated with digital intubation is

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Hypoxia

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Foreign body airway obstruction should be suspected in a child who presents with

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Acute respiratory distress without fever

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Paramedic should be especially dilligent when confirming tube placement following blind nasotracheal intubation because

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he or she did not visualize the tube passing between the vocal cords

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Signs of clinical improvement during CPAP therapy include

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increased ease of speaking

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Patient with respiratory splinting

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Is breathing shallowly to alleviate chest pain

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Oropharynx is

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Forms the posterior portion of the oral cavity

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Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the

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pH of the CSF decreases

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Which of the following is NOT a step that is performed during nasotracheal intubation?

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Ensuring that the patient's head is hyperflexed

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Hypoventilation causes a(n) ____ and leads to ____

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Decreased minute volume, hypercarbia

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Surgical opening into the trachea is called a

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tracheostomy

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66 year old man with chronic bronchitis presents with severe respiratory distress. The patient's wife tells you that he takes medications for high blood pressure and bronchitis, is on home oxygen therapy, and has recently been taking an over the counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of the patient's respiratory distress?

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Recent antitussive use

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Intubating a 60 year old man in cardiac arrest and have visualized the ET tube passing between the vocal cords. AFter removing the laryngoscope blade from the patient's mouth, manually stabilizing the tube, and removing the stylet, you should

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inflate the distal cuff with 5 to 10 mL of air

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When performing an open cricothyrotomy, you will MOST likely avoid damage to the jugular veins if

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The cricothyroid membrane is incised vertically

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Chest compressions and repositioning of the airway are unsucessful in removing a severe airway obstruction in an unconscious patient, you should

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Perform laryngoscopy and use Magill forceps

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Procedure in which the vocal cords are visualized for placement of an ET tube is called direct

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Laryngoscopy

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When performing nasotracheal intubation, you should use an ET tube that is

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1 to 1.5 mm smaller than you would use for orotracheal intubation

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Whistle tip suction catheter is MOST often used to

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Remove secretions from an ET tube

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Which of the following statements regarding field extubation is correct

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It is generally better to sedate the patient rather than extubate

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Airway obstruction secondary to a severe allergic reaction

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Requires specific and aggressive treatment

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8 year old child in cardiac arrest has been intubated. When ventilating the child, the paramedic should

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Deliver 8 to 10 breaths per minute

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During ventilation with the LMA, the paramedic should

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Observe the patient for signs of inadequate ventilation

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Exchange of oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries is called

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External respiration

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With regard to pulse oximetry, the more hypoxic a patient becomes

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The faster he or she will desaturate

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Neuromuscular blocking agents

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Convert a breathing patient with a marginal airway into an apneic patient with no airway

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You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see

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two white fibrous bands that lie vertically within the glottic opening

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According to the most current guidelines for emergency cardiac care, the MOST reliable method for monitoring correct ET tube placement is

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Waveform capnography

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Which of the following conditions would you be LEAST likely to encounter pulse paradoxus

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Moderate asthma attack

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Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia

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Kussmaul respirations

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Patients with decompensated asthma or COPD who require positive-pressure ventilation

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May develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly

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Increasing peak expiratory flow reading in a patient with respiratory distress suggests that the patient is

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responding to bronchodilator therapy

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Patient's hemoglobin level is 8 g/dL due to a hemorrhage and all of the hemoglobin molecules are attached to oxygen, the patient's oxygen saturation would MOST likely read

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above 95%

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Typically, ETCO2 is approximately

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2 to 5 mm Hg lower than the arterial PaCO2

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Function of the lower airway is to

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Exchange oxygen and carbon dioxide

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Hyperpnea and tachypnea

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cause an increase in minute ventilation

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External jugular veins run ______ and are located ____ to the cricothyroid membrane

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Vertically, lateral

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______ is an anatomic space located between the base of the tongue and the epiglottis

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Vallecula

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Albueterol (Proventil, Ventolin) - RESPIRATORY DRUG

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Adult Dose: Adult 2.5mg in 2-3 mL NS via nebulizer Class: sympathomimetic dilator MOA: Beta-2 agonist that causes bronchodilation. Relaxes the smooth muscles of the bronchial tree. Indications: bronchospasms, asthma, COPD, emphysema chronic bronchitis,allergic reaction involving the airway. (Wheezing) Contraindications: hypersensitivity (allergic), precaution : heart rate greater than 150 HR>150 Side effects: tachycardia, palpitations, lightheadedness, tremors, mucous production. Pediatric Dose: 20 kg 2.5 mg/dose via hand nebulizer over 20 minutes.

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Benzocaine spray (Hurricane) - RESPIRATORY DRUG

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Adult Dose: 0.5-1.0 second spray, repeat as needed. Repeat as needed. Class: topical anesthetic MOA: suppresses the pharyngeal and tracheal gag reflex Indications: intact gag reflex Contraindications: allergy, suppressed gag reflex Adverse reaction: methemoglobinemia (causes an inability of oxygen to bind to hemoglobin and prevents oxygen that is already bound to hemoglobin to be released at the cellular level, can cause cellular hypoxia) Pediatric Dose: 0.25-0.5 second spray. Repeat as needed.

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Bumetanide (Bumex) - RESPIRATORY DRUG

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Adult Dose: 0.5-1.0mg IV over 1-2 minutes. IM 2-2.5 times stronger than Lasix. Class: Loop diuretic MOA: a potent loop diuretic with a rapid onset and short duration. Blocks the reabsorption of sodium and chloride at the Loop of Henle. Indications: CHF, pulmonary edema. Won't be used for hypertensive crisis. Contraindications: allergic, hypovelemic, hypotension, suspect electrolyte imbalance. Side effects: orthostatic hypotension Pediatric Dose: Safety and effectiveness in pediatric patients is not established.

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Dexamethasone (Decadron) - RESPIRATORY DRUG

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Adult Dose: 1mg/kg slow IV (typical dose 10-100mg). Class: corticosteroid, Antiimflammatory MOA: suppresses acute and chronic inflammation Indications: anaphylaxis, asthma, croup, spinal cord injury Contraindications: allergy, suspected sepsis Pediatric Dose: 0.25 -1.0 mg/kg (IV/IM/IO)

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Diazepam (Valium) - SEDATIVE

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Adult Dose: seizure activity, anxiety, agitation, cocaine induced SVT's, acute alcohol withdrawal: 5-10mg slow IV/IM every 10-15 minutes as needed (PRN) Premedication for RSI, Cardioversion: 5-15mg slow IV Class: benzodiazepine sedative/ hypnotic, anticonvulsant MOA: Long acting sedative / hypnotic, controls seizure threshold Indications: Extreme anxiety, agitation, acute alcohol withdrawal, seizure activity, sedation for medical procedures (RSI, Cardioversion), cocaine induced SVT Contraindications: allergic, acute narrow angle glaucoma, respiratory depression, hypotension Side effects: respiratory depression, hypotension a Pediatric Dose: Not recommended in prehospital setting.

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Diphenhydramine (Benadryl) - RESPIRATORY DRUG

answer

Dose: 25-50 mg IV, IM Class: Antihistamine, Anticholinergic MOA: Blocks cellular histamine receptors Indications: Allergic reactions, acute days tonic reactions Contraindications: hypersensitivity

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Epinephrine (adrenaline) - RESPIRATORY DRUG ETC.

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Class: Sympathomimetic MOA: Alpha-1 vasoconstriction, Beta-1 Inotropic, Chronotropic and Dromotropic effects, Beta-2 bronchial smooth muscle relaxation. Indications: Initial drugs used in cardiac arrest (asystole, PEA, V-fib, V-tach) an alternative to Dopamine, allergic reaction (anaphylaxis), and severe asthma. Contraindications: hypertension, hypothermic, hypovelemic shock. Adult Dose: cardiac arrest - 1.0mg (1:10,000 solution) IV/IO every 3-5 minutes, follow each dose with 20mL flush and elevate extremity. Alternative to Dopamine - add 1.0mg of Epi 1:1,000 solution into 500mL NS bag (yields 2mcg/mL), administer and infusion rate of 1-10mcg/min, titrate to effect. Mild allergic reaction and severe asthma - 0.3-0.5mg (0.3-0.5mL 1:1,000 solution) SC/IM Anaphylaxis- 0.1mg (1mL of 1:10,000 solution) IV *supplied 1mg in 10mL of solution.

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Epi Racemic (Micronefrin) - RESPIRATORY DRUG

answer

Adult Dose: mix 0.5 mg of Epi 1:1000 in 5 mL of NS by nebulizer. One time dose only. Class: sympathomimetic MOA: stimulates beta-2 receptors in the lungs causing bronchodilation, reduces airway resistance, reduces laryngeal edema. Indications: asthma, Croup (laryngotrachealbronchitis), laryngeal edema Contraindications: hypertension, cardiovascular disease, epiglotitis, allergy Side effects: tachycardia, nausea, vomiting, anxious, palpitations

question

Furosemide (Lasix) - RESPIRATORY DRUG ETC.

answer

Adult Dose: 0.5 - 1.0 mg/kg over 1-2 minutes. Typical dose is 40-120 mg for test purposes street dosage typically 30-40 mg *lung sounds rales/crackles *orange vial or syringe Class: Loop Diuretic MOA: inhibits the absorption of sodium (Na+) or chloride at the loop of Henle causing increased urine output. Indications: CHF, pulmonary edema, hypertensive crisis, *They have to have had a diagnosis of CHF Contraindications: allergic, hypovelemia, hypotension, suspect electrolyte imbalance, fever Side effects: orthostatic hypotension (vital signs change with a change in body position.

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Ipratropium (Atrovent) - RESPIRATORY DRUG

answer

ADULT/PED Dose Same: 500 mcg in 2-3 mL NS via nebulizer, 0.5 mg in 2.3 mL NS via nebulizer, 1 time dose (usually given in conjunction with Albueterol.) Class: Anticholinergic bronchodilator MOA: Dries secretions and causes bronchodilation Indications: bronchospasms, asthma, COPD, emphysema chronic bronchitis, allergic reaction involving the airway. (Wheezing) Contraindications: hypersensitivity (allergic), peanuts

question

Isoetherine (Bronchosol) - RESPIRATORY DRUG

answer

Dosage: 2.5-5.0mg in 3mL of NS by nebulizer. Class: sympathomimetic MOA: beta-2 agonist, relaxes bronchioles Indications: asthma, bronchospasms especially in COPD Contraindications: allergy, cardiovascular disease. *use caution in patients with diabetes Side effects: tachycardia, palpitations, nausea, vomiting

question

Levalbueterol (Xoponex) - RESPIRATORY DRUG

answer

Adult Dose: 1.25-2.5mg in 3mL NS by nebulizer up to 3 doses. Class: Sympathomimetic bronchodilators MOA: stimulates beta-2 receptors resulting in smooth muscle relaxation of the bronchial tree and peripheral vasculature. Indications: Acute bronchospasms in patients with COPD and asthma. Contraindications: allergy, Tachycardia 160>

question

Magnesium Sulfate - RESPIRATORY DRUG ETC.

answer

Adult Dose: syringe (Eclampsia 1-4g IV over 3 minutes); cardiac (refractory to Amiodarone) 1-2g IV,IO; Torsades 1-2g IV,IO; infusion (respiratory) 1-2g in 100mL NS 5-10 minutes 10 gtts/mL set Pink top, supplied 1g/ 2mL Class: Electrolyte, Anti Inflammatory MOA: anti Inflammatory, relaxes muscles Indications: Asthma, Emphysema, COPD, Chronic Bronchitis, Eclampsia (seizures of pregnancy), Torsades De Pointes (issue in v-tach), Hypomagnasemia, cardiac arrest (v-fib, v-tach) refractory to amiodarone Contraindication: allergy, heart block Side effects: hypotensive, CNS depression

question

Metaproterenal (Alupent) - RESPIRATORY DRUG

answer

Adult Dose: 0.2-0.3mL of a 5% solution in 2.5mL of NS Class: beta-2 agonist, bronchodilator MOA: relax smooth muscles of bronchial tree Indications: asthma, bronchospasms, chronic bronchitis, COPD Contraindications: allergy, tachycardia Side effects: tachycardia, palpitations, nausea, vomiting.

question

Methylprednisone (Solu-medrol)

answer

Dose: Adult 1-2 mg/kg given IV/IM/IO. Typical dosage is 125 mg given IV/IM/IO. *has to be mixed prior to use Class: Corticosteroid, anti inflammatory, smooth muscle relaxer, Synthetic MOA: Antiimflammatory Indications: asthma, COPD, emphysema,chronic bronchitis, allergic reaction involving the airway. Acute spinal cord injury to help reduce swelling Contraindications: Allergic Side effects: negligible

question

Morphine Sulfate (MSO4)

answer

Adult Dose: acute MI (STEMI) , CHF, pulmonary edema: 2-4mg slow IV every 5-15 minutes to max 10 mg Moderate/ severe pain: 2-10mg slow IV Class: Opiod analgesic (schedule II narcotic) MOA: alleviates pain through CNS action, increases peripheral vasodilation and decreases preload. Indications: severe CHF, pulmonary edema, chest pain associated with an acute MI, moderate to severe pain. Contraindications: allergic, significant head injury, depressed respiratory drive, hypotension, undiagnosed abdominal pain, decreased Loc Side effects: sedation, CNS depression, respiratory depression, hypotension, nausea and vomiting.

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