Chapter 10 Rationale – Flashcards
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If you determine that your patient has an adequate respiratory rate but has an inadequate tidal volume, this will lead to: A. increased respiratory volume. B. an adequate tidal volume over time. C. inadequate breathing. Your answer is correct.D. improved health of the patient.
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Rationale To have adequate breathing, one needs an adequate rate as well as adequate ventilation volume. An adequate rate will clear the CO2 and bring in O2 at a needed rate, and an adequate depth will ensure that the inhaled air is reaching the alveoli, the site of gas exchange. If the tidal volume is too small, then air will not reach the alveoli, the alveoli will not be ventilated, and normal oxygen and carbon dioxide gas exchange cannot take place. This will lead to inadequate breathing.
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Which of the following anatomical differences between the pediatric airway and the adult airway renders pediatric patients more susceptible to airway occlusion when they become unresponsive? A. Proportionally larger tongue as compared to oral cavity size Your answer is correct.B. The pediatric patient has a metabolic rate that is double that of an adult patient. C. Cricoid ring is smaller in size than the glottis opening D. The pediatric patient has very poor perfusion to the lungs in comparison to the adult.
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Rationale Although fundamentally the same as the adult airway, the pediatric airway has special considerations that make it unique. For example, the combination of a smaller jaw and oral cavity and a larger tongue results in more airway occlusion when a child becomes unresponsive and the tongue falls into the posterior pharynx. The pediatric patient does have a faster metabolic rate, but this does not cause airway occlusion, and the amount of perfusion to the lungs is appropriate for each age bracket.
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Which of the following assessment findings would be considered abnormal in determining the quality of a patient's respiratory status? A. Light expiratory wheezing Your answer is correct. B. An acceptable respiratory rate C. Clear and equal breath sounds bilaterally D. Good chest rise and fall with each ventilation
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Rationale The signs of adequate breathing include normal respiratory rate, clear and equal breath sounds bilaterally, adequate air movement heard and felt from nose and mouth, and good chest rise and fall with each ventilation (tidal volume). Wheezing, even if it is minor, is an abnormal finding (it typically reflects bronchoconstriction). Its presence does not mean that the patient is breathing inadequately; it just means that there is more going on with the respiratory system that the EMT may have to manage.
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When inserting the rigid tip catheter into the mouth of a patient, how far should it be inserted? A. No further than the base of the tongue Your answer is correct.B. Until the tip hits something and stops C. The same distance as from the tip of the nose to the tip of the ear D. No deeper than the glottic opening
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Rationale The catheter should be inserted only as far as you can see, typically not farther than the base of the tongue. The tip of the suction catheter may stimulate a gag reflex and cause vomiting if it touches the back of the oropharynx.
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Your new EMT partner is changing the oxygen humidifier in the ambulance, and asks you where to get the water that goes inside. What would be your answer? A. "Fill it with bottled water from the crew lounge." B. "You can fill it from the drinking fountain or bathroom faucet." C. "Fill it from a new bottle of sterile water." Your answer is correct.D. "Open an IV bag and use the fluid to add to the humidifier."
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Rationale Bacteria can easily grow in a humidifier, so it should be stored dry and partially filled with sterile water as needed for a long trip. Some services utilize disposable units that would need to be filled before each use; there are other disposable humidifiers that are already prefilled. If your EMS service uses the humidifiers that must be filled before use, only sterile water should be used for humidification.
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Which of the following patients should the EMT be MOST cautious with when providing artificial ventilation? A. A pediatric patient who has a traumatic brain injury. B. A pediatric patient who swallowed a poison and has a heart rate of 110 per minute. C. An adult patient who was traumatized and has a blood pressure of 86/58. Your answer is correct.D. An adult patient with a history of drug overdose.
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Rationale When providing positive pressure ventilation, the lack of a negative intrathroacic pressure causes a drop in preload to the heart. This in turn results in a drop in cardiac output and blood pressure. As such, if a patient is already hypotensive at the onset of PPV, the pressure may drop even further.
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What is the BEST way for the EMT to avoid the occurrence of gastric inflation? A. Do not over ventilate the patient. Your answer is correct.B. Do not over oxygenate the patient. C. Do not ventilate the patient unless they are in a semi-sitting position. D. Do not under ventilate the patient. .
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Rationale Over ventilating the patient (by way of ventilating too fast, too deep, or creating too high an airway pressure) will promote the development of gastric inflation which then increases the risk of vomiting and worsens lung compliance
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What is the overall ventilatory goal when assisting ventilations with a patient who is spontaneously breathing? A. Get the ventilatory rate to 14 to 20/min. B. Keep the ventilatory rate at whatever the patient is spontaneously breathing. C. Get the ventilatory rate to 10 to 12/min. Your answer is correct.D. Get the ventilatory rate to 8 to 10/min.
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Rationale The goal of providing supplemental ventilations is to deliver ventilations at a rate of 10 to 12 per minute with an adequate tidal volume in each ventilation. For example, if the adult patient is breathing at a rate of 42 per minute and the tidal volume is shallow, you would initially assist the ventilations at the patient's rate by delivering a ventilation with each breath. Over the next 5 to 10 ventilations, you would slowly adjust the rate so that you are ventilating every 5 to 6 seconds with one of the patient's breaths. Over time, as the patient's hypoxia subsides and hypercapnia resolves, the rate should automatically start to slow toward a normal ventilatory rate.
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You are caring for a patient with the following findings: history of COPD, clinical findings of dyspnea, SpO22 94 percent, HR 110, B/P 180/86, skin diaphoretic with ashen fingers and toes, bilaterally diminished breath sounds with slight expiratory wheeze, alveolar sounds still present. The patient also has a headache. Given these findings, how would you characterize this patient's degree of hypoxemia? A. Severe hypoxemia present B. No hypoxia present C. Mild hypoxemia present Your answer is correct.D. Low hypoxemia present
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Rationale Signs of moderate hypoxia include: tachypnea (increased respiratory rate); dyspnea (shortness of breath); pale, cool, clammy skin that may be ashen; tachycardia (increase in heart rate); elevation in blood pressure; restlessness and agitation (from hypoxic brain cells); disorientation and confusion (from high carbon dioxide levels in the blood); and a headache.
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A patient with multiple broken ribs would have an initial problem with what aspect of respiration? A. Cellular respiration B. External ventilation C. Internal respiration D. Pulmonary ventilation Your answer is correct. A patient with multiple broken ribs would have an initial problem with what aspect of respiration? A. Cellular respiration B. External ventilation C. Internal respiration D. Pulmonary ventilation Your answer is correct.
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Rationale Pulmonary ventilation is movement of gases in and out of the lungs. If multiple ribs are broken, this would be a cause for pulmonary ventilation failure. Internal respiration is the gas exchange process that occurs between the cells and the systemic capillaries. Internal respiration, also known as cell/capillary gas exchange, is responsible for delivering oxygen to the cells and removing carbon dioxide from the cell. External respiration is the exchange of gases between the alveoli and capillary bed. Cellular respiration occurs inside the cells and is a function of aerobic metabolism, finally, external ventilation is a fictitious term.
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In a newborn patient, what is considered to be an early sign of hypoxia? A. Bradycardia Your answer is correct.B. Tachycardia C. Tachypnea D. Hypotension
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Rationale In a newborn, bradycardia (slow heart rate) may be an early sign of hypoxia. Infants and young children normally have higher heart rates than adults. As an example, a heart rate of 80 bpm, which would be normal in an adult, may be an indication of hypoxia in a week-old infant, in which a heart rate of 120 to150 bpm would be normal. It is important in the assessment of newborns to suspect hypoxia as a cause of a slower-than-expected heart rate, since this is a primary cause of bradycardia in this group.
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You are caring for a 17-year-old male patient who was bitten by a dog. Although the patient has some soft tissue trauma to his leg, you notice that the pulse oximeter is reading only 90 percent saturation. The heart rate is 76/min, BP is 128/80, and respirations are 8/min. The patient states that he is breathing fine. Given this pulse ox reading, what should you do? A. Initiate low-flow oxygen and reassess the patient. Your answer is correct.B. Administer no oxygen. C. Administer high-flow oxygen via NRB. D. Disassemble and reassemble the pulse ox to see if it is malfunctioning.
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Rationale There is a de-emphasis for the use of high-flow oxygen on patients who do not need it according to the pulse ox reading. However, if the pulse ox reading does not match the clinical presentation of the patient, you should administer oxygen on the basis of the patient's suspected need. A good guide is to start with low flow and then titrate the oxygen content higher until you achieve the desired level of oxygenation. Since the pulse oximeter does not really have any end-user maintenance, attempting to disassemble it is not a viable option, and taking your unit out of service can be detrimental to your patient, who then may not be receiving the care he needs
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You are suctioning the oral cavity of a patient who has food poisoning and is vomiting profusely. You are using a soft catheter to help clear the oral cavity, but it keeps getting clogged. What should the EMT consider doing NEXT? A. Switch to a rigid tip catheter. Your answer is correct.B. Insert the catheter deeper into the airway. C. Turn up the negative vacuum amount on the suction unit. D. Tell the patient to start swallowing the vomit to keep it out of his airway.
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Rationale The rigid catheter is designed with a larger internal bore so that it can suction up larger amounts of fluid more quickly or fluid that is thicker in nature or that has larger particulate matter mixed in. These situations often result in plugging if a soft catheter is used. The EMT should never insert a catheter farther than recommended.
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You are transporting a patient who drank too much alcohol at a party, and now he is unresponsive and vomiting profusely. You have been using your on-board suction unit to keep his airway clear, but suddenly the suction unit stops working. What should the EMT do? A. Grab your portable suctioning unit and resume patient care. Your answer is correct.B. Insert an OPA or NPA so that no more vomitus will enter the airway. C. Stop suctioning the patient until you arrive at the emergency department. D. Call for backup and transfer the patient to the other ambulance for the remaining portion of the trip so you can use their suctioning unit.
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Rationale The advantage of having both a wall-mounted and a portable suction unit is that they can generate about the same negative pressure. So if one fails while en route to the hospital, you can switch to the other one rapidly and thus minimize any compromise to patient care. Inserting an OPA or NPA will not remove the fluid from the airway, and calling for backup or waiting to get to the ED to resume suctioning is poor patient care
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In what part of the lower airway are the conducting airways wrapped in smooth muscle and have the capability to either constrict or relax in response to a stimulus? A. Bronchi B. Trachea C. Bronchioles Your answer is correct.D. Mainstem bronchi
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Rationale The right and left mainstem bronchi, which are the two major branches of the trachea, extend from the carina into the lungs, where they continue to divide into smaller sections or branches known as bronchioles. The bronchi are larger airways and contain cartilage. The bronchioles, which become increasingly smaller as they continue to branch, are lined with smooth muscle and mucous membranes. The smooth muscle can allow the bronchioles to either constrict (making it harder for air to travel through them) or dilate, in response to a stimulus.
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What can a pressure regulator for a portable oxygen tank do that a therapy regulator cannot? A. Be used with an ATV Your answer is correct.B. Be attached to a portable "E" tank. C. Be attached to the oxygen tank mounted in the ambulance. D. Indicate how much pressure is left in the tank.
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Rationale The high-pressure regulator can provide 50 psi to power a flow-restricted, oxygen-powered ventilation device or an automatic transport ventilator. This type of regulator has only one gauge, which registers the cylinder pressure, and a threaded outlet. Some pressure regulators cannot be used interchangeably with the therapy regulator because they have no mechanism for controlling and adjusting the flow rate for an oxygenation adjunct such as a nasal cannula or nonrebreather mask.
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You encounter a patient who was at a dorm party and was found unresponsive in an upstairs bedroom. The patient presents with a gurgling sound in his upper airway. What problem does this indicate? A. The patient has subdural edema. B. The airway is occluded by the tongue. C. The airway is partially occluded by fluid. Your answer is correct.D. The glottic opening is swelling shut.
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Rationale Gurgling, a sound like gargling, usually indicates the presence of blood, vomitus, secretions, or other liquid in the airway. When this is found, the EMT should immediately suction the substance from the airway. Snoring is from the tongue obstructing the airway, and stridor is from the glottic opening swelling shut. Subdural edema is a fictitious airway condition.
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In an infant, which of the following may be a critical finding? A. Capillary refill of two seconds B. History of a recent URI C. Excessive crying D. Obstructed nasopharynx Your answer is correct.
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Rationale The noses and mouths of infants and children are smaller than those of adults. Thus, they are more easily obstructed by foreign bodies, swelling, blood, mucus, and secretions. Infants are obligate nose breathers, meaning that they want to breathe through the nose and not the mouth; thus, it is especially important to keep the nose clear of obstructions. If the nasal cavity becomes obstructed for some reason (e.g., with mucous or blood), the infant may actually hypoventilate and become hypoxic.
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You have a patient who has fluid in the airway, labored breathing, absent breath sounds, a low pulse ox, and is unresponsive. Given this, what should be managed FIRST by the EMT? A. Inadequate ventilations B. Low pulse ox C. Diminished mental status D. Airway occlusion Your answer is correct.
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Rationale In this scenario, to manage the patient by priorities, the airway occlusion should be managed first. Without an open airway, the patient cannot oxygenate, ventilate, or hope to have a normal mental status. Also, the pulse oximeter reading cannot increase until normal ventilations are resumed, and that cannot happen until the airway is open
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You are ventilating a patient with a drug overdose, and occasionally, you need to suction him. What are the guidelines for ventilating him prior to the suctioning in order to wash out the nitrogen and increase the functional reserve of oxygen? A. Rate of 14/min for 2 minutes B. Rate of 10/min for 3 minutes C. Rate of 10/min for 4 minutes D. Rate of 12/min for 5 minutes Your answer is correct.
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Rationale Before suctioning mucus and small amounts of secretions in a patient who is being artificially ventilated, ventilate him at a rate of 12 ventilations per minute for 5 minutes to wash out the residual nitrogen and increase the functional oxygen reserve. After suctioning, resume ventilation.
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An oxygenation adjunct that is used to provide exact oxygen concentrations for the patient who needs lower concentrations of oxygen is a: A. nonrebreather mask. B. partial rebreather mask. C. Venturi mask. Your answer is correct.D. simple face mask.
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Rationale The Venturi mask is a low-flow oxygen system that provides precise concentrations of oxygen through an entrainment valve connected to the face mask. The entrainment valve can be changed to deliver precise oxygen concentrations at preset flow rates. This mask is commonly prescribed to a patient by a physician for use in COPD disorders because of its ability to deliver a precise concentration of oxygen. The other types of oxygenation masks listed are used by the EMT and can provide a general amount of oxygen, not a specific amount of oxygen.
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During the monthly check of ambulance-mounted patient care equipment, you test the suction pump to ensure that it is performing to expectations. In doing so, you would know that the recommended airflow and vacuum amount that the suction unit in the back of the ambulance is capable of should be: A. less than<40 lpm and less than30 lpm and greater than>-200 mmHg C. greater than>40 lpm and greater than>-300 mmHg Your answer is correct.D. less than<30 lpm and less than<-200 mmHg
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Rationale Fixed or installed units should be part of the required on-board ambulance equipment. They should be powerful enough to provide an airflow of >40 lpm at the end of the delivery tube and create a vacuum of more than -300 mmHg on the gauge when the tubing is clamped or kinked.
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Your patient was found unconscious at the bottom of a dark stairway. The BEST method to use to open his airway would be the: A. head-tilt, chin-lift maneuver. B. neck-lift, head-tilt maneuver. C. modified chin-lift maneuver. D. jaw-thrust maneuver. Your answer is correct.
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Rationale If the patient is known or suspected to be traumatized, the EMT should employ the jaw-thrust maneuver when opening the airway. When the maneuver is performed, the patient's head and neck must be brought into and maintained in a neutral, inline position first. The jaw (mandible) is then displaced forward by the EMT's fingers while the head is stabilized in line; lifting the jaw causes the patient's tongue to be pulled forward, away from the back of the airway. The head-tilt, chin-lift maneuver is used for non-trauma patients, and the neck lift and modified neck lift are fictitious airway maneuvers.
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In the absence of oxygen at the cellular level, what happens to adenosine triphosphate (ATP) production? A. It increases. B. It decreases. Your answer is correct.C. It stops. D. It stays the same.
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Rationale In the absence of oxygen, the cells shift from aerobic to anerobic metabolism, which yields lower amounts of ATP and more wastes and acids. This starts a cascade of events that leads to cellular death and rupture, which leads to tissue and organ failure and eventually causes organism death.
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The on-board suction units in the back of the ambulance are typically powered by: A. oxygen pressure found in the main oxygen tank. B. a foot pump near the captain's chair. C. an electrical vacuum pump. Your answer is correct.D. a battery pack mounted to it.
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Rationale Mounted on-board suction units found in the back of the ambulance are typically powered by an electric vacuum pump or by the vacuum produced by the ambulance engine manifold. Portable suction units are powered either manually or by a smaller electrical motor attached to a small battery pack. While some older-style portable suction units were powered by oxygen pressure, the ones mounted to the ambulance patient compartment were not.
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Which of the following drugs administered by an EMT is inhaled? A. Epinephrine B. Activated charcoal C. Oxygen Your answer is correct.D. Nitro spray
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Rationale Oxygen is a colorless, odorless gas that is normally present in the atmosphere in a concentration of approximately 21 percent. After preparation for administration, 100 percent oxygen is available in the O2 tank and is administered via inhalation. Nitroglycerin spray is administered sublingually for chest pain, epinephrine is administered via intramuscular for allergic reactions, and activated charcoal is used for ingested poisonings and in swallowed.
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Which of the findings is MOST suggestive of a patient who is significantly hypoxic? A. SpO22 of 95 percent in a 34-year-old patient. B. A blood pressure of 90/60 in a 44-year-old patient. C. Diminished breath sounds in a 14-year-old patient. D. A heart rate of 58 in a six-week-old patient. Your answer is correct.
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Rationale In newborns and infants, bradycardia (slow heart rate) may be an early sign of hypoxia. Infants and young children normally have higher heart rates than adults. As an example, a heart rate of 80 bpm, which would be normal in an adult, may be an indication of hypoxia in a week-old infant in which a heart rate of 120 to 150 bpm would be normal. It is important in the assessment of newborns to suspect hypoxia as a cause of a slower than expected heart rate, since this is a primary cause of bradycardia in this group. An infant who can struggle vigorously is likely not terribly hypoxic.
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The process of gas exchange that occurs between the cells and the systemic capillaries is known as: A. external ventilation. B. cellular respiration. C. pulmonary ventilation. D. internal respiration. Your answer is correct.
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Rationale Internal respiration is the gas exchange process that occurs between the cells and the systemic capillaries. Internal respiration, also known as cell/capillary gas exchange, is responsible for delivering oxygen to the cells and removing carbon dioxide from the cell.
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During the provision of compressions and ventilations for an adult patient in cardiac arrest who has an endotracheal tube (advanced airway) inserted, the ventilation rate should be: A. 10 to 12 per minute. B. 12 to 14 per minute. C. 8 to 10 per minute. Your answer is correct.D. 14 to 16 per minute.
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Rationale If the patient has an advanced airway in place, such as an endotracheal tube, esophagealdash-tracheal Combitube, or Laryngeal Mask Airway (LMA), the ventilation in the patient without a pulse is reduced to 8 to 10 ventilations per minute. One EMT provides continuous chest compressions at a rate of at least 100 compressions per minute without pausing for any ventilation. A rate of 8 to 10 per minute is one breath every 6 to 8 seconds.
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While looking at your therapy regulator, you see the pressure in the tank reads 1,000 psi. What does that information mean? A. The tank is half empty. Your answer is correct.B. The tank is full. C. It is time to change the tank as the flow will start to become irregular from a low pressure. D. There is still another 1,000 minutes of oxygen left.
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Rationale The pressure in the tank, about 2,000 psi when full, decreases proportionately as the volume of oxygen in the tank decreases. Therefore, a pressure reading of 1,000 psi would indicate that the tank is half full.
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What would be the expected clinical change to your unresponsive trauma patient who had ineffective spontaneous breathing if you are overventilating the patient during positive pressure ventilation (PPV)? A. The pulse pressure will get wider. B. The skin will become cyanotic. C. The heart rate will decrease. D. The blood pressure will decrease. Your answer is correct.
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Rationale When a patient is overventilated, where the rate and volume delivered with the ventilation are in excess of the recommended rate and volume, large amounts of air may become trapped in the alveoli, causing the pressure in the chest to remain higher than it should be during inhalation and exhalation. The overinflated alveoli may cause the capillaries in the lungs to become compressed and obstruct blood flow to the left atrium. Also, the constant high pressure in the chest would reduce the negative pressure that can be generated, thereby reducing the vacuum effect that sucks blood into the right side of the heart with each breath. This would reduce the blood volume that is available to the left ventricle, causing a reduction in cardiac output and eventually blood pressure.
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What is one thing the EMT may have to do with a portable suction unit that is typically NOT necessary with a wall-mounted suction unit? A. Ensure that the catheters that fit the wall unit also fit the portable unit. B. Turn it on during morning equipment check to make sure it works. C. Make sure the batteries are charged. Your answer is correct.D. Keep it in the airway bag so that someone does not try to use it over the wall unit when a patient is in the ambulance.
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Rationale Although there are manually operated portable suction units, most of them used today are actually battery operated. As such, the EMT will need to assure the unit is plugged in and fully charged. All suction catheters are designed to be interchangeable, and both units should be tested during the morning equipment checks to ensure they are working properly.
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If a patient cannot maintain a pulse ox reading of greater than or equals≥94 percent on 6 lpm via cannula and the EMT wants to increase the oxygen concentration another 10 percent or so, what oxygenation adjunct should be used? A. Nonrebreather mask B. Partial rebreather mask Your answer is correct.C. Venturi mask D. Nasal cannula
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Rationale The partial rebreather mask looks very similar to the nonrebreather mask but is equipped with a two-way valve that allows the patient to rebreathe about one-third of the exhaled air. Since the initial portion of exhaled air is principally from the patient's dead space, where gas exchange does not occur, it contains mostly oxygen-enriched air from the previous inhalation. The flow rate is typically set at 10 lpm but should be no less than 6 lpm. Partial rebreather masks can provide oxygen concentrations of between 35 and 60 percent.
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A patient is lying on his back, working beneath an automobile, and the automobile falls off the jacks and pins him against the ground. What answer would best represent why this patient is going to suffer from an alveolar hypoventilation? A. Because the trachea will be crushed and air cannot get into the lungs B. Because of the inability to inhale deeply enough because of the weight of the car Your answer is correct.C. Because of the blood flow changes through the chest D. Because both lungs will be totally collapsed against the back of the thoracic wall
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Rationale The patient who has a heavy weight on the chest may be unable to inhale deeply as a result of the inability to move the thoracic and abdominal walls. This causes alveolar hypoventilation and can lead to death and would be the primary reason for inadequate breathing. This syndrome is called traumatic asphyxia. There may be a change in pulmonary perfusion, but this does not change alveolar ventilation. A crushed trachea would not be as likely in this scenario, especially since the trachea is anatomically lower than the anterior thoracic ribcage from the perspective of lying on one's back under a car.
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Why do pediatric patients have to rely more on the diaphragm for breathing than the adult patient does? A. Because the intercostal muscles are not yet attached to the ribcage in the infant patient B. Because of the increased compliance of the thoracic wall in the infant Your answer is correct.C. Because the ribs are stiffer than in the adult patient D. Because the diaphragm is more well developed than the intercostal muscles in an infant
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Rational The chest wall in an infant or a child is softer and more pliable than that in an adult. This leads to a much greater compliance (elasticity, response to pressure) or movement during ventilation. Hence, infants and children rely more on the diaphragm for breathing. The intercostal muscles contribute less in normal breathing and act more like accessory muscles. That is why retractions are seen more prominently in infants and young children than in adults.
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If you arrive on scene and the patient is unresponsive, what should be one of the FIRST parameters you should assess on the patient? A. Breathing status B. Systolic blood pressure C. Airway status Your answer is correct.D. Blood sugar level
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Rationale A patient who is found to be unresponsive should also be assumed to have an airway occlusion until proved otherwise. This is why, during your primary assessment, you assess airway before breathing or circulation. Assessing the vitals for the BP or BGL level is also done after the completion of the primary survey.
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When ventilating the adult patient who has a pulse, the bag mask should be used with supplemental oxygen to achieve visible chest rise every: A. 3 to 4 seconds. B. 8 to 10 seconds. C. 10 to 15 seconds. D. 5 to 6 seconds. Your answer is correct.
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Rationale The ventilation rate in the adult patient with a pulse is 10 to 12 breaths per minute (one breath every 5 to 6 seconds). If the patient is pulseless (no perfusing rhythm), the ventilation rates are reduced and are performed in conjunction (synchronized) with chest compressions. The compression-to-ventilation ratio in the adult patient for both one- and two-person CPR is 30 compressions to 2 ventilations.
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Which of the following is a TRUE statement regarding the use of the NPA? A. It allows the EMT to spend less time monitoring the patient's airway. B. It can only be used in patients without a gag reflex. C. It should be lubricated with a water-soluble lubricant before insertion. Your answer is correct.D. It is more likely to stimulate vomiting than the oral airway.
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Rationale The NPA helps to keep the tongue off the back of the throat after it has been inserted through the nasal cavity. For this reason, the NPA should be lubricated before insertion with a sterile, water soluble lubricant. This will ease the insertion and lessen the chance of trauma to the nasal mucous lining. The NPA is used when a gag reflex is present, as it does not simulate vomiting to the degree that the OPA will. Even if the NPA is inserted, since the trachea is not protected, the EMT must always monitor the airway.
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The oxygen/carbon dioxide exchange takes place in what structure prior to the carbon dioxide being exhaled into the environment? A. Alveoli Your answer is correct.B. Bronchioles C. Bronchi D. Alveolar ducts
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Rationale After gas exchange occurs in the alveoli, the carbon dioxide is loaded into the alveoli, where it is then exhaled, and with the next inhalation, fresh air with a higher content of oxygen is breathed in. The bronchi, bronchioles, and alveolar ducts are all part of the respiratory system conducting airways that deliver air to the alveoli during inhalation.
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Which of the following can cause a change to the pressure found inside an oxygen tank? A. If the oxygen was filled in the United States versus a U.S. territory B. A change in ambient temperature Your answer is correct.C. If the oxygen was manufactured from a distilling process rather than an extracting process D. If the tank was filled on a weekday versus a weekend
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Rationale The pressure in the tank will vary with changes in the ambient temperature. An increase in ambient temperature would cause the pressure in the tank to increase, whereas a decrease in ambient temperature would cause a decrease in tank pressure. The day of the week the tank is filled does not matter, as this is a standard procedure, as is how oxygen is extracted from the air (there are not two different processes). Finally, a tank is filled the same amount for any use in the continental United States or U.S. territory.
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If you suspect that your patient has excessive gastric inflation during the management of a cardiac arrest, what piece of equipment would you want to have available? A. A backboard B. The AED C. Another BVM D. The suction unit Your answer is correct.
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Rationale A patient with gastric inflation is at a greater risk for vomiting when the pressure in the stomach gets so high that the contents opens the esophagus and flood the back of the mouth and throat. As such, having the suction available will allow you to rapidly manage this emergency.
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You are attending an in-house CE program on CPAP use because your EMS system has just purchased new units for each ambulance. During the class, the instructor asks you which of the following four patients could benefit from CPAP. Which one would you select? A. Patient with pulmonary edema Your answer is correct.B. Patient with hypocapnea C. Patient with a tension pneumothorax D. Patient with hypotension
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Rationale The use of CPAP on pulmonary edema is beneficial because the back pressure not only improves oxygen diffusion into the bloodstream, but also helps to displace alveolar fluid accumulation back into the vascular system. It should never be used on any patient who is hypotensive, as CPAP will worsen hypotension. It will also likely worsen a tension pneumothorax and should be avoided there also. Finally, if the patient is hypocapnic, this means that he is likely overventilating, which means that the CPAP is not indicated.
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You arrive at a restaurant, and as you approach your 58-year-old male patient, you note that he is sitting at a table, panicked and laboring to breathe. As you get closer you note audible stridor, and the patient is cyanotic. You feel NO movement of air from his mouth or nose; your initial impression would be: A. upper airway obstruction from food. Your answer is correct.B. asthma. C. airway obstruction from fluid. D. anaphylaxis.
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Rationale The signs and symptoms that present in this patient are typical for a partial airway obstruction with significantly poor air exchange. This patient is in need of immediate airway management. Asthma produces bronchoconstriction, as does an anaphylaxis. Fluid obstruction produces a gurgling sound. Given that the sound is from an upper airway obstruction and the patient is sitting in a restaurant, then a differential field impression would be possible choking.
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What should you do if, during the ventilation of an adult patient who is apneic, you notice the patient's abdomen getting larger with ongoing ventilations? A. Roll the patient onto his side for a while. B. Ensure your ventilations are only enough to provide visible chest rise. Your answer is correct.C. Turn down the oxygen concentration. D. Call for a Paramedic unit.
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Rational In this situation, you should reevaluate how you are ventilating the patient, as it seems likely that the ventilation is over-distending the lungs and causing air to enter the stomach. Ensure that the volume is enough to observe visual chest rise and no more. Airway pressures that are too high will open the esophagus and allow air to flow into the stomach, increasing the risk for regurgitating and inhibiting the diaphragm from moving.
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What should the EMT do if it is discovered that the patient he is ventilating has upper and lower dentures in place? A. Remove only the lower dentures. B. Leave them in place if they are still seated properly. Your answer is correct.C. Remove only the upper dentures. D. Remove both the upper and lower dentures.
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Rationale If the patient has dentures that are secure in the mouth, leave them in place. It is much easier to establish a tight mask seal with the dentures in place. If the dentures are extremely loose, remove them so they do not dislodge and occlude the airway. Partial dentures (plates) may also become dislodged and occlude the airway. If the partial plate is loose, remove it. Reassess the mouth frequently in patients who have dentures or partial dentures to ensure that these appliances have not come loose.
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Why should a patient with a history of COPD or emphysema, relying on the hypoxic drive to breathe, still receive high flow oxygen if he is objectively dyspneic? A. Because it is impossible to test arterial blood gases (ABGs) before the hospital setting, the EMT has no idea about the level of hypoxia and, therefore, should always oxygenate the patient. B. Because the absence of oxygen will cause excessive levels of carbon dioxide to build up in the brain. C. Because the patient may have a rapid pulse and rapid respiratory rate. D. Because even if oxygen saturations are elevated, it will not suddenly cause the patient to stop breathing in the prehospital environment. Your answer is correct.
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Rationale Although it is true that the hypoxic drive is present in a COPD patient, the provision of oxygen (even high flow) will not cause the patient to stop breathing as the saturation of oxygen in the bloodstream elevates. It takes a considerable amount of time for the hypoxic drive to be affected enough to diminish the quality of ventilations, a longer period of time than the EMT is caring for the patient in the vast majority of situations. Oxygen can be administered for more reasons than tachycardia and tachypnea, and the EMT guides oxygen therapy on the basis of patient's needs, not ABG values.
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When ventilating with a bag-mask device, the EMT should do each of the following, EXCEPT: A. ventilate over one second. B. watch the chest to ensure visual chest rise with each ventilation. C. ensure there are no leaks around the mask seal. D. hyperventilate the patient. Your answer is correct.
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Rationale When using a bag-valve mask device on a patient, you should ensure that you are ventilating each breath over one second while watching for visible and adequate chest rise, that there are no leaks around the mask, and that you are not accidently hyperventilating the patient by ventilating with either too much volume or too fast a rate.
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How do you know if the ventilations you are providing to a patient who is spontaneously breathing, but is breathing too shallow, are effective? A. You are using high-flow oxygen. B. The heart rate remains over 100/min. C. You do not hear a leak in the mask seal. D. You can hear alveolar breath sounds with each ventilation. Your answer is correct.
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Rationale The best indication that the ventilations you are providing are immediately effective is if they create alveolar breath sounds. This means that you are ventilating the patient with a volume that is sufficient to deliver oxygen to the alveoli, where the gas exchange takes place. Having no seal leak does not mean that you are ventilating the patient deeply enough, it just means that the mask is appropriately placed on the face. The use of high-flow oxygen ensures oxygenation, not ventilation. If the heart rate remains over 100/minute, this may be a sign of ongoing hypoxia.
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You are establishing CPAP on a patient with respiratory distress. What would be an appropriate initial pressure setting if the patient has acute pulmonary edema? A. 1 to 5 cmH220 B. 5 to 10 cmH220 Your answer is correct.C. 20 to 25 cmH220 D. 15 to 20 cmH220
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Rationale The constant pressure provided by CPAP may be set by the provider depending on the type of equipment. In any instance, however, the standard back pressure used for patients with pulmonary edema is 5 to 10 cmH20.
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Which of the following age brackets would MOST likely become hypoxic the fastest if they experienced an airway occlusion? A. A patient who is 44-years-old B. A patient who is 22-years-old C. A patient who is 12-years-old D. A patient who is 2-years-old Your answer is correct.
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Rationale Infants and children are smaller and have more limited oxygen reserves than adults. Therefore, they have less oxygen in the lungs available during periods of inadequate breathing or apnea (complete cessation of breathing). Also, they have twice the metabolic rate of adults, causing them to use oxygen at a much faster rate. Their smaller reserve of oxygen and greater metabolic rate will cause infants and children to become hypoxic more rapidly than adult patients. Hypoxia is the most common cause of cardiac arrest in children.
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Which one of the following airway assessment findings is MOST indicative of a patient who may rapidly become hypoxic? A. Absent airway sounds when attempting to breathe Your answer is correct.B. Snoring on inhalation C. Stridor on inhalation D. Gurgling on exhalation
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Rationale You should be able to hear quiet air exchange from in and out of the mouth even in the patient who has no airway occlusion. However, if the patient has a fully occluded airway, there will be no sound of air exchange, and obviously, the patient will become hypoxic the most quickly with a total obstruction than with a partial one (as indicated by snoring, gurgling, or stridor).
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A patient with a slowed respiratory rate and depth from a drug overdose would MOST likely develop what problem? A. High levels of oxygen in the blood B. Too narrow of a pulse pressure C. High levels of carbon dioxide in the blood Your answer is correct.D. Low levels of sugar in the blood
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Rationale The level of carbon dioxide in the blood stream is largely determined by the quality of alveolar ventilation. If the patient has hypoventilation, then carbon dioxide will not get washed out and the levels will start to increase in the bloodstream. This makes the blood more acidic and can contribute to cellular death.
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What is the approximate amount of oxygen in a portable E cylinder? A. 625 liters Your answer is correct.B. 575 liters C. 700 liters D. 450 liters
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Rationale The following are sizes and related volumes of oxygen cylinders used in emergency medical care: D cylinderlong dash—350 liters; E cylinderlong dash—625 liters; M cylinderlong dash—3,000 liters; G cylinderlong dash—5,300 liters; H cylinderlong dash—6,900 liters.
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Which of the following steps is NOT correct when using the jaw-thrust maneuver to open your patient's airway? A. Stabilize the patient's head with your forearms. B. Do not allow the head to flex or extend during the maneuver. C. Using your index fingers, push the angles of the lower jaw forward. D. Tilt the head back by applying pressure to the forehead. Your answer is correct.
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Rationale When the jaw-thrust maneuver is performed on a trauma patient, the patient's head and neck must be brought into and maintained in a neutral, inline position. This means that the head is not turned to the side, tilted forward (flexed), or tilted backward (extended). The jaw-thrust maneuver is used to open the airway in such a patient because the head and neck are not tilted back during this maneuver. The jaw (mandible) is displaced forward by the EMT's fingers; this causes the patient's tongue to be pulled forward, away from the back of the airway.
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Your patient in cardiac arrested has dentures. As you prepare to establish and maintain an airway, what should you do with the dentures? A. Remove them and place them in a small cup of sterile saline. B. Remove the dentures so that you can properly place an OPA. C. Leave them in place if they are firmly seated. Your answer is correct.D. Remove the dentures only if they are the upper half of the teeth.
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Rationale If the patient has dentures that are secure in the mouth, leave them in place. It is much easier to establish a tight mask seal with the dentures in place. If the dentures are extremely loose, remove them so that they do not dislodge and occlude the airway. Partial dentures (plates) may also become dislodged and occlude the airway. If the partial plate is loose, remove it. Reassess the mouth frequently in patients who have dentures or partial dentures to ensure that these appliances have not come loose.
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Low oxygen content in the blood is called: A. hypoxia. B. dysoxia. C. hypoxemia. Your answer is correct.D. anoxia.
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Rationale Hypoxemia is a state of lowered oxygen content in arterial blood. This is a much more specific type of low oxygen than hypoxia, which refers to inadequate delivery of oxygen to the cells. While the former means a lowered content in the bloodstream, the latter means that the tissue cells are not getting sufficient oxygen, which may be as a result of a lowered oxygen content or the inability of the body to perfuse oxygen-rich blood to the peripheral tissues. Anoxia is an absence of oxygen, and dysoxia can refer to the abnormal amount of oxygen or the abnormal utilization of oxygen by the cells of the body.
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You are providing intermittent suctioning to a patient as he has a small bleed into his airway during PPV. When performing this skill, what is the maximum amount of time you should suction prior to reoxygenating him? A. 10 seconds B. 5 seconds C. 20 seconds D. 15 seconds Your answer is correct.
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Rationale While suctioning the oral cavity, the EMT should apply suction only on the way out of the airway after the tip of the catheter is properly placed. When suctioning, keep moving the catheter tip from side to side to clear material from the mouth as the catheter is being removed. If possible, suction for no more than 15 seconds at a time in the adult; in infants and children, suction in shorter periods, approximately 5 seconds.
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The use of an oxygen humidifier is recommended if the transport time of the patient receiving oxygen exceeds: A. 30 minutes. B. 60 minutes. Your answer is correct.C. 90 minutes. D. 120 minutes.
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Rationale For short periods, it is not harmful to deliver dry oxygen to the patient. Generally, a humidifier is not needed for prehospital administration of oxygen. If oxygen is to be delivered over a long period, as in a transport of an hour or more, a humidifier should be considered.
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Which of the situations would allow artificial ventilation to provide better alveolar ventilation than spontaneous breathing? A. A patient with pneumonia. B. A patient with a history of COPD. Your answer is not correct.C. A patient with a large flail chest. This is the correct answer.D. A patient with anemia.
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Rationale If a patient has a condition or injury that does not allow the thorax to expand adequately, such as a flail segment, not enough negative pressure is generated to draw a sufficient amount of air into the lungs. With the application of positive pressure ventilation, the patient does not have to rely on his own ability to produce negative pressure; thus, in this situation, the treatment of choice is to force air into the lungs and the alveoli. Patients with pneumonia, anemia, and COPD can still create a negative intrathoracic pressure; if you need to ventilate them, it is because they cannot adequately oxygenate, not because they cannot generate a negative intrathoracic pressure.
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The automatic transport ventilator (ATV) may NOT be appropriate for: A. patients under the age of five. Your answer is correct.B. the nonbreathing adult patient. C. a cardiac arrest resuscitation. D. adult patients with a possible spinal injury.
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Rationale Some ATVs cannot be used in children younger than five years of age because these ATVs do not have settings that will turn down low enough for volumes and pressures that a pediatric patient would need. These patients would need to be manually ventilated. The ATV can be used on adult patients with spinal injury, apneic adults, and arrested adults; these are all normal indications for ATV use.
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When there are two rescuers to dedicate to the airway, the MOST appropriate device to use on a nonbreathing patient would be: A. a nonrebreather mask. B. CPAP. C. a partial-rebreather mask. D. a bag-mask device. Your answer is correct.
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Rationale Of the devices listed, the bag-valve mask device is the most appropriate device to use on the nonbreathing patient. In this situation, one EMT can use two hands to hold the mask and maintain a seal, and the second EMT can use both hands to squeeze the BVM. Oxygenation masks will be of no use if the patient is not breathing, and CPAP is to be used only on a spontaneously and adequately breathing patient.
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What is the approximate amount of oxygen in an ambulance mounted M cylinder? A. 2,500 liters B. 4,000 liters C. 3,500 liters D. 3,000 liters Your answer is correct.
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Rationale The following are sizes and related volumes of oxygen cylinders used in emergency medical care: D cylinderlong dash—350 liters; E cylinderlong dash—625 liters; M cylinderlong dash—3,000 liters; G cylinderlong dash—5,300 liters; H cylinderlong dash—6,900 liters.
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Which of the following is the most desirable outcome in the ventilatory management of a patient in cardiac arrest? A. Ensuring that the patient is intubated by an ALS provider B. Attaching the pulse oximeter and monitoring the readings C. Providing appropriate ventilations Your answer is correct.D. Being able to insert a simple airway adjunct
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Rationale It is essential to adhere to the recommended ventilation rates and volumes when ventilating a patient, especially the cardiac arrest patient. More ventilation is not good for the patient. What is good for the patient is establishing and maintaining a patent airway, providing good ventilations at the right rate and tidal volume, and providing supplemental oxygen with ventilations. Using a pulse oximeter will not ensure adequate ventilations, and using a simple or advanced airway does not ensure that the patient will be ventilated appropriately.
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Insertion of a nasopharyngeal airway includes: A. lubricating the tube with a petroleum jelly-type product. B. facing the bevel of the airway toward the outside of the nostril. C. measuring the airway from the tip of the nose to the tip of the earlobe. Your answer is correct.D. keeping the flange of the airway approximately 1 cm from the flare of the nostril.
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Rationale Measure the airway by placing it next to the patient's face. A properly sized airway should extend from the tip of the patient's nose to the tip of the earlobe. It is also acceptable to measure the airway from the tip of the nose to the angle of the jaw. The diameter of the airway must be such that it can fit inside the patient's nostril without blanching the skin of the nose. The bevel of the NPA is inserted facing the septum and is advanced until the flange is resting on the external naris. A water-based lubricant should be used on the NPA before insertion.
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What is the primary smooth muscle that participates in normal inhalation called? A. Accessory muscle B. Lung C. Visceral pleura D. Diaphragm Your answer is correct.
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Rationale The diaphragm is a smooth muscle that separates the chest cavity from the abdominal cavity. It is the major muscle used in breathing. It is responsible for approximately 60 to 70 percent of the effort of ventilation. The lungs are the site for actual gas exchange, the visceral pleura is a lining that adheres to the interior of the thoracic cavity and assists with lung inflation, and the accessory muscles are those that help to augment breathing in situations of heightened respiratory effort.
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Why should a portable oxygen tank never be allowed to stand upright in the ambulance or in a patient's home? A. Not all the oxygen will be able to be used when the tank is standing upright. B. It may fall and crack the neck or break the valve. Your answer is correct.C. The oxygen regulator does not function properly if the tank is not lying on its side. D. The liter flow is unreliable when the tank is upright.
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Rationale Lay the oxygen tank down next to the patient. Never stand an oxygen tank upright or in any position in which it may fall and possibly break off its valve. If the tank is punctured or if a valve breaks off when the tank falls, an oxygen cylinder can accelerate with enough force to penetrate concrete walls; this is enough force to cause bodily harm as well.
