Paramedic Airway FISDAP Review Part
1 Rated 100% Correct!!
Appropriate airway management - Answer *Steps must be performed in order.
Bypass steps that do not apply.*
a. Open and maintain a patent airway.
b. Recognize and treat airway obstructions.
c. Assess ventilation and oxygenation status.
d. Administer supplemental oxygen.
e. Provide ventilatory assistance.
Upper airway - Answer Consists of all anatomic airway structures above the glottic
opening.
*1. Tongue*
a. Must be manipulated
b. Tends to fall back into the posterior pharynx in unresponsive patient
*2. Pharynx*
a. Muscular tube that extends from the nose and mouth to the esophagus and
trachea
b. Composed of:
i. Nasopharynx
ii. Oropharynx
iii. Laryngopharynx (hypopharynx)
Lower airway - Answer Extends from the glottis to the pulmonary capillary
membrane.
1. *Larynx*
2. *Thyroid cartilage*
3. *Cricoid cartilage (cricoid ring)*
4. *Cricothyroid membrane*
5. *Glottis*
6. *Trachea*
1. Larynx - Answer -Complex structure formed by many independent cartilaginous
structures
-Marks where the upper airway ends and lower airway begins
2. Thyroid cartilage - Answer -Shield-shaped structure formed by two plates that join
in a "V" shape anteriorly to form the laryngeal prominence
i. Known as the Adam's apple
ii. More pronounced in men
iii. Can be difficult to locate in obese or short-necked patients
-Suspended from the hyoid bone by the thyroid ligament
-Directly anterior to the glottic opening
3. Cricoid cartilage (cricoid ring) - Answer -Lies inferiorly to the thyroid cartilage
-Forms the lowest portion of the larynx
-More prominent in females
4. Cricothyroid membrane - Answer -Located between the thyroid and cricoid
cartilage
,Paramedic Airway FISDAP Review Part
1 Rated 100% Correct!!
-Site for emergency surgical and nonsurgical access to the airway
-Bordered laterally and inferiorly by the highly vascular thyroid gland
5. Glottis - Answer -Narrowest portion of the adult airway
-Vocal cords are located at the lateral borders of the glottis.
-Epiglottis is located at the superior border of the glottis.
-ET intubation requires visualizing the epiglottis, glottis, and vocal cords before
inserting the ET tube.
6. Trachea - Answer -Immediately descends into the thoracic cavity
-Not a straight tube, which is key to understand when placing an ET tube
The respiratory and cardiovascular systems work together to ensure that: - Answer
1. A constant supply of oxygen and nutrients is delivered to every cell.
2. Waste products are removed from every cell.
Ventilation - Answer -Physical act of moving air into and out of the lungs
1. *Inhalation* is the active, muscular part of breathing.
2. *Exhalation* is a passive process and does not normally require muscular effort.
Oxygenation - Answer -Process of loading oxygen molecules onto hemoglobin
molecules in the bloodstream
-Requires adequate *FiO2 (Percentage of oxygen in inhaled air)*
Respiration - Answer -Process of exchanging O2 and CO2-->
1. *External respiration (Also called pulmonary respiration)*: Process of exchanging
O2 and CO2 between the alveoli and blood in pulmonary capillaries.
2. *Internal respiration (Also called cellular respiration)*: Exchange of O2 and CO2
between the systemic circulation and the body's cells.
Pathophysiology of Respiration - Answer -Multiple conditions can inhibit the body's
ability to effectively provide oxygen to cells.
1. Disruption of pulmonary ventilation, oxygenation, and respiration will cause
immediate effects on the body.
a. Must be recognized and corrected immediately
b. Important to distinguish a primary ventilation problem from a primary oxygenation
or respiration problem
2. Every cell needs a constant supply of oxygen to survive.
a. Some tissues are more resilient than others.
b. Sufficient levels of external respiration and perfusion are required.
3. Hypoxia, ventilation-perfusion ratio and mismatch, factors affecting ventilation,
factors affecting oxygenation and respiration, and acid-base balance.
1. Hypoxia - Answer Tissues and cells do not receive enough oxygen --> Death may
occur quickly if not corrected.
,Paramedic Airway FISDAP Review Part
1 Rated 100% Correct!!
- Varying signs and symptoms
a. Onset and degree of tissue damage often depend on the quality of ventilations.
b. Early signs include restlessness, irritability, apprehension, tachycardia, and
anxiety.
c. Late signs include mental status changes, a weak pulse, and cyanosis.
d. Responsive patients often report dyspnea and may not be able to speak in
complete sentences.
-Best to administer oxygen before signs and symptoms appear
2. Ventilation-perfusion ratio and mismatch - Answer -Air and blood flow must be
directed to the same place at the same time (ventilation and perfusion must be
matched).
-Failure to match ventilation and perfusion (V/Q mismatch) lies behind most
abnormalities in oxygen and carbon dioxide exchange.
-In most people, normal resting minute ventilation is approximately 6 L/min.
a. Resting alveolar volume: Approximately 4 L/min
b. Pulmonary artery blood flow: Approximately 5 L/min
c. Overall ratio of ventilation to perfusion: 4:5 L/min, or 0.8 L/min
-Because neither ventilation nor perfusion is distributed equally, both are distributed
to dependent regions of the lungs at rest. However, an increase in gravity-dependent
flow is more marked with perfusion than with ventilation.
--> Ratio of ventilation to perfusion is highest at the apex of the lung and lowest at
the base.
-When ventilation is compromised but perfusion continues:
a. Blood passes over alveolar membranes without gas exchange.
b. CO2 is recirculated into the bloodstream.
i. Results in V/Q mismatch
ii. Could lead to severe hypoxemia if not recognized and treated
-When perfusion across the alveolar membrane is disrupted:
a. Less O2 is absorbed into the bloodstream; less CO2 is removed (V/Q mismatch).
b. Can lead to hypoxemia --> Immediate intervention is needed to prevent further
damage or death.
3. Factors affecting ventilation - Answer A patent airway is critical for the provision of
O2 to tissues. Intrinsic and extrinsic factors can cause airway obstruction.
*1. Intrinsic factors*: infection, allergic reactions, and unresponsiveness.
a. The tongue is the most common obstruction in an unresponsive patient.
b. Some factors are not necessarily directly part of the respiratory system. Ex...
i. Interruptions in the central and peripheral systems.
ii. Medications that depress the central nervous system.
iii. Trauma to the head and spinal cord.
iv. Neuromuscular disorders.
, Paramedic Airway FISDAP Review Part
1 Rated 100% Correct!!
XV v. Neuromuscular blocking agents.
XV XV XV
XV c. Allergic reactions
XV XV
XV i. Swelling (angioedema) can obstruct the airway.
XV XV XV XV XV XV
XV ii. Bronchoconstriction can decrease pulmonary ventilation.
XV XV XV XV XV
*2. Extrinsic factors*: trauma and foreign body airway obstruction.
XV XV XV XV XV XV XV XV
a. Trauma to the airway or chest --
XV XV XV XV XV XV XV XV
> Requires immediate evaluation and intervention
XV XV XV XV XV
b. Blunt or penetrating trauma and burns can disrupt airflow through the trachea an
XV XV XV XV XV XV XV XV XV XV XV XV XV XV
d into the lungs --> Quickly results in oxygenation deficiencies
XV XV XV XV XV XV XV XV XV
c. Trauma to the chest wall can lead to inadequate pulmonary ventilation. Example
XV XV XV XV XV XV XV XV XV XV XV XV XV
: A patient with numerous rib fractures or a flail chest may purposely breathe shallo
XV XV XV XV XV XV XV XV XV XV XV XV XV XV
wly in an attempt to alleviate pain from the injury (Respiratory splinting) --
XV XV XV XV XV XV XV XV XV XV XV XV
> Can result in decreased pulmonary ventilation
XV XV XV XV XV XV
**Proper ventilatory support is crucial. XV XV XV XV
*3. Hypoventilation & Hyperventilation*-
XV XV XV
*a. Hypoventilation*: occurs when CO2 production exceeds CO2 elimination.
XV XV XV XV XV XV XV XV XV
*b. Hyperventilation* occurs when carbon dioxide elimination exceeds carbon dioxi
XV XV XV XV XV XV XV XV XV XV
de production.
XV
--
> Hypoventilation and hyperventilation could represent the body's attempt to compe
XV XV XV XV XV XV XV XV XV XV
nsate for various abnormal conditions. For example, if the pH of the blood alkalotic,
XV XV XV XV XV XV XV XV XV XV XV XV XV X
the patient's breathing may become slow or shallow in an attempt to retain CO2 to
V XV XV XV XV XV XV XV XV XV XV XV XV XV XV XV
decrease the pH<-- XV XV
*4. Hypercarbia & Hypocarbia*:
XV XV XV
a. Decrease in minute volume decreases CO2 elimination --
XV XV XV XV XV XV XV XV XV
> Results in buildup of CO2 in the blood (*hypercarbia*)
XV XV XV XV XV XV XV XV XV
b. Increase in minute volume increases CO2 elimination --
XV XV XV XV XV XV XV XV XV
> Lowers CO2 in the blood (*hypocarbia*)
XV XV XV XV XV XV
4. Factors affecting oxygenation and respiration - Answer *1. External factors:*
XV XV XV XV XV XV XV XV XV
a. External factors in ambient air. Examples: Atmospheric pressure, partial pressur
XV XV XV XV XV XV XV XV XV XV XV
e of oxygen --
XV XV XV
> At high altitudes, the percentage of oxygen remains the same, but partial pressur
XV XV XV XV XV XV XV XV XV XV XV XV XV
e decreases because total atmospheric pressure decreases. --
XV XV XV XV XV XV XV
> Closed environments may also have decreases in ambient oxygen. Examples: Mi
XV XV XV XV XV XV XV XV XV XV XV XV
nes and trenches XV XV
b. Toxic gases displace oxygen in the environment. --
XV XV XV XV XV XV XV XV XV
> CO inhibits the proper transport of oxygen to tissues
XV XV XV XV XV XV XV XV XV
*2. Internal factors:*
XV XV
a. Conditions that reduce the surface area for gas exchange also decrease th
XV XV XV XV XV XV XV XV XV XV XV
e body's oxygen supply.
XV XV XV
b. Medical conditions may also decrease surface area of the alveoli by damagin
XV XV XV XV XV XV XV XV XV XV XV
g them or by leading to an accumulation of fluid in the lungs.
XV XV XV XV XV XV XV XV XV XV XV XV
c. Nonfunctional alveoli inhibit the diffusion of oxygen and carbon dioxide -- XV XV XV XV XV XV XV XV XV XV
> Called intrapulmonary shunting
XV XV XV
d. Submersion victims and patients with pulmonary edema have fluid in the alveoli-->
XV XV XV XV XV XV XV XV XV XV XV
i. Inhibits adequate gas exchange at the alveolar membrane
XV XV XV XV XV XV XV
1 Rated 100% Correct!!
Appropriate airway management - Answer *Steps must be performed in order.
Bypass steps that do not apply.*
a. Open and maintain a patent airway.
b. Recognize and treat airway obstructions.
c. Assess ventilation and oxygenation status.
d. Administer supplemental oxygen.
e. Provide ventilatory assistance.
Upper airway - Answer Consists of all anatomic airway structures above the glottic
opening.
*1. Tongue*
a. Must be manipulated
b. Tends to fall back into the posterior pharynx in unresponsive patient
*2. Pharynx*
a. Muscular tube that extends from the nose and mouth to the esophagus and
trachea
b. Composed of:
i. Nasopharynx
ii. Oropharynx
iii. Laryngopharynx (hypopharynx)
Lower airway - Answer Extends from the glottis to the pulmonary capillary
membrane.
1. *Larynx*
2. *Thyroid cartilage*
3. *Cricoid cartilage (cricoid ring)*
4. *Cricothyroid membrane*
5. *Glottis*
6. *Trachea*
1. Larynx - Answer -Complex structure formed by many independent cartilaginous
structures
-Marks where the upper airway ends and lower airway begins
2. Thyroid cartilage - Answer -Shield-shaped structure formed by two plates that join
in a "V" shape anteriorly to form the laryngeal prominence
i. Known as the Adam's apple
ii. More pronounced in men
iii. Can be difficult to locate in obese or short-necked patients
-Suspended from the hyoid bone by the thyroid ligament
-Directly anterior to the glottic opening
3. Cricoid cartilage (cricoid ring) - Answer -Lies inferiorly to the thyroid cartilage
-Forms the lowest portion of the larynx
-More prominent in females
4. Cricothyroid membrane - Answer -Located between the thyroid and cricoid
cartilage
,Paramedic Airway FISDAP Review Part
1 Rated 100% Correct!!
-Site for emergency surgical and nonsurgical access to the airway
-Bordered laterally and inferiorly by the highly vascular thyroid gland
5. Glottis - Answer -Narrowest portion of the adult airway
-Vocal cords are located at the lateral borders of the glottis.
-Epiglottis is located at the superior border of the glottis.
-ET intubation requires visualizing the epiglottis, glottis, and vocal cords before
inserting the ET tube.
6. Trachea - Answer -Immediately descends into the thoracic cavity
-Not a straight tube, which is key to understand when placing an ET tube
The respiratory and cardiovascular systems work together to ensure that: - Answer
1. A constant supply of oxygen and nutrients is delivered to every cell.
2. Waste products are removed from every cell.
Ventilation - Answer -Physical act of moving air into and out of the lungs
1. *Inhalation* is the active, muscular part of breathing.
2. *Exhalation* is a passive process and does not normally require muscular effort.
Oxygenation - Answer -Process of loading oxygen molecules onto hemoglobin
molecules in the bloodstream
-Requires adequate *FiO2 (Percentage of oxygen in inhaled air)*
Respiration - Answer -Process of exchanging O2 and CO2-->
1. *External respiration (Also called pulmonary respiration)*: Process of exchanging
O2 and CO2 between the alveoli and blood in pulmonary capillaries.
2. *Internal respiration (Also called cellular respiration)*: Exchange of O2 and CO2
between the systemic circulation and the body's cells.
Pathophysiology of Respiration - Answer -Multiple conditions can inhibit the body's
ability to effectively provide oxygen to cells.
1. Disruption of pulmonary ventilation, oxygenation, and respiration will cause
immediate effects on the body.
a. Must be recognized and corrected immediately
b. Important to distinguish a primary ventilation problem from a primary oxygenation
or respiration problem
2. Every cell needs a constant supply of oxygen to survive.
a. Some tissues are more resilient than others.
b. Sufficient levels of external respiration and perfusion are required.
3. Hypoxia, ventilation-perfusion ratio and mismatch, factors affecting ventilation,
factors affecting oxygenation and respiration, and acid-base balance.
1. Hypoxia - Answer Tissues and cells do not receive enough oxygen --> Death may
occur quickly if not corrected.
,Paramedic Airway FISDAP Review Part
1 Rated 100% Correct!!
- Varying signs and symptoms
a. Onset and degree of tissue damage often depend on the quality of ventilations.
b. Early signs include restlessness, irritability, apprehension, tachycardia, and
anxiety.
c. Late signs include mental status changes, a weak pulse, and cyanosis.
d. Responsive patients often report dyspnea and may not be able to speak in
complete sentences.
-Best to administer oxygen before signs and symptoms appear
2. Ventilation-perfusion ratio and mismatch - Answer -Air and blood flow must be
directed to the same place at the same time (ventilation and perfusion must be
matched).
-Failure to match ventilation and perfusion (V/Q mismatch) lies behind most
abnormalities in oxygen and carbon dioxide exchange.
-In most people, normal resting minute ventilation is approximately 6 L/min.
a. Resting alveolar volume: Approximately 4 L/min
b. Pulmonary artery blood flow: Approximately 5 L/min
c. Overall ratio of ventilation to perfusion: 4:5 L/min, or 0.8 L/min
-Because neither ventilation nor perfusion is distributed equally, both are distributed
to dependent regions of the lungs at rest. However, an increase in gravity-dependent
flow is more marked with perfusion than with ventilation.
--> Ratio of ventilation to perfusion is highest at the apex of the lung and lowest at
the base.
-When ventilation is compromised but perfusion continues:
a. Blood passes over alveolar membranes without gas exchange.
b. CO2 is recirculated into the bloodstream.
i. Results in V/Q mismatch
ii. Could lead to severe hypoxemia if not recognized and treated
-When perfusion across the alveolar membrane is disrupted:
a. Less O2 is absorbed into the bloodstream; less CO2 is removed (V/Q mismatch).
b. Can lead to hypoxemia --> Immediate intervention is needed to prevent further
damage or death.
3. Factors affecting ventilation - Answer A patent airway is critical for the provision of
O2 to tissues. Intrinsic and extrinsic factors can cause airway obstruction.
*1. Intrinsic factors*: infection, allergic reactions, and unresponsiveness.
a. The tongue is the most common obstruction in an unresponsive patient.
b. Some factors are not necessarily directly part of the respiratory system. Ex...
i. Interruptions in the central and peripheral systems.
ii. Medications that depress the central nervous system.
iii. Trauma to the head and spinal cord.
iv. Neuromuscular disorders.
, Paramedic Airway FISDAP Review Part
1 Rated 100% Correct!!
XV v. Neuromuscular blocking agents.
XV XV XV
XV c. Allergic reactions
XV XV
XV i. Swelling (angioedema) can obstruct the airway.
XV XV XV XV XV XV
XV ii. Bronchoconstriction can decrease pulmonary ventilation.
XV XV XV XV XV
*2. Extrinsic factors*: trauma and foreign body airway obstruction.
XV XV XV XV XV XV XV XV
a. Trauma to the airway or chest --
XV XV XV XV XV XV XV XV
> Requires immediate evaluation and intervention
XV XV XV XV XV
b. Blunt or penetrating trauma and burns can disrupt airflow through the trachea an
XV XV XV XV XV XV XV XV XV XV XV XV XV XV
d into the lungs --> Quickly results in oxygenation deficiencies
XV XV XV XV XV XV XV XV XV
c. Trauma to the chest wall can lead to inadequate pulmonary ventilation. Example
XV XV XV XV XV XV XV XV XV XV XV XV XV
: A patient with numerous rib fractures or a flail chest may purposely breathe shallo
XV XV XV XV XV XV XV XV XV XV XV XV XV XV
wly in an attempt to alleviate pain from the injury (Respiratory splinting) --
XV XV XV XV XV XV XV XV XV XV XV XV
> Can result in decreased pulmonary ventilation
XV XV XV XV XV XV
**Proper ventilatory support is crucial. XV XV XV XV
*3. Hypoventilation & Hyperventilation*-
XV XV XV
*a. Hypoventilation*: occurs when CO2 production exceeds CO2 elimination.
XV XV XV XV XV XV XV XV XV
*b. Hyperventilation* occurs when carbon dioxide elimination exceeds carbon dioxi
XV XV XV XV XV XV XV XV XV XV
de production.
XV
--
> Hypoventilation and hyperventilation could represent the body's attempt to compe
XV XV XV XV XV XV XV XV XV XV
nsate for various abnormal conditions. For example, if the pH of the blood alkalotic,
XV XV XV XV XV XV XV XV XV XV XV XV XV X
the patient's breathing may become slow or shallow in an attempt to retain CO2 to
V XV XV XV XV XV XV XV XV XV XV XV XV XV XV XV
decrease the pH<-- XV XV
*4. Hypercarbia & Hypocarbia*:
XV XV XV
a. Decrease in minute volume decreases CO2 elimination --
XV XV XV XV XV XV XV XV XV
> Results in buildup of CO2 in the blood (*hypercarbia*)
XV XV XV XV XV XV XV XV XV
b. Increase in minute volume increases CO2 elimination --
XV XV XV XV XV XV XV XV XV
> Lowers CO2 in the blood (*hypocarbia*)
XV XV XV XV XV XV
4. Factors affecting oxygenation and respiration - Answer *1. External factors:*
XV XV XV XV XV XV XV XV XV
a. External factors in ambient air. Examples: Atmospheric pressure, partial pressur
XV XV XV XV XV XV XV XV XV XV XV
e of oxygen --
XV XV XV
> At high altitudes, the percentage of oxygen remains the same, but partial pressur
XV XV XV XV XV XV XV XV XV XV XV XV XV
e decreases because total atmospheric pressure decreases. --
XV XV XV XV XV XV XV
> Closed environments may also have decreases in ambient oxygen. Examples: Mi
XV XV XV XV XV XV XV XV XV XV XV XV
nes and trenches XV XV
b. Toxic gases displace oxygen in the environment. --
XV XV XV XV XV XV XV XV XV
> CO inhibits the proper transport of oxygen to tissues
XV XV XV XV XV XV XV XV XV
*2. Internal factors:*
XV XV
a. Conditions that reduce the surface area for gas exchange also decrease th
XV XV XV XV XV XV XV XV XV XV XV
e body's oxygen supply.
XV XV XV
b. Medical conditions may also decrease surface area of the alveoli by damagin
XV XV XV XV XV XV XV XV XV XV XV
g them or by leading to an accumulation of fluid in the lungs.
XV XV XV XV XV XV XV XV XV XV XV XV
c. Nonfunctional alveoli inhibit the diffusion of oxygen and carbon dioxide -- XV XV XV XV XV XV XV XV XV XV
> Called intrapulmonary shunting
XV XV XV
d. Submersion victims and patients with pulmonary edema have fluid in the alveoli-->
XV XV XV XV XV XV XV XV XV XV XV
i. Inhibits adequate gas exchange at the alveolar membrane
XV XV XV XV XV XV XV
