Page 1 of 82
ITLS Advanced 100 Exam Questions |
Airway, TBI, Chest Trauma, Shock | 9th
Edition 2026/2027 | Paramedic & EMS
1. A 45-year-old patient is found unresponsive after a motor
vehicle collision. He has facial trauma and copious blood in
the oropharynx. What is the priority airway maneuver?
Answer: Suction the oropharynx and consider a definitive
airway (e.g., endotracheal intubation or supraglottic device).
Rationale: The priority is to clear the airway of blood and debris.
Suctioning must be performed immediately. If the patient cannot
protect his airway or ventilation is inadequate, a definitive
airway is indicated.
2. A patient with a suspected cervical spine injury requires
airway management. Which technique is most appropriate?
Answer: Jaw thrust without head extension, with manual in-line
,Page 2 of 82
stabilization.
Rationale: The jaw thrust is the preferred initial maneuver for an
unresponsive patient with suspected spinal injury because it
opens the airway without moving the cervical spine. Head tilt-chin
lift is contraindicated.
3. A 30-year-old patient has a GCS of 8 after a fall. He is
breathing at 8 breaths per minute with shallow effort. What is
the most appropriate intervention?
Answer: Assist ventilations with a bag-valve-mask (BVM) and
prepare for advanced airway placement.
Rationale: A GCS ≤ 8 often indicates inability to protect the
airway. The patient is bradypneic with shallow breathing,
indicating respiratory failure. Assisted ventilation is required, and
advanced airway management (e.g., endotracheal intubation)
should be performed.
,Page 3 of 82
4. Which of the following is the most reliable indicator of
proper endotracheal tube placement?
Answer: Continuous waveform capnography showing a stable
end-tidal CO₂ trace.
Rationale: Waveform capnography is the gold standard for
confirming ET tube placement in the trachea. It provides
immediate feedback and is superior to auscultation and
colorimetric devices.
5. A patient with a traumatic brain injury has a decreasing
level of consciousness and is actively vomiting. What airway
intervention is indicated?
Answer: Rapid sequence intubation (RSI) with cricoid pressure (if
no contraindication) to protect the airway from aspiration.
Rationale: The patient is at high risk for aspiration. Definitive
airway control via intubation is needed. RSI facilitates intubation
while preventing aspiration.
, Page 4 of 82
6. Which of the following is a contraindication to the use of a
nasopharyngeal airway (NPA)?
Answer: Suspected basilar skull fracture (e.g., raccoon eyes,
Battle’s sign, CSF otorrhea/rhinorrhea).
Rationale: Inserting an NPA in the presence of a basilar skull
fracture risks intracranial placement. An oropharyngeal airway
(OPA) is preferred if the patient is unresponsive.
7. A patient has a stoma and is breathing spontaneously.
Which device is most appropriate for assisted ventilation?
Answer: A pediatric mask placed directly over the stoma, or a
supraglottic device designed for stomas.
Rationale: A standard BVM mask can be placed over the stoma.
If the patient has a tracheostomy tube, a BVM can be attached
directly to the tube.
8. During orotracheal intubation, the stylet should be
removed:
ITLS Advanced 100 Exam Questions |
Airway, TBI, Chest Trauma, Shock | 9th
Edition 2026/2027 | Paramedic & EMS
1. A 45-year-old patient is found unresponsive after a motor
vehicle collision. He has facial trauma and copious blood in
the oropharynx. What is the priority airway maneuver?
Answer: Suction the oropharynx and consider a definitive
airway (e.g., endotracheal intubation or supraglottic device).
Rationale: The priority is to clear the airway of blood and debris.
Suctioning must be performed immediately. If the patient cannot
protect his airway or ventilation is inadequate, a definitive
airway is indicated.
2. A patient with a suspected cervical spine injury requires
airway management. Which technique is most appropriate?
Answer: Jaw thrust without head extension, with manual in-line
,Page 2 of 82
stabilization.
Rationale: The jaw thrust is the preferred initial maneuver for an
unresponsive patient with suspected spinal injury because it
opens the airway without moving the cervical spine. Head tilt-chin
lift is contraindicated.
3. A 30-year-old patient has a GCS of 8 after a fall. He is
breathing at 8 breaths per minute with shallow effort. What is
the most appropriate intervention?
Answer: Assist ventilations with a bag-valve-mask (BVM) and
prepare for advanced airway placement.
Rationale: A GCS ≤ 8 often indicates inability to protect the
airway. The patient is bradypneic with shallow breathing,
indicating respiratory failure. Assisted ventilation is required, and
advanced airway management (e.g., endotracheal intubation)
should be performed.
,Page 3 of 82
4. Which of the following is the most reliable indicator of
proper endotracheal tube placement?
Answer: Continuous waveform capnography showing a stable
end-tidal CO₂ trace.
Rationale: Waveform capnography is the gold standard for
confirming ET tube placement in the trachea. It provides
immediate feedback and is superior to auscultation and
colorimetric devices.
5. A patient with a traumatic brain injury has a decreasing
level of consciousness and is actively vomiting. What airway
intervention is indicated?
Answer: Rapid sequence intubation (RSI) with cricoid pressure (if
no contraindication) to protect the airway from aspiration.
Rationale: The patient is at high risk for aspiration. Definitive
airway control via intubation is needed. RSI facilitates intubation
while preventing aspiration.
, Page 4 of 82
6. Which of the following is a contraindication to the use of a
nasopharyngeal airway (NPA)?
Answer: Suspected basilar skull fracture (e.g., raccoon eyes,
Battle’s sign, CSF otorrhea/rhinorrhea).
Rationale: Inserting an NPA in the presence of a basilar skull
fracture risks intracranial placement. An oropharyngeal airway
(OPA) is preferred if the patient is unresponsive.
7. A patient has a stoma and is breathing spontaneously.
Which device is most appropriate for assisted ventilation?
Answer: A pediatric mask placed directly over the stoma, or a
supraglottic device designed for stomas.
Rationale: A standard BVM mask can be placed over the stoma.
If the patient has a tracheostomy tube, a BVM can be attached
directly to the tube.
8. During orotracheal intubation, the stylet should be
removed:
