Airway, ABG, and Flight Final Exam Study Guide 2023
Verified for you
You have been dispatched to transport a patient diagnosed with CHF exacerbation who
is currently intubated and being mechanically ventilated. The patient's current ventilator
settings are:
SIMV-Volume
Vt 480 ml
(f) 20
FIO2 1.0
I:time 0.8
PEEP 5 cmH20
The patient's current vital signs are:
BP: 176/98 SPO2 87% CO2 45 mmHg HR: 99
What is the most appropriate intervention to perform for the patient?
A. Increase PEEP
B. Increase Vt
C. Increase (f)
D. Decrease inspiratory time
E. Decrease Vt
A. Increase PEEP
PEEP should be increased to increase oxygenation.
An increased PEEP will help "drive" the oxygen molecule through the alveolar-capillary
membrane under higher pressures.
This will help to increase a high-pressure gradient to displace pulmonary edema so
better oxygenation can take place. (same idea as CPAP in a 911 CHF setting)
True or False
Patient's with ARDS often require a prolonged expiratory time.
A. Yes
B. No
B. No
Patients with ARDS often require a prolonged Inspiratory time (I- Time).
Patients with ARDS have a hard time breathing out. Focus on a PAWP 18-20 and
oxygenation with increasing PEEP >10, lowering Vt: <8 cc/kg increase rate (f) to
maintain minute volume (Vt x rate= minute volume)
You have arrived on the scene of a 56 y/o M complaining of chest pain and difficulty
breathing with copious amounts of frothy sputum coming out. Your cardiac 12-lead
interpretation reveals an Anterior STEMI.
Which of the following medications would be the drug of choice for induction in the RSI
process?
A. Etomidate
B. Fentanyl
,C. Ketamine
D. Midazolam
A. Etomidate
Providers should avoid the use of Ketamine in patients who they suspect are in heart
failure. The direct effect of ketamine on the heart is negatively inotropic, especially in
heart failure. Etomidate or Versed would be a better choice for induction agents.
You are called to transport a patient that is being mechanically ventilated. The patient is
currently on the following ventilator settings:
A/C-Volume
Vt: 450 mL
(f) 18
Inspiratory time: 0.8 sec.
FIO2 1.0
PEEP 5 cmH2O
While assessing the ventilator you note a Pplat of 20 and a PIP of 22. What is the next
best course of action?
A. Increase Vt
B. Increase FIO2
C. Decrease (f)
D. Increase expiratory time
E. None of the above
A. Increase Vt
A PIP of 22 and a Pplat of 20 suggests that more lung can be recruited with ventilation.
Vt and F can both be increased to recruit more lung tissue and obtain a pPlat goal of
approximately 25-27.
Remember that the Pplat should NEVER exceed 30.
You have been dispatched to transport a patient from a rural ICU facility. The patient
report that you receive from the sending physician states that the patient was initially
admitted for and NSTEMI but now has marked ST elevation in the Anterior Leads and
has become increasingly difficult to ventilate and oxygenate with mechanical ventilation.
Currently, the ventilator settings are:A/C-V Vt 380 ml (F) 20 Inspiratory time: 0.80 secs.
FIO2 1.0 PEEP 10 cmH2O, Pplat 28 mmHg.The patient is currently laying supine with
HOB at 30' and has the following ABGpH 7.25 PCO2 30mmHg HCO3 16 mEq/L PaO2
50mmHgGiven all of the information available, which of the following changes can you
make on the ventilator to improve the PaO2?
A. Increase I-Time
B. Decrease PEEP
C. Increase Vt
D. Increase Rate
A. Increase I-Time
Based on the above settings the patient with a hypoxic respiratory failure is in need of
more I-Time to allow the diffusion of the oxygen across the alveolar membrane. This will
,lead to an inverse I:E ratio (2:1). Also, consider FiO2 to 1.0 if not already and additional
PEEP after increasing I - time.
You have been called to the scene of a major vehicle accident. On your approach, you
see a female patient partially ejected out of the windshield with her head and torso
exposed only. The patient has irregular respirations noted at 6 per minute along with
trismus present. The patient's pupils are noted to be unequal and she is not responsive.
Vital signs are noted to be HR 52 BPM BP 180/105 mmHg SpO2 of 78%.
What is the most appropriate treatment for this patient?
A. Establish an IO
B. Start an IV
C. Administer Ketamine IN
D. Perform a surgical airway
E. Establish an LMA
D. Perform a surgical airway
This patient needs to receive immediate oxygenation and ventilation. A surgical airway
for this patient is indicated.
A surgical airway is going to be both the fastest and easiest method to control the
airway and oxygenate/ventilate the patient.
This can be done much faster than attempting RSI of a patient that is only partially
exposed.
It is likely the patient will stimulate a gag reflex when attempting to place a supraglottic
device. This can cause possible vomiting and aspiration.
You are on the scene of a medical patient who has been exposed to with
organophosphates with copious amounts of secretions.
The patient has the following vital signs: BP: 140/ 80 HR: 160 SPo2: 80% RR: 42
labored
The patient now is breathing irregularly and unable to control his airway requiring RSI
procedure.
Which of the following paralytics should you avoid?
A. Succinylcholine
B. Etomidate
C. Vecuronium
D. Rocuronium
A. Succinylcholine
When you have a patient that has been exposed to an organophosphate type
poisoning, the clinician should anticipate a prolonged Succinylcholine-Induced paralysis
in organophosphate poisoning and depending on the level of poisoning succinylcholine
may be ineffective at paralysis. Rocuronium may be a better paralytic to initiate
paralysis.
You and your crew are dispatched on an interfacility transport for a 14 y/o female that
ingested a large amount of aspirin. Prior to takeoff, you observe the following ABG: pH
7.39; PaCO2 32 mmHg; HCO3- 19 mEq/L. Which of the following acid-base imbalances
, do you suspect your patient is experiencing?
A. Uncompensated Metabolic Acidosis
B. Uncompensated Respiratory Acidosis
C. Compensated Metabolic Acidosis
D. Compensated Respiratory Acidosis
C. Compensated Metabolic Acidosis
pH: compensated and below 7.4
CO2: low (alkalotic) below 35
HCO3: low (acidic) below 22
pH and HCO3 are traveling together, therefore this is a compensated metabolic
acidosis.
When in a ventilator mode utilizing PC (Pressure Control), what value must be
monitored?
A. VTE
B. pPlat
C. PIP
D. PEEP
E. High pressure alarm
A. VTE
In a ventilator mode utilizing pressure control, this means pressure being delivered with
each ventilation is constant. It is important to remember that based on lung compliance
the volume delivered with each breath can be variable.
This is why it is important to monitor VTE (expired tidal volumes) VTE should be
approximately 50 ml within what the expected calculated tidal volume should be.
You are transporting a 12 y/o male post-fall with a visible right humeral fracture. Prior to
leaving the sending facility, you are provided with the following ABG: pH 7.42; PaCO2
25 mmHg; HCO3- 20 mEq/L. Based on the following ABG, which of the following acid-
base imbalances do you suspect?
A. Compensated Respiratory Alkalosis
B. Compensated Metabolic Acidosis
C. Uncompensated Respiratory Alkalosis
D. Mixed Gas Imbalance
pH: Normal and fully compensated (7.42)
CO2: low (alkalotic) below 35 mmHg
pH and CO2 are traveling opposite of each other making the respiratory system the
offender.
HCO3: low (acidic) below 22 mEq/L.
This is compensating for respiratory alkalosis. Using 7.4 as a perfect pH, 7.42 is closer
to the alkalotic range making this a fully compensated alkalosis. CO2 is low and also
Verified for you
You have been dispatched to transport a patient diagnosed with CHF exacerbation who
is currently intubated and being mechanically ventilated. The patient's current ventilator
settings are:
SIMV-Volume
Vt 480 ml
(f) 20
FIO2 1.0
I:time 0.8
PEEP 5 cmH20
The patient's current vital signs are:
BP: 176/98 SPO2 87% CO2 45 mmHg HR: 99
What is the most appropriate intervention to perform for the patient?
A. Increase PEEP
B. Increase Vt
C. Increase (f)
D. Decrease inspiratory time
E. Decrease Vt
A. Increase PEEP
PEEP should be increased to increase oxygenation.
An increased PEEP will help "drive" the oxygen molecule through the alveolar-capillary
membrane under higher pressures.
This will help to increase a high-pressure gradient to displace pulmonary edema so
better oxygenation can take place. (same idea as CPAP in a 911 CHF setting)
True or False
Patient's with ARDS often require a prolonged expiratory time.
A. Yes
B. No
B. No
Patients with ARDS often require a prolonged Inspiratory time (I- Time).
Patients with ARDS have a hard time breathing out. Focus on a PAWP 18-20 and
oxygenation with increasing PEEP >10, lowering Vt: <8 cc/kg increase rate (f) to
maintain minute volume (Vt x rate= minute volume)
You have arrived on the scene of a 56 y/o M complaining of chest pain and difficulty
breathing with copious amounts of frothy sputum coming out. Your cardiac 12-lead
interpretation reveals an Anterior STEMI.
Which of the following medications would be the drug of choice for induction in the RSI
process?
A. Etomidate
B. Fentanyl
,C. Ketamine
D. Midazolam
A. Etomidate
Providers should avoid the use of Ketamine in patients who they suspect are in heart
failure. The direct effect of ketamine on the heart is negatively inotropic, especially in
heart failure. Etomidate or Versed would be a better choice for induction agents.
You are called to transport a patient that is being mechanically ventilated. The patient is
currently on the following ventilator settings:
A/C-Volume
Vt: 450 mL
(f) 18
Inspiratory time: 0.8 sec.
FIO2 1.0
PEEP 5 cmH2O
While assessing the ventilator you note a Pplat of 20 and a PIP of 22. What is the next
best course of action?
A. Increase Vt
B. Increase FIO2
C. Decrease (f)
D. Increase expiratory time
E. None of the above
A. Increase Vt
A PIP of 22 and a Pplat of 20 suggests that more lung can be recruited with ventilation.
Vt and F can both be increased to recruit more lung tissue and obtain a pPlat goal of
approximately 25-27.
Remember that the Pplat should NEVER exceed 30.
You have been dispatched to transport a patient from a rural ICU facility. The patient
report that you receive from the sending physician states that the patient was initially
admitted for and NSTEMI but now has marked ST elevation in the Anterior Leads and
has become increasingly difficult to ventilate and oxygenate with mechanical ventilation.
Currently, the ventilator settings are:A/C-V Vt 380 ml (F) 20 Inspiratory time: 0.80 secs.
FIO2 1.0 PEEP 10 cmH2O, Pplat 28 mmHg.The patient is currently laying supine with
HOB at 30' and has the following ABGpH 7.25 PCO2 30mmHg HCO3 16 mEq/L PaO2
50mmHgGiven all of the information available, which of the following changes can you
make on the ventilator to improve the PaO2?
A. Increase I-Time
B. Decrease PEEP
C. Increase Vt
D. Increase Rate
A. Increase I-Time
Based on the above settings the patient with a hypoxic respiratory failure is in need of
more I-Time to allow the diffusion of the oxygen across the alveolar membrane. This will
,lead to an inverse I:E ratio (2:1). Also, consider FiO2 to 1.0 if not already and additional
PEEP after increasing I - time.
You have been called to the scene of a major vehicle accident. On your approach, you
see a female patient partially ejected out of the windshield with her head and torso
exposed only. The patient has irregular respirations noted at 6 per minute along with
trismus present. The patient's pupils are noted to be unequal and she is not responsive.
Vital signs are noted to be HR 52 BPM BP 180/105 mmHg SpO2 of 78%.
What is the most appropriate treatment for this patient?
A. Establish an IO
B. Start an IV
C. Administer Ketamine IN
D. Perform a surgical airway
E. Establish an LMA
D. Perform a surgical airway
This patient needs to receive immediate oxygenation and ventilation. A surgical airway
for this patient is indicated.
A surgical airway is going to be both the fastest and easiest method to control the
airway and oxygenate/ventilate the patient.
This can be done much faster than attempting RSI of a patient that is only partially
exposed.
It is likely the patient will stimulate a gag reflex when attempting to place a supraglottic
device. This can cause possible vomiting and aspiration.
You are on the scene of a medical patient who has been exposed to with
organophosphates with copious amounts of secretions.
The patient has the following vital signs: BP: 140/ 80 HR: 160 SPo2: 80% RR: 42
labored
The patient now is breathing irregularly and unable to control his airway requiring RSI
procedure.
Which of the following paralytics should you avoid?
A. Succinylcholine
B. Etomidate
C. Vecuronium
D. Rocuronium
A. Succinylcholine
When you have a patient that has been exposed to an organophosphate type
poisoning, the clinician should anticipate a prolonged Succinylcholine-Induced paralysis
in organophosphate poisoning and depending on the level of poisoning succinylcholine
may be ineffective at paralysis. Rocuronium may be a better paralytic to initiate
paralysis.
You and your crew are dispatched on an interfacility transport for a 14 y/o female that
ingested a large amount of aspirin. Prior to takeoff, you observe the following ABG: pH
7.39; PaCO2 32 mmHg; HCO3- 19 mEq/L. Which of the following acid-base imbalances
, do you suspect your patient is experiencing?
A. Uncompensated Metabolic Acidosis
B. Uncompensated Respiratory Acidosis
C. Compensated Metabolic Acidosis
D. Compensated Respiratory Acidosis
C. Compensated Metabolic Acidosis
pH: compensated and below 7.4
CO2: low (alkalotic) below 35
HCO3: low (acidic) below 22
pH and HCO3 are traveling together, therefore this is a compensated metabolic
acidosis.
When in a ventilator mode utilizing PC (Pressure Control), what value must be
monitored?
A. VTE
B. pPlat
C. PIP
D. PEEP
E. High pressure alarm
A. VTE
In a ventilator mode utilizing pressure control, this means pressure being delivered with
each ventilation is constant. It is important to remember that based on lung compliance
the volume delivered with each breath can be variable.
This is why it is important to monitor VTE (expired tidal volumes) VTE should be
approximately 50 ml within what the expected calculated tidal volume should be.
You are transporting a 12 y/o male post-fall with a visible right humeral fracture. Prior to
leaving the sending facility, you are provided with the following ABG: pH 7.42; PaCO2
25 mmHg; HCO3- 20 mEq/L. Based on the following ABG, which of the following acid-
base imbalances do you suspect?
A. Compensated Respiratory Alkalosis
B. Compensated Metabolic Acidosis
C. Uncompensated Respiratory Alkalosis
D. Mixed Gas Imbalance
pH: Normal and fully compensated (7.42)
CO2: low (alkalotic) below 35 mmHg
pH and CO2 are traveling opposite of each other making the respiratory system the
offender.
HCO3: low (acidic) below 22 mEq/L.
This is compensating for respiratory alkalosis. Using 7.4 as a perfect pH, 7.42 is closer
to the alkalotic range making this a fully compensated alkalosis. CO2 is low and also
