Paramedic Exam Study Prep - Airway and Breathing

Paramedic Exam Study Prep - Airway and Breathing A child in respiratory distress may grunt as the child breathes. This is a result of (A) increase tidal volume. (B) an increased respiratory rate. (C) creating pressure to help maintain open airways. (D) an indication that the child is tired and will progress to respiratory arrest. C. Grunting involves exhaling against a partially closed glottis. This creates pressure to help maintain open lower airways similar to pursed-lip breathing in adults with COPD. This short low-pitched sound is often mistaken for whimpering and suggests severe hypoxia. Respiratory acidosis is caused by (A) an excess of bicarbonate. (B) excess carbon dioxide retention. (C) a loss of bicarbonate. (D) excess carbon dioxide excretion. B. Respiratory acidosis is caused by excess carbon dioxide retention. Scenario: You are using an end-tidal carbon dioxide detector as a tool to assist for proper endotracheal intubation placement. Question: The absence of carbon dioxide in exhaled air indicates the endotracheal tube has been (A) placed in the right mainstem bronchus. (B) correctly placed in the trachea. (C) placed in the esophagus. (D) placed in the left mainstem bronchus. C. The absence of carbon dioxide likely indicates that the endotracheal tube has been placed in the esophagus. Verifying correct endotracheal tube placement is absolutely essential. ETCO2 is only one method to assist in verification. Scenario: You are using an end-tidal carbon dioxide detector as a tool to assist for proper endotracheal intubation placement. Question: Your next action is to (A) deflate the cuff, pull the endotracheal tube back 2 cm, and reassess placement. (B) secure the endotracheal tube and confirm correct placement by auscultation. (C) inflate the distal cuff with 7-10 cc of air and secure the endotracheal tube. (D) remove the endotracheal tube and provide several ventilations prior to attempting intubation again. D. The endotracheal tube is likely placed in the esophagus. Your next action is to remove the endotracheal tube and provide several ventilations with supplemental oxygen prior to attempting another intubation. Which of the following drugs is used for rapid sequence intubation? (A) Vecuronium (B) Succinylcholine (C) Lidocaine and atropine (D) All of the above D. All of the above. Vecuronium is a common nondepolarizing neuromuscular blocker. Lidocaine is commonly used in RSI to prevent dysrhythmias associated with stimulation of the glottis associated with intubation. Atropine is often administered to decrease the incidence of bradycardia associated with the administration of succinylcholine. You are called for a 54-year-old woman who is unconscious. Your assessment reveals the patient to be apneic and pulseless. Initial management of this patient's airway should include (A) assisted ventilation with a bag-valve device at 6-10 LPM. (B) assisted ventilation with a nonrebreather mask at 10-15 LPM. (C)immediate nasotracheal intubation and ventilation with a bag-valve device. (D) insertion of an oropharyngeal airway and ventilation with a bag-valve device. D. Of the choice listed, insertion of an oropharyngeal airway and ventilating with a bag-valve device is the best answer. (A). is incorrect because it utilizes a nonrebreather mask to assist ventilations. nonrebreather are not designed for or capable of assisting ventilations. (C). is incorrect because an apneic patient cannot be nasotracheally intubated. The Esophageal Tracheal Combitube (ETCT) and the pharyngotracheal lumen airway (PTL) are similar because (A) neither requires assessment for accurate placement. (B)both require manipulation of the head and neck for insertion. (C)neither is inserted blindly. (D) None of the above. D. None of the above are correct. (A). is in correct because both devices require assessment for accurate placement. With the PTL you begin ventilation though a short tube (the one without the stylet); with the Combitube, you begin ventilation through a longer blue tube. If chest rise and presence of breath sounds are not observe, you must switch immediately to the other ventilation port and reassess. (B). is incorrect because both are inserted in the neutral position and no manipulation of the head and neck is required for insertion. (C). is incorrect because both devices are inserted blindly. Breath sounds such as crackles and rhonchi that are not normally heard are defined as ----- breath sounds. (A) bronchial (B) adventitious (C) vesicular (D) bronchovesicular B. Adventitious breath sounds are considered abnormal sounds such as crackles and rhonchi. Which of the following correctly describes the flow of air from outside the body into the trachea? (A) Nose, nasopharynx, laryngopharynx, oropharynx, larynx, trachea (B) Nose, nasopharynx, larynx, laryngopharynx, oropharynx, trachea (C) Nose, nasal cavities, nasopharynx, oropharynx, laryngopharynx, larynx, trachea (D) Nose, nasal cavities, laryngopharynx, nasopharynx, oropharynx, larynx, trachea C. This is a simple anatomy and physiology question. The nose, nasal cavities, nasopharynx, oropharynx, larynx, and trachea correctly described the flow of air. You are called for an unresponsive 29-year-old man. Bystanders report he has been drinking heavily all day. Assessment reveals the patient to be responsive only to painful stimuli. His breathing is shallow at a rate of four times per minute. How would you manage this patient? (A) Nasal cannula at 2-4 LPM (B) Simple face mask at 4-6 LPM (C) Nonrebreather mask at 10-15 LPM (D) Bag-valve device with a reservoir at 10-15 LPM D. Breathing must be supported with a bag-valve device with supplemental high-flow oxygen. This patient's breathing is too slow and too shallow to receive enough oxygen for proper gas exchange to take place. The normal arterial pH range in the human body is (A) 7.0-7.15 (B) 7.15-7.35 (C) 7.35-7.45 (D) 7.45-7.80 C. The normal arterial pH range in the human body is: 7.35-7.45. You have orally intubated a patient. While your partner ventilates the patient with a bag-valve device, you assess for proper placement. Auscultation reveals sounds heard over the right chest and an absence of breath sounds over the left chest. Your best course of action would be to (A) hyperventilate the patient and prepare the equipment necessary for a surgical cricothyrotomy. (B) deflate the endotracheal tube cuff, withdraw the tube 2 cm and reevaluate breath sounds, and reinflate the cuff. (C) deflate the endotracheal tube cuff, remove the endotracheal tube, and hyperventilate the patient with a bag-valve device. (D) insert a large diameter needle into the fourth or fifth intercostal space, midaxillary line. B. This patient was most likely intubated in the right mainstem bronchus. Deflating the endotracheal tube cuff, withdrawing the tube slightly, reinflating the cuff, and reevaluating breath sounds is the proper procedure when a right mainstem bronchus intubation is suspected. The Sellick maneuver (A) is used to clear a foreign body airway obstruction in an infant or child. (B) is used to clear blood or mucus from an endotracheal tube or the nasopharynx. (C) may be used to minimize gastric distention and facilitate placement of an endotracheal tube into the glottic opening. (D) is the preferred method for opening the airway of an unconscious patient when cervical spine injury is suspected. C. Posterior pressure exerted on the cricoid cartilage (the sellick maneuver) will effectively compress the esophagus, minimizing the potential for gastric distention. This maneuver will also reposition the vocal cord for clearer visualization of anatomic structures. The area where the trachea divides into the right and left mainstem bronchi is known as the (A) pleura. (B) xiphoid process. (C) carina. (D) sternal angle. C. This is a basic anatomy and physiology question. The area where the trachea divides into the right and left mainstem bronchi is known as the carina. The administration of which of the following may result in a decrease in the respiratory rate? (A) Nubain (B) Diltazem (C) Cordarone (D) Morphine sulphate D. Morphine is an opiate that can cause central nervous system depression. Administration may result in a decrease in the respiratory rate. Patients receiving morphine must be monitored closely for respiratory depression. The anatomical structure between the base of the tongue and the epiglottis into which the tip of the curved blade (Macintosh blade) is placed during orotracheal intubation is the (A) carina. (B) vallecula. (C) glottis. (D) esophagus. B. The anatomical structures between the base of the tongue and the epiglottis into which the tip of the curved blade is placed during orotracheal intubation is the vallecula. The term used to describe normal breath sounds heard over the most of the chest wall is (A) bronchial. (B) adventitious. (C) vesicular. (D) bronchovesicular. C. Vesicular breath sounds are defined as normal sounds heard over most of the chest wall. When blood levels of carbon dioxide or hydrogen ions increase above normal, the respiratory center of the brain responds by (A) decreasing the rate and increasing the depth of respiration. (B) increasing the rate and depth of respiration. (C) increasing the rate and decreasing the depth of respiration. (D) decreasing the rate and decreasing the depth of respiration. B. Rate and depth of respiration are increased to eliminate excess CO2 and therefore decreasing hydrogen ion concentrations. This is a normal compensatory mechanism of the body. The blood component responsible for transporting oxygen from the lungs to the body tissues and transporting carbon dioxide from the body tissue to the lungs is the (A) plasma. (B) platelets. (C) leukocytes. (D) erythrocytes. D. Erythrocytes are defined as the blood component responsible for transporting oxygen from the lungs to the body tissues and transporting carbon dioxide from the tissue to the lungs. Which of the following is an advantage of the laryngeal mask airway (LMA)? (A) It is blindly inserted. (B) It isolates the esophagus. (C) It does not protect against regurgitation and aspiration. (D) It can be used with an intact gag reflex. A. LMA insertion does not require laryngoscopy. (B). is incorrect because the LMA isolates the trachea, not the esophagus. (C). is a factual statement but is not an advantage of the LMA. Regurgitation and aspiration is the most significant complication