Paramedic Airway FISDAP Review Part 1 Exam Questions and
Answers.
Appropriate airway management - Correct 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 - Correct 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 - Correct 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 - Correct Answer -Complex structure formed by many independent cartilaginous
structures
-Marks where the upper airway ends and lower airway begins
2. Thyroid cartilage - Correct 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) - Correct Answer -Lies inferiorly to the thyroid cartilage
-Forms the lowest portion of the larynx
-More prominent in females
4. Cricothyroid membrane - Correct Answer -Located between the thyroid and cricoid
cartilage
-Site for emergency surgical and nonsurgical access to the airway
-Bordered laterally and inferiorly by the highly vascular thyroid gland
5. Glottis - Correct 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 - Correct 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: - Correct
Answer 1. A constant supply of oxygen and nutrients is delivered to every cell.
2. Waste products are removed from every cell.
Ventilation - Correct 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 - Correct Answer -Process of loading oxygen molecules onto hemoglobin
molecules in the bloodstream
-Requires adequate *FiO2 (Percentage of oxygen in inhaled air)*
Respiration - Correct 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 - Correct 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 - Correct Answer Tissues and cells do not receive enough oxygen --> Death
may occur quickly if not corrected.
- 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 - Correct 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
Answers.
Appropriate airway management - Correct 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 - Correct 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 - Correct 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 - Correct Answer -Complex structure formed by many independent cartilaginous
structures
-Marks where the upper airway ends and lower airway begins
2. Thyroid cartilage - Correct 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) - Correct Answer -Lies inferiorly to the thyroid cartilage
-Forms the lowest portion of the larynx
-More prominent in females
4. Cricothyroid membrane - Correct Answer -Located between the thyroid and cricoid
cartilage
-Site for emergency surgical and nonsurgical access to the airway
-Bordered laterally and inferiorly by the highly vascular thyroid gland
5. Glottis - Correct 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 - Correct 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: - Correct
Answer 1. A constant supply of oxygen and nutrients is delivered to every cell.
2. Waste products are removed from every cell.
Ventilation - Correct 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 - Correct Answer -Process of loading oxygen molecules onto hemoglobin
molecules in the bloodstream
-Requires adequate *FiO2 (Percentage of oxygen in inhaled air)*
Respiration - Correct 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 - Correct 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 - Correct Answer Tissues and cells do not receive enough oxygen --> Death
may occur quickly if not corrected.
- 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 - Correct 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
