EMT I Exam Practice - Airways

The tongue is the primary cause of airway obstruction in unconscious patients because when a person loses consciousness, the muscles in their body relax, including the muscles in the tongue. As a result, the tongue can fall back and block the airway, making it difficult or impossible for the patient to breathe. This is why it is important to properly position the unconscious patient's head and jaw to keep the airway open and prevent obstruction. Loose-fitting dentures, toys or other small objects, and incompletely chewed food can also potentially cause airway obstruction, but the tongue is the most common and significant cause in this scenario.

In ideal circumstances, suctioning an adult patient should not exceed 15 seconds. This is because prolonged suctioning can lead to tissue damage, hypoxia, and discomfort for the patient. It is important to limit the duration of suctioning to minimize these risks and ensure the patient's safety and comfort.

The maximum acceptable flow rate for a nasal cannula is 6 L/min. This is because a nasal cannula is a device used to deliver supplemental oxygen to patients, and a flow rate of 6 L/min is considered safe and effective in providing adequate oxygenation. Higher flow rates may cause discomfort or dryness in the nasal passages, while lower flow rates may not provide sufficient oxygenation.

The greatest difficulty in using a bag-valve-mask device for mouth-to-mouth ventilation is maintaining an adequate mask seal. This is because a proper mask seal is essential for delivering the necessary amount of oxygen to the patient's lungs. If the mask seal is not adequate, there may be air leakage, which can lead to ineffective ventilation and reduce the amount of oxygen reaching the patient. Therefore, ensuring a proper mask seal is crucial for successful mouth-to-mouth ventilation using a bag-valve-mask device.

The correct answer is cricoid cartilage. The Sellick maneuver, also known as cricoid pressure, is a technique used during intubation to prevent regurgitation of stomach contents. It involves applying pressure against the cricoid cartilage, which is a ring-shaped structure located at the base of the larynx. By compressing the cricoid cartilage, the esophagus is occluded, reducing the risk of gastric aspiration during intubation. This maneuver is commonly performed in emergency medicine and anesthesia to ensure patient safety.

Hyperventilation can lead to low carbon dioxide levels in the body. When a person hyperventilates, they breathe in excessive amounts of oxygen and exhale more carbon dioxide than normal. This can disrupt the balance of gases in the blood, causing a decrease in carbon dioxide levels. Low carbon dioxide levels can result in symptoms such as dizziness, tingling in the hands and feet, and muscle spasms.

Suctioning should be activated upon extraction of the suction catheter. This means that negative pressure should be applied when removing the catheter from the patient's airway. It is important to activate suctioning during this step to effectively remove any secretions or obstructions that may have been suctioned during the insertion of the catheter. The insertion of the catheter alone does not require suctioning, as it is the extraction that is crucial for removing any collected material.

Cheyne-Stokes is a respiratory pattern characterized by deep, rapid respirations followed by a period of apnea. It is commonly seen in patients with severe heart failure or neurological conditions. The deep, rapid respirations are caused by increased stimulation of the respiratory centers in the brain, while the period of apnea occurs due to decreased stimulation. This pattern can be observed during sleep or in patients who are critically ill.

The paramedic should perform orotracheal intubation without the use of specialized equipment. Orotracheal intubation involves inserting a tube through the mouth into the trachea to establish an airway. This can be done using basic equipment such as a laryngoscope and endotracheal tube. It is a common method used by paramedics to secure the airway in emergency situations.

The most likely explanation for the findings in the "Intubation Scenario" is right mainstream intubation. This means that the endotracheal tube has been inserted into the right main bronchus instead of the trachea. As a result, lung sounds are only heard over the right lung because the left lung is not receiving any ventilation. The depth of the ET tube at 27 cm at the teeth indicates that it has been inserted too far into the bronchus. This is a common mistake during intubation and can lead to inadequate ventilation and oxygenation of the patient.

In the Intubation Scenario, the next appropriate action is to deflate the cuff and withdraw 1 to 2 cm of the tube. This is because deflating the cuff will help to prevent damage to the tracheal mucosa and reduce the risk of pressure-related complications. Withdrawing 1 to 2 cm of the tube ensures that the tip of the tube is properly positioned in the trachea, optimizing ventilation and reducing the risk of complications such as aspiration.

Capnography is a medical procedure that measures the levels of carbon dioxide in exhaled air. It is used to monitor the effectiveness of ventilation and the overall respiratory status of a patient. By analyzing the carbon dioxide levels, healthcare professionals can assess the patient's respiratory rate, the efficiency of gas exchange in the lungs, and detect any abnormalities or complications in the respiratory system. Monitoring carbon dioxide levels in exhaled air is crucial in various medical settings, such as during anesthesia, in intensive care units, and in emergency medicine.

The correct answer is the tip of the nose to the tragus. The tragus is a small, pointed projection of cartilage located in front of the ear canal. Measuring the nasal airway from the tip of the nose to the tragus ensures an accurate assessment of the distance and size of the airway. This measurement is important for selecting the appropriate size of a nasal airway device, such as a nasal trumpet or nasal cannula, to ensure proper airflow and oxygenation.

Agonal respiration is a respiratory pattern characterized by an irregular and gasping breathing pattern, with intermittent periods of apnea. It is often seen in individuals who are in the final stages of life or experiencing a severe medical emergency. Agonal respiration is a sign of impending respiratory failure and is associated with a very poor prognosis. It is important for healthcare providers to recognize this pattern and provide appropriate interventions and support.

Nasotracheal intubation would be the airway procedure of choice for patients with COPD because it allows for better access to the lower airway and can help prevent complications such as air trapping and hyperinflation that can occur with oral intubation. Additionally, nasotracheal intubation can help maintain the patient's ability to communicate and clear secretions more effectively, which is important in managing COPD.

Placing the head in the sniffing position involves flexing the head and extending the neck. This means that the head is brought forward, towards the chest, while the neck is stretched out. This position allows for better alignment of the airway and facilitates better airflow during sniffing.

If an endotracheal tube has been correctly placed, an esophageal detector device will give a normal CO2 readout. This is because the esophageal detector device is used to confirm correct placement of the endotracheal tube in the trachea rather than the esophagus. The device detects the presence of exhaled CO2, which indicates that the tube is in the correct position and the patient is effectively ventilating. Therefore, a normal CO2 readout confirms the correct placement of the endotracheal tube.

The major determinant in controlling respiration is the partial pressure of carbon dioxide. This is because an increase in carbon dioxide levels in the blood triggers the respiratory centers in the brain to stimulate breathing. The respiratory centers then send signals to the respiratory muscles to increase the rate and depth of breathing in order to eliminate excess carbon dioxide and maintain proper gas exchange in the lungs. The pH of capillary blood and oxygen content in the blood can also influence respiration, but the partial pressure of carbon dioxide has the strongest effect. Impulses generated within the lungs do not directly control respiration.

A catheter that is flexible and designed to suction smaller portions of the airway or through an endotracheal tube is known as a whistle-tip catheter.

In this scenario, the correct course of action for the paramedic is to remove the endotracheal tube and oxygenate the patient. This is because the question implies that there is a problem with the current endotracheal tube, which is preventing proper oxygenation of the patient. By removing the tube and providing alternative means of oxygenation, the paramedic can ensure that the patient receives the necessary oxygen for their breathing.

The distal cuff of the ET tube should hold 5 to 10 mL of air. This is because the distal cuff is designed to create a seal between the trachea and the tube, preventing air leakage and ensuring proper ventilation. Inflation of the cuff with too much air can cause pressure on the tracheal mucosa, leading to complications such as tracheal damage or ischemia. Therefore, it is important to inflate the distal cuff with the appropriate amount of air to maintain a secure seal without causing harm to the patient.

The correct answer is "under the epiglottis." When intubating an adult patient with a curved blade, the tip of the blade should be placed under the epiglottis. This is because the epiglottis covers the opening of the larynx and needs to be lifted to allow the insertion of the endotracheal tube. Placing the blade under the epiglottis helps to visualize the vocal cords and facilitates successful intubation.

When using a straight blade to intubate an adult patient, the tip of the blade should be placed directly on the epiglottis. This is because the epiglottis acts as a barrier between the esophagus and the trachea, and by placing the blade directly on it, it helps to lift and expose the epiglottis for successful intubation. Placing the blade under the epiglottis or in the vallecula may not provide the necessary visibility and access, while placing it past the epiglottis at the vocal chords would be incorrect as it would bypass the epiglottis altogether.

The endotracheal tube size refers to the external diameter in millimeters. This measurement is important because it determines the appropriate size of the tube that will be inserted into the patient's trachea. The external diameter of the tube is crucial for ensuring a proper fit and maintaining a secure airway during intubation and mechanical ventilation.

The laryngoscope should be held in the left hand and inserted on the left side of the mouth. This is because the laryngoscope is typically held in the non-dominant hand to allow for better control and maneuverability. Inserting the laryngoscope on the left side of the mouth allows for easier visualization of the vocal cords and the proper placement of the endotracheal tube during intubation.

The curved blade is recommended for use on infants because their airways are smaller and more delicate compared to adults. The curved shape of the blade allows for better visualization and access to the glottis, making intubation easier and safer. Additionally, the curvature provides more room for the passage of the endotracheal tube without causing damage or trauma to the infant's airway. This makes the curved blade a preferred choice for intubating infants.

In this scenario, the paramedic listens to the lungs and hears no sounds, indicating that the endotracheal tube is not in the trachea. However, when listening over the epigastrium, gurgling sounds are heard, suggesting that the tube is in the esophagus. Therefore, the correct answer is that the endotracheal tube is most likely placed in the esophagus.