FP-C - Flight Paramedic-Certification Advanced Airway Management Questions and Answers — Questions and Answers
Question 1: A flight paramedic is managing a 68-year-old male with severe COPD exacerbation. Despite aggressive bronchodilator therapy and BiPAP, the patient's mental status is declining, and his capnography waveform shows a pronounced 'shark-fin' appearance. What is the most likely indication for this waveform morphology?
- Bronchospasm (Correct answer)
- Esophageal intubation
- Hypoventilation
- Rebreathing of CO2
Correct answer: Bronchospasm
The 'shark-fin' capnography waveform is a classic indicator of bronchospasm. The sloped, prolonged expiratory upstroke (Phase II) and a delayed alveolar plateau (Phase III) signify an obstruction to expiratory airflow, which is characteristic of conditions like asthma and COPD.
Question 2: You are preparing for a Rapid Sequence Intubation (RSI) of a 45-year-old male with a traumatic brain injury and a GCS of 6. Which of the following induction agents is known for its hemodynamic stability, making it a preferred choice in potentially hypotensive patients?
- Propofol
- Ketamine (Correct answer)
- Midazolam
- Thiopental
Correct answer: Ketamine
Ketamine is often the preferred induction agent in hemodynamically unstable patients or those at risk for hypotension. It typically increases heart rate and blood pressure, which is beneficial in trauma settings. Etomidate is also known for its hemodynamic stability, but Ketamine is another primary choice, especially in the context of potential hypovolemia.
Question 3: A 3-year-old child has a complete upper airway obstruction from a foreign body that cannot be dislodged with basic life support maneuvers. Orotracheal intubation is unsuccessful due to the obstruction. What is the most appropriate next step in managing this patient's airway?
- Perform a surgical cricothyrotomy
- Attempt a retrograde intubation
- Perform a needle cricothyrotomy (Correct answer)
- Place a laryngeal mask airway (LMA)
Correct answer: Perform a needle cricothyrotomy
Surgical cricothyrotomy is generally contraindicated in young children (typically under the age of 10-12) due to the anatomical differences in the pediatric airway, such as a smaller cricothyroid membrane and a more funnel-shaped larynx. In a 'cannot intubate, cannot ventilate' scenario in a pediatric patient, a needle cricothyrotomy is the indicated emergency procedure to provide temporary oxygenation.
Question 4: During the transport of a mechanically ventilated patient, you notice the capnography waveform does not return to the baseline of zero at the end of exhalation. This finding is most consistent with:
- Pulmonary embolism
- Inadequate paralytic agent
- Hyperventilation
- Rebreathing of carbon dioxide (Correct answer)
Correct answer: Rebreathing of carbon dioxide
When the capnography waveform does not return to zero, it indicates that the patient is inhaling air that still contains carbon dioxide. This is known as rebreathing and can be caused by a faulty expiratory valve in the ventilator circuit, inadequate fresh gas flow, or an exhausted CO2 absorber in a rebreathing system.
Question 5: Which of the following is an absolute contraindication for performing a surgical cricothyrotomy in an adult patient?
- Massive maxillofacial trauma preventing intubation
- Inability to ventilate with a BVM after failed intubation
- Transection of the trachea with retraction of the distal end (Correct answer)
- Severe laryngeal edema from anaphylaxis
Correct answer: Transection of the trachea with retraction of the distal end
While most situations in a 'cannot intubate, cannot ventilate' scenario are indications for a cricothyrotomy, transection of the trachea with retraction of the distal segment into the mediastinum is a contraindication. In this case, an incision at the cricothyroid membrane would not access the distal, patent portion of the airway.
Question 6: A flight crew is managing a patient with a difficult airway. After two failed intubation attempts, they are unable to ventilate the patient effectively with a bag-valve-mask. According to difficult airway algorithms, what is the immediate priority?
- Attempting intubation with a different blade
- Administering another dose of paralytic
- Proceeding to a rescue airway device or surgical airway (Correct answer)
- Placing the patient in a sniffing position and re-attempting BVM
Correct answer: Proceeding to a rescue airway device or surgical airway
In a 'cannot intubate, cannot ventilate' (CICV) situation, the primary goal shifts from intubation to oxygenation. Difficult airway algorithms stress moving systematically to the next step when a technique fails. After failed intubation and failed BVM ventilation, the immediate priority is to establish an airway via other means, such as a supraglottic airway or, if that fails or is not possible, a surgical cricothyrotomy.
FP-C - Flight Paramedic-Certification Advanced Airway Management Questions and Answers
A flight paramedic is managing a 68-year-old male with severe COPD exacerbation.
Despite aggressive bronchodilator therapy and BiPAP, the patient's mental status is declining, and his capnography waveform shows a pronounced 'shark-fin' appearance.
What is the most likely indication for this waveform morphology?