Paramedics Exam Airway Management 3 — Questions and Answers
Question 1: A combative patient requires RSI. After administering succinylcholine, you are unable to visualize the cords after two attempts. What is the next step?
- Continue attempting laryngoscopy
- Attempt blind nasotracheal intubation
- Declare a failed airway and proceed per protocol (BVM then surgical airway) (Correct answer)
- Administer more succinylcholine
Correct answer: Declare a failed airway and proceed per protocol (BVM then surgical airway)
After two failed intubation attempts, a failed airway algorithm should be activated, prioritizing oxygenation via BVM and preparing for surgical airway if needed.
Question 2: Which laryngoscope blade is preferred for a patient with a long, floppy epiglottis?
- Macintosh (curved) blade
- Miller (straight) blade (Correct answer)
- McCoy blade
- Bullard blade
Correct answer: Miller (straight) blade
The Miller straight blade directly lifts the epiglottis, making it preferred when the epiglottis is long or floppy.
Question 3: What is the minimum oxygen saturation that should be maintained during intubation attempts?
- 85%
- 90% (Correct answer)
- 93%
- 98%
Correct answer: 90%
Pulse oximetry should not drop below 90% during intubation; if it does, stop and re-oxygenate with BVM before reattempting.
Question 4: A supraglottic airway device (e.g., King LT) is inserted but you are unable to achieve adequate ventilation. What should you check FIRST?
- Cuff pressures and tube depth (Correct answer)
- Lung compliance
- Tidal volume settings
- Chest x-ray
Correct answer: Cuff pressures and tube depth
Inadequate ventilation with a supraglottic airway most commonly results from improper depth or insufficiently inflated cuffs.
Question 5: Which medication used in RSI provides neuromuscular blockade with the LONGEST duration of action?
- Succinylcholine
- Rocuronium
- Vecuronium (Correct answer)
- Etomidate
Correct answer: Vecuronium
Vecuronium is a non-depolarizing agent with a duration of 25-40 minutes, longer than rocuronium (30-60 min) and much longer than succinylcholine (8-12 min).
Question 6: During transport of an intubated patient, EtCO2 suddenly drops to near zero. What is the FIRST concern?
- Hyperventilation by crew
- Tube displacement or disconnection (Correct answer)
- Improving cardiac output
- Capnograph malfunction
Correct answer: Tube displacement or disconnection
A sudden drop in EtCO2 to near zero most commonly indicates tube displacement, disconnection, or cardiac arrest.
Question 7: Which sign is MOST reliable to confirm esophageal intubation in the field?
- Absence of breath sounds over the stomach
- Lack of chest rise with ventilation
- Flat waveform on continuous capnography (Correct answer)
- SpO2 remaining above 95%
Correct answer: Flat waveform on continuous capnography
Continuous capnography waveform absence (flat line) is the most reliable indicator of esophageal intubation in the prehospital setting.
Paramedics Exam Airway Management 3
A combative patient requires RSI.
After administering succinylcholine, you are unable to visualize the cords after two attempts.
What is the next step?