Paramedics Exam Airway, Respiration & Ventilation 4 — Questions and Answers
Question 1: A patient on CPAP for pulmonary edema suddenly deteriorates with decreased LOC and apnea. What is your next step?
- Increase CPAP pressure to 15 cmH2O
- Remove CPAP and initiate BVM ventilation with consideration for intubation (Correct answer)
- Switch to a simple face mask at 15 LPM
- Administer furosemide IV and reassess
Correct answer: Remove CPAP and initiate BVM ventilation with consideration for intubation
A patient on CPAP who deteriorates to apnea requires removal of CPAP and transition to BVM ventilation, with preparation for RSI if the patient cannot protect the airway.
Question 2: Which anatomical landmark differentiates the upper from the lower airway?
- The epiglottis
- The carina (level of T4-T5)
- The vocal cords (glottis) (Correct answer)
- The nasopharynx
Correct answer: The vocal cords (glottis)
The glottis (vocal cords) marks the division between the upper and lower airways; structures above are upper airway, below (trachea, bronchi, lungs) are lower airway.
Question 3: Which sign most specifically suggests right mainstem bronchus intubation after ETT placement?
- SpO2 declining after intubation
- Absent breath sounds on the left with present sounds on the right (Correct answer)
- ETCO2 reading of 25 mmHg
- Cyanosis around the lips
Correct answer: Absent breath sounds on the left with present sounds on the right
Unilateral absent breath sounds (typically left side) after intubation indicates right mainstem intubation because the right mainstem bronchus is shorter and more aligned with the trachea.
Question 4: When using a video laryngoscope, the paramedic obtains an excellent view of the glottis but cannot pass the ETT. What is the most likely reason?
- The tube is too large for the trachea
- The tube is not following the line of sight of the camera angle (Correct answer)
- The patient's SpO2 is too low to intubate
- The ETT cuff is already inflated
Correct answer: The tube is not following the line of sight of the camera angle
Video laryngoscopes create a hyperangulated view; the ETT must be angled with a stylet to match the camera's curved line of sight, not the direct line of vision.
Question 5: A patient with a GCS of 6 is breathing at 24/min with shallow respirations. What ventilation strategy is most appropriate?
- Allow spontaneous breathing and monitor only
- Assisted ventilation via BVM at 10–12 breaths/min coordinated with patient's efforts (Correct answer)
- Hyperventilate at 20 breaths/min to reduce ICP
- Place an OPA and apply a non-rebreather mask
Correct answer: Assisted ventilation via BVM at 10–12 breaths/min coordinated with patient's efforts
A GCS of 6 with inadequate ventilation warrants assisted BVM ventilation; over-ventilation (hyperventilation) is harmful unless herniation is suspected.
Question 6: Which of the following is the correct sequence of events confirming ETT placement?
- Direct visualization → ETCO2 → chest rise → SpO2 → auscultation
- Direct visualization through cords → bilateral breath sounds → chest rise → waveform capnography (Correct answer)
- SpO2 reading → chest X-ray → ETCO2 → auscultation
- Auscultation only → secure tube → monitor SpO2
Correct answer: Direct visualization through cords → bilateral breath sounds → chest rise → waveform capnography
Best practice: visualize ETT passing through the cords, then confirm with chest rise, bilateral breath sounds, and continuous waveform capnography.
Question 7: A patient with Ludwig's angina presents with a rapidly swelling floor of the mouth and muffled voice. Which airway approach carries the highest risk of complete obstruction?
- Surgical cricothyrotomy under local anesthesia
- Awake nasal intubation with topical anesthesia
- RSI with succinylcholine and direct laryngoscopy (Correct answer)
- Early definitive airway via fiberoptic guidance
Correct answer: RSI with succinylcholine and direct laryngoscopy
RSI with paralytics in Ludwig's angina risks loss of the airway without guaranteed ability to intubate, as swelling distorts anatomy; if intubation fails post-paralysis, rescue is extremely difficult.
Paramedics Exam Airway, Respiration & Ventilation 4
A patient on CPAP for pulmonary edema suddenly deteriorates with decreased LOC and apnea.
What is your next step?