Paramedics Exam Airway, Respiration & Ventilation 5 — Questions and Answers
Question 1: A patient has a tracheostomy and is in respiratory arrest. Your initial attempt to ventilate via the stoma is unsuccessful. What is the next step?
- Attempt orotracheal intubation only
- Seal the stoma and ventilate via BVM applied to mouth and nose, then reattempt stoma ventilation (Correct answer)
- Perform surgical cricothyrotomy immediately
- Administer epinephrine and reassess
Correct answer: Seal the stoma and ventilate via BVM applied to mouth and nose, then reattempt stoma ventilation
If stoma ventilation fails (e.g., mucus plug), occlude the stoma and attempt oral/nasal BVM ventilation; if that also fails, clear the stoma or insert a pediatric ETT into the stoma.
Question 2: Persistent ETCO2 above 50 mmHg in a mechanically ventilated patient most likely indicates:
- Hyperventilation — reduce rate
- Hypoventilation — increase rate or tidal volume (Correct answer)
- Effective CPR — maintain current rate
- Pulmonary embolism — increase FiO2
Correct answer: Hypoventilation — increase rate or tidal volume
Elevated ETCO2 above 45 mmHg indicates CO2 retention from hypoventilation; the ventilation rate or tidal volume should be increased.
Question 3: When sizing a nasopharyngeal airway (NPA), the correct method is:
- Measure from the center of the mouth to the angle of the jaw
- Measure from the tip of the nose to the earlobe, and select diameter matching the patient's pinky finger (Correct answer)
- Use the patient's age to select size from a pediatric chart
- Select the largest size that fits in the nare for maximum airflow
Correct answer: Measure from the tip of the nose to the earlobe, and select diameter matching the patient's pinky finger
An NPA is sized by measuring from the tip of the nose to the earlobe for length, and choosing a diameter approximately equal to the patient's little finger.
Question 4: A drowning victim is unresponsive with agonal respirations. Which is true regarding ventilation priorities?
- Chest compressions take absolute priority over ventilations in drowning
- Early rescue breaths are particularly important in drowning as cardiac arrest is usually asphyxial (Correct answer)
- Wait for ALS equipment before providing any ventilation
- Ventilate at 20 breaths/min to compensate for hypoxia
Correct answer: Early rescue breaths are particularly important in drowning as cardiac arrest is usually asphyxial
Drowning cardiac arrest is primarily asphyxial; early rescue breaths to correct hypoxia are especially important and should not be delayed.
Question 5: Which lung compliance finding is consistent with tension pneumothorax in a ventilated patient?
- Decreasing peak airway pressures over time
- Sudden increase in peak airway pressures with decreased tidal volume delivery (Correct answer)
- Stable airway pressures with declining SpO2
- Increased tidal volume delivery at the same pressure
Correct answer: Sudden increase in peak airway pressures with decreased tidal volume delivery
Tension pneumothorax causes the affected lung to collapse and mediastinal shift, dramatically increasing airway resistance and peak pressures while reducing effective tidal volume.
Question 6: A patient is intubated after a heroin overdose. During transport, ETCO2 suddenly drops from 40 to 5 mmHg. SpO2 was 99% and is now declining. What is the most likely cause?
- Patient's respiratory drive has returned, causing spontaneous hyperventilation
- ETT has become dislodged from the trachea (Correct answer)
- Bronchospasm is reducing CO2 elimination
- The capnography sensor has malfunctioned
Correct answer: ETT has become dislodged from the trachea
An abrupt near-zero ETCO2 with declining SpO2 strongly indicates ETT dislodgement; esophageal placement produces very low or absent ETCO2 after initial CO2 is cleared.
Question 7: Which of the following describes the correct technique when using a two-person BVM to ventilate an apneic adult?
- One provider squeezes the bag with two hands while the second provider manages the IV line
- One provider uses a C-E clamp with both hands to maintain mask seal; the second provider squeezes the bag (Correct answer)
- Both providers alternate squeezing the bag to reduce fatigue
- One provider holds the mask while the second tilts the head and monitors SpO2
Correct answer: One provider uses a C-E clamp with both hands to maintain mask seal; the second provider squeezes the bag
Two-person BVM technique has one provider dedicated to maintaining a two-handed C-E clamp mask seal while the second provider delivers breaths by squeezing the bag.
Paramedics Exam Airway, Respiration & Ventilation 5
A patient has a tracheostomy and is in respiratory arrest.
Your initial attempt to ventilate via the stoma is unsuccessful.
What is the next step?