Paramedic Airway Exam

How does the body initially compensate for a decrease in cardiac output?

Increasing the systemic vascular resistance

How would you position a bariatric patient?

Use Fowler's or semi-Fowler's position if respiratory distress is present, ensuring comfort and maintaining airway. Utilize additional resources as needed for safety.

A higher pH is more acidic or basic?

A higher pH is more basic (or alkalotic)

A lower pH is more acidic or basic?

A lower pH is more acidic

Describe the procedure for performing pleural decompression.

1. Identify the second intercostal space at the midclavicular line. 2. Prep the area with antiseptic. 3. Administer local anesthesia. 4. Insert a large-bore needle or catheter over-the-needle into the pleural space. 5. Aspirate air or fluid to relieve pressure. 6. Secure the catheter and dress the wound. 7. Confirm placement with chest X-ray

Describe the signs and symptoms of a patient requiring pleural decompression.

Severe dyspnea, decreased breath sounds on affected side, tracheal deviation away from affected side, hypoxia, cyanosis, increased respiratory effort, and jugular venous distension

How do we evaluate effective bag-mask valve ventilations?

Observe chest rise and fall, listen for bilateral breath sounds, monitor for improvement in patient's color and oxygen saturation, and ensure the absence of gastric distension

How do we evaluate the adequacy of respirations?

Assess respiratory rate, depth, and rhythm; use pulse oximetry to check oxygen saturation; observe chest wall movement; and listen to breath sounds for adequacy of air exchange

How do we treat a patient who has ingested a toxic substance?

Assess ABCs, administer activated charcoal if appropriate, provide supportive care, possibly perform gastric lavage if within 1 hour of ingestion and indicated, and contact poison control for specific advice

How do we treat a patient with a tracheostomy tube?

Ensure patency of the tube, suction as needed, provide humidified oxygen if required, monitor for signs of infection or obstruction, and replace the tube as per protocol if dislodged

How long should your intubation attempt be (i.e. blade in the mouth)

30 seconds

If a patient is still wheezing after receiving an albuterol nebulizer, should you give them more albuterol?

Yes and also considering adding Atrovent (ipratroprium bromide) to the neb treatment (A&A neb)

If a piece of food on a choking victim cannot be dislodged during compressions, what should you do?

Use your laryngoscope blade and Magill forceps to attempt to locate and remove the obstruction

If pCO2 is higher than 45, is this a respiratory or metabolic cause (we are NOT considering any compensation here)?

Respiratory

If pCO2 is less than 35, is this a respiratory or metabolic cause (we are NOT considering any compensation here)?

Metabolic

If you cause bleeding during intubation, you should?

Suction

If you hear gurgling in the airway, you should?

Suction

Is a pCO2 greater than 45 acidic or basic?

Acidic

Is a pCO2 less than 35 acidic or basic?

Basic

Name several opioid drugs/medications.

oxycodone (OxyContin), hydrocodone (Vicodin), morphine, methadone, fentanyl, heroin.

Describe the hypoxic drive.

A respiratory drive where the primary stimulus for breathing is low oxygen levels in the blood, typically seen in patients with chronic CO2 retention, such as those with advanced COPD

What acid-base disturbance does hyperventilation cause?

Respiratory alkalosis

What are some pre-existing conditions that pose a threat to a patient?

Chronic obstructive pulmonary disease, heart failure, diabetes, immunocompromised states, renal failure, and severe allergies

What are the areas of a normal ETCO2 waveform?

Baseline (represents no CO2), ascending phase (expiratory upstroke), alveolar plateau (end-tidal CO2 measurement), and descending phase (inspiratory downstroke)

What are the characteristics of cystic fibrosis?

Thick, sticky mucus production, frequent respiratory infections, malabsorption disorders, and progressive lung damage

What are the complications of ET tube placement?

Trauma to teeth or airway, misplacement into the esophagus, pneumothorax, inability to ventilate, and vocal cord damage

What are the complications of hyperventilation?

Respiratory alkalosis, decreased cerebral blood flow, tingling of extremities, and cardiac arrhythmias

What are the complications of intubating a burn patient?

Airway edema, difficult airway visualization, increased risk of infection, and potential for worsening airway obstruction

What are the differences between the different laryngoscope blades?

Macintosh blade (curved) is designed to fit into the vallecula, elevating the epiglottis indirectly. Miller blade (straight) is used to directly lift the epiglottis.

What are the different techniques for suctioning an intubated patient?

Closed-system (in-line) suctioning and open suctioning. Technique depends on the patient's condition and the type of suction equipment available.

What are the indications for intubating a burn patient?

Signs of airway compromise, such as burns to the face or neck, stridor, hoarseness, difficulty breathing, or carbonaceous sputum

What are the indications of inserting an NG tube?

Gastric decompression, administration of nutrition or medication, prevention of nausea and vomiting, and to remove gastric contents for analysis

What are the physiologic effects of COPD?

Decreased airflow, air trapping, hyperinflation of lungs, increased work of breathing, hypoxemia, and hypercapnia

What are the signs and symptoms of a lower airway injury?

Cough, dyspnea, wheezing, decreased breath sounds, hypoxia, and possibly cyanosis

What are the signs and symptoms of a tension pneumothorax?

Severe dyspnea, tracheal deviation away from affected side, distended neck veins, hypotension, and absent breath sounds on affected side

What are the signs and symptoms of hyperventilation?

Rapid breathing, feeling of breathlessness, dizziness, tingling in the hands and feet, and chest pain

What are the signs and symptoms of left sided ventricular heart failure?

Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, coughing, wheezing, and fatigue

What are the signs and symptoms of upper airway edema?

Hoarseness, stridor, difficulty breathing, and potentially drooling or difficulty swallowing

What are the signs/symptoms of congestive heart failure (CHF)?

Shortness of breath, fatigue, swollen legs, rapid heartbeat, and persistent cough or wheezing

What are the steps to determine acid-base balance causes (again ignore compensation)?

Look at the pH (<7.35 is acidosis, >7.45 is alkalosis). Then look at the pCO2 (<35 is metabolic, >45 is respiratory). Combine the words into either: metabolic acidosis, metabolic alkalosis, respiratory acidosis, or respiratory alkalosis)

What are the ways in which we can confirm tube placement?

Auscultation of breath sounds, observation of chest rise, use of end-tidal CO2 detector, and confirmation with chest X-ray

What background information might lead you to suspect a pulmonary embolus in a patient with SOB?

Birth control, long flight, recent surgery, sedentary lifestyle, smokers, trauma, pregnancy

What is a supraglottic airway?

A device used to provide airway support that is positioned above the vocal cords and does not require visualization of the glottis for placement

What is apneustic breathing?

A pattern of prolonged inspiration followed by a pause at full inspiration, then a brief, insufficient release

What is meant by the term "definitive care"?

The comprehensive, specialized medical care and treatment provided to patients after initial stabilization to address the root cause of their condition

What is one way to remember whether a pH is more acidic or alkalotic?

Acidic has fewer letters than alkalotic. Lower pH numbers are acidic, higher pH numbers are alkalotic.

What is orthopneia?

Shortness of breath that occurs when lying flat, forcing the person to sleep propped up in bed or sitting in a chair

What is the anatomical area used to elevate the epiglottis while intubating with a Mac blade?

epiglottic vallecula

What is the difference between left- and right- sided heart failure?

Left-sided failure causes respiratory symptoms due to pulmonary congestion, while right-sided failure leads to systemic venous congestion and peripheral edema

What is the normal pCO2?

35- 45 mmHg

What is the normal pH in the human body?

7.35-7.45

What is the pathophysiology of COPD?

Chronic inflammation leads to airway narrowing, destruction of lung parenchyma, and impaired gas exchange resulting in decreased oxygen intake and retention of carbon dioxide

What is the space called where the Mac blade goes to lift the epiglottis?

Vallecula

What is the treatment for a benzodiazepine overdose (including Diazepam and Midazolam)?

Supportive care, monitoring of vital signs, and administration of Flumazenil as an antidote if clinically indicated

What is the treatment for a patient with respiratory acidosis?

Improve ventilation, may require mechanical ventilation, and address the underlying cause of the respiratory failure

What shape is a Mac intubation blade?

Curved

What shape is a Miller intubation blade?

Straight

When is a supraglottic airway used?

When intubation is not possible or contraindicated, during cardiopulmonary resuscitation (CPR) as a temporary airway, or when ventilation is difficult

When should you administer narcan?

Suspected opioid overdose

When should you use nasotracheal intubation?

When a person needs an advanced airway and has clenched teeth

When would it be necessary to remove a dual lumen airway?

When you can't ventilate through either port

Where is the Mac blade placed in order to view the vocal cords?

In the vallecula, anterior to the epiglottis

Where is the Miller blade placed in order to view the vocal cords during intubation?

Directly under the epiglottis, lifting it to expose the vocal cords

Why do EMS personnel need to worry about orthopneia?

Orthopnea can indicate heart failure or severe respiratory distress, requiring immediate attention to prevent further complications.

Why should EMS personnel care about cystic fibrosis?

Understanding cystic fibrosis is important as it affects breathing and increases infection risk, requiring specialized care during respiratory distress or other complications.

What is the average ET depth when measured at the teeth?

The average ET (endotracheal tube) depth for adults is typically around 21-23 cm at the teeth for men and 19-21 cm for women.

If you see a number larger than that, what should you suspect?

A number larger than the average suggests possible right mainstem intubation, necessitating tube adjustment to ensure proper lung ventilation.

What are the indications for performing a needle cricothyrotomy?

Severe upper airway obstruction, inability to ventilate or intubate by conventional means, and as an emergency procedure in airway compromise when other methods fail.

What is the dosage for ipratroprium bromide (Atrovent) for asthma?

0.5 mg by nebulizer

How do you manage a patient with snoring respirations who is unresponsive?

Open the airway and maintain it with an OPA or NPA

What is an objective indicator of successful intubation?

ETCO2 waveform

When should you double check the placement of your ET tube?

After moving a patient (ex. from bed to stretcher, floor to stretcher, down a flight of stairs, strecher to ER bed)

What should you do if you are unable to intubate a patient after 2 attempts after you have administered a paralytic?

Insert an OPA and begin ventilating the patient

When do we administer epinephrine IM?

For severe allergic reactions (anaphylaxis), asthma exacerbations unresponsive to nebulizers, or cardiac arrest to improve hemodynamic stability.

If ventilations become difficult after intubation, what should you suspect?

Pneumothorax

If you see an ETCO2 waveform with expiration 4x longer than inspiration, what should you suspect?

Bronchospasm

What are the signs of a dislodged ET tube?

Sudden difficulty in ventilation, loss of end-tidal CO2, decreased or absent breath sounds, gastric distention, and patient's inability to speak (if previously able).

What are the indications for intubation?

Inability to maintain airway patency, inadequate oxygenation or ventilation, anticipated clinical course suggesting impending airway compromise.

Is wheezing an upper or lower airway issue?

Lower airway (below the vocal cords)

What does a "shark fin" indicate on the ETCO2 waveform?

Bronchospasm (administer albuterol)

What range should you maintain ETCO2 for an intubated patient?

35-45 mmHg

Should EMS withhold oxygen (or only use a nasal cannula) for a patient with COPD?

No, give the patient enough oxygen to improve their oxygenation

If a choking patient is unconscious after abdominal thrusts, what should you do next?

Start chest compressions

A patient has a long-term cough, rhonchi, and peripheral cyanosis. What should you suspect?

Chronic bronchitis

What type of patient is at risk of aspiration?

Patients with a decreased LOC (alcohol, drugs, etc)

If a choking patient is able to cough, what is your next step?

Encourage them to cough

If you are unable to reach around a patient to do abdominal thrusts (pregnancy or obesity), what should you do?

Perform chest compressions

What are the signs/symptoms of subcutaneous emphysema?

Swelling and a crackling sensation under the skin, especially around the neck and chest, indicating air leakage from the lung or airway into subcutaneous tissue.

What are the signs and symptoms of a pulmonary embolus?

Sudden onset of dyspnea, chest pain (pleuritic), tachycardia, hypoxia, hemoptysis, and possibly syncope.

What types of patients are prone to a pulmonary embolus?

Those with deep vein thrombosis, recent surgery, immobilization, cancer, history of PE, and certain genetic conditions.

What is one of the most likely causes if you hear crackles in the lungs?

Pulmonary edema

How does emphysema affect the lungs?

It erodes the lining of the alveoli creating less surface area. Imagine a group of alveoli like a cluster of grapes. Emphsema erodes the "grape walls" so there are fewer "grapes". In the lungs, there are fewer alveoli walls and less area for oxygen exchange.

What are the signs/symptoms of congestive heart failure?

Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema, fatigue, and increased respiratory rate.

What are the signs/symptoms of emphysema?

Chronic dyspnea, wheezing, a barrel chest, prolonged expiratory phase, and weight loss.

What are the signs/symptoms of pneumonia?

Fever, cough with phlegm, chest pain, shortness of breath, and fatigue.

What are the signs/symptoms of chronic bronchitis?

Chronic productive cough, wheezing, shortness of breath, and frequent respiratory infections.

What are the signs/symptoms of an allergic reaction?

Hives, itching, swelling, difficulty breathing, dizziness, and possible anaphylaxis.

What are the signs/symptoms of LEFT-SIDED congestive heart failure?

Pulmonary congestion, dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Left side backs up into LAKE LUNGS.

What are the signs/symptoms of RIGHT-SIDED congestive heart failure? Peripheral edema, jugular venous distension, abdominal distension, and hepatomegaly.

Peripheral edema, jugular venous distension, abdominal distension, and hepatomegaly. Right side backs up into LAKE LEGS.

What are the signs/symptoms of pleural effusion?

Dyspnea, chest pain, diminished breath sounds over the affected area, and dullness to percussion.