Deck 48: Advanced Airway Management

Question 1

A 6-year-old requires immediate intubation. To rapidly determine the proper-sized tube, use the tube that is the same:

A) size as the patient's age.
B) length as the distance from the patient's mouth to his earlobe.
C) size as 2 + (age in years divided by 4).
D) diameter as the patient's little finger.

Answer 1

D

Question 2

The EMT has just placed an endotracheal tube in an unresponsive patient who is vomiting. Placement has been confirmed. With the placement of this airway, the EMT recognizes that:

A) the head-tilt, chin-lift still must be maintained.
B) the tongue still can block the airway.
C) the risk of aspiration is eliminated.
D) maintaining a seal with the bag-valve mask is easier.

Answer 2

C

Question 3

When checking for proper tube placement in a patient who has just been intubated, you note that breath sounds are heard in the epigastrium but not in either lung. In this situation, which one of the following represents the greatest threat to the patient's life?

A) Trauma to the airway
B) Hypoxia
C) Bleeding
D) Aspiration

Answer 3

B

Question 4

You are assisting a paramedic with the placement of an endotracheal tube. The paramedic states that he needs to indirectly lift the epiglottis by pressing on the ligament located in the vallecula to visualize the vocal cords. Which laryngoscope blade should you hand him?

A) Wide
B) Straight
C) Short
D) Curved

Question 5

Why would providing Sellick's maneuver be beneficial when performing endotracheal intubation?

A) Assist the paramedic in visualizing the glottis opening.
B) Movement of air from the pharynx into the esophagus is increased.
C) Chance of vomitus entering the esophagus is decreased.
D) Sellick's stabilizes the cervical spine while intubation is attempted.

Question 6

When attempting to place an endotracheal tube in an apneic adult patient, what is the maximum amount of time that ventilations can be interrupted?

A) 5 seconds
B) 15 seconds
C) 30 seconds
D) 60 seconds

Question 7

Which one of the following indicates that the EMT is properly using the stylet?

A) It extends no more than 1 inch beyond the end of the tube.
B) It is secured with the endotracheal tube after intubation to maintain placement.
C) It is lubricated with petroleum lubricant.
D) It is recessed ½ inch from the end of the endotracheal tube.

Question 8

Why is a laryngoscope blade used when placing an endotracheal tube?

A) To guide the endotracheal tube into the esophagus
B) To provide visualization of the vocal cords
C) To keep the airway open during the intubation attempt
D) To determine if the patient has a gag reflex

Question 9

You have just inserted an endotracheal tube into an unresponsive patient whom you believe has suffered a stroke. Which one of the following actions should you take immediately after removing the laryngoscope from the patient's mouth?

A) Inflate the cuff with 15 mL of air.
B) Attach the bag-valve mask and start ventilations.
C) Carefully remove the stylet if used.
D) Secure the tube with a commercial device or tape.

Question 10

A paramedic has just placed an endotracheal tube and asks you to confirm its placement. You hear breath sounds in the right lung, but not in the left lung or over the epigastrium. Given these findings, what statement is appropriate?

A) "You need to pull back on the tube a little."
B) "You need to ventilate with more force."
C) "The tube is misplaced and needs to be removed."
D) "The tube is in the trachea, so continue ventilations."

Question 11

An endotracheal tube has just been placed in an unresponsive asthmatic patient. To confirm proper placement, which one of the following interventions should be performed first?

A) Attach an end-tidal CO₂ detector and watch for color changes.
B) Listen for sounds of ventilation over the epigastrium.
C) Listen for breath sounds over each lung field.
D) Determine the ease by which positive pressure ventilation can be delivered.

Question 12

Which of the following would cause the EMT to immediately reassess for proper placement of the endotracheal tube?

A) Equal breath sounds to both lungs
B) Condensation in the tube with each exhalation
C) Absent breath sounds in the left lung
D) Observation that the pilot balloon contains air

Question 13

During an intubation attempt, you can see the patient's vocal cords, but you are having a difficult time directing the endotracheal tube upward and through them. Which of the following pieces of equipment would be beneficial?

A) Stylet
B) Curved laryngoscope blade
C) Flashlight
D) Murphy eye

Question 14

A 4-year-old requires endotracheal intubation with an uncuffed tube. What tube size is most appropriate?

A) 5.0 mm
B) 3.0 mm
C) 1.0 mm
D) 7.0 mm

Question 15

An endotracheal tube is properly placed when the distal end lies in the:

A) esophagus.
B) bronchus.
C) trachea.
D) lungs.

Question 16

You are at the scene of a multiple-casualty incident. Which patient is the best candidate for immediate endotracheal intubation?

A) 31-year-old unresponsive patient who is apneic with an oral airway in place
B) 22-year-old female who will not tolerate an oral airway but is vomiting and requires continual suctioning
C) 46-year-old male who responds to painful stimuli, is breathing at 6 times a minute, and will not tolerate an oral airway
D) 52-year-old alert and oriented patient with severe respiratory distress and stridorous respirations

Question 17

Which of the following patients has the best means of airway protection?

A) 52-year-old overdose patient being ventilated with a bag-valve mask and oral airway in place
B) 41-year-old male stroke patient with an endotracheal tube properly in place but no head-tilt, chin-lift
C) 37-year-old male with an altered LOC, a nasal airway in place, and an endotracheal tube in the esophagus
D) Unresponsive 75-year-old patient who is receiving the head-tilt, chin-lift, has an oral airway in place, and is receiving positive pressure ventilation

Question 18

You have elected to place an endotracheal tube in an unresponsive, apneic patient. Prior to inserting the laryngoscope blade into the patient's mouth, what instruction would you give your partner?

A) "Lubricate the endotracheal tube with a petroleum-based lubricant."
B) "Test the cuff by inflating it with 20 mL of air."
C) "Insert the stylet into the endotracheal tube so that it extends ½ inch beyond the end of the tube."
D) "Hyperoxygenate the patient for 2 minutes with the bag-valve mask."

Question 19

You have decided to place an endotracheal tube in a 43-year-old female who was shot once in the chest and is unresponsive. What size endotracheal tube is most appropriate?

A) Medium
B) 9.0 mm
C) Large
D) 7.5 mm

Question 20

While assisting a paramedic with the placement of an endotracheal tube, she asks you to perform Sellick's maneuver. You would:

A) lift the jaw upward with your index finger and thumb.
B) press downward on the cricoid cartilage.
C) stabilize the neck to prevent side-to-side motion.
D) gently move the trachea to the right.

Question 21

An advantage of using the Esophageal Tracheal Combitube is:

A) either a straight or curved laryngoscope blade can be used with it.
B) It can be used on any age patient.
C) It can provide ventilations whether placed in the trachea or in the esophagus.
D) It can be used on responsive patients.

Question 22

Of the following airway devices, which one is most likely to provide a secure airway by isolating the trachea after insertion?

A) Laryngeal Mask Airway
B) King LT Airway
C) Oropharyngeal Airway
D) Esophageal Tracheal Combitube

Question 23

You have just placed an Esophageal Tracheal Combitube (ETC) in a patient and inflated the cuffs as appropriate. The bag-valve mask is attached and ventilation is being delivered through tube #1. Auscultation reveals that breath sounds are present in the epigastrium and not in the lungs. You should:

A) provide ventilation through tube #2.
B) continue to ventilate.
C) slightly pull back on the ETC and listen again.
D) remove the ETC and reinsert it.

Question 24

The major difference between the use of the straight and curved laryngoscope blades is the that the straight blade:

A) is used to directly lift the epiglottis.
B) is used to illuminate the airway.
C) is placed in the vallecula.
D) will not induce the gag reflex.

Question 25

As the trachea extends from the upper portion of the airway, it splits at the carina into the:

A) alveoli.
B) bronchi.
C) vallecula.
D) epiglottis.

Question 26

Oxygen can be delivered more effectively by orotracheal intubation because:

A) a higher liter flow of oxygen can be used.
B) an air-tight seal can be made with the face mask of the BVM.
C) oxygen can be ventilated directly into the lungs.
D) a lower liter flow of oxygen can be used.

Question 27

The instrument inserted into the mouth and used to illuminate and observe the vocal cords is called the:

A) laryngoscope.
B) tracheal tube.
C) illumination oral airway.
D) malleable stylet.

Question 28

Which one of the following statements shows that the EMT has an accurate understanding of endotracheal intubation and the pediatric patient?

A) "A cuffed endotracheal tube should be used for patients under 8 years of age."
B) "A straight laryngoscope blade is preferred in infants."
C) "Sellick's maneuver is contraindicated in the pediatric patient."
D) "Ventilations should never be interrupted for more than 60 seconds when intubating a pediatric patient."

Question 29

When intubating a patient, you note a leaf-shaped structure that covers the opening of the larynx. You recognize that it is which one of the following structures?

A) Esophagus
B) Vallecula
C) Cricoid cartilage
D) Epiglottis

Question 30

Which one of the following endotracheal tubes can be used safely in either the adult male or female patient?

A) 5.0 mm
B) 7.5 mm
C) Any size, uncuffed
D) Medium size

Question 31

When performing orotracheal suctioning in an adult patient, the suction should be applied for no longer than how many seconds?

A) 10
B) 15
C) 20
D) 30

Question 32

Which one of the following conditions causes the greatest immediate threat to life when you are attempting an intubation of a patient?

A) Trauma to the airway while you are inserting the tube
B) Increase in the patient's heart rate
C) Placement of the tube into the trachea
D) Placement of the tube in the esophagus

Question 33

You are ventilating an intubated patient who suffered multisystem trauma. While the paramedic with whom you are working is starting an IV, you both glance at the capnometer device and see that the numeric display is dropping quickly. If there has been no change in ventilatory rate or depth, what could be another cause for this end-tidal carbon dioxide change?

A) There is a drop in blood flow to the lungs from the heart.
B) Patient's blood pressure is rising.
C) Patient's lungs are receiving too much oxygen.
D) The body's metabolic activity is finally starting to improve.

Question 34

When using the curved laryngoscope blade, the tip of the blade should be placed in the:

A) trachea.
B) esophagus.
C) vallecula.
D) carina.

Question 35

Each and every time a patient is intubated, it is imperative that the EMT visualizes what structure?

A) Glottic opening
B) Vallecula
C) Carina
D) Alveoli

Question 36

As the laryngoscope is inserted into the patient's mouth, the tongue should be:

A) swept to the right.
B) compressed by the blade.
C) swept to the left.
D) pulled forward.

Question 37

The Pharyngeo-tracheal Lumen (PtL) airway is most similar in design and function as what other airway device?

A) Esophageal Tracheal Combitube
B) King LT airway
C) Oropharyngeal airway
D) Endotracheal tube airway

Question 38

After confirming endotracheal tube placement with auscultation, you attach a bulb-type esophageal detector for added confirmation. Given how this device works, what should happen to the bulb after it is depressed and attached to the end of the endotracheal tube?

A) It should not reinflate.
B) It should slowly reinflate.
C) It should rapidly reinflate.
D) It should not reinflate until you begin ventilations.

Question 39

You are attempting orotracheal intubation with a laryngoscope handle and a #3 curved blade on a 210-pound, obese male. You cannot achieve adequate glottic visualization for passing the tube despite application of cricoid pressure. Which one of the following changes could be helpful on your next attempt?

A) Use a #2 curved blade.
B) Use a #1 straight blade.
C) Use a gum elastic bougie.
D) Cease application of cricoid pressure.

Question 40

Of the following intubation techniques, which one is most likely to be successful on first attempt?

A) Digital intubation
B) Intubation with an ETC in place
C) Lighted stylet intubation
D) Visual orotracheal intubation

Question 41

Your paramedic partner is having difficulty placing an endotracheal tube in an unresponsive trauma patient. He asks you to get the King LT airway prepared. As such, you would gather:

A) King airway device.
B) King airway and laryngoscope.
C) King airway and a malleable stylet.
D) King airway, 7.0 endotracheal tube, and laryngoscope.

Question 42

The EMT understands that capnometry informs the care provider of:

A) Level of oxygen in the lungs.
B) Amount of CO₂ being exhaled.
C) Measure of O₂ being delivered to the cells.
D) The adequacy of oxygen diffusion into the bloodstream.

Question 43

You are ventilating a patient in cardiac arrest and you see a sudden rise in the capnometry measurement. Your statement to the crew providing care would be:

A) "Please reassess the tube for proper placement."
B) "Please increase the rate of ventilations to 20."
C) "Stop CPR and check for a carotid pulse."
D) "Can you let the paramedic know we need something to sedate the patient?"

Question 44

While transporting a patient with an Esophageal Tracheal Combitube (ETC) airway in place, the patient regains consciousness and begins gagging on the device. You would immediately:

A) encourage the patient to relax and accept the airway.
B) contact medical direction for advisement.
C) deflate the cuffs and remove the airway.
D) suction the airway through the ETC.

Question 45

You have been called to help transport a sedated patient who has been endotracheally intubated and is on a capnometer. The vital signs are: pulse 88, respiration 12 (delivered through a ventilator), and blood pressure 106/64 mmHg. If the tube is in place, what should you see on the capnometer?

A) CO₂ reading of near 0
B) Decreasing SpO₂ reading
C) CO₂ level of 40 mmHg
D) Unchanging blood pressure

Question 46

You are transporting an intubated patient, with a heartbeat and on the ventilator, to another hospital for specialized care. The patient is sedated with the following vital signs: pulse 68, respiration via ventilator at 12/minute, blood pressure 112/68, SpO₂ 97%, and PETCO₂ 40 mHg. When reassessing the patient, which of the following is the greatest concern and demands that the EMT notify the ALS provider?

A) Blood pressure 102/58
B) SpO₂ drop to 96%
C) Pupils both are 4 mm
D) PETCO₂ level 15 mmHg

Question 47

Which of the following is the best way to continually monitor endotracheal tube placement and ongoing ventilation of the lungs?

A) Capnometer
B) Esophageal detection device
C) Pulse oximeter
D) Breath sounds

Question 48

Which of the following is true when a King LT airway is correctly placed?

A) The lungs can be suctioned by passing a catheter through the airway.
B) The distal end lies in the esophagus.
C) The main lumen (tube) is placed in the trachea.
D) The large size of the device does not allow for capnometry.

Question 49

After an unsuccessful attempt to place a King LT airway, the patient vomits. You would immediately:

A) attempt placement of the King LT.
B) suction through the King LT.
C) place an oral airway and start positive pressure ventilation.
D) suction the airway.