Chapter 10 - Airway Management Flashcards

Questions and Answers

An unconscious patient found in a prone position must be placed in a supine position in case he or she:

Has increased tidal volume

Regains consciousness

Requires CPR (correct)

Begins to vomit

Gas exchange in the lungs is facilitated by:

Pulmonary capillary constriction

Surfactant-destroying organisms

Adequate amounts of surfactant (correct)

Water or blood within the alveoli

The MOST serious complication associated with using a nasopharyngeal airway in a patient with trauma to the head or face is:

Causing severe bleeding

Fracturing the septum

Penetrating the cranium (correct)

Damaging the turbinates

Intrapulmonary shunting occurs when:

Blood coming from the right side of the heart bypasses nonfunctional alveoli Signup and view all the answers

A 71-year-old male is semiconscious following a sudden, severe headache. The EMT must immediately:

Perform oropharyngeal suctioning Signup and view all the answers

The nasal cannula is MOST appropriately used in the prehospital setting:

When the patient cannot tolerate a nonrebreathing mask Signup and view all the answers

A ventilation/perfusion (V/Q ratio) mismatch occurs when:

A disruption in blood flow inhibits gas exchange Signup and view all the answers

During your assessment of a patient with respiratory distress, you hear wheezing when listening to breath sounds. This indicates:

A lower airway obstruction Signup and view all the answers

In which of the following patients would the head tilt-chin lift maneuver be the MOST appropriate method of opening the airway?

A 37-year-old female who is found unconscious in her bed Signup and view all the answers

What occurs when a patient is breathing very rapidly and shallowly?

Air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchange Signup and view all the answers

Which of the following oxygen flowmeters is NOT affected by gravity and can be used in any position when attached to an oxygen cylinder?

Bourdon-gauge flowmeter Signup and view all the answers

The partial pressure of oxygen in the alveoli is _ mm Hg, while the partial pressure of carbon dioxide in the alveoli is _ mm Hg.

104, 40 Signup and view all the answers

The main advantage of the Venturi mask is:

The use of its fine adjustment capabilities in long-term management Signup and view all the answers

Tidal volume is defined as the volume of air that:

Moves into or out of the lungs in a single breath Signup and view all the answers

Central chemoreceptors located in the medulla provide feedback to increase the rate and depth of breathing when they sense:

Slight increases in carbon dioxide or a decrease in pH of the cerebrospinal fluid Signup and view all the answers

You have inserted an oral airway and are ventilating an apneic woman with a bag-valve mask. She suddenly begins regurgitating large amounts of vomit. You should:

Roll her onto her side and remove the oral airway Signup and view all the answers

While providing CPAP to a patient in severe respiratory distress, you note that his heart rate has increased by 20 beats/min. He is conscious, but is no longer following verbal commands. You should:

Remove the CPAP device and ventilate him with a bag-valve mask Signup and view all the answers

Which of the following statements regarding breathing adequacy is correct?

Patients breathing shallowly may require assisted ventilation despite a normal respiratory rate Signup and view all the answers

You are ventilating an apneic woman with a bag-valve mask. She has dentures, which are tight-fitting. When you reassess the patency of her airway, you note that her dentures are now loose. You should:

Remove her dentures, resume ventilations, and assess for adequate chest rise Signup and view all the answers

How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?

It forces the alveoli open and pushes oxygen across the alveolar membrane Signup and view all the answers

The primary waste product of aerobic metabolism is:

Carbon dioxide Signup and view all the answers

As the single EMT managing an apneic patient's airway, the preferred initial method of providing ventilations is the:

Mouth-to-mask technique with a one-way valve Signup and view all the answers

The actual exchange of oxygen and carbon dioxide occurs in the:

Alveolar sacs Signup and view all the answers

The process of exchanging oxygen and carbon dioxide between the alveoli and the blood of the capillaries is called:

External respiration Signup and view all the answers

A nasopharyngeal airway is inserted:

With the bevel facing the septum if inserted into the right nare Signup and view all the answers

Inhalation occurs when the:

Diaphragm and intercostal muscles contract and cause a decrease in intrathoracic pressure Signup and view all the answers

Which of the following structures is contained within the mediastinum?

Esophagus Signup and view all the answers

Which of the following would NOT cause a decrease in tidal volume?

Deep respirations Signup and view all the answers

Which of the following patients should you place in the recovery position?

A 31-year-old semiconscious male with low blood sugar and adequate breathing Signup and view all the answers

Which of the following patients would MOST likely require insertion of an oropharyngeal airway?

A 40-year-old unconscious patient with slow, shallow respirations Signup and view all the answers

What is the alveolar minute volume of a patient with a tidal volume of 500 mL, a dead space volume of 150 mL, and a respiratory rate of 16 breaths/min?

5,600 mL Signup and view all the answers

Complications associated with using a manually triggered ventilation device include:

Lung tissue injury and gastric distention Signup and view all the answers

Proper technique for suctioning the oropharynx of an adult patient includes:

Suctioning while withdrawing the catheter from the oropharynx Signup and view all the answers

An oxygen cylinder should be taken out of service and refilled when the pressure inside it is less than:

500 psi Signup and view all the answers

Which of the following structures is NOT found in the upper airway?

Bronchus Signup and view all the answers

You and your partner are treating a 66-year-old man who experienced a sudden onset of respiratory distress. His oxygen saturation reads 80%. You should:

Assist his ventilations with a bag-valve mask Signup and view all the answers

The diaphragm is innervated by the __________ nerve, which allows it to contract.

phrenic Signup and view all the answers

In contrast to inhalation, exhalation:

Is a passive process caused by increased intrathoracic pressure Signup and view all the answers

A 51-year-old female presents with a sudden onset of difficulty breathing. Her respirations are 22 breaths/min and regular. You should:

Administer oxygen via a nonrebreathing mask Signup and view all the answers

In the presence of oxygen, the cells convert glucose into energy through a process called:

Aerobic metabolism Signup and view all the answers

Which of the following organs or tissues can survive the longest without oxygen?

Muscle Signup and view all the answers

Prior to applying a nonrebreathing mask to a patient, you must ensure that the:

Reservoir bag is fully inflated Signup and view all the answers

You and your partner are caring for a critically injured patient. After repositioning the mask several times, you are unable to effectively ventilate the patient. You should:

Begin ventilations using the mouth-to-mask technique Signup and view all the answers

A man was found unresponsive in his bed at home. The patient's face is cyanotic, yet the pulse oximeter reads 98%. Which of the following would MOST likely explain this?

Carbon monoxide poisoning Signup and view all the answers

Which of the following statements regarding oxygenation and ventilation is correct?

In carbon monoxide (CO) poisoning, ventilation is impaired because CO binds to oxygen very quickly Signup and view all the answers

Ventilation may continue despite adequate oxygenation in mines or confined spaces.

True Signup and view all the answers

Which of the following statements regarding oxygen is correct?

Oxygen supports the combustion process and may cause a fire. Signup and view all the answers

How should you manage the airway of a patient with severe head trauma who is unconscious?

Alternate 15 seconds of oral suctioning with 2 minutes of assisted ventilation. Signup and view all the answers

To select the proper size oropharyngeal airway, you should measure from the:

Corner of the mouth to the earlobe. Signup and view all the answers

A patient suspected of being hypoxic and breathing adequately should be given supplemental oxygen with a:

Nonrebreathing mask. Signup and view all the answers

With a good mask-to-face seal and an oxygen flow rate of 15 L/min, the nonrebreathing mask is capable of delivering up to ______% inspired oxygen.

90 Signup and view all the answers

Each cell of the body combines nutrients and oxygen and produces energy and waste products through a process called:

Metabolism. Signup and view all the answers

If ventilation is impaired, carbon dioxide levels in the bloodstream will increase. This condition is called:

Hypercarbia. Signup and view all the answers

The __________ cartilage is a firm ring that forms the inferior part of the larynx.

cricoid Signup and view all the answers

Your FIRST action should be to:

Log roll him as a unit to a supine position. Signup and view all the answers

Oxygen toxicity is a condition in which:

Cellular tissue damage occurs from excessive oxygen levels in the blood. Signup and view all the answers

What is the MOST common cause of airway obstruction in an unconscious patient?

The tongue. Signup and view all the answers

Your protocols state that during the first few minutes of working on a cardiac arrest patient, you should provide passive ventilation. This means that you will:

Allow recoil of the chest between compressions to draw air into the lungs. Signup and view all the answers

Irregular respirations characterized by an increasing rate and depth of breathing followed by periods of apnea are called:

Cheyne-Stokes respirations. Signup and view all the answers

The MOST significant complication associated with oropharyngeal suctioning is:

Hypoxia due to prolonged suction attempts. Signup and view all the answers

A 19-year-old female is found unconscious. As you insert an oropharyngeal airway, she begins to gag violently. You should:

Remove the airway and be prepared to suction her oropharynx. Signup and view all the answers

All of the following will help minimize the risk of gastric distention when ventilating an apneic patient with a bag-valve mask, EXCEPT:

Increasing the amount of delivered tidal volume. Signup and view all the answers

While eating dinner, your partner suddenly grabs his throat. He has a weak cough and faint stridor. You should:

Stand behind him and administer abdominal thrusts. Signup and view all the answers

Which of the following factors will cause a decreased minute volume in an adult?

Shallow breathing. Signup and view all the answers

You are ventilating a patient with a stoma; however, air is escaping from the mouth and nose. To prevent this, you should:

Seal the mouth and nose. Signup and view all the answers

Which of the following statements regarding positive-pressure ventilation is correct?

With positive-pressure ventilation, more volume is required to have the same effects as normal breathing. Signup and view all the answers

Which of the following is a late sign of hypoxia?

Cyanosis. Signup and view all the answers

Based on current guidelines, in which of the following situations should supplemental oxygen be administered?

Exposure to carbon monoxide and an oxygen saturation of 95%. Signup and view all the answers

The physical act of moving air into and out of the lungs is called:

Ventilation. Signup and view all the answers

The jaw-thrust maneuver is used to open the airway of patients with suspected:

Cervical spine injuries. Signup and view all the answers

You are performing mouth-to-mask ventilations with oxygen connected and set at a flow rate of 15 L/min. What percentage of oxygen is your patient receiving?

55%. Signup and view all the answers

Hypoxia is MOST accurately defined as:

Inadequate oxygen to the tissues and cells. Signup and view all the answers

When testing a mechanical suctioning unit, you should turn on the device, clamp the tubing, and ensure that it generates a vacuum pressure of more than:

300 mm Hg. Signup and view all the answers

The nasopharyngeal airway is MOST beneficial because it:

Can maintain a patent airway in a semiconscious patient with a gag reflex. Signup and view all the answers

Despite your attempts to coach a conscious young female's respirations, she continues to hyperventilate with a marked reduction in tidal volume. You should:

Explain to her that you will assist her ventilations. Signup and view all the answers

Which of the following statements regarding normal gas exchange in the lungs is correct?

Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries. Signup and view all the answers

Which of the following statements regarding the one-person bag-valve mask technique is correct?

Adequate tidal volume is often difficult to achieve when one EMT is operating the bag-valve mask. Signup and view all the answers

The purpose of the pin-indexing system for compressed gas cylinders is to:

Ensure that the correct regulator is used for the cylinder. Signup and view all the answers

Structures of the lower airway include all of the following, EXCEPT:

The epiglottis. Signup and view all the answers

Without adequate oxygen, the body's cells:

Incompletely convert glucose into energy, and lactic acid accumulates in the blood. Signup and view all the answers

A 37-year-old male has an apparent foreign body airway obstruction. He is conscious and alert and is coughing forcefully. What is the MOST appropriate treatment for this patient?

Encouraging him to cough and transporting. Signup and view all the answers

At a flow rate of 6 L/min, a nasal cannula can deliver an approximate oxygen concentration of up to:

44%. Signup and view all the answers

How does positive-pressure ventilation affect cardiac output?

It increases intrathoracic pressure, which decreases venous return to the heart and causes a decrease in cardiac output. Signup and view all the answers

Which of the following would cause an increase in the amount of exhaled carbon dioxide?

Increased cardiac output. Signup and view all the answers

The hypoxic drive is influenced by:

Low blood oxygen levels. Signup and view all the answers

The pressure of gas in a full cylinder of oxygen is approximately _______ pounds per square inch (psi).

2,000 Signup and view all the answers

You are ventilating a 40-year-old uninjured man who is apneic but has a pulse. When your partner reassesses his blood pressure, she notes that it has decreased significantly from previous readings. You should:

Reduce the rate or volume of the ventilations you are delivering. Signup and view all the answers

Which of the following is the MOST reliable indicator of adequately performed bag-valve mask ventilations in an apneic adult with a pulse?

Adequate rise of the chest when squeezing the bag. Signup and view all the answers

Which of the following patients is breathing adequately?

A conscious male with respirations of 19 breaths/min and pink skin. Signup and view all the answers

CPAP is indicated for patients who:

Have pulmonary edema and can follow verbal commands. Signup and view all the answers

Study Notes

Airway Management Key Concepts

When an unconscious patient is found in a prone position, they must be quickly repositioned supine to facilitate CPR, especially if they may vomit or regain consciousness.
Gas exchange in the lungs relies on adequate amounts of surfactant, which prevents alveoli from collapsing and supports optimal gas exchange.
Using a nasopharyngeal airway on a trauma patient carries risks, primarily of penetrating the cranium, which can be life-threatening.
Intrapulmonary shunting refers to unoxygenated blood bypassing nonfunctional alveoli, leading to decreased oxygenation in the body.
For a semiconscious patient with slow and shallow respirations after vomiting, immediate oropharyngeal suctioning is critical.
A nasal cannula is best for patients who cannot tolerate a nonrebreathing mask and is typically used for low to moderate oxygen supplementation.
A ventilation/perfusion (V/Q) mismatch indicates that blood flow disruption occurs even when alveoli are filled, impairing gas exchange.
Wheezing during breath sounds signifies a lower airway obstruction and may indicate conditions like asthma or pulmonary edema.
The head tilt-chin lift maneuver is most suitable for an unconscious patient without head trauma, ensuring a clear airway.
Rapid, shallow breathing results primarily in air movement through anatomical dead space, limiting effective gas exchange.
Bourdon-gauge flowmeters are unique as they function regardless of gravity, making them versatile for oxygen delivery.
The partial pressure of oxygen in the alveoli is 104 mm Hg, while the carbon dioxide level is 40 mm Hg, highlighting gas exchange efficiency.
The Venturi mask allows precise adjustment of inspired oxygen percentages, particularly beneficial for stable patients over time.
Tidal volume is defined as the air volume exchanged during a single breath, essential for assessing ventilation.
Central chemoreceptors react to slight carbon dioxide increases or pH decreases in cerebrospinal fluid, triggering deeper and more rapid breathing.
For an apneic patient who begins to regurgitate during ventilation, rolling them onto their side and removing the airway ensures safety.
Increased heart rate and decreased responsiveness during CPAP treatment warrant transitioning to bag-valve mask ventilation quickly.
Patients with shallow breathing may require assisted ventilation even with a normal respiratory rate, as minute volume may be inadequate.
In cases with dentures in place, loose fittings should be prioritized by removing them and resuming ventilations for effective airway management.
CPAP improves oxygenation by forcing open the alveoli, facilitating oxygen transfer into the blood.
Carbon dioxide is the primary waste product of aerobic metabolism, highlighting its role in energy production.
The preferred method of ventilation for an apneic patient by a single EMT is using a mouth-to-mask technique for efficiency and safety.
The exchange of gases occurs in the alveolar sacs, while external respiration describes the process of gas exchange between alveoli and pulmonary capillaries.
A nasopharyngeal airway is inserted with the bevel facing the septum, ensuring proper alignment for airway patency.
Inhalation occurs when the diaphragm and intercostal muscles contract, creating negative intrathoracic pressure.
The esophagus is located within the mediastinum, distinguishing it from upper airway structures.
Deep respirations do not decrease tidal volume, which is vital for effective ventilation strategies.
The recovery position is appropriate for semiconscious patients with adequate breathing, ensuring airway protection.
An oropharyngeal airway is necessary for an unconscious patient with slow, shallow respirations to maintain airway patency.
Alveolar minute volume calculation takes into account both tidal volume and dead space volume factors.
Using a manually triggered ventilation device can cause lung injury and gastric distention if not correctly managed.
Proper oropharyngeal suctioning involves withdrawing the catheter while suctioning rather than continuous suctioning.
Oxygen cylinders should be refilled when pressure drops below 500 psi to ensure adequacy in emergencies.
The bronchus is not part of the upper airway; it belongs to the lower respiratory system.
For a patient experiencing severe respiratory distress, assisting with bag-valve mask ventilation is crucial for adequate oxygen delivery.
The diaphragm is primarily innervated by the phrenic nerve, facilitating its contraction during breathing.
Exhalation is a passive process derived from increased intrathoracic pressure rather than an active muscular effort.
Proper oxygen delivery requires that a nonrebreathing mask’s reservoir bag is fully inflated before administration.
In the context of poisoning (like carbon monoxide), adequate oxygen saturation may mask underlying hypoxia issues.
Ventilation may continue even with good oxygenation in environments with low oxygen levels, emphasizing the distinction between both processes.
Oxygen is a fire supporter; safety protocols must always be followed during administration in any setting.
Managing airway for severe head trauma includes alternating suctioning and assisted ventilation to clear secretions effectively.
Selecting the right size for an oropharyngeal airway involves measuring from the corner of the mouth to the earlobe.
A nonrebreathing mask is the preferred method for delivering supplemental oxygen to a hypoxic patient with adequate breathing.### Oxygen Delivery and Ventilation
A nonrebreathing mask can deliver up to 90% inspired oxygen at an oxygen flow rate of 15 L/min.
The process of combining nutrients and oxygen to produce energy and waste products is called metabolism.
Hypercarbia refers to elevated carbon dioxide levels in the bloodstream due to impaired ventilation.
Cricoid cartilage forms the lower part of the larynx, providing structural support.

Emergency Response Protocols

In an unconscious patient found in a prone position, the first action should be to log roll him to a supine position.
Oxygen toxicity damages cellular tissue from excessive oxygen levels in the blood.
The most common cause of airway obstruction in an unconscious patient is the tongue.

Ventilation Techniques

Passive ventilation during cardiac arrest involves allowing chest recoil to draw air into the lungs.
Cheyne-Stokes respirations are characterized by alternating periods of increasing and decreasing respirations.
Hypoxia during suctioning may result from prolonged suction attempts causing low oxygen levels.

Airway Management

If a patient gags during the insertion of an oropharyngeal airway, it should be removed and suctioning performed.
Gastric distention during bag-valve mask ventilation can be minimized by not increasing tidal volume.
Back blows and abdominal thrusts are used for conscious patients with foreign body airway obstruction.

Respiratory Mechanics

Shallow breathing decreases minute volume in adults.
Sealing the mouth and nose is necessary when ventilating a patient with a stoma to prevent air escape.
Positive-pressure ventilation requires more volume to achieve the same effects as normal breathing.

Hypoxia and Gas Exchange

Cyanosis is a late sign of hypoxia, indicating significant oxygen deficiency.
Supplemental oxygen is warranted under specific conditions, like carbon monoxide exposure with low saturation rates.
Ventilation refers to the act of moving air into and out of the lungs.

Advanced Techniques and Equipment

The jaw-thrust maneuver is critical for patients with suspected cervical spine injuries.
A mouth-to-mask technique provides 55% oxygen when set up correctly with oxygen flow at 15 L/min.
Mechanical suctioning units should generate a vacuum pressure of more than 300 mm Hg for effective suctioning.

Response to Altered Breathing

Nasopharyngeal airways are useful in maintaining airflow in semi-conscious patients with a gag reflex.
Inadequate oxygen leads to incomplete glucose metabolism and lactic acid accumulation in cells.
Encouraging a conscious, alert patient with foreign body obstruction to cough is the appropriate response.

Oxygen Concentrations and Delivery

A nasal cannula at a flow rate of 6 L/min can deliver approximately 44% oxygen concentration.
Positive-pressure ventilation increases intrathoracic pressure, which may lead to decreased cardiac output.
Increased cardiac output results in higher levels of exhaled carbon dioxide, indicating active metabolism.

Hypoxic Drive and Gas Cylinder Safety

The hypoxic drive is primarily influenced by low blood oxygen levels.
Full oxygen cylinders roughly contain 2,000 psi, highlighting the need for safety protocols.
Care should be taken to reduce ventilation rates if blood pressure drops significantly during rescue efforts.

Indicators of Effective Ventilation

Adequate rise of the chest when squeezing the bag is the most reliable indicator of effective bag-valve mask ventilation.
A conscious male with normal respiratory rates and pink skin demonstrates adequate breathing, unlike patients with distress signs.
CPAP therapy is indicated for patients with pulmonary edema who are alert and following commands.

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Test your knowledge on airway management concepts with these flashcards. This quiz covers essential topics related to patient positioning, gas exchange, and the required actions in emergency situations. Ensure you grasp the critical aspects of airway management effectively.