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FISDAP Paramedic Airway Practice Exam With Answers (184 Solved Questions)

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! Appropriate airway management - Answer *Steps must be performed in order. Bypass steps that do not apply.* a. Open and maintain a patent airway. b. Recognize and treat airway obstructions. c. Assess ventilation and oxygenation status. d. Administer supplemental oxygen. e.Provide ventilatory assistance. Upper airway - Answer Consists of all anatomic airway structures above the glottic opening. *1. Tongue* a. Must be manipulated b. Tends to fall back into the posterior pharynx in unresponsive patient *2. Pharynx* a. Muscular tube that extends from the nose and mouth to the esophagus and trachea b. Composed of: i. Nasopharynx ii. Oropharynx iii. Laryngopharynx (hypopharynx) Lower airway - Answer Extends from the glottis to the pulmonary capillary membr ane. 1. *Larynx* 2. *Thyroid cartilage* 3. *Cricoid cartilage (cricoid ring)* 4. *Cricothyroid membrane* 5. *Glottis* 6. *Trachea* 1. Larynx - Answer - Complex structure formed by many independent cartilaginous structures - Marks where the upper airway ends and lower airway begins 2. Thyroid cartilage - Answer - Shield - shaped structure formed by two plates that join in a "V" shape anteriorly to form the laryngeal prominence i. Known as the Adam's apple ii. More pronounced in men iii. Can be difficult to locate in obese or short - necked patients - Suspended from the hyoid bone by the thyroid ligament - Directly anterior to the glottic opening 3. Cricoid cartilage (cricoid ring) - Answer - Lies inferiorly to the thyroid cartilage - Forms the lowest portion of t he larynx - More prominent in females 4. Cricothyroid membrane - Answer - Located between the thyroid and cricoid cartilage

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! - Site for emergency surgical and nonsurgical access to the airway - Bordered laterally and inferiorly by the highly vascular thyroid g land 5. Glottis - Answer - Narrowest portion of the adult airway - Vocal cords are located at the lateral borders of the glottis. - Epiglottis is located at the superior border of the glottis. - ET intubation requires visualizing the epiglottis, glottis, and vocal cords before inserting the ET tube. 6. Trachea - Answer - Immediately descends into the thoracic cavity - Not a straight tube, which is key to understand when placing an ET tube The respiratory and cardiovascular systems work together to ensure that: - Answer 1. A constant supply of oxygen and nutrients is delivered to every cell. 2. Waste products are removed from every cell. Ventilation - Answer - Physical act of moving air into and out of the lungs 1. *Inhalation* is the active, muscular part of breathing. 2. *Exhalation* is a passive process and does not normally require muscular effort. Oxygenation - Answer - Process of loading oxygen molecules onto hemoglobin molecules in the bloodstream - Requires adequate *FiO2 (Percentage of oxygen in inhaled air)* Respiration - Answer - Process of exchanging O2 and CO2 -- > 1. *External respiration (Also called pulmonary respiration)*: Process of exchanging O2 and CO2 between the alveoli and blood in pulmonary capillaries. 2. *Internal respiration (Also called cellular respiration)*: Exchange of O2 and CO2 between the systemic circulation and the body's cells. Pathophysiology of Respiration - Answer - Multiple conditions can inhibit the body's ability to effectively provide oxygen to cells. 1. Disruption of pulm onary ventilation, oxygenation, and respiration will cause immediate effects on the body. a. Must be recognized and corrected immediately b. Important to distinguish a primary ventilation problem from a primary oxygenation or respiration problem 2. Every cell needs a constant supply of oxygen to survive. a. Some tissues are more resilient than others. b.Sufficient levels of external respiration and perfusion are required. 3. Hypoxia, ventilation - perfusion ratio and mismatch, factors affecting ventilation, factors affecting oxygenation and respiration, and acid - base balance. 1. Hypoxia - Answer Tissues and cells do not receive enough oxygen -- > Death may occur quickly if not corrected.

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! - Varying signs and symptoms a. Onset and degree of tissue damage ofte n depend on the quality of ventilations. b. Early signs include restlessness, irritability, apprehension, tachycardia, and anxiety. c. Late signs include mental status changes, a weak pulse, and cyanosis. d. Responsive patients often report dyspnea and may not be able to speak in complete sentences. - Best to administer oxygen before signs and symptoms appear 2. Ventilation - perfusion ratio and mismatch - Answer - Air and blood flow must be directed to the same place at the same time (ventilation and perfusion must be matched). - Failure to match ventilation and perfusion (V/Q mismatch) lies behind most abnormalities in oxygen and carbon dioxide exchange. - In most people, normal resting minute ventilation is approximately 6 L/min. a. Resting alveolar volume: Approximately 4 L/min b. Pulmonary artery blood flow: Approximately 5 L/min c. Overall ratio of ventilation to perfusion: 4:5 L/min, or 0.8 L/min - Because neither ventilation nor perfusion is distributed equally, both are distributed to dependent regions of the lungs at rest. However, an increase in gravity - dependent flow is more marked with perfusion than with ventilation. -- > Ratio of ventilation to perfusion is highest at the apex of the lung and lowest at the base. - When ventilation is comprom ised but perfusion continues: a. Blood passes over alveolar membranes without gas exchange. b. CO2 is recirculated into the bloodstream. i. Results in V/Q mismatch ii. Could lead to severe hypoxemia if not recognized and treated - When perfusion across the alveolar membrane is disrupted: a. Less O2 is absorbed into the bloodstream; less CO2 is removed (V/Q mismatch). b. Can lead to hypoxemia -- > Immediate intervention is needed to prevent further damage or death. 3. Factors affecting ventilation - Answer A patent airway is critical for the provision of O2 to tissues. Intrinsic and extrinsic factors can cause airway obstruction. *1. Intrinsic factors*: infection, allergic reactions, and unresponsiveness. a. The tongue is the most common obstruction in an un responsive patient. b. Some factors are not necessarily directly part of the respiratory system. Ex... i. Interruptions in the central and peripheral systems. ii. Medications that depress the central nervous system. iii. Trauma to the head and spinal cord. iv. Neuromuscular disorders.

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! v. Neuromuscular blocking agents. c. Allergic reactions i. Swelling (angioedema) can obstruct the airway. ii. Bronchoconstriction can decrease pulmonary ventilation. *2. Extrinsic factors*: trauma and foreign body airway obstruction. a. Trauma to the airway or chest -- > Requires immediate evaluation and intervention b. Blunt or penetrating trauma and burns can disrupt airflow through the trachea and into the lungs -- > Quickly res ults in oxygenation deficiencies c. Trauma to the chest wall can lead to inadequate pulmonary ventilation. Example: A patient with numerous rib fractures or a flail chest may purposely breathe shallowly in an attempt to alleviate pain from the injury (Res piratory splinting) -- > Can result in decreased pulmonary ventilation **Proper ventilatory support is crucial. *3. Hypoventilation & Hyperventilation* - *a. Hypoventilation*: occurs when CO2 production exceeds CO2 elimination. *b. Hyperventilation* occu rs when carbon dioxide elimination exceeds carbon dioxide production. -- > Hypoventilation and hyperventilation could represent the body's attempt to compensate for various abnormal conditions. For example, if the pH of the blood alkalotic, the patient's br eathing may become slow or shallow in an attempt to retain CO2 to decrease the pH< -- *4. Hypercarbia & Hypocarbia*: a. Decrease in minute volume decreases CO2 elimination -- > Results in buildup of CO2 in the blood (*hypercarbia*) b. Increase in minute volume increases CO2 elimination -- > Lowers CO2 in the blood (*hypocarbia*) 4. Factors affecting oxygenation and respiration - Answer *1. External factors:* a. External factors in ambient air. Examples: Atmospheric pressure, partial pressure of oxygen -- > At high altitudes, the percentage of oxygen remains the same, but partial pressure decreases because total atmospheric pressure decreases. -- > Closed environments may also have decreases in ambient oxygen. Examples: Mines and trenches b. Toxic gases displace oxygen in the environment. -- > CO inhibits the proper transport of oxygen to tissues *2. Internal factors:* a. Conditions that reduce the surface area for gas exchange also decrease the body's oxygen supply. b. Medical conditions may also decrease surface area of the alveoli by damaging them or by leading to an accumulation of fluid in the lungs. c. Nonfunctional alveoli inhibit the diffusion of oxygen and carbon dioxide -- > Called intrapulmonary shunting d. Submersion victims and patients with pulmonary edema have fluid in the alveoli -- > i. Inhibits adequate gas exchange at the alveolar membrane

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! ii. Results in decreased oxygenation and respiration iii. Exposure to certain environmental conditions or occupational hazard s. Examples: High altitudes, epoxy resins iv. Can result in anaerobic respiration and an increase in lactic acid accumulation. e. Other conditions that affect cells include: i. Hypoglycemia -- > Oxygen and glucose levels decrease ii. Infection -- > Increase s metabolic needs, disrupts homeostasis iii. Hormonal imbalances: If insulin levels decrease, cellular uptake of glucose will decrease -- > Results in ketoacidosis. *3. Circulatory compromise* a. Leads to inadequate perfusion; oxygen demands will not be me t. b. Obstruction of blood is typically related to trauma emergencies, including: i. Simple or tension pneumothorax ii. Open pneumothorax iii. Hemothorax iv. Hemopneumothorax v. Pulmonary embolism c. Inhibits gas exchange at the tissue level. d. Conditions such as heart failure and cardiac tamponade inhibit the heart's ability to effectively pump oxygenated blood to the tissues. e. Blood loss and anemia reduce the oxygen - carrying ability of the blood. f. Shock - oxygen is not delivered to cells efficiently. i. Hemorrhagic shock ii. Vasodilatory shock iii.Both forms of shock result in poor tissue perfusion that leads to anaerobic metabolism. 5. Acid - base balance - Answer *Hypoventilation, hyperventilation, and hypoxia can disrupt the acid - base balance* -- > May lead to rapid deterioration and death. - Respiratory and renal systems help maintain homeostasis (Tendency toward stability in the body's internal environment): Requires a balance between acids and bases. -- > Fastest way to eliminate excess acid is thr ough the respiratory system. (a) Can be expelled as carbon dioxide from the lungs (b) Slowing respirations will increase the level of carbon dioxide. - Anything that inhibits respiratory function can lead to acid retention and acidosis. - Alkalosis can dev elop if the respiratory rate is too high (or the volume too much). a. Four main clinical presentations of acid - base disorders: 1. Respiratory acidosis: Fluctuations in pH due to respiratory disorders result in respiratory acidosis or alkalosis. 2. Respiratory alkalosis 3. Metabolic acidosis: Fluctuations in pH due to available bicarbonate result in metabolic acidosis or alkalosis. 4. Metabolic alkalosis

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! Patient Assessment: Airway Evaluation - Answer The importance of carefully assessing a patient's airway and ventilatory status cannot be overemphasized. - The quality of your assessment determines the quality of care. Assessing airway patency - Answer 1. Determine if patient's airway is patent -- > An unresponsive patient has a compromised airway unti l that is ruled out by a careful assessment. 2. Signs of airway compromise in an unresponsive patient include: a. Snoring b. Vomitus draining from the mouth c. Gurgling sound heard during breathing 3. Secretions pooling in the patient's mouth indicate a ma rkedly depressed or absent gag reflex -- > Absence significantly increases risk of aspiration. Recognizing adequate breathing - Answer 1. An adult who is responsive, alert, and able to speak. 2. Normal breathing in an adult at rest is characterized by: i. Rate between 12 and 20 breaths/min ii. Adequate depth (tidal volume) iii. Regular pattern of inhalation and exhalation iv. Clear and equal breath sounds bilaterally 3. Changes in rate and regularity should be subtle. Recognizing inadequate breathing - Ans wer Breathing does not necessarily mean adequate breathing. ** General rule: If you can see or hear a patient breathe, there is a problem.** Inadequate Breathing - Answer 1. An adult who is breathing at a rate of less than 12 breaths/min or more than 20 b reaths/min must be evaluated for other signs of inadequate ventilation, such as: a. Shallow breathing b. Irregular pattern of breathing c. Altered mentation d. Adventitious airway sounds 2. Cyanosis is a clear indicator of low blood oxygen. 3. Preferential positioning -- > a. Upright sniffing (tripod) position; b. Semi - Fowler position. Potential Causes of Inadequate Breathing - Answer a. Severe infection (sepsis) b. Trauma c. Brainstem insult d. Noxious or oxygen - poor environment e. Renal failure f. Upper a nd/or lower airway obstruction g. Respiratory muscle impairment h. Central nervous system impairment Proper Airway Management - Answer *Follow steps IN ORDER:*

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! a. Open the airway b. Clear the airway c. Assess breathing d. Provide appropriate intervention(s) Airway Evaluation - Answer - Evaluation includes visual observations, palpation, and auscultation. - Visual techniques: 1. Patient position (ex. tripod position) 2. Experiencing orthopnea 3. Adequate rise and fall of the chest 4. Patient ga sping for air 5. Skin: i. Color ii. Moist or clammy f. Nostrils flaring 6. Breathing through pursed lips 7. Retractions: i. Intercostal ii. At the suprasternal notch iii. At the supraclavicular fossa iv. Subcostal 8. Accessory muscle use 9. Asymmetric ches t wall movement 10. Patient taking a series of quick breaths, followed by prolonged exhalation Labored breathing - Answer - May involve the use of accessory muscles i. Sternocleidomastoid ii. Chest pectoralis major iii. Abdominal Signs of inadequate ventilation - Answer a. Respiratory rate of fewer than 12 breaths/min or more than 20 breaths/min in the presence of dyspnea b. Irregular rhythm c. Diminished, absent, or noisy breath sounds d. Abdominal breathing e. Reduced flow of exh aled air at the nose and mouth f. Unequal or inadequate chest expansion g. Increased effort of breathing h. Shallow depth of breathing i. Pale, cyanotic, cool, moist, or mottled skin j. Retractions k. Staccato speech patterns (one - or two - word dyspnea) Pulsus Paradoxus - Answer Systolic blood pressure drops more than 10 mm Hg during inhalation -- > May detect a change in pulse quality or even the disappearance of a pulse during inhalation

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! - Generally seen in patients with conditions that cause an increase in intrathoracic pressure; such as: i. Decompensating COPD ii. Severe pericardial tamponade iii. Tension pneumothorax iv. Severe asthma attack Ask questions to determine the evolution of the current problem: - Answer a. Onset sudden or gradual? b. Known c ause or "trigger"? c. Duration: Constant or recurrent? d. Does anything alleviate or exacerbate the problem? e. Other symptoms, such as a productive cough (color of sputum), chest pain or pressure, or fever? f. Any interventions attempted before EMS arrival? g. Has the patient been evaluated by a physician or admitted to the hospital for this condition in the past? i. Was the patient hospitalized or seen in the emergency department and released? ii. If hospitalized, admitted to intensive care (clinica lly significant) or a regular, unmonitored floor? h. Is the patient currently taking any medications? If so, determine overall compliance by asking: i. Have you been able to take all of your pills as directed? ii. Is there anything that has stopped you fro m taking your pills as directed? iii. Is there something that bothers you about taking a certain pill? iv. Look at the prescription date and directions to verify information. v. Were there any changes in the current prescription, such as a new medication o r changes in the prescribing directions of an existing medication? i. Any risk factors that could cause or exacerbate the condition Reflexes of the Airway - Answer Coughing, sneezing, and gagging Sighing - Answer A slow, deep inhalation followed by a pro longed exhalation - Periodically hyperinflates the lungs, thereby reexpanding atelectatic alveoli - Average person sighs about once per minute. Hiccupping - Answer A sudden inhalation, due to spasmodic contraction of the diaphragm, cut short by closure of t he glottis - Serves no physiologic purpose - Persistent hiccups may be clinically significant. Breath sounds - Answer *1. Tracheal breath sounds (bronchial breath sounds)*: Heard by placing the stethoscope diaphragm over the trachea or sternum. - Assess for duration, pitch, and intensity. *2. Vesicular breath sounds:* Softer, muffled sounds - Heard in the expiratory phase: Barely audible *3. Bronchovesicular sounds:* Combination of the two - Heard in places where airways and alveoli are found

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! - Should be assessed for duration, pitch, and intensity Assessment of Breath Sounds - Answer Auscultate breath sounds with a stethoscope. - Should be clear and equal on both sides of the chest, anteriorly, and posteriorly - Compare each apex of the lung with the opposi te apex and each base of the lung with the opposite base. - Remember: 1. Breath sounds are created as air moves through the tracheobronchial tree. a. Size of the airway determines the type of sound. b. Breath sounds: Heard over the majority of the chest, re present airflow into alveoli 2. Duration: Length of time for the inspiratory and expiratory phase of the breath 4. Pitch is described as higher or lower than normal (stridor or wheezing). 5. Always auscultate directly on skin. 6. Sounds that are present in an unexpected area can indicate an abnormal condition. 7. Adventitious breath sounds: Usually classified as continuous or discontinuous. Duration of Breath - Answer a. Normally, expiration is at least twice as long as inspiration: Relationship is express ed by I/E ratio (inspiratory/expiratory ratio) -- > I/E ratio is 1:2. b. When the lower airway is obstructed, expiratory phase may be four to five times as long as inspiration -- > I/E ratio is 1:4 or 1:5. c. In patients who are tachypneic, the expiratory phase is short and approaches that of inspiration -- > I/E ratio may be 1:1. Pitch of Sound - Answer Described as higher or lower than normal (stridor or wheezing) - Intensity of sound depends on: a. Airflow rate b. Constancy of flow throughout inspiration c. Patient position/Site selected for auscultation - Less intense sounds are said to be diminished. Adventitious Breath Sounds - Answer Adventitious breath sounds: Usually classified as continuous or discontinuous. *a. Wheezing* *b. Rhonchi* *c. Crackles (formerly known as rales)* *d. Stridor* *e. Pleural friction rub* a. Wheezing - Answer High - pitched sound that may be heard on inspiration, expiration, or both.

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! b Rhonchi - Answer Continuous, low - pitched sounds -- > Indicate mucus or fluid in larger lower airways c. Crackles (formerly known as rales) - Answer Occur when airflow causes mucus or fluid in the airways to move in the smaller lower airways -- > Tend to clear with coughing - May also be heard when collapsed airways or alveoli pop ope n - Discontinuous sounds - May occur early or late in the inspiratory cycle 1. Early inspiratory crackles -- > Usually occur when larger, proximal bronchi open. Common in patients with COPD. Tend NOT to clear with coughing. 2. Late inspiratory crackles -- > Occur when peripheral alveoli and airways pop open. More common in dependent lung regions. d. Stridor - Answer Loud, high - pitched sound typically heard during inspiration. - Results from foreign body aspiration, infection, swelling, disease, or trauma within or immediately above the glottic opening e. Pleural Friction Rub - Answer Results from inflammation that causes the pleura to thicken -- > Surfaces of the visceral and parietal pleura rub together. - Often creates stabbing pain with breathing or any movement of the thorax Pulse oximetry - Answer Measures the percentage of hemoglobin (Hb) in arterial blood that is saturated with oxygen. a. A sensor probe transmits light through the vascular bed to a light - sensing detector -- > Amount of light depends on the proportion of hemoglobin that is saturated with oxygen. b. To ensure that the instrument is measuring arterial and not venous oxygen saturation, pulse oximeters assess only pulsating blood vessels. c. Also measure pulse -- > Check device functioning by comparing its pulse reading with the patient's palpated pulse Oximetry Reading - Answer A normally oxygenated, normally perfused person should have an Spo2 of greater than 95% while breathing room air. a. Less than 95% in a nonsmoker suggests hypoxemia. b. Less than 90% signals a need for aggressive oxygen therapy. Oximetry Uses - Answer May be useful in the following prehospital situations: a. Monitoring the oxygenation status of a patient during an intubation attempt or during suct ioning b. Identifying deterioration in the condition of a trauma victim c. Identifying deterioration in the condition of a patient with cardiac disease d. Identifying high - risk patients with respiratory problems e. Assessing vascular status in orthopedic t rauma i. Use with a fractured extremity to evaluate the pulse distal to the fracture. ii. Loss of a pulse means that the limb may require urgent action in the field. iii. A pulse oximeter clipped to a finger or toe on a broken limb might provide informatio n about circulation to the limb.

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! Circumstances that might produce erroneous oximetry readings: - Answer 1. Bright ambient light -- > May enter the spectrophotometer and create an incorrect reading -- > Cover the sensor clip with a towel or aluminum foil to protect it. 2. Patient motion 3. Poor perfusion -- > If the vessels in a patient's limbs are constricted and the limbs are cold, you may need to place the clip on the earlobe or nose. 4. Nail polish 5. Venous pulsations occurring with right - sided heart fai lure 6. Abnormal hemoglobin 7. Normal Spo2 values may be observed in the presence of methemoglobin and carboxyhemoglobin even though the body is not receiving sufficient oxygen. a. Methemoglobin (metHb): Formed by oxidation of the iron on hemoglobin b. Car boxyhemoglobin (COHb): Hemoglobin loaded with CO Two types of hemoglobin normally found: - Answer *a. Oxyhemoglobin (HbO2)*: Hemoglobin that is occupied by oxygen *b. Reduced hemoglobin*: Hemoglobin after oxygen has been released to cells CO - oximeter, or CO monitor - Answer Measures absorption at several wavelengths to distinguish Hbo2 from COHb. - Determines HbO2 saturation (percentage of oxygenated Hb compared with the total amount of hemoglobin) including COHb, metHb, HbO2, and reduced Hb . Peak Expiratory Flow Measurement - Answer - Bronchoconstriction can be evaluated by measuring the peak rate of a forceful exhalation with a peak expiratory flowmeter: a. Increasing peak expiratory flow: Suggests patient is responding to treatment. b. Decreasing peak expiratory flow: Suggests patient's condition is deteriorating. - Varies based on gender, height, and age -- > Healthy adults have a peak expiratory flow rate of 350 to 750 mL. - To assess peak expiratory flow: 1. Place the patient in a seated position with legs dangling. 2. Assemble the flowmeter. 3. Ensure that it reads zero. 4. Ask the patient to take a deep breath, place the mouthpiece in his or her mouth, and exhale as forcefully as possible (make sure there are no air leaks). 5. Perform t he test three times. 6. Take the best peak flow rate of the three readings. Arterial blood gas analysis - Answer 1. Most comprehensive quantitative information about the respiratory system 2. Blood is obtained from a superficial artery. 3. Blood is analyz ed for pH, Paco2, PaO2, Hco3−, base excess (indicating acidosis or alkalosis), and Sao2. a. pH and Hco3− are used to evaluate a patient's acid - base status. b. Paco2 indicates the effectiveness of ventilation.

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! c. PaO2 and Sao2 are indicators of oxygenation. End - tidal carbon dioxide (ETCO2) assessment - Answer ETCO2 monitors detect carbon dioxide in exhaled air -- > Adjuncts for determining ventilation adequacy - Types of monitors include colorimetric, digital, and digital/waveform. Colorimetric - Answer Provides qualitative (does not assign a numeric value) information regarding the presence of carbon dioxide in exhaled breath - After 6 to 8 positive pressure breaths, paper inside the detector should turn from purple to yellow during exhalation -- > Indicat es the presence of exhaled carbon dioxide - Should be used during initial confirmation of ET tube placement and replaced as soon as possible with a quantitative device - Sensitive to temperature extremes and humidity i. May be less reliable if vomitus or oth er secretions get into it ii. Paper inside degrades over time. Capnometer - Answer Displays a numeric reading of exhaled carbon dioxide. -- > More reliable than the colorimetric co2 detector Capnography - Answer Provides a graphic representation of exhale d carbon dioxide. - Capnography can indicate chest compression effectiveness and detect return of spontaneous circulation. - Two types: 1. Waveform capnography: Provides real - time information and displays a graphic waveform -- > Many portable cardiac monito r/defibrillators provide a numeric reading and a waveform (digital/waveform capnography). 2. Quantitative waveform capnography: Detection of bronchospasm, hypoventilation, and hyperventilation -- > Recommended method of monitoring initial and ongoing placem ent of an advanced airway device. - Uses of waveform capnography in the nonintubated patient: i. Assess the severity of asthma, COPD, or any pathologic process that causes pulmonary air trapping ii. Gauge the effectiveness of treatment - If inadvertent extubation occurs, then you would expect to see a complete loss of a capnographic waveform and etco2 reading. - On occasion, the sampling tubing from the in - line adaptor to the cardiac monitor/defibrillator gets obstructed with blood or other debris, block ing the flow of gas to the sensor and "zeroing out" the waveform and etco2 reading. -- > Replace the in - line adaptor to restore the waveform and etco2 reading.

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! Carbon Dioxide (CO2) - Answer - Carbon dioxide concentration in exhaled gases: 35 - 45 mm Hg - Typically, etco2 is approximately 2 to 5 mm Hg lower than arterial Paco2. - ETCO2 monitoring is limited with cardiac arrest: a. In a patient with a short arrest interval, exhaled carbon dioxide may be detected despite a lack of perfusion. b. Patients with prolonged cardiac arrest will have minimal to no exhaled carbon dioxide because of severe acidosis and minimal or no carbon dioxide return to the lungs. Normal Capnographic Waveform - Answer - Key features: i. Contour ii. Baseline level iii. Rate and rise of the carbon dioxide level - Four distinct phases: *i. Phase I (A - B):* Known as the respiratory baseline, initial stage of exhalation. *ii. Phase II (B - C):* Expiratory upslope. *iii. Phase III (C - D):* Expiratory or alveolar plateau. *iv. Phase IV (D - E):* Inspiratory downstroke. - The duration (width) of each waveform corresponds to the duration of ventilation, and the space between waveforms corresponds with the patient's respiratory rate. Abnormal Capnographic Waveforms - Answer - Shape of the capnographi c waveform can provide information about: 1. Hypoventilation 2. Hyperventilation 3. Bronchospasm 4. Rebreathing 5. Inadvertent extubation 1. Hypoventilation - Answer - Waveforms are tall and the etco2 value is correspondingly high (greater than 45 mm Hg) . - Bradypnea produces a prolonged alveolar plateau (phase III [C - D]) and longer - than - normal intervals between waveforms. 2. Hyperventilation - Answer - Waveforms are small and the etco2 value is correspondingly low (less than 35 mm Hg). - Tachypnea produces a short alveolar plateau (phase III [C - D]) and shorter - than - normal intervals between waveforms. Uses of waveform capnography in the nonintubated patient: - Answer 1. Assess the severity of asthma, COPD, or any pathologic process that causes pulm onary air trapping 2. Gauge the effectiveness of treatment

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! Airway Management - Answer Air reaches the lungs only through the trachea, so a patent airway is essential. - In a compromised airway, clearing the airway and maintaining patency are vital. 1. Posi tion the patient 2. Use manual airway maneuvers Positioning the patient - Answer Unresponsive patients found in a prone position must be positioned in a supine position. a. Log roll the person as a unit. b. Once the patient is supine, quickly assess for b reathing by visualizing the chest for visible movement. c. If the patient is breathing adequately and is not injured, move to recovery position (Left lateral recumbent position): -- > Use in all nontrauma patients with decreased LOC who can maintain their airway spontaneously and are breathing adequately. Manual airway Maneuvers - Answer - If an unresponsive patient has a pulse but is not breathing open the airway manually. - The most common cause of airway obstruction in an unresponsive patient is the tongue. - Maneuvers: 1. head tilt, chin - lift maneuver 2. jaw thrust maneuver 3. Tongue - jaw Lift maneuver Head tilt - chin lift maneuver - Answer - Preferred technique with a patient who has not sustained trauma - Occasionally, the patient will resume breathing with this technique alone. - Considerations: *1. Indications* a. Unresponsive patient b. No mechanism for cervical spine injury c. Patient is unable to protect his or her own airway. *2. Contraindications* a. Responsive patient b. Possible cervical spine injury *3. Advantages* a. No equipment required b. Noninvasive *4. Disadvantages* a. Hazardous to patients with spinal injury b. No protection from aspiration - Technique

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    Paramedic Airway FISDAP Review Part 1 Rated 100% Correct!! i. With the patient in a supine po sition, position yourself beside the patient's head. ii. Place one hand on the patient's forehead, and apply firm backward pressure with your palm to tilt the patient's head back. iii. Place the tips of your fingers of your other hand under the lower jaw n ear the bony part of the chin. Do not compress the soft tissue under the chin because this action may block the airway. iv. Lift the chin upward, bringing the entire lower jaw with it, helping to tilt the head back. Do not use your thumb to lift the chin. Lift so that the teeth are nearly brought together, but avoid closing the mouth completely. Continue to hold. Jaw - thrust maneuver - Answer - Use if you suspect a cervical spine injury. - Considerations: *1. Indications* a. Unresponsive patient b. Possible cervical spine injury c. Patient is unable to protect his or her own airway. *2. Contraindications* a. Responsive patient with resistance to opening the mouth b. May be needed in a responsive patient who has sustained a jaw fracture *3. Advantages* a. May be used in patients with cervical spine injury b. May use with cervical collar in place c. No special equipment required *4. Disadvantages* a. Cannot maintain if patient becomes responsive or combative b. Difficult to maintain for an extended time c. Very difficult to use in conjunction with bag - mask ventilation d. Thumb must remain in place to maintain jaw displacement. e. Requires second rescuer for bag - mask ventilation f. No protection against aspiration - Technique i. Position yourself at the top o f the supine patient's head. ii. Place the meaty portion of the base of your thumbs on the zygomatic arches, and hook the tips of your index fingers under the angle of the mandible, in the indentation below each ear. iii. While holding the patient's head i n a neutral in - line position, displace the jaw upward and open the patient's mouth with the tips of your thumbs. Because opening and maintaining a patent airway is so critical, you should carefully perform the head tilt - chin lift maneuver if the jaw - thrust maneuver fails to adequately open the airway. Tongue - Jaw Lift Maneuver - Answer - Used more commonly to open a patient's airway for the purpose of suctioning or inserting an oropharyngeal airway.

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