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

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Paramedic Airway FISDAP Review Part1Rated 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. Administersupplemental oxygen.e.Provide ventilatory assistance.Upper airway-Answer Consists of all anatomic airway structures above the glotticopening.*1. Tongue*a. Must be manipulatedb. 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 andtracheab. Composed of:i. Nasopharynxii. Oropharynxiii. Laryngopharynx (hypopharynx)Lower airway-Answer Extends from the glottis to the pulmonary capillarymembrane.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 cartilaginousstructures-Marks where the upper airway endsand lower airway begins2. Thyroid cartilage-Answer-Shield-shaped structure formed by two plates that joinin a "V" shape anteriorly to form the laryngeal prominencei. Known as the Adam's appleii. More pronounced in meniii. Can be difficult tolocate in obese or short-necked patients-Suspended from the hyoid bone by the thyroid ligament-Directly anterior to the glottic opening3. Cricoid cartilage (cricoid ring)-Answer-Lies inferiorly to the thyroid cartilage-Forms the lowest portion of the larynx-More prominent in females4. Cricothyroid membrane-Answer-Located between the thyroid and cricoidcartilage

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Paramedic Airway FISDAP Review Part1Rated 100% Correct!!-Site for emergency surgical and nonsurgical access to the airway-Bordered laterally and inferiorly by the highly vascular thyroid gland5. 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, andvocal cords beforeinserting 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 tubeThe respiratory and cardiovascular systems work together to ensure that:-Answer1. 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 lungs1. *Inhalation* is the active, muscular part ofbreathing.2. *Exhalation* is a passive process and does not normally require muscular effort.Oxygenation-Answer-Process of loading oxygen molecules onto hemoglobinmolecules in the bloodstream-Requires adequate *FiO2 (Percentage of oxygen in inhaledair)*Respiration-Answer-Process of exchanging O2 and CO2-->1. *External respiration (Also called pulmonary respiration)*: Process of exchangingO2 and CO2 between the alveoli and blood in pulmonary capillaries.2. *Internal respiration (Also calledcellular respiration)*: Exchange of O2 and CO2between the systemic circulation and the body's cells.Pathophysiology of Respiration-Answer-Multiple conditions can inhibit the body'sability to effectively provide oxygen to cells.1. Disruption of pulmonary ventilation, oxygenation, and respiration will causeimmediate effects on the body.a. Must be recognized and corrected immediatelyb. Important to distinguish a primary ventilation problem from a primary oxygenationor respiration problem2. Everycell 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 mayoccur quickly if not corrected.

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Paramedic Airway FISDAP Review Part1Rated 100% Correct!!-Varying signs and symptomsa. Onset and degree of tissue damage often depend on the quality of ventilations.b. Early signs include restlessness, irritability, apprehension, tachycardia, andanxiety.c. Late signs include mental status changes, a weak pulse, and cyanosis.d. Responsive patients often report dyspnea and maynot be able to speak incomplete sentences.-Best to administer oxygen before signs and symptoms appear2. Ventilation-perfusion ratio and mismatch-Answer-Air and blood flow must bedirected to the same place at the same time (ventilation andperfusion must bematched).-Failure to match ventilation and perfusion (V/Q mismatch) lies behind mostabnormalities in oxygen and carbon dioxide exchange.-In most people, normal resting minute ventilation is approximately 6 L/min.a. Resting alveolarvolume: Approximately 4 L/minb. Pulmonary artery blood flow: Approximately 5 L/minc. 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 distributedto dependentregions of the lungs at rest. However, an increase in gravity-dependentflow is more marked with perfusion than with ventilation.--> Ratio of ventilation to perfusion is highest at the apex of the lung and lowest atthe base.-When ventilation is compromised but perfusion continues:a. Blood passes over alveolar membranes without gas exchange.b. CO2 is recirculated into the bloodstream.i. Results in V/Q mismatchii. Could lead to severe hypoxemia if not recognized and treated-When perfusion across thealveolar 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 furtherdamage or death.3. Factors affecting ventilation-Answer Apatent airway is critical for the provision ofO2 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 unresponsive 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 Part1Rated 100% Correct!!v. Neuromuscular blocking agents.c. Allergic reactionsi. Swelling (angioedema) can obstruct the airway.ii. Bronchoconstriction can decrease pulmonary ventilation.*2. Extrinsicfactors*: trauma and foreign body airway obstruction.a. Trauma to the airway or chest--> Requires immediate evaluation and interventionb. Blunt or penetrating trauma and burns can disrupt airflow through the trachea andinto the lungs--> Quickly results in oxygenation deficienciesc. 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 shallowlyin an attempt to alleviate pain from the injury (Respiratory splinting)--> Can result indecreased pulmonary ventilation**Proper ventilatory support is crucial.*3. Hypoventilation & Hyperventilation*-*a. Hypoventilation*: occurs when CO2 production exceeds CO2 elimination.*b. Hyperventilation* occurs when carbon dioxide elimination exceeds carbondioxide production.--> Hypoventilation and hyperventilation could represent the body's attempt tocompensate for various abnormal conditions. For example, if the pH of the bloodalkalotic, the patient's breathing may become slow or shallow in an attempt to retainCO2 to decrease the pH<--*4. Hypercarbia & Hypocarbia*:a. Decrease in minute volume decreases CO2 elimination--> Results in buildup ofCO2 in the blood (*hypercarbia*)b. Increase in minutevolume increases CO2 elimination--> Lowers CO2 in theblood (*hypocarbia*)4. Factors affecting oxygenation and respiration-Answer *1. External factors:*a. External factors in ambient air. Examples: Atmospheric pressure, partial pressureof oxygen--> At high altitudes, the percentage of oxygen remains the same, butpartial pressure decreases because total atmospheric pressure decreases.-->Closed environments may also have decreases in ambient oxygen. Examples: Minesand trenchesb. Toxic gases displace oxygen in the environment.--> CO inhibits the propertransport of oxygen to tissues*2. Internal factors:*a. Conditions that reduce the surface area for gas exchange also decrease thebody's oxygen supply.b. Medicalconditions may also decrease surface area of the alveoli by damagingthem or by leading to an accumulation of fluid in the lungs.c. Nonfunctional alveoli inhibit the diffusion of oxygen and carbon dioxide--> Calledintrapulmonary shuntingd. Submersionvictims 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 Part1Rated 100% Correct!!ii. Results in decreased oxygenation and respirationiii. Exposure to certain environmental conditions or occupational hazards. Examples:High altitudes, epoxy resinsiv. 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 decreaseii. Infection--> Increases metabolic needs, disrupts homeostasisiii. Hormonal imbalances: If insulin levels decrease, cellular uptake of glucose willdecrease--> Results in ketoacidosis.*3. Circulatory compromise*a. Leads to inadequate perfusion; oxygen demands will not be met.b. Obstruction of blood is typically related to trauma emergencies, including:i. Simple or tension pneumothoraxii. Open pneumothoraxiii. Hemothoraxiv. Hemopneumothoraxv. Pulmonary embolismc. Inhibits gas exchange at the tissue level.d. Conditionssuch as heart failure and cardiac tamponade inhibit the heart's ability toeffectively 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 shockii. Vasodilatory shockiii.Both forms of shock result in poor tissue perfusion that leads to anaerobicmetabolism.5. Acid-base balance-Answer *Hypoventilation, hyperventilation, and hypoxia candisrupt the acid-base balance*-->May lead to rapid deterioration and death.-Respiratory and renal systems help maintain homeostasis (Tendency towardstability in the body's internal environment): Requires a balance between acids andbases.--> Fastest way to eliminate excess acid is through 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 develop 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 inrespiratory acidosis or alkalosis.2.Respiratory alkalosis3. Metabolic acidosis: Fluctuations in pH due to available bicarbonate result inmetabolic acidosis or alkalosis.4. Metabolic alkalosis

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Paramedic Airway FISDAP Review Part1Rated 100% Correct!!Patient Assessment: Airway Evaluation-Answer The importance of carefullyassessing a patient'sairway 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--> Anunresponsive patient has a compromised airway until that is ruled out by a carefulassessment.2. Signs of airway compromise in an unresponsive patient include:a. Snoringb. Vomitus draining from the mouthc. Gurgling sound heard during breathing3. Secretions pooling in the patient's mouth indicate a markedly depressed or absentgag reflex--> Absence significantly increases risk of aspiration.Recognizing adequate breathing-Answer 1. An adult who is responsive, alert, andable to speak.2. Normal breathing in an adult at rest is characterized by:i.Rate between 12 and 20 breaths/minii. Adequate depth (tidal volume)iii. Regular pattern of inhalation and exhalationiv. Clear and equal breath sounds bilaterally3. Changes in rate and regularity should be subtle.Recognizing inadequate breathing-Answer Breathing does not necessarily meanadequate 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 12breaths/min or more than 20 breaths/min must be evaluated for other signs ofinadequate ventilation, such as:a. Shallow breathingb. Irregular pattern of breathingc. Altered mentationd. Adventitious airway sounds2. Cyanosis is a clear indicator of low blood oxygen.3. Preferentialpositioning--> a. Upright sniffing (tripod) position; b. Semi-Fowlerposition.Potential Causes of Inadequate Breathing-Answer a. Severe infection (sepsis)b. Traumac. Brainstem insultd. Noxious or oxygen-poor environmente. Renal failuref. Upper and/or lower airway obstructiong. Respiratory muscle impairmenth. Central nervous system impairmentProper Airway Management-Answer *Follow steps IN ORDER:*

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Paramedic Airway FISDAP Review Part1Rated 100% Correct!!a. Open the airwayb. Clear the airwayc. Assess breathingd. Provide appropriateintervention(s)Airway Evaluation-Answer-Evaluation includes visual observations, palpation, andauscultation.-Visual techniques:1. Patient position (ex. tripod position)2. Experiencing orthopnea3. Adequate rise and fall of the chest4. Patient gasping for air5. Skin:i. Colorii. Moist or clammyf. Nostrils flaring6. Breathing through pursed lips7. Retractions:i. Intercostalii. At the suprasternal notchiii. At the supraclavicular fossaiv. Subcostal8. Accessory muscle use9. Asymmetric chest wall movement10. Patient taking a series of quick breaths, followed by prolonged exhalationLabored breathing-Answer-May involve the use of accessory musclesi. Sternocleidomastoidii. Chest pectoralis majoriii. AbdominalSigns of inadequate ventilation-Answer a. Respiratory rate of fewer than 12breaths/min or more than 20 breaths/min in the presence of dyspneab. Irregular rhythmc. Diminished, absent, or noisy breath soundsd. Abdominal breathinge. Reduced flow of exhaled air at the nose and mouthf. Unequal or inadequate chest expansiong. Increased effort of breathingh. Shallow depth of breathingi. Pale, cyanotic, cool, moist, or mottled skinj. Retractionsk. Staccato speech patterns (one-or two-word dyspnea)Pulsus Paradoxus-Answer Systolic blood pressure drops more than 10 mm Hgduring inhalation--> May detect a change in pulse quality or even the disappearanceof a pulse during inhalation

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Paramedic Airway FISDAP Review Part1Rated 100% Correct!!-Generally seen in patients with conditions that cause an increasein intrathoracicpressure; such as:i. Decompensating COPDii. Severe pericardial tamponadeiii. Tension pneumothoraxiv. Severe asthma attackAsk questions to determine the evolution of the current problem:-Answer a. Onsetsudden or gradual?b. Known cause 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 orpressure, or fever?f. Any interventions attempted before EMSarrival?g. Has the patient been evaluated by a physician or admitted to the hospital for thiscondition in the past?i. Was the patient hospitalized or seen in the emergency department and released?ii. If hospitalized, admitted to intensive care (clinically significant) or a regular,unmonitored floor?h. Is the patient currently taking any medications? If so, determine overallcompliance by asking:i. Have you been able to take all of your pills as directed?ii. Is there anything that has stopped you from 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 orchanges in the prescribing directions of an existing medication?i. Any risk factors that could cause or exacerbate the conditionReflexes of the Airway-Answer Coughing, sneezing, and gaggingSighing-Answer A slow, deep inhalation followed by a prolonged 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 thediaphragm, cut short by closure of the 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 forduration, 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 Part1Rated 100% Correct!!-Should beassessed for duration, pitch, and intensityAssessment of Breath Sounds-Answer Auscultate breath sounds with astethoscope.-Should be clear and equal on both sides of the chest, anteriorly, and posteriorly-Compare each apex of the lung with the opposite apex and each base of the lungwith 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, represent airflow into alveoli2. Duration: Length of time for the inspiratory and expiratory phase of the breath4. Pitch is described as higher or lower than normal (stridor or wheezing).5. Always auscultate directly on skin.6. Sounds that are present inan unexpected area can indicate an abnormalcondition.7. Adventitious breath sounds: Usually classified as continuous or discontinuous.Duration of Breath-Answer a. Normally, expiration is at least twice as long asinspiration: Relationship is expressed by I/E ratio (inspiratory/expiratory ratio)--> I/Eratio is 1:2.b. When the lower airway is obstructed, expiratory phase may be four to five timesas long as inspiration--> I/E ratio is 1:4 or 1:5.c. In patients who are tachypneic, the expiratoryphase is short and approaches thatof inspiration--> I/E ratio may be 1:1.Pitch of Sound-Answer Described as higher or lower than normal (stridor orwheezing)-Intensity of sound depends on:a. Airflow rateb. Constancy of flow throughout inspirationc. Patient position/Site selected for auscultation-Less intense sounds are said to be diminished.Adventitious Breath Sounds-Answer Adventitious breath sounds: Usually classifiedas 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 Part1Rated 100% Correct!!b Rhonchi-Answer Continuous, low-pitched sounds--> Indicate mucus or fluid inlarger lower airwaysc. Crackles (formerly known as rales)-Answer Occur when airflow causes mucus orfluid in the airways to move in the smaller lower airways--> Tend to clear withcoughing-May also be heard when collapsed airways or alveoli pop open-Discontinuous sounds-May occur early or late in the inspiratory cycle1. 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 traumawithin orimmediately above the glottic openinge. Pleural Friction Rub-Answer Results from inflammation that causes the pleura tothicken--> Surfaces of the visceral and parietal pleura rub together.-Often creates stabbing pain with breathing or anymovement of the thoraxPulse oximetry-Answer Measures the percentage of hemoglobin (Hb) in arterialblood that is saturated with oxygen.a. A sensor probe transmits light through the vascular bed to a light-sensing detector--> Amount of light dependson the proportion of hemoglobin that is saturated withoxygen.b. To ensure that the instrument is measuring arterial and not venous oxygensaturation, pulse oximeters assess only pulsating blood vessels.c. Also measure pulse--> Check device functioningby comparing its pulse readingwith the patient's palpated pulseOximetry Reading-Answer A normally oxygenated, normally perfused personshould have an Spo2 of greater than 95% while breathing room air.a. Less than 95% in a nonsmokersuggests 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 orduring suctioningb. Identifying deterioration in the condition of a trauma victimc. Identifying deterioration in the condition of a patient with cardiac diseased. Identifying high-risk patients with respiratory problemse. Assessing vascular status in orthopedic traumai. 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 provideinformation about circulation to the limb.

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Paramedic Airway FISDAP Review Part1Rated 100% Correct!!Circumstances that might produce erroneous oximetry readings:-Answer 1. Brightambient light--> May enter the spectrophotometer and create an incorrect reading--> Cover the sensor clip with a towel or aluminum foil toprotect it.2. Patient motion3. Poor perfusion--> If the vessels in a patient's limbs are constricted and the limbs are cold, you mayneed to place the clip on the earlobe or nose.4. Nail polish5. Venous pulsations occurring with right-sided heart failure6. Abnormal hemoglobin7. Normal Spo2 values may be observed in the presence of methemoglobin andcarboxyhemoglobin even though the body is not receiving sufficient oxygen.a. Methemoglobin (metHb): Formed by oxidation of the iron on hemoglobinb. Carboxyhemoglobin (COHb): Hemoglobin loaded with COTwo 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 cellsCO-oximeter, or CO monitor-Answer Measures absorption at several wavelengthsto distinguish Hbo2 from COHb.-Determines HbO2 saturation (percentage of oxygenated Hb compared with the totalamount of hemoglobin) including COHb, metHb, HbO2, and reduced Hb.Peak Expiratory Flow Measurement-Answer-Bronchoconstriction can be evaluatedby 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 expiratoryflow rate of 350 to 750 mL.-To assess peak expiratory flow:1. Place the patient in a seatedposition 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 the test three times.6. Take the best peak flow rate of the three readings.Arterial blood gas analysis-Answer 1. Most comprehensive quantitative informationabout the respiratory system2. Blood is obtained from a superficial artery.3. Blood is analyzed for pH, Paco2, PaO2, Hco3−, base excess (indicating acidosisor 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 Part1Rated 100% Correct!!c. PaO2 and Sao2 are indicators of oxygenation.End-tidal carbon dioxide (ETCO2) assessment-Answer ETCO2 monitors detectcarbon dioxide in exhaled air--> Adjuncts for determining ventilation adequacy-Types of monitors include colorimetric, digital, and digital/waveform.Colorimetric-AnswerProvides 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 frompurple to yellow during exhalation--> Indicates the presence of exhaled carbondioxide-Should be used during initial confirmation of ET tube placement and replaced assoon as possible with a quantitative device-Sensitive to temperature extremes and humidityi. May be less reliable if vomitus or other secretions get into itii. Paper inside degrades over time.Capnometer-Answer Displays a numeric reading of exhaled carbon dioxide.--> More reliable than the colorimetric co2 detectorCapnography-Answer Provides a graphic representation of exhaled carbon dioxide.-Capnography can indicate chest compression effectiveness and detect return ofspontaneous circulation.-Two types:1. Waveform capnography: Provides real-time information and displays a graphicwaveform--> Many portable cardiac monitor/defibrillators provide a numeric reading and awaveform (digital/waveform capnography).2. Quantitative waveform capnography: Detection of bronchospasm, hypoventilation,and hyperventilation--> Recommended method of monitoring initial and ongoing placement of anadvanced airway device.-Uses of waveform capnography in the nonintubated patient:i. Assess the severity of asthma, COPD, or any pathologic process that causespulmonary air trappingii. Gauge the effectiveness of treatment-If inadvertentextubation occurs, then you would expect to see a complete loss of acapnographic waveform and etco2 reading.-On occasion, the sampling tubing from the in-line adaptor to the cardiacmonitor/defibrillator gets obstructed with blood or other debris, blocking the flow ofgas 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 Part1Rated 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 detecteddespite a lack of perfusion.b. Patients withprolonged cardiac arrest will have minimal to no exhaled carbondioxide because of severe acidosis and minimal or no carbon dioxide return to thelungs.Normal Capnographic Waveform-Answer-Key features:i. Contourii. Baseline leveliii. Rate and riseof 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 capnographic waveformcan provide information about:1. Hypoventilation2. Hyperventilation3. Bronchospasm4. Rebreathing5. Inadvertent extubation1. Hypoventilation-Answer-Waveforms are tall and the etco2 value iscorrespondingly 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 iscorrespondingly low (less than 35 mm Hg).-Tachypneaproduces 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 theseverity of asthma, COPD, or any pathologic process that causes pulmonary airtrapping2. Gauge the effectiveness of treatment

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Paramedic Airway FISDAP Review Part1Rated 100% Correct!!Airway Management-Answer Air reaches the lungs only through the trachea, so apatent airway is essential.-In a compromised airway, clearing the airway and maintaining patency are vital.1. Position the patient2. Use manual airway maneuversPositioning the patient-Answer Unresponsive patients found in a prone positionmust be positioned in a supine position.a. Log roll the person as a unit.b. Once the patient is supine, quickly assess for breathing by visualizing the chest forvisible movement.c. If the patient is breathing adequately and is not injured, move to recovery position(Left lateral recumbent position):--> Use in all nontraumapatients with decreased LOC who can maintain their airwayspontaneously and are breathing adequately.Manual airway Maneuvers-Answer-If an unresponsive patient has a pulse but isnot breathing open the airway manually.-The most common cause of airwayobstruction in an unresponsive patient is thetongue.-Maneuvers:1. head tilt, chin-lift maneuver2. jaw thrust maneuver3. Tongue-jaw Lift maneuverHead tilt-chin lift maneuver-Answer-Preferred technique with a patient who has notsustained trauma-Occasionally, the patient will resume breathing with this technique alone.-Considerations:*1. Indications*a. Unresponsive patientb. No mechanism for cervical spine injuryc. Patient is unable to protect his or her own airway.*2. Contraindications*a. Responsive patientb. Possible cervical spine injury*3. Advantages*a. No equipment requiredb. Noninvasive*4. Disadvantages*a. Hazardous to patients with spinal injuryb. No protection from aspiration-Technique

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Paramedic Airway FISDAP Review Part1Rated 100% Correct!!i. With the patient in a supine position, position yourself beside the patient's head.ii. Place one hand on the patient's forehead, and apply firm backward pressure withyour palm to tilt the patient's head back.iii. Place the tips of your fingers of your other hand under the lower jaw near the bonypart of the chin. Do not compress the soft tissue under the chin because this actionmay block the airway.iv. Lift the chin upward, bringing the entire lower jaw with it, helping to tilt the headback. Do not use your thumb to lift the chin.Lift so that the teeth are nearly broughttogether, 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 patientb. Possiblecervical spine injuryc. Patient is unable to protect his or her own airway.*2. Contraindications*a. Responsive patient with resistance to opening the mouthb. May be needed in a responsive patient who has sustained a jaw fracture*3. Advantages*a.May be used in patients with cervical spine injuryb. May use with cervical collar in placec. No special equipment required*4. Disadvantages*a. Cannot maintain if patient becomes responsive or combativeb. Difficult to maintain for an extended timec.Very difficult to use in conjunction with bag-mask ventilationd. Thumb must remain in place to maintain jaw displacement.e. Requires second rescuer for bag-mask ventilationf. No protection against aspiration-Techniquei. Position yourself at the top of the supine patient's head.ii. Place the meaty portion of the base of your thumbs on the zygomatic arches, andhook the tips of your index fingers under the angle of the mandible, in the indentationbelow each ear.iii. While holding the patient's head in a neutral in-line position, displace the jawupward and open the patient's mouth with the tips of your thumbs. Because openingand maintaining a patent airway is so critical, you should carefully perform the headtilt-chin lift maneuver if the jaw-thrustmaneuver fails to adequately open the airway.Tongue-Jaw Lift Maneuver-Answer-Used more commonly to open a patient'sairway for the purpose of suctioning or inserting an oropharyngeal airway.

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