NREMT Paramedic – Airway/Respiration/Ventilation — Quick Review

A paramedic is preparing for rapid sequence intubation (RSI) of a trauma patient with a predicted difficult airway. Which assessment tool or mnemonic is used to predict a difficult intubation?

A paramedic is performing RSI and administers etomidate followed by succinylcholine. After 60 seconds, the patient’s jaw is relaxed and the mouth opens easily. The first intubation attempt fails because the paramedic cannot visualize the glottic opening due to blood in the airway. A second attempt with suction also fails. The patient’s SpO2 is dropping rapidly to 78%. What is the most appropriate next step?

Which medication used in rapid sequence intubation is a depolarizing neuromuscular blocker with a rapid onset of approximately 45 to 60 seconds?

After performing endotracheal intubation, the paramedic notes that breath sounds are present on the right side but absent on the left. ETCO2 waveform is present. What is the most likely cause and appropriate corrective action?

What is the most reliable method for confirming correct endotracheal tube placement in the trachea?

A paramedic is preparing to intubate an adult patient with a Macintosh (curved) laryngoscope blade. Where should the tip of the blade be positioned during direct laryngoscopy?

Which supraglottic airway device does not require cuff inflation, using a pre-formed gel cuff that conforms to the patient’s anatomy?

A paramedic inserts a King airway in an unresponsive patient. After inflation, ventilation with the BVM produces audible gurgling sounds, gastric distension, and minimal chest rise. What is the most likely problem?

Which of the following is a contraindication to supraglottic airway device insertion?

A paramedic has a patient who cannot be intubated and cannot be ventilated with a supraglottic airway. The SpO2 is 62% and dropping. What is the definitive intervention?

In which patient population is surgical cricothyrotomy contraindicated, requiring needle cricothyrotomy with jet ventilation instead?

A paramedic is managing a mechanically ventilated patient during transport. The ventilator alarms for high peak inspiratory pressure. The paramedic notes the patient is biting on the ET tube. What is the most appropriate intervention?

What tidal volume range is recommended when mechanically ventilating an adult patient to minimize the risk of ventilator-induced lung injury?

A mechanically ventilated patient develops breath stacking (auto-PEEP). The patient is becoming increasingly difficult to ventilate and hypotensive. What is the immediate management?

A patient with asthma is being treated with nebulized albuterol. The capnography waveform displays a characteristic ‘shark fin’ pattern. What does this waveform indicate?

What is the normal range for end-tidal CO2 (ETCO2) in a healthy adult with adequate ventilation?

During procedural sedation for cardioversion, the patient’s ETCO2 gradually rises from 40 mmHg to 62 mmHg over several minutes. What does this trend indicate?

A paramedic is considering CPAP for a patient in acute respiratory distress. Which of the following conditions is a contraindication to CPAP application?

What is the primary difference between CPAP and BiPAP in terms of pressure delivery?

A non-rebreather mask at a flow rate of 15 liters per minute delivers approximately what percentage of inspired oxygen (FiO2)?

A patient with COPD and chronic CO2 retention is experiencing mild dyspnea with an SpO2 of 88% on room air. What is the most appropriate oxygen delivery strategy?

What is the maximum duration of suctioning in an adult patient before reoxygenation is required?

A paramedic needs to suction copious amounts of blood and vomitus from the oropharynx of an unresponsive trauma patient. Which suction device is most appropriate?

Which anatomical difference between pediatric and adult airways makes children more susceptible to airway obstruction from swelling?

A paramedic is preparing to intubate a 5-year-old child. Using the standard formula for uncuffed tube size estimation, what size endotracheal tube should be selected?

When positioning an infant for bag-valve mask ventilation, why should a small towel or pad be placed under the shoulders?

Which type of suction catheter is best suited for clearing large volumes of fluid and particulate matter from the oropharynx?

A paramedic needs to suction secretions from an endotracheal tube in an intubated patient. Which catheter type and technique is most appropriate?

What is the maximum recommended vacuum pressure for suctioning an adult patient’s oropharynx in the prehospital setting?

A paramedic is suctioning the oropharynx of an unresponsive adult patient who vomited. After 15 seconds of continuous suctioning, the patient’s SpO2 drops from 96% to 88%. What is the most appropriate next action?

A paramedic arrives on scene to find a newborn delivered at home with meconium-stained amniotic fluid. The newborn is limp, not crying, and has a heart rate of 80 beats per minute. What is the most appropriate initial airway management step?

When selecting a flexible suction catheter for endotracheal suctioning, what is the general guideline for sizing relative to the endotracheal tube?

A paramedic responding to a motor vehicle collision finds a patient with copious bleeding from the mouth due to facial trauma. The portable suction unit’s battery is depleted. Which alternative method should the paramedic use to maintain the airway?

A paramedic is caring for a patient with a tracheostomy who is experiencing increased work of breathing and audible gurgling from the stoma. Which suctioning approach is most appropriate?

What is the key difference between shallow suctioning and deep suctioning of an endotracheal tube?

A paramedic is suctioning an intubated patient and notices a sudden decrease in heart rate from 88 to 52 beats per minute during the procedure. Which physiological mechanism most likely explains this bradycardia?

When suctioning the oropharynx of an adult patient with a rigid catheter, what is the maximum recommended duration for each suctioning attempt?

Which formula is used to estimate the appropriate uncuffed endotracheal tube size for a pediatric patient?

Why is a straight (Miller) blade preferred over a curved (Macintosh) blade for intubation in infants and young children?

A paramedic is preparing to intubate a 6-year-old child in respiratory failure. Using the standard formula, what is the estimated uncuffed endotracheal tube size, and what additional sizes should be immediately available?

Compared to the adult airway, the pediatric larynx is positioned differently. How does this anatomical difference affect airway management in young children?

A paramedic is managing the airway of an unresponsive 2-year-old child. After placing a shoulder roll and positioning the head, the paramedic selects a BVM for ventilation. What is the correct technique for BVM ventilation in this patient?

Why is a shoulder roll or small towel placed under the shoulders of an infant during airway management?

A paramedic attempts to intubate a 3-year-old child and encounters difficulty visualizing the vocal cords. The larynx appears to be positioned more anteriorly and superiorly than expected. After two failed intubation attempts, SpO2 has dropped to 88%. What is the most appropriate next step?

Compared to adults, the pediatric tongue is proportionally larger relative to the oral cavity. How does this anatomical difference affect airway management?

A paramedic needs to select a supraglottic airway device for a 10 kg infant who cannot be intubated. Which of the following is the correct approach to sizing?

A 4-year-old child with croup presents with inspiratory stridor at rest, a barking cough, and moderate intercostal retractions. SpO2 is 93% on room air. The child is sitting upright in the mother’s lap and appears anxious but is consolable. What is the most appropriate airway management strategy?

What is the Broselow tape primarily used for in pediatric emergency care?

A paramedic is ventilating a 9-month-old infant with a BVM and notices that the stomach is becoming progressively distended despite adequate chest rise. What is the most likely cause and appropriate correction?

A paramedic successfully intubates a 5-year-old child with a 5.0 mm uncuffed ETT. After securing the tube, the paramedic notices a significant audible air leak around the tube during positive pressure ventilation. ETCO2 waveform is present but the colorimetric detector shows inconsistent color change. What is the most appropriate action?

When initiating mechanical ventilation on a transport ventilator, what is the standard initial FiO2 setting for a patient in respiratory failure?

A paramedic is managing a mechanically ventilated patient during an interfacility transport. The ventilator is set to assist control mode with a rate of 14, tidal volume of 500 mL, and FiO2 of 0.6. The high-pressure alarm activates repeatedly. Which of the following is the most likely cause?

Minute ventilation is calculated by multiplying which two parameters?

A mechanically ventilated patient with COPD has an ETCO2 reading of 28 mmHg during transport. The ventilator is set to assist control with a rate of 18, tidal volume of 550 mL, and FiO2 of 0.5. What adjustment should the paramedic consider?

During transport, a paramedic notices that the peak airway pressure on the ventilator has increased from 22 cmH2O to 38 cmH2O over 15 minutes, but the plateau pressure remains unchanged at 18 cmH2O. This pattern most likely indicates which of the following?

In volume-controlled ventilation mode, which parameter remains constant with each delivered breath regardless of changes in patient lung compliance?

A paramedic is preparing to place a 78 kg male patient on a transport ventilator following endotracheal intubation for respiratory failure. Using ideal body weight calculations, what is the most appropriate initial tidal volume setting?

A patient on a transport ventilator in assist control mode is set at a rate of 12. The ventilator display shows an actual rate of 22. The patient appears anxious and is triggering additional breaths. ETCO2 reads 24 mmHg. What is the best course of action?

Which ventilator mode delivers a set number of mandatory breaths but allows the patient to take spontaneous breaths between them at their own tidal volume?

A patient with a severe asthma exacerbation has been intubated and placed on a transport ventilator. The paramedic sets assist control with a rate of 10, tidal volume of 450 mL, and FiO2 of 1.0. Which additional ventilator adjustment is most important for this patient population?

During an interfacility transport, a ventilated patient with ARDS suddenly becomes hypotensive with BP dropping from 112/72 to 68/40. The ventilator shows no alarms, ETCO2 drops from 38 to 22 mmHg, and the patient has bilateral breath sounds present but diminished. Heart rate increases from 88 to 134. The paramedic should first consider which ventilator-related complication?

Pressure support ventilation (PSV) is primarily used to accomplish which goal in mechanically ventilated patients?

What is the normal range for end-tidal carbon dioxide (ETCO2) in a patient with adequate ventilation?

You are monitoring a patient with a history of asthma who is in moderate respiratory distress. The capnography waveform shows a characteristic “shark fin” or upsloping appearance during the expiratory phase. What does this pattern indicate?

During endotracheal intubation, the capnography device shows a complete loss of the CO2 waveform immediately after tube placement. What is the most likely cause?

You are performing CPR on a 62-year-old patient in cardiac arrest. The ETCO2 reading has been stable at 15 mmHg during compressions. Suddenly, the ETCO2 value rises sharply to 40 mmHg. What does this finding most likely indicate?

During CPR on a witnessed cardiac arrest, continuous capnography shows a persistently low ETCO2 reading of 8 mmHg after 4 minutes of resuscitation. Ventilation is being provided through a confirmed endotracheal tube. What does this low ETCO2 value most likely reflect?

An intubated patient has an ETCO2 reading of 55 mmHg that has been steadily increasing over the past 10 minutes. The patient’s respiratory rate on the ventilator is set at 12 breaths per minute. Breath sounds are equal bilaterally. What is the most appropriate action?

A patient with a pulmonary embolism is intubated and being ventilated. The capnography shows an ETCO2 of 18 mmHg despite a normal respiratory rate and tidal volume. The patient’s arterial blood gas shows a PaCO2 of 42 mmHg. What accounts for the large difference between the ETCO2 and PaCO2?

Which type of ETCO2 detector provides a continuous numeric reading and waveform display?

You place a colorimetric CO2 detector on an endotracheal tube after intubation. The device remains purple after six ventilations. What does this finding indicate?

A patient is undergoing procedural sedation with ketamine for a dislocated shoulder reduction. Capnography monitoring shows a gradual decrease in ETCO2 from 38 mmHg to 22 mmHg over 3 minutes, with a decreasing respiratory rate. What does this trend suggest?

On a normal capnogram, what does the expiratory plateau (Phase III) represent?

During procedural sedation for a fracture reduction, a patient’s capnography waveform suddenly shows a decreasing ETCO2 value from 40 mmHg to 15 mmHg over 30 seconds. The patient’s SpO2 remains at 98%. The respiratory rate has dropped from 14 to 6 breaths per minute. Which statement best explains why capnography detected this deterioration before pulse oximetry?

An intubated patient’s capnography waveform shows a gradual decrease in ETCO2 from 38 mmHg to 12 mmHg over 5 minutes. The waveform morphology remains normal in shape. Breath sounds are present but diminished, and the patient’s skin is becoming cool and mottled. What is the most likely cause of the decreasing ETCO2?

Which component of a slow-speed handpiece requires separate sterilization after each patient use?

A dental assistant is preparing a cephalometric radiograph. Which infection control step is specific to this type of exposure?

A 68-year-old male with severe COPD is in respiratory distress with an SpO2 of 84% and labored breathing at 28 breaths per minute. He is alert and able to speak in short phrases. What is the most appropriate initial oxygen therapy?

After taking radiographs, a dental assistant needs to disinfect the lead apron. Which method is appropriate?

What is the primary reason dental handpieces are classified as semicritical devices for infection control purposes?

A paramedic is preparing to use a portable oxygen cylinder for a patient transfer. The D-cylinder gauge reads 1,000 psi and the patient requires 10 LPM. Approximately how many minutes of oxygen are available?

What is the maximum oxygen concentration that can be delivered by a nonrebreather mask with the reservoir bag fully inflated and oxygen flowing at 15 LPM?

A 52-year-old asthmatic is being treated with a nebulized albuterol treatment. His SpO2 is 97% on room air, but during the nebulizer treatment his SpO2 drops to 91%. Which explanation best accounts for this finding?

A post-cardiac arrest patient with return of spontaneous circulation has an SpO2 of 100% on a nonrebreather mask at 15 LPM. The patient is intubated and being mechanically ventilated. According to current resuscitation guidelines, what adjustment should the paramedic make?

During the annual review of the dental office’s Exposure Control Plan, the office manager identifies a new safety-engineered needle system available on the market. What action is required?

A paramedic is using a high-flow nasal cannula at 40 LPM with heated humidification on a patient in acute respiratory distress. Which patient population benefits most from this device compared to a standard nonrebreather mask?

What is the most common endotracheal tube size used for an average adult male?

Which laryngoscope blade is designed to fit into the vallecula to indirectly lift the epiglottis during intubation?

A paramedic has intubated a cardiac arrest patient. Auscultation reveals breath sounds on the right side only with absent sounds on the left. What is the most likely cause?

After intubating a patient, the paramedic inflates the ET tube cuff. What is the primary purpose of cuff inflation?

What does a deflated pilot balloon on an endotracheal tube indicate?

Which method is considered the most reliable for confirming endotracheal tube placement in a patient with a perfusing rhythm?

During intubation attempts, gurgling sounds are heard in the epigastric region during ventilation. What does this finding most likely indicate?

After successful intubation, what is the recommended method for securing the endotracheal tube?

What is the purpose of applying cricoid pressure (Sellick maneuver) during intubation?

During a difficult intubation, the paramedic asks an assistant to apply backward, upward, rightward pressure on the thyroid cartilage. What is this technique called?

In the Cormack-Lehane grading system for laryngoscopic view, what does a Grade III view indicate?

A paramedic attempts intubation and obtains a Cormack-Lehane Grade III view on direct laryngoscopy. After one failed attempt, what is the most appropriate next step?

What is a key advantage of video laryngoscopy over traditional direct laryngoscopy during prehospital intubation?

A dental assistant needs to reprocess a high-speed handpiece between patients. After flushing, cleaning the exterior, and lubricating, what should the assistant do next?

Which part of a panoramic radiography unit requires disinfection between patients?

Which of the following items from a dental office would be classified as general (nonregulated) waste?

How should conventional (D-speed or F-speed) film packets be protected during intraoral radiography?

A dental assistant is cleaning a slow-speed handpiece motor and notices that the prophy angle used during the appointment was a disposable single-use type. How should the prophy angle be handled?

In addition to federal EPA regulations, dental offices must also comply with which level of government for waste disposal requirements?

A dental office wants to reduce the amount of hazardous waste it generates. Which of the following strategies would be most effective for waste minimization?

A dental assistant discovers that a biohazard waste bag stored in the utility area has a small tear near the bottom and fluid is leaking onto the floor. Which sequence of actions is most appropriate?

How should scrap amalgam from dental procedures be stored before it is sent for recycling?

What is the primary advantage of a supraglottic airway device compared to endotracheal intubation in a cardiac arrest setting?

A paramedic is preparing to insert an i-gel supraglottic airway in an unconscious adult male patient weighing approximately 80 kg. How should the paramedic determine the correct device size?

After inserting a King LT supraglottic airway in a cardiac arrest patient, the paramedic begins ventilations but notices significant air leak and poor chest rise. What should the paramedic do first?

A paramedic inserts a supraglottic airway in an unresponsive patient with cardiac arrest. After placement, capnography shows an EtCO2 waveform with appropriate values and bilateral chest rise is observed. Two minutes later, the EtCO2 waveform disappears and ventilation resistance increases. What is the most likely cause?

A paramedic places an i-gel supraglottic airway in an unconscious adult patient. After confirming ventilation with capnography, the paramedic notes progressive epigastric distension. Which action should the paramedic take next?

A paramedic is ventilating a patient through a King LT airway following cardiac arrest. ETCO2 reads 35 mmHg, but blood-tinged fluid is noted draining from the patient’s mouth. The patient has a history of heavy alcohol use and recent vomiting. What is the greatest concern with continued use of this device?

Which formula is used to determine the appropriate uncuffed endotracheal tube size for a pediatric patient?

Which laryngoscope blade is preferred for direct laryngoscopy in an infant?

A paramedic is preparing to place a supraglottic airway in an unresponsive 4-year-old child weighing 16 kg following a drowning incident. Which of the following is a key consideration when selecting a pediatric supraglottic device?

Compared to adult anatomy, which characteristic of the pediatric airway makes it more susceptible to obstruction from swelling?

A paramedic is intubating a 6-year-old patient and finds it difficult to visualize the vocal cords despite proper positioning. The laryngeal view shows the epiglottis but the glottic opening appears to be significantly anterior. Which technique would most likely improve visualization?

A paramedic is managing the airway of a 2-year-old child in respiratory failure. Which anatomical difference between pediatric and adult patients requires the paramedic to avoid hyperextension of the neck during airway positioning?

A paramedic needs to calculate a weight-based medication dose for a 5-year-old child but no scale or length-based tape is available. Using the standard pediatric weight estimation formula (2 x age in years) + 8, what is the estimated weight?

What is the primary mechanism by which CPAP improves oxygenation in a patient with acute pulmonary edema?

A 68-year-old patient presents with severe respiratory distress, bilateral crackles, SpO2 of 82%, blood pressure of 160/100 mmHg, and a history of congestive heart failure. The patient is alert and can follow commands. Which ventilation strategy is most appropriate?

A paramedic initiates CPAP on a patient with an acute COPD exacerbation. After 5 minutes, the patient becomes more agitated, SpO2 drops from 88% to 84%, and the capnography reading shows a sharp decline in ETCO2. The mask appears to have significant air leak around the bridge of the nose. What is the most likely cause of the deterioration?

Which of the following is an absolute contraindication to initiating non-invasive positive pressure ventilation (NIPPV) in the prehospital setting?

A paramedic is treating a patient in severe respiratory distress with a history of asthma. The patient is alert and sitting upright with accessory muscle use, SpO2 of 86%, and minimal air movement on auscultation. After administering a nebulized bronchodilator with minimal improvement, which ventilatory support strategy should the paramedic consider next?

What is the key difference between CPAP and BiPAP in terms of pressure delivery?

A paramedic is applying CPAP to a patient with acute pulmonary edema who also has a nasogastric tube in place. Which mask type is most appropriate for this patient?

A paramedic has placed a patient with acute CHF on CPAP at 10 cmH2O. After 8 minutes, the patient’s blood pressure drops from 148/92 mmHg to 86/54 mmHg, heart rate increases from 100 to 128 bpm, and the patient appears diaphoretic. SpO2 has improved from 84% to 93%. What should the paramedic do?

What is the primary purpose of preoxygenation before endotracheal intubation?