PLATINUM FINAL EXAM EMTP 3.3 REVIEW QUESTIONS
AND CORRECT DETAILED ANSWERS COMPLETE
What is the best airway device to use for smoke inhalation?
Endotracheal intubation is frequently needed for supportive therapy in the management of inhalation
injury.
Most pertinent piece of information in evaluating a patient's ventilatory status?
Ventilation is the movement of air in and out of the lungs through a patent airway. The majority of
observations regarding ventilation focus on the movements of the chest.
SIGNS OF ADEQUATE VENTILATION:
In most patients, your assessment of ventilation will be based on observing their respiratory rate (normal
12 to 20) and listening for clear breathing sounds in the left and right chest. Auditory confirmation of
breathing sounds is the strongest sign of adequate ventilation. In patients on ventilators or bag-valve-
mask, this does not change.
Most pertinent piece of information in evaluating a patient's oxygenation status?
Oxygenation is the delivery of oxygen to the tissues of the body, poor ventilation or respiration will
generally lead to poor oxygenation. Loss of oxygenation is the ultimate result of ventilatory or respiratory
failure. You need to observe the patient's mental status, skin color, oral mucosa, and check a pulse
oximeter.
Mental status is either normal or abnormal, assessing mental status is based on asking questions about
who the person is, what time/date it is, where they are, and why they are here.
Skin and mucosal color are important indicators of oxygenation. Just as with poor respiration, cyanosis,
pallor, or mottling are signs of decreased oxygen delivery.
Pulse oximetry level is the most objective measure of oxygenation, it reads the saturation of hemoglobin
(reported as SPO2), note that a pulse oximeter is not foolproof. A patient with poor oxygenation in the
limbs may have sufficient oxygenation to their core or vise-versa. Pulse oximeters can also be fooled by
specific toxic gases. Always ensure that you match up your pulse oximetry readings with physical findings
and ensure they support one another. Pulse oximeters are imperfect and are not a real-time measure of
O2 saturation
Most important assessment in evaluating a patient's oxygen delivery to the brain?
Prior to applying supplemental oxygen, objective data regarding patient status should quickly be obtained
such as airway patency, respiratory rate, pulse oximetry, and lung sounds. Signs of cyanosis in the
skin or nail bed assessment should also be noted.
What is the next step to take if a patient's breathing does not improve with an NRB?
BVM
,What is the next step to take after opening the airway of an unresponsive patient with slow, shallow
respirations?
After manually opening an unconscious patient's airway, you should: check the mouth for secretions,
foreign bodies, or dentures. If clear, then started manually ventilating!
Know your ventilation rates
Adult: 12-20/minute
Child: 15-30/minute
Infant: 25-50/minute
Flow rates for 02 devices:
Nasal Cannula - 2-6L/min
Nebulizer - 6-8L/min
Non-ReBreather - 10-15L/min
BMV - 15L/min
EndoTracheal Tube - 15L/min
King LTS-D - 15L/min
CPAP - 25L/min (oxygen port)
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
ET Tube
One intubation attempt with the definitive airway on patients in cardiac arrest before a provider can
attempt placement of a supraglottic airway (King Airway). If the first attempt fails, the provider may
attempt at intubation again, or elect to place the King Airway or return to the BLS airway (BVM).
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
King LT
These devices are best used when the ET Tube does not work.
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
LMA / iGel
It is secured in the throat via the inflation cuff, although the seal of the LMA is not as effective as that of
an ETT. An iGel works the same way, and does not have an inflatable cuff.
These devices are best used when the ET Tube does not work.
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
CPAP
Used for patients with CHF, or drowning victims. Used to help get fluid out of the lungs that is signified by
crackles or rales. Must meet requirements of blood pressure and consciousness to be used. Can have a
nebulizer connected if the situation requires it.
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
Nasal Cannula
Used for minimal oxygen for patients that have a lower SPO2 than 95%
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
Non-Rebreather
,Used for patients that require more than 6L of oxygen, and can be used with a nebulizer for maximum
efficiency.
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
BVM
BLS airway that is used initially before an advanced airway, and connected to one if one is placed.
TX of a patient in anaphylaxis when epinephrine has failed to improve the patient's condition and he/she
is deteriorating
If 0.3mg IM 1:1000 Epi does not work, peripheral perfusion isn't good enough to circulate the medication!
IV EPI: 1:10,000 is the only solution to get the epinephrine to the patient.
Know the advantages and disadvantages of a surgical vs needle cricothyrotomy. Which one is the
quickest to perform?
Once established, surgical cricothyroidotomy has a number of advantages over use of a cannula –
provision of a definitive airway (protection by a cuffed tube) being just one. Despite this, the technique is
used far less frequently. This may be due to fears about the complication of hemorrhage.
Research suggests that needle cricothyroidotomy can provide effective ventilation in the presence of
increasing airway obstruction. The failure of the needle systems in the presence of upper airway
obstruction results from inadequate exhalation via the narrow 1.5mm lumen of the 13G cannula. Which
can lead to:
Barotrauma/pneumothorax = from over-inflation*
Bleeding
Subcutaneous emphysema
Survey data from the prehospital and hospital settings show the needle airway to be the most frequently
used emergency cricothyroidotomy method, whereas the surgical airway is rarely used.
Assessment findings in a patient with a spontaneous pneumothorax
Shortness of breath, sudden onset of sharp chest pain, pallor, tachypnea, diaphoresis.
Severe symptoms include tachycardia, AMS, cyanosis, decreased breath sounds on the affected side.
Best method to protect a patient's airway who vomits each time you try to intubate
Inadequate depth of anesthesia or unexpected responses to surgical stimulation may evoke
gastrointestinal motor responses, such as gagging or recurrent swallowing, increasing gastric pressure
over and above LOS pressure facilitating reflux.
In the setting of aspiration, regurgitation occurs three times more commonly than active vomiting. An
unprotected airway, excessively light depths of anesthesia, and one or more predisposing risk factors for
aspiration combine to significantly increase the risks of aspiration.
A summary of the available strategies for reducing aspiration risk:
Reducing gastric volume (NRB instead of BVM)
, Second-generation supra-glottic airway devices
Cricoid pressure
Rapid sequence induction
Position (left lateral, head down or upright)
What are the advantages / disadvantages of tracheal intubation vs using an extraglottic airway device?
Insertion of a supraglottic airway device is simpler and faster than tracheal intubation, and proficiency
requires less training and ongoing practice.
Tracheal intubation is a more complex skill than supraglottic airway device insertion and requires 2
practitioners, additional equipment, and good access to the patient's airway
The strategy of using a supraglottic airway device first also achieved initial ventilation success more often.
Although regurgitation and aspiration occurred with similar frequency overall, regurgitation and aspiration
during or after advanced airway management were significantly more common in the supraglottic airway
device group. Conversely, patients in the tracheal intubation group were significantly more likely to
regurgitate and aspirate before advanced airway management, possibly due to less frequent use of
advanced techniques to secure the airway in this group and the increased time required for tracheal
intubation compared with insertion of a supraglottic airway device.
What would cause a patient's respirations to be shallow after striking his/her head while diving
Breathing problems: If the spine is severely compressed, your lungs may not work properly and you can
have trouble breathing. Specifically, the C3, C4, and C5 spinal nerves innervate the diaphragm. After a
spinal cord injury at or above the C5 level, messages from the brain may not be able to get past the
damage, resulting in loss of control over the diaphragm.
This causes breathing to be weakened, therefore it’s essential to seek immediate medical attention. With
the help of a ventilator, respiratory functions may be restored.
First step in treating a patient with a slow pulse, slow respirations, and low BP
ABCs -> BVM patient with inadequate ventilations!
What is the first assessment you perform for each and every patient?
PRIMARY SURVEY/RESUSCITATION:
Verbalizes the general impression of the patient
Determines responsiveness/level of consciousness (AVPU)
Determines chief complaint/apparent life-threats
1-2. Assesses airway and breathing:
Assessment
Assures adequate ventilation
Initiates appropriate oxygen therapy
3. Assesses circulation:
Assesses/controls major bleeding
Checks pulse
Assesses skin [either skin color, temperature or condition]
AND CORRECT DETAILED ANSWERS COMPLETE
What is the best airway device to use for smoke inhalation?
Endotracheal intubation is frequently needed for supportive therapy in the management of inhalation
injury.
Most pertinent piece of information in evaluating a patient's ventilatory status?
Ventilation is the movement of air in and out of the lungs through a patent airway. The majority of
observations regarding ventilation focus on the movements of the chest.
SIGNS OF ADEQUATE VENTILATION:
In most patients, your assessment of ventilation will be based on observing their respiratory rate (normal
12 to 20) and listening for clear breathing sounds in the left and right chest. Auditory confirmation of
breathing sounds is the strongest sign of adequate ventilation. In patients on ventilators or bag-valve-
mask, this does not change.
Most pertinent piece of information in evaluating a patient's oxygenation status?
Oxygenation is the delivery of oxygen to the tissues of the body, poor ventilation or respiration will
generally lead to poor oxygenation. Loss of oxygenation is the ultimate result of ventilatory or respiratory
failure. You need to observe the patient's mental status, skin color, oral mucosa, and check a pulse
oximeter.
Mental status is either normal or abnormal, assessing mental status is based on asking questions about
who the person is, what time/date it is, where they are, and why they are here.
Skin and mucosal color are important indicators of oxygenation. Just as with poor respiration, cyanosis,
pallor, or mottling are signs of decreased oxygen delivery.
Pulse oximetry level is the most objective measure of oxygenation, it reads the saturation of hemoglobin
(reported as SPO2), note that a pulse oximeter is not foolproof. A patient with poor oxygenation in the
limbs may have sufficient oxygenation to their core or vise-versa. Pulse oximeters can also be fooled by
specific toxic gases. Always ensure that you match up your pulse oximetry readings with physical findings
and ensure they support one another. Pulse oximeters are imperfect and are not a real-time measure of
O2 saturation
Most important assessment in evaluating a patient's oxygen delivery to the brain?
Prior to applying supplemental oxygen, objective data regarding patient status should quickly be obtained
such as airway patency, respiratory rate, pulse oximetry, and lung sounds. Signs of cyanosis in the
skin or nail bed assessment should also be noted.
What is the next step to take if a patient's breathing does not improve with an NRB?
BVM
,What is the next step to take after opening the airway of an unresponsive patient with slow, shallow
respirations?
After manually opening an unconscious patient's airway, you should: check the mouth for secretions,
foreign bodies, or dentures. If clear, then started manually ventilating!
Know your ventilation rates
Adult: 12-20/minute
Child: 15-30/minute
Infant: 25-50/minute
Flow rates for 02 devices:
Nasal Cannula - 2-6L/min
Nebulizer - 6-8L/min
Non-ReBreather - 10-15L/min
BMV - 15L/min
EndoTracheal Tube - 15L/min
King LTS-D - 15L/min
CPAP - 25L/min (oxygen port)
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
ET Tube
One intubation attempt with the definitive airway on patients in cardiac arrest before a provider can
attempt placement of a supraglottic airway (King Airway). If the first attempt fails, the provider may
attempt at intubation again, or elect to place the King Airway or return to the BLS airway (BVM).
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
King LT
These devices are best used when the ET Tube does not work.
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
LMA / iGel
It is secured in the throat via the inflation cuff, although the seal of the LMA is not as effective as that of
an ETT. An iGel works the same way, and does not have an inflatable cuff.
These devices are best used when the ET Tube does not work.
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
CPAP
Used for patients with CHF, or drowning victims. Used to help get fluid out of the lungs that is signified by
crackles or rales. Must meet requirements of blood pressure and consciousness to be used. Can have a
nebulizer connected if the situation requires it.
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
Nasal Cannula
Used for minimal oxygen for patients that have a lower SPO2 than 95%
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
Non-Rebreather
,Used for patients that require more than 6L of oxygen, and can be used with a nebulizer for maximum
efficiency.
When to use what airway device given a scenario / When to use what ventilation device given a scenario:
BVM
BLS airway that is used initially before an advanced airway, and connected to one if one is placed.
TX of a patient in anaphylaxis when epinephrine has failed to improve the patient's condition and he/she
is deteriorating
If 0.3mg IM 1:1000 Epi does not work, peripheral perfusion isn't good enough to circulate the medication!
IV EPI: 1:10,000 is the only solution to get the epinephrine to the patient.
Know the advantages and disadvantages of a surgical vs needle cricothyrotomy. Which one is the
quickest to perform?
Once established, surgical cricothyroidotomy has a number of advantages over use of a cannula –
provision of a definitive airway (protection by a cuffed tube) being just one. Despite this, the technique is
used far less frequently. This may be due to fears about the complication of hemorrhage.
Research suggests that needle cricothyroidotomy can provide effective ventilation in the presence of
increasing airway obstruction. The failure of the needle systems in the presence of upper airway
obstruction results from inadequate exhalation via the narrow 1.5mm lumen of the 13G cannula. Which
can lead to:
Barotrauma/pneumothorax = from over-inflation*
Bleeding
Subcutaneous emphysema
Survey data from the prehospital and hospital settings show the needle airway to be the most frequently
used emergency cricothyroidotomy method, whereas the surgical airway is rarely used.
Assessment findings in a patient with a spontaneous pneumothorax
Shortness of breath, sudden onset of sharp chest pain, pallor, tachypnea, diaphoresis.
Severe symptoms include tachycardia, AMS, cyanosis, decreased breath sounds on the affected side.
Best method to protect a patient's airway who vomits each time you try to intubate
Inadequate depth of anesthesia or unexpected responses to surgical stimulation may evoke
gastrointestinal motor responses, such as gagging or recurrent swallowing, increasing gastric pressure
over and above LOS pressure facilitating reflux.
In the setting of aspiration, regurgitation occurs three times more commonly than active vomiting. An
unprotected airway, excessively light depths of anesthesia, and one or more predisposing risk factors for
aspiration combine to significantly increase the risks of aspiration.
A summary of the available strategies for reducing aspiration risk:
Reducing gastric volume (NRB instead of BVM)
, Second-generation supra-glottic airway devices
Cricoid pressure
Rapid sequence induction
Position (left lateral, head down or upright)
What are the advantages / disadvantages of tracheal intubation vs using an extraglottic airway device?
Insertion of a supraglottic airway device is simpler and faster than tracheal intubation, and proficiency
requires less training and ongoing practice.
Tracheal intubation is a more complex skill than supraglottic airway device insertion and requires 2
practitioners, additional equipment, and good access to the patient's airway
The strategy of using a supraglottic airway device first also achieved initial ventilation success more often.
Although regurgitation and aspiration occurred with similar frequency overall, regurgitation and aspiration
during or after advanced airway management were significantly more common in the supraglottic airway
device group. Conversely, patients in the tracheal intubation group were significantly more likely to
regurgitate and aspirate before advanced airway management, possibly due to less frequent use of
advanced techniques to secure the airway in this group and the increased time required for tracheal
intubation compared with insertion of a supraglottic airway device.
What would cause a patient's respirations to be shallow after striking his/her head while diving
Breathing problems: If the spine is severely compressed, your lungs may not work properly and you can
have trouble breathing. Specifically, the C3, C4, and C5 spinal nerves innervate the diaphragm. After a
spinal cord injury at or above the C5 level, messages from the brain may not be able to get past the
damage, resulting in loss of control over the diaphragm.
This causes breathing to be weakened, therefore it’s essential to seek immediate medical attention. With
the help of a ventilator, respiratory functions may be restored.
First step in treating a patient with a slow pulse, slow respirations, and low BP
ABCs -> BVM patient with inadequate ventilations!
What is the first assessment you perform for each and every patient?
PRIMARY SURVEY/RESUSCITATION:
Verbalizes the general impression of the patient
Determines responsiveness/level of consciousness (AVPU)
Determines chief complaint/apparent life-threats
1-2. Assesses airway and breathing:
Assessment
Assures adequate ventilation
Initiates appropriate oxygen therapy
3. Assesses circulation:
Assesses/controls major bleeding
Checks pulse
Assesses skin [either skin color, temperature or condition]
