NREMT Airway, Respiration and Ventilation Flashcards

Question 1

SGA stops ventilating and troubleshooting fails: next step?

Accepted Answer

Deflate the cuff, remove it with suction ready, and return to bag-valve mask with an oral or nasal airway. Oxygenation beats the device.

Question 2

Needle cricothyrotomy limit

Accepted Answer

Oxygenates but ventilates poorly: CO2 rises. A temporary bridge to a definitive airway.

Question 3

Colorimetric CO2 detector: three weaknesses

Accepted Answer

No waveform or number; may fail to change color in cardiac arrest (little CO2 delivered); can briefly change after gastric CO2 or be ruined by vomit and secretions. Waveform capnography is preferred.

Question 4

Infant airway — the four differences that change your hands

Accepted Answer

Big tongue · big occiput (pad the shoulders for neutral) · narrow airway where slight edema explodes resistance · near-obligate nose breathing. Hyperextension obstructs too.

Question 5

Methemoglobinemia clues and antidote

Accepted Answer

Cyanosis not fixed by oxygen, chocolate-brown blood, SpO2 drifting toward the mid-80s regardless of reality. Causes: some anesthetics, nitrites, dapsone. Antidote: methylene blue.

Question 6

Capnography

Accepted Answer

Normal 35–45 mmHg · sudden rise in CPR → ROSC · drop to zero → displaced tube/arrest · shark fin → bronchospasm.

Question 7

Short safe apnea time

Accepted Answer

Obesity · late pregnancy · young children · sepsis/fever. Small oxygen reservoir or high demand. Preoxygenate head-up, keep nasal cannula on, set an abort saturation.

Question 8

Saturation lag on high-flow oxygen

Accepted Answer

SpO2 stays normal for minutes after ventilation fails. Capnography (rising ETCO2) catches hypoventilation first. Normal SpO2 ≠ adequate ventilation.

Question 9

Distress vs failure

Accepted Answer

Distress = anxious, fast, working, upright. Failure = drowsy, tiring, rate SLOWING. A falling rate in a hard-working patient means assist ventilation.

Question 10

Minimum pediatric bag size

Accepted Answer

At least 450-500 mL self-inflating bag for infants and young children; squeeze only to visible chest rise.

Question 11

Why an SGA is not a definitive airway for inhalation injury

Accepted Answer

It sits above the glottis; swelling at or below the cords can still block airflow. Get ALS early for a definitive airway.

Question 12

Fading capnography after intubation

Accepted Answer

A few waveforms that vanish in a perfused patient = esophageal tube (gastric CO2 washing out). Pull it and reoxygenate.

Question 13

Cricothyrotomy by age

Accepted Answer

Adult: surgical through cricothyroid membrane (thyroid above, cricoid below). Young child: needle cricothyrotomy.

Question 14

CPAP working vs failing

Accepted Answer

Working: longer sentences, slower rate, rising SpO2. Failing: drowsy + rising EtCO2 → remove, bag-mask. BP falls → remove.

Question 15

Sizing a nasal airway

Accepted Answer

Tip of the nose to the earlobe — that puts the tip in the pharynx behind the tongue. Mouth corner to jaw angle is the ORAL airway landmark.

Question 16

Confirming an endotracheal tube

Accepted Answer

A sustained waveform over several breaths is the standard, and it keeps working as a displacement alarm. Condensation and an easy pass prove nothing — both happen in the esophagus.

Question 17

'Shark fin' waveform

Accepted Answer

Sloping upstroke = uneven alveolar emptying = lower-airway obstruction (bronchospasm).

Question 18

Patient on CPAP vomits: first action

Accepted Answer

Remove the mask at once, position, suction. Positive pressure plus a sealed mask drives vomit into the airway.

Question 19

SGA leak under high pressure (asthma, obesity)

Accepted Answer

Cuff seal pressure is limited. Slow the rate, long exhalation, just enough volume for chest rise. Don't overfill the cuff.

Question 20

Match minute volume after intubating metabolic acidosis

Accepted Answer

DKA/sepsis patients compensate by blowing off CO2. A standard rate after intubation removes it → pH crashes. Match pre-intubation minute volume; follow ETCO2.

Question 21

V/Q mismatch vs shunt

Accepted Answer

Ventilated but not perfused = dead space (embolism). Perfused but not ventilated = shunt (pneumonia, atelectasis, edema) — and a shunt barely responds to more oxygen. Recruit it.

Question 22

Dead space — why fast and shallow fails

Accepted Answer

About a third of every breath never reaches an alveolus. Halve the depth and dead space eats most of what is left, so alveolar ventilation falls even when the rate looks fine.

Question 23

Advanced airway confirmation

Accepted Answer

Continuous capnography waveform. Right-only breath sounds + waveform → tube too deep.

Question 24

Depolarizing vs nondepolarizing paralytic

Accepted Answer

Depolarizing: activates the acetylcholine receptor, causes fasciculations, short acting, can raise potassium. Nondepolarizing: competitively blocks the receptor, no fasciculations, longer acting.

Question 25

Suction — which catheter, and the pediatric warning

Accepted Answer

Thick or particulate vomit needs a rigid catheter; a soft one is for a nasal airway or a tube lumen. In children keep passes brief — pharyngeal stimulation causes vagal bradycardia.

Question 26

Pseudo-normal end-tidal CO2 in asthma

Accepted Answer

Low early (hyperventilation). A 'normal' or rising value in a drowsy, quieter-chested asthmatic means exhaustion and impending failure.

Question 27

CPAP exclusions

Accepted Answer

Hypotension, cannot follow commands/protect airway, apnea, pneumothorax, vomiting. Works by raising chest pressure → lowers preload.

Question 28

Apneic oxygenation

Accepted Answer

High-flow nasal cannula left on during laryngoscopy. Oxygen keeps reaching alveoli while apneic → longer safe apnea time.

Question 29

Four types of hypoxia

Accepted Answer

Hypoxemic — too little O2 into blood (altitude, hypoventilation). Anemic — too little working Hb (bleeding, CO). Stagnant — blood not flowing (shock). Histotoxic — cells can't use O2 (cyanide).

Question 30

Resuscitate before you intubate

Accepted Answer

Hypotension + hypoxia = peri-intubation arrest risk. Preoxygenate head-up, apneic oxygenation, restore perfusion, avoid rapid post-tube ventilation.

Question 31

Oxygen cylinder duration formula

Accepted Answer

(Gauge psi - 200 safe residual) x cylinder constant / L per min. D = 0.16, E = 0.28, M = 1.56.

Question 32

DOPE — the sudden deterioration checklist

Accepted Answer

Displacement · Obstruction · Pneumothorax · Equipment. Check the tube, suction it, examine the chest, swap the bag — then prove the fix with capnography.

Question 33

The hypoxic drive question, answered

Accepted Answer

Never withhold oxygen from a hypoxic COPD patient. Hypoxia kills in minutes; any drive effect is slow and is managed by watching and being ready to ventilate.

Question 34

Advanced airway in cardiac arrest

Accepted Answer

Continuous compressions + 1 breath about every 6 s (10/min). No 30:2 pauses. Avoid overventilation.

Question 35

The endotracheal tube catches at the cords while railroading over a bougie — fix?

Accepted Answer

Keep the laryngoscope in and rotate the tube a quarter turn counterclockwise so the bevel slips past the arytenoids.

Question 36

BVM troubleshooting order

Accepted Answer

Reposition/jaw lift + reseat mask → look and suction → OPA/NPA + two-rescuer → supraglottic airway. Seal and position cause most failures.

Question 37

Absorption atelectasis

Accepted Answer

High O2 for long periods washes out nitrogen that splints alveoli open; the O2 is absorbed and poorly ventilated alveoli collapse. Titrate O2 to target.

Question 38

SpO2 in anemia

Accepted Answer

Reports the % of Hb saturated, not how much Hb exists. 99% of too little hemoglobin is still too little oxygen.

Question 39

Stridor vs wheeze

Accepted Answer

Stridor = at or above the larynx. Wheeze = lower airways. The sound locates the problem.

Question 40

V/Q mismatch vs shunt: response to oxygen

Accepted Answer

V/Q mismatch improves with supplemental oxygen. True shunt (perfused but unventilated alveoli: pneumonia, edema, ARDS) responds poorly; it needs alveolar recruitment such as PEEP or CPAP.

Question 41

Ventilation rate with an advanced airway: adult vs child

Accepted Answer

Adult: 1 breath every 6 s (10/min). Infant or child: 1 breath every 2-3 s (20-30/min). Compressions continuous in both.

Question 42

Oxygen saturation targets

Accepted Answer

Most patients: about 94-98%. COPD with CO2 retention: about 88-92%. After return of circulation: about 92-98%. Titrate, don't flood.

Question 43

Normal or rising ETCO2 in a tiring asthmatic

Accepted Answer

Early asthma drives ETCO2 down from fast breathing. A 'normal' or climbing ETCO2 as the patient tires means CO2 retention and impending respiratory failure; prepare to assist ventilation.

Question 44

Peak vs plateau pressure

Accepted Answer

Peak up, plateau same = resistance (biting, kink, secretions, bronchospasm). Both up = compliance (pneumothorax, mainstem, edema).

Question 45

Ventilator alarms

Accepted Answer

HIGH pressure = resistance: biting, secretions, pneumothorax, bronchospasm. LOW pressure = leak: disconnect, cuff, dislodged tube.

Question 46

BVM not moving air — first fix

Accepted Answer

The seal. Go two-person before anything else.

Question 47

What a paralytic does NOT provide

Accepted Answer

Neuromuscular blockers give no sedation, amnesia or analgesia. A paralyzed but unsedated patient is awake and suffering. Sedate before paralysis and keep sedation going after the tube is placed.

Question 48

Intubated patient crashes — DOPE

Accepted Answer

Displaced tube, Obstructed tube (secretions, kink), Pneumothorax (tension), Equipment failure (oxygen, bag, vent). Also think stacked breaths. Disconnect from vent and hand-bag to sort it out.

Question 49

Tube follows the chin

Accepted Answer

Flexion → tube deeper (right mainstem). Extension → tube up toward cords. Reconfirm after every move.

Question 50

Esophageal detector bulb: how it works

Accepted Answer

Compressed bulb on the tube: the rigid trachea lets it refill quickly; the collapsible esophagus blocks refill. Less reliable in obesity, late pregnancy and heavy secretions. An adjunct, not proof.

Question 51

Dissociation curve shifts

Accepted Answer

Right shift (releases O2): fever, acidosis, high CO2. Left shift (holds O2): cold, alkalosis, carbon monoxide, hyperventilation.

Question 52

Auto-PEEP (breath stacking) in COPD or asthma

Accepted Answer

Too little exhalation time traps air: rising pressures, falling BP, falling ETCO2, possible PEA. Fix: slow the rate, lengthen exhalation, briefly disconnect and allow full exhalation.

Question 53

Obstructions an SGA can't bypass

Accepted Answer

Anything at or below the glottis: lodged foreign body, laryngeal edema, fractured larynx. It fixes tongue and soft-tissue obstruction only.

Question 54

Laryngectomy stoma ventilation

Accepted Answer

No connection mouth-to-lungs. Seal a small (infant/child) mask over the stoma. Face mask or oral device inflates the stomach.

Question 55

Diffusion: CO2 vs O2

Accepted Answer

CO2 diffuses ~20x more easily. Early pulmonary edema: SpO2 falls first, CO2 normal or low. A rising CO2 means the patient is tiring.

Question 56

Intubating the acidotic patient

Accepted Answer

His fast deep breathing is compensation. After paralysis, match his high minute ventilation or the pH crashes.

Question 57

RODS (difficult supraglottic airway)

Accepted Answer

Restricted mouth opening · Obstruction at/below larynx · Disrupted/distorted airway · Stiff lungs.

Question 58

Best single confirmation of tube placement

Accepted Answer

Continuous waveform capnography showing a persistent CO2 waveform over several breaths. Breath sounds, chest rise and misting support it but can mislead; keep monitoring to catch later displacement.

Question 59

Paralytics

Accepted Answer

No sedation, no analgesia — always add both. Depolarizing class can raise potassium: avoid in crush, late burns, longstanding paralysis.

Question 60

Supraglottic airway — when to take it out

Accepted Answer

No waveform after repositioning · vomit filling the device · no chest rise on a fresh attempt · the patient waking and gagging. Go back to a bag and mask.

Question 61

Breath stacking (auto-PEEP)

Accepted Answer

Asthma/COPD bagged too fast → air trapping, hypotension. Disconnect to exhale, then slower rate, longer exhalation.

Question 62

Main drive to breathe

Accepted Answer

Rising CO2 sensed by central chemoreceptors in the medulla. Low O2 (carotid/aortic bodies) is the backup stimulus.

Question 63

Raised capnography baseline

Accepted Answer

Baseline should be zero. Climbing baseline = rebreathing CO2 (short exhalation time, dead space, bad valve).

Question 64

Ventilation, respiration, oxygenation — which is which

Accepted Answer

Ventilation = air moving. Respiration = gas crossing a membrane. Oxygenation = oxygen loaded on hemoglobin and delivered. A patient can pass one and fail another.

NREMT Airway, Respiration and Ventilation Flashcards

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