EMT airway practice questions

C. Directly over the tracheostomy stoma. The key clues are the patient has a permanent tracheostomy following treatment for throat cancer, is in obvious respiratory distress, and requires supplemental oxygen. A permanent tracheostomy creates a direct opening from the trachea to the outside of the neck, bypassing the nose, mouth, and upper airway. Because this stoma is now the patient's only functional airway, oxygen should be directed over the tracheostomy stoma using the appropriate equipment while the EMT continually reassesses breathing and oxygenation. If ventilatory support becomes necessary, ventilations should also be delivered through the tracheostomy rather than the mouth or nose. A permanent tracheostomy changes the patient's anatomy, so always think "stoma first" for both oxygen delivery and assisted ventilations.

B. Insert an oropharyngeal airway. The key clues are the patient is unresponsive, continues to have snoring respirations after airway positioning, and has no gag reflex. These findings indicate persistent upper-airway obstruction from relaxed soft tissues, making an oropharyngeal airway appropriate. An OPA helps prevent the tongue from falling backward and obstructing the pharynx and is specifically indicated for an unresponsive patient without an intact gag reflex. Persistent snoring after proper positioning with an absent gag reflex is a strong indication for OPA placement to help maintain airway patency.

A. An expanding neck hematoma causing progressive upper airway compromise The key clues are direct anterior neck trauma followed by progressively increasing neck swelling, a muffled voice, and increasing difficulty swallowing secretions. These findings strongly suggest an expanding hematoma that is compressing or displacing structures of the upper airway. Because swelling within the neck can progress rapidly, a patient who initially appears to be breathing adequately may deteriorate to critical airway obstruction. The EMT should administer appropriate oxygen, closely monitor airway and breathing, prepare to assist ventilations if necessary, and expedite transport while notifying the receiving facility of the worsening airway. Progressive neck swelling combined with voice changes and difficulty handling secretions should be treated as an impending airway emergency.

C. Airway swelling may rapidly develop despite an initially adequate airway. The key clues are exposure to a smoke-filled enclosed space, hoarseness, singed nasal hairs, and soot around the mouth despite initially clear breath sounds and an adequate SpO₂. These findings strongly suggest inhalation injury and possible thermal damage to the upper airway. Airway edema can progressively worsen after the initial burn, potentially making ventilation and advanced airway management increasingly difficult. The EMT should closely monitor for voice changes, stridor, increasing respiratory effort, or decreasing mental status while providing appropriate oxygen and arranging rapid transport. The greatest immediate concern is that an airway that appears adequate now may become critically narrowed as swelling develops.

D. Roll the patient to protect the airway and suction as needed. The key clues are the patient is lying supine after a witnessed seizure, is breathing spontaneously, is actively vomiting, and has loud gurgling respirations. These findings indicate an immediate airway threat caused by emesis and pooled secretions, placing the patient at high risk for aspiration. The EMT should immediately roll the patient onto the side while maintaining spinal precautions if indicated, suction the airway as needed, and then reassess the airway, breathing, and need for additional interventions such as oxygen or assisted ventilations. Frequent reassessment is essential because postictal patients may experience recurrent vomiting, declining mental status, or worsening airway compromise. When a postictal patient is vomiting and gurgling, airway protection always comes before oxygen administration, airway adjuncts, or other assessments because maintaining a clear airway is the highest priority.

C. Apply CPAP if no contraindications exist. The key clues are severe respiratory distress, bilateral crackles, an SpO₂ of 86% on room air, and an elevated blood pressure in an alert patient. These findings are highly suggestive of acute cardiogenic pulmonary edema, in which fluid accumulates within the alveoli and impairs gas exchange. CPAP provides positive end-expiratory pressure (PEEP), helping recruit collapsed alveoli, push fluid back into the pulmonary capillaries, improve oxygenation, reduce the work of breathing, and decrease preload on the heart. Before applying CPAP, the EMT should confirm that the patient has no contraindications, such as an inability to protect the airway, active vomiting, altered mental status, significant hypotension, or respiratory arrest.

B. Suction the airway The key clues are gurgling respirations and visible blood in the airway, both of which indicate that fluid is obstructing the airway. Gurgling respirations are an important sign that blood, vomit, or secretions are interfering with airflow and must be removed before effective oxygenation or ventilation can occur. At the EMT level, suctioning should be performed only long enough to clear the airway—generally no more than 15 seconds in adults—to minimize interruptions in oxygenation. Once the airway is cleared, the EMT should immediately reassess breathing and provide airway adjuncts, oxygen, or assisted ventilations as indicated. Airway obstruction must always be corrected before other airway interventions can be effective.

B. Insert a nasopharyngeal airway (NPA), if not contraindicated. The key clues are the noisy respirations signaling partial airway obstruction, the altered mental status indicating a reduced level of consciousness, and the gag reflex triggered by the OPA attempt. A gag reflex means the patient retains enough protective reflex to reject an oral airway but still has enough altered consciousness to need airway support. The NPA bypasses the oral cavity entirely and travels through the nasal passage, making it far less likely to trigger vomiting while still maintaining a patent airway. EMTs should size the NPA appropriately, confirm there are no contraindications such as suspected basilar skull fracture or severe nasal trauma, then insert it to protect the airway during transport. Any patient who gags on an OPA but still has noisy, compromised respirations is the textbook candidate for an NPA.

C. Begin assisted ventilations with a bag-valve mask attached to high-flow oxygen. A respiratory rate of 8 breaths per minute with shallow chest rise indicates that the patient is no longer ventilating effectively and requires immediate ventilatory support. Assisted ventilations with a bag-valve mask provide adequate tidal volume while high-flow oxygen increases the oxygen concentration delivered with each breath. This combination improves oxygen delivery and promotes removal of carbon dioxide, addressing both oxygenation and ventilation. Early recognition of respiratory failure and prompt initiation of assisted ventilations help prevent progression to respiratory arrest and cardiac arrest.

B. The patient's respirations appear adequate and within normal limits. A normal adult respiratory rate is generally between 12 and 20 breaths per minute, but the rate alone does not determine whether breathing is adequate. This patient is breathing 16 times per minute, is speaking in full sentences, demonstrates normal chest rise, and shows no signs of increased work of breathing, all of which indicate effective ventilation. Evaluating respiratory status requires assessing rate, depth, effort, chest rise, and the patient's ability to speak, not simply counting respirations. EMTs should combine these findings to determine whether ventilation is adequate before deciding if intervention is necessary.

B. Suction and maintain the airway. The key clues are the patient is becoming increasingly drowsy, has loud gurgling respirations, saliva pooling in the mouth, and is no longer clearing secretions effectively. Gurgling indicates fluid or secretions are partially obstructing the upper airway, creating an immediate threat to oxygen movement into the lungs. The EMT should suction the airway, position it appropriately, use an airway adjunct if indicated, and reassess breathing to determine whether assisted ventilations are needed. Stroke, hypoglycemia, intoxication, or another medical condition may explain the decline in mental status, but none of those assessments should delay correction of an active airway problem. When you hear gurgling, think suction immediately because identifying the cause of altered mental status is secondary to keeping the airway open.

B. Assist the patient with the prescribed albuterol inhaler if permitted by local protocol and no contraindications exist. The key clues are the known asthma history, short-sentence speech, audible wheezing, similarity to prior attacks, and availability of the patient’s prescribed albuterol inhaler. These findings indicate acute bronchospasm, and albuterol acts primarily at beta-2 receptors to relax bronchial smooth muscle and improve airflow. When permitted by local protocol, an EMT may assist with the patient’s prescribed inhaler after confirming the medication is appropriate and assessing for relevant contraindications. When bronchospasm is the underlying problem, albuterol directly targets the airway constriction rather than merely supporting oxygenation.