EMT Chapter 40 ALS Assist

Advanced airway management techniques should performed ONLY after:
basic airway techniques have been completed

After opening a patient’s airway, you should:
ensure the airway is clear

Endotracheal intubation is MOST accurately defined as:
inserting a tube into the trachea to maintain the airway and ventilate

Endotracheal intubation is indicated for patients:
who are unconscious and cannot protect their own airway

If a patient is being adequately ventilated with a bag-mask device attached to high-flow oxygen:
endotracheal intubation may not be necessary

Visualized orotracheal intubation requires all of the following equipment, EXCEPT a:
local anesthetic

Prior to performing orotracheal intubation in a cardiac arrest patient, it is MOST important to:
adequately preoxygenate with a bagmask device.

Although you should carry a variety of endotracheal (ET) tube sizes, a _____ ET tube will adequately fit most adults.
7.5mm

Regardless of the size of the ET tube that you will use to intubate your patient, you should:
have one tube smaller and one tube larger

When determining the proper size ET tube to use in an infant or small child, you should:
use a length-based resuscitation tape measure

When an ET tube is placed in an adult patient, the tube-to-teeth mark is usually around:
22 cm.

When inserting the stylet inside an ET tube, you should:
avoid inserting the stylet past Murphy’s eye

The distal cuff on an ET tube should be inflated with no more than ______ of air after it is placed into the trachea.
10 mL

Prior to attempting endotracheal intubation, the EMT should:
obtain authorization from medical control

A single intubation attempt in the adult patient should not exceed:
30 seconds.

Intubating a patient who is in cardiac arrest should occur after:
the patient has been assessed to determine if defibrillation is indicated

After successfully intubating a 56 year old man who is in cardiac arrest, you should:
perform asynchronous CPR

The appropriate method of inserting a laryngoscope blade into the patient’s mouth to visualize the vocal cords is to:
insert the blade in the right side of the mouth, sweep the tongue to the left, and lift

During visualized orotracheal intubation, the straight blade:
directly lifts the epiglottis and exposes the vocal cords.

To avoid obscuring your view of the vocal cords during intubation, you should
not pass the ET tube down the center of the laryngoscope blade

You respond to a construction site where a steel girder collapsed on a 22-year-old male’s chest. Coworkers removed the girder prior to your arrival. Your assessment reveals that he is unconscious and apneic, but has a pulse. You should:
maintain stabilization of his head, open his airway with the jaw-thrust maneuver, ventilate with a bag-mask device, and prepare to intubate him.

Immediately after you place an ET tube in the trachea, you should remove the stylet and then:
inflate the distal cuff and detach the syringe

Confirmation techniques and devices used to determine correct ET tube placement include all of the following, EXCEPT:
rise and fall of the abdomen

Which of the following is the MOST reliable indicator of successful endotracheal intubation?
visualization of the tube passing between the vocal cords

After intubating a 44-year-old unconscious, apneic male, you place him on the ambulance stretcher and prepare to load him into the ambulance. After he is placed into the ambulance, you should:
reconfirm that the ET tube is still correctly positioned

Complications associated with endotracheal intubation include all of the following, EXCEPT:
left main stem bronchus intubation

You have inserted an ET tube but are unable to hear breath sounds on the left side of the chest. You should:
withdraw the tube approximately 1′′ and reassess breath sounds.

You have attempted to intubate a 66year-old male twice without success. Medical control is unable to be contacted. Your MOST appropriate action should be to:
insert an oral airway, ventilate with a bag-mask device, and transport.

After performing endotracheal intubation on an elderly male in cardiac arrest, you think you hear breath sounds, but also hear gurgling over the epigastrium. You should:
remove the ET tube at once, ventilate with a bag-mask device for 2 to 3 minutes, and reattempt intubation.

A 50-year-old female is found semiconscious by her son. Your assessment reveals that her respirations are slow and shallow and there is vomitus draining from her mouth. When you attempt to suction her oropharynx, she begins to gag. You should:
ensure that her airway is clear, attempt to insert a nasopharyngeal airway, and assist her ventilations with a bag-mask device.

You are transporting an intubated 24year-old female when her level of consciousness improves and she becomes combative. You should anticipate that your paramedic partner will:
give her a sedative drug per local protocol.

Which of the following statements regarding multilumen airway devices is correct?
Ventilations can be provided whether the device is in the trachea or the esophagus

A major benefit when using a multilumen airway device is that:
maintenance of a mask-to-face seal is not required.

You should NOT attempt to insert a Combitube in a patient who:
has ingested a caustic substance

If it is necessary to remove a multilumen airway in the field, you should:
turn the patient onto his or her side and have suction ready.

Which of the following statements regarding the King LT airway is correct?
When the King LT is properly placed in the esophagus, one cuff is designed to seal the esophagus and the other cuff is designed to seal the oropharynx.

A disadvantage of the King LT airway is that it:
does not completely protect the airway from aspiration.

The laryngeal mask airway (LMA) helps protect the airway and allows for adequate ventilation by:
molding and sealing itself around the laryngeal opening by inflation of the mask.

In the prehospital setting, gastric tubes are used primarily to:
decompress the stomach

Proper confirmation of correct gastric tube placement includes:
injecting air into the tube and auscultating the stomach for gurgling

For which of the following patients would the use of a continuous positive airway pressure (CPAP) device be of MOST benefit?
62-year-old man with severe respiratory distress, a history of congestive heart failure, and audible rhonchi in the lungs

The MOST important step in assembling intravenous (IV) equipment is to:
strictly adhere to standard precautions

Common IV solutions used in the prehospital setting include all of the following, EXCEPT:
5% albumin solution

D₅W is MOST commonly used for:
mixing and administering medications

Once an IV solution is removed from its protective wrap, it must be used within:
24 hours

Which of the following statements regarding the IV administration set is correct?
It moves fluid from the IV bag into the patient’s vascular system

A microdrip administration set delivers 1 mL of fluid after every ______ drops.
60

You should routinely inspect a bag of IV fluid for all of the following, EXCEPT:
the manufacturer

After sliding the piercing spike of the administration set into the IV bag port, you should next:
prime the line and flush the air out of the tubing.

The purpose of a saline lock is to:
maintain an active IV site without running fluids through the vein

ALS providers choose the type and size of the IV catheter based on all of the following factors, EXCEPT the:
gender of the patient

Which of the following over-the-needle IV catheters has the largest diameter?
14-gauge

Which of the following IV catheters would deliver fluid at the slowest rate?
22-gauge

Intraosseous (IO) needles are used when:
immediate IV access is difficult or impossible to obtain.

An IO needle is inserted into the:
proximal tibia

Signs of an infiltrated IV include:
edema at the catheter site

If an IV line is found to be infiltrated, you should:
remove the catheter and apply direct pressure

Local reactions associated with IV therapy include all of the following, EXCEPT:
catheter shear

Approximately 20 minutes after initiating an IV line of normal saline, your patient complains of generalized itching and develops a generalized rash. These are signs and symptoms of:
an allergic reaction

A 50-year-old male develops acute respiratory distress and cyanosis shortly after an IV line has been established. You should administer high-flow oxygen and:
place him on his left side with his head down.

Signs and symptoms of acute circulatory overload include all of the following, EXCEPT:
a drop in blood pressure

Vasovagal reactions that occur in patients receiving IV therapy are MOST often the result of:
a fear of needles or the sight of blood

An IV line is not running as fast as it should be. There are no signs of infiltration. You should:
ensure that the tourniquet has been released

What is a Volutrol and when should it be used?
Volutrol is a 100mL calibrated drip chamber that can be shut off from the IV bag. It should be used to prevent fluid overload in pediatric and geriatric patients.

Which of the following statements regarding vascular access in geriatric patients is correct?
Elderly patients often have fragile skin that is easily damaged

The heart’s primary pacemaker is the:
sinoatrial (SA) node

The left and right bundle branches:
travel through the interventricular septum and lead to the Purkinje fibers

Which of the following correctly describes the normal path of electricity through the cardiac conduction system?
SA node, internodal pathways, AV node, bundle of His, left and right bundle branches, Purkinje system

The SA node normally paces at a rate of:
60 to 100/min.

When an electrical impulse moves toward a positive electrode:
the ECG records an upward wave

A single ECG complex consists of all of the following components, EXCEPT:
an R-R interval.

When looking at ECG graph paper, one large box represents:
0.20 seconds.

If each small box on the ECG graph paper represents 0.04 seconds, and there are 5 small boxes in one large box, how many large boxes represent 6 seconds?
30

A normal sinus rhythm (NSR) is characterized by all of the following, EXCEPT:
an irregular heart rate

A P wave is created when:
electricity travels through the atria

The only route of communication between the atria and the ventricles is/are the:
AV node

The QRS complex is an electrical representation of:
ventricular contraction

Which of the following statements regarding sinus bradycardia is correct?
It may be a normal variant in some individuals

Sinus tachycardia is differentiated from a normal sinus rhythm by the:
irregular heart rate

When the heart rate becomes exceedingly high:
ventricular filling time decreases

Any electrical impulse that originates in the ventricular conduction system has:
wide, abnormally shaped QRS complexes.

Ventricular tachycardia is characterized by:
wide QRS complexes and a heart rate greater than 100 beats/min.

A rapid, chaotic rhythm that is completely disorganized is called:
ventricular fibrillation

The MOST effective treatment for ventricular fibrillation or pulseless ventricular tachycardia of short duration is:
prompt, rapid defibrillation

Which of the following cardiac arrhythmias is characterized by a complete absence of myocardial electrical and mechanical activity?
asystole

When applying the 4lead ECG electrodes to a patient, the white (negative) lead should be placed:
on the right arm

It does not matter if you place the arm leads on the patient’s shoulders or arms, as long as:
they are at least 10 cm from the heart

Leads V₁ and V₂ in a 12-lead ECG should be positioned:
on each side of the sternum at the fourth intercostal space

Obtaining an accurate ECG tracing can be difficult in patients experiencing a cardiac emergency because:
the patient is often diaphoretic

A 12-lead ECG:
may identify myocardial ischemia or injury

Which of the following leads views the lateral wall of the left ventricle?
V₅ and V₆

Your paramedic partner has just acquired a 12lead ECG on a middle-aged man with chest discomfort. The patient is conscious, but anxious. His blood pressure is 140/84 mm Hg and his heart rate is 80 beats/min. He has a history of hypertension and type 2 diabetes. Your partner states that she believes the patient is experiencing a myocardial infarction of the anterior wall. Which of the following is the MOST likely basis for her statement?
She has detected ST segment elevation in leads V₃ and V₄

The ultimate goal in treating a patient who is experiencing an ST-segment elevation myocardial infarction (STEMI) is to:
rapidly restore perfusion to the injured heart

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