NREMT Paramedic Daily Question
Past questions
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Question 1 · Airway, Respiration and VentilationYou have placed a supraglottic airway. Capnography shows a low but present ETCO2 with a square waveform. What does this confirm?
- A. The device is in the airway and ventilating the lungs
- B. Esophageal placement
- C. Mainstem intubation
- D. Need for immediate removal and reinsertion of the device
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A. The device is in the airway and ventilating the lungsA persistent square-wave capnography tracing confirms that the supraglottic airway is delivering ventilation to the lungs.
A 71-year-old man with known COPD calls 911 for severe dyspnea. He is using accessory muscles, speaking in one-word sentences, and has diminished breath sounds bilaterally. Vital signs: HR 124, RR 32, BP 148/86, SpO2 86% on his home oxygen at 2 L/min. What is the most appropriate initial oxygen therapy?
- A. Non-rebreather mask at 15 L/min
- B. Nasal cannula at 6 L/min, increasing the flow until the SpO2 reaches 98 to 100%
- C. Bag-valve-mask ventilation with 100% oxygen
- D. Titrate oxygen via nasal cannula or simple mask to a target SpO2 of 88 to 92%
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D. Titrate oxygen via nasal cannula or simple mask to a target SpO2 of 88 to 92%In COPD with chronic CO2 retention, oxygen is titrated to an SpO2 of 88 to 92%. Excess oxygen worsens hypercapnia mainly by releasing hypoxic pulmonary vasoconstriction (worsening V/Q mismatch) and through the Haldane effect. Choice A gives high-flow oxygen that is likely to overshoot the target. Choice B aims for a saturation that is too high for this patient. Choice C, assisted ventilation, is reserved for respiratory failure or a patient who cannot protect the airway.
A 62-year-old male is found unresponsive after a fall. He has snoring respirations and blood in the oropharynx. After suctioning and opening the airway with a jaw-thrust, you are unable to ventilate with a bag-valve mask despite repositioning. What is the most appropriate next intervention?
- A. Insert a nasopharyngeal airway and continue ventilation attempts
- B. Perform immediate needle cricothyrotomy
- C. Insert a supraglottic airway device
- D. Begin chest compressions while preparing for intubation
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C. Insert a supraglottic airway deviceWhen basic airway maneuvers and bag-mask ventilation fail in an unresponsive patient, a supraglottic airway is the appropriate next step. Needle cricothyrotomy is reserved for failed advanced airway attempts. NPA is relatively contraindicated with significant oral/facial bleeding, and compressions are not indicated without cardiac arrest.
You place an endotracheal tube and observe a continuous square-wave capnography tracing with an ETCO2 of 35 mmHg. This finding confirms:
- A. Esophageal placement.
- B. Right mainstem intubation only.
- C. Correct tracheal placement.
- D. The need for immediate extubation.
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C. Correct tracheal placement.A persistent square-wave waveform with a physiologic ETCO2 value confirms tracheal placement and effective ventilation.
During RSI of a trauma patient, you visualize the vocal cords but cannot pass the tube. SpO2 falls to 78%. What is the most appropriate immediate action?
- A. Stop, and ventilate with a two-person BVM and an oral airway, then reassess
- B. Continue intubation attempts with a bougie until the tube passes
- C. Perform a surgical cricothyrotomy immediately, before any ventilation attempt
- D. Switch to a video laryngoscope and keep attempting without ventilating
Show the answer
A. Stop, and ventilate with a two-person BVM and an oral airway, then reassessFailed intubation with desaturation requires immediate re-oxygenation via the most effective method available (optimized BVM). Further instrumentation without restoring oxygenation worsens hypoxemia. Surgical airway is the next step only after failed oxygenation attempts.
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