10 free EMT practice questions: Respiratory Emergencies & Airway Management

Pulmonary embolism: The breath sounds are decreased on one side, and a pulmonary embolism leaves them equal. A pulmonary embolism is a clot in the blood vessels of the lung, not air around the lung, so air still moves into both lungs. It also usually comes with a risk factor, like being immobile, a long trip, recent surgery, or a swollen, tender calf, and this question gives you none of those.

Acute coronary syndrome: usually pressure or heaviness that does not change with breathing, in a patient with cardiac risk factors. Acute coronary syndrome does not change the breath sounds on one side. This patient is 19, the pain gets worse with a deep breath, and one side of the chest is quiet. Those are signs of a lung problem.

Musculoskeletal chest wall pain: Chest wall pain never decreases the breath sounds, and this patient's are decreased on one side. Chest wall pain usually has a cause like a fall, heavy lifting, or a hard cough, and it gets worse when you press on the spot. This pain started at rest without any injury, and no tenderness is described.

Difficulty breathing: tells you the patient is in trouble and you need to move fast. Every respiratory emergency causes difficulty breathing. Asthma, pulmonary edema, pneumothorax, and angioedema all do. Difficulty breathing cannot tell you where the narrowing is. The question asks for a finding that only upper airway narrowing causes.

Whispered speech: A whisper shows how severe the problem is. A patient who can only whisper is moving very little air. Anything that limits airflow or vocal cord movement can cause a whisper, in the upper airway or the lower airway. Whispered speech tells you how bad this is, not where the narrowing sits.

Facial and lip swelling: a reason to suspect the tongue and airway are swelling too. That is why this patient is treated as an airway emergency. Swelling you can see on the outside does not prove where airflow is blocked. A patient can have facial swelling with a fully open airway. Stridor comes from air moving past the narrowing itself, so stridor is direct proof of where the narrowing is.

No supplemental oxygen, since the patient denies significant distress: This patient denies real distress, but the lips are cyanotic and the patient keeps drifting off. When what the patient says and what you see disagree, go with the physical findings. Holding oxygen leaves a hypoxic patient hypoxic.

Nasal cannula titrated to effect: The lips are already cyanotic and the patient is losing alertness, which is too much hypoxia for a nasal cannula. A cannula gives a low flow and a low oxygen concentration. Start with the NRB, then turn the oxygen down once the color and the mental status come back.

Assist ventilations with a BVM: Breathing at 22 a minute in full sentences without extra effort is adequate, so this patient does not need a BVM. A BVM is for breaths that are too slow or too shallow to move enough air, and agonal breathing or no breathing at all are the clearest cases. Altered mental status alone calls for airway care first, like positioning and suction, not a BVM.

Deliver back blows, since the patient is at higher risk due to the underlying lung disease: This patient still has an effective cough, and hitting a patient who is still moving air can knock a partial blockage into a spot where it blocks the airway completely. The lung disease means this patient has less reserve, and you still do not step in while the patient is moving air. Back blows are used with chest thrusts for a choking infant under 1 year, and some systems also use them for a severe obstruction in older patients.

Assume the cough is from the patient's baseline COPD and continue the assessment: The cough started suddenly on a bite of food, and the family says it sounds different from the patient's usual cough, so this is not baseline COPD. If you call a sudden new cough baseline COPD, a foreign body can get missed until the patient can no longer cough or talk.

Perform abdominal thrusts due to the patient's underlying lung disease: Right now the patient is talking between coughs and the skin is pink, so air is still moving. Abdominal thrusts start the moment this patient stops moving air. Watch for the patient going silent, not being able to speak, or turning cyanotic.

Presence of inspiratory stridor: Stridor on inspiration tells you the obstruction is in the upper airway. Stridor is part of why this child is so sick. Croup is the most common cause of stridor in children, and epiglottitis causes stridor too. A finding both conditions share cannot tell them apart.

Presence of fever without other signs: Fever shows up in both conditions, and in croup it is often the first thing a parent notices. This option also says fever without other signs. This child has drooling, stridor, a muffled voice, and tripod positioning along with the fever. Fever points to an infection, but fever does not tell you which infection.

Tripod positioning during breathing: Tripod positioning is real and important. The child is holding the airway in its most open position, and you should never force the child out of it. Tripod positioning happens in croup, epiglottitis, and severe asthma. Any hard work of breathing causes tripod positioning, not one specific infection. Tripod positioning tells you how hard the child is working, not which disease is causing it.

Position the child upright for transport: An arrest is worked on a firm, flat surface, not in a seat, and this child is unresponsive and not breathing. Packaging the child first uses up the minutes that matter and delays the compressions that can move the grape.

Assist ventilations with a BVM: Air from the bag has nowhere to go, because a grape is stuck in this child's airway and bystanders saw it happen. Squeezing the bag against a complete obstruction wastes time. The air can go into the stomach instead, which raises the risk of aspiration, and no oxygen gets in.

Insert an oropharyngeal airway and ventilate: A grape is blocking this airway, and an oral airway only holds the tongue off the back of the throat. The tongue is the most common obstruction in an unresponsive patient, and an OPA does nothing for a grape stuck below the device. Sliding a rigid device into the mouth can push the grape further down. Chest compressions create the pressure that can push the grape out.

Assist ventilations with a BVM: Breathing 16 times a minute with good, equal chest rise is adequate, so this patient does not need a BVM. A lower level of consciousness by itself is not a reason to bag. A BVM is for breathing that is too slow, too fast, or too shallow to move enough air. Forcing breaths into a patient who is already breathing well can push air into the stomach and cause vomiting.

Insert an oropharyngeal airway and begin ventilating: Withdrawing to pain and making sounds mean some gag reflex is still there, so an oral airway is likely to be gagged out or cause vomiting. In a deeply unresponsive patient with no gag reflex, an oral airway holds the tongue forward better than a nasal airway does. Option C also adds ventilations this patient does not need, with a rate of 16 and good, equal chest rise.

Apply an NRB without an airway adjunct: A patient this altered cannot keep the tongue out of the airway, and a mask does not hold the airway open. A tongue that falls back blocks the airway just as badly with 15 liters flowing. Open and hold the airway first, and then the oxygen can do its job.

It reduces airway swelling over several hours: Steroids reduce swelling in the airways and are part of asthma care. Steroids take hours to days to work, and this patient needs relief in minutes. The wheezing here comes from muscle spasm, and albuterol relaxes that spasm right away.

It thins mucus so it can be coughed up: Mucolytic and expectorant drugs thin mucus so the patient can cough it up. Albuterol does not change mucus at all. This patient's wheezing comes from airways squeezed narrow by muscle spasm, not from thick mucus.

It sedates the patient to reduce anxiety-driven breathing: A sedative can calm fast breathing caused by anxiety. Albuterol does not sedate the patient or calm anxiety. This patient's trouble breathing comes from narrowed airways, so a sedative would do nothing for the airflow.

The child is improving in response to the oxygen therapy and should continue the current treatment unchanged: This child's level of consciousness is dropping while the breathing effort goes down. A drop in both means respiratory failure, not a child getting better on oxygen, so this child needs more than the current treatment.

The child has responded well to the oxygen and can be weaned off the supplemental oxygen during transport: Weaning oxygen is only for a child who is truly improving. This child is getting less responsive, so the oxygen stays on while you get ready to assist ventilations.

The child is calming in response to the mother's reassurance, and the slower breathing reflects improving oxygenation: Reassurance does not make a child less responsive to the mother's own voice. Slower breathing with dropping responsiveness means the child is tiring out and heading into respiratory failure.

Apply high-flow oxygen by NRB to achieve an oxygen saturation of 98% or greater: Pushing the saturation to 98% or higher with a nonrebreather overshoots for this patient. A patient with COPD often has a lower saturation at baseline. Titrate the oxygen to how the patient responds instead of chasing a fixed high number.

Withhold supplemental oxygen to avoid suppressing the patient's hypoxic respiratory drive: Withholding oxygen comes from the old idea that oxygen suppresses a COPD patient's hypoxic drive to breathe. That idea is outdated and has been debunked. Current EMS teaching does not support withholding needed oxygen from a hypoxic patient. This patient is at 88% and needs oxygen.

Place the patient supine and begin positive pressure ventilations with a BVM: Lying a patient supine and giving positive pressure ventilations with a BVM is for a patient whose breathing is inadequate. This patient is sitting upright by choice, speaking in short phrases, and moving air. Lying this patient flat works against the position that is helping the patient breathe.