10 free AEMT practice questions: Advanced Airway Management and Adjuncts

A hematoma over the left forehead: A forehead hematoma tells you where the impact landed, and any sign of head trauma should make you look harder at everything else. A hematoma over the frontal bone does not tell you the skull base is involved, and it does not change which route you use.

Bleeding from a scalp laceration: Scalp bleeding is dramatic and it pulls your eye first, since the scalp bleeds heavily from small wounds. A laceration is a soft tissue injury, and on its own it says nothing about the bone underneath or about the nasal passage.

A left pupil larger than the right: Unequal pupils is a genuinely serious finding and it should change how fast you move. It points at rising pressure inside the skull rather than at a fracture of the skull base, and it has no bearing on which airway adjunct you reach for.

Use a bulb syringe, clearing both nares first: Clearing the nares matters more in an infant than in anyone else, since an infant breathes through the nose by preference, which is exactly why this order is tempting. Going to the nose first triggers a breath that pulls the milk still sitting in the mouth down into the airway, so the mouth comes first.

Use a soft catheter in the nares with the unit's pressure turned down: Lowering the pressure for a small patient sounds like the careful thing to do, and it is the single most common belief about pediatric suctioning. Suction force is not adjusted by age, and a unit turned down that far does not clear the secretions at all.

Use a rigid catheter in the mouth for no more than 10 seconds: A rigid catheter is what you reach for with an adult airway full of fluid, so it is a habit carried into the wrong patient. It is too large for an infant's mouth, and 10 seconds is the child's limit rather than the infant's 5 seconds.

Inserted with suction applied so secretions are caught on the way down: Catching secretions on the way down sounds more efficient, and the mental picture of a vacuum cleaner makes it feel right. Suction on the way in pulls oxygen out of the lungs during the trip down and lets the tip grab tracheal tissue, so you cause injury and hypoxia for nothing.

Advanced to the carina, then withdrawn with the suction cycled on and off: Advancing to the carina and cycling the vacuum comes from thinking deeper is more thorough. Touching the carina sets off the strongest vagal response and the worst coughing, and the catheter is measured against the tube for exactly that reason, so the tip sits just past the end.

Inserted and withdrawn with continuous suction for a full 15 seconds: Continuous suction on a stopwatch sounds disciplined, and 15 seconds is a real number you should know. The limit is a ceiling rather than a target, and leaving the vacuum on during insertion is what makes this wrong no matter how long the attempt runs.

Hold steady pressure until the device passes through the resistance: Pushing through feels like persistence, and a patient who is not breathing puts real pressure on you to get the airway in. Force is what causes bleeding and swelling in the tissue you need, and the device is not going to pass an epiglottis it has already folded over.

Remove it and insert the next smaller size instead: Downsizing is a reasonable thought and it is the right move when the device genuinely does not fit. Resistance at the halfway point is a path problem rather than a size problem, and swapping devices spends an insertion attempt you did not need to spend.

Rotate it 90 degrees and advance along the lateral pharynx: Rotation is a real technique for an oral airway, so borrowing it here has a logic to it. Taking a blind insertion device off the midline points the tip into the piriform recess instead of the hypopharynx, which makes the seat worse rather than better.

Insert the nasopharyngeal airway in the opposite nostril: Drainage from one nostril makes the other side look clean and usable, and switching sides is what you would do for a deviated septum or a nosebleed. The contraindication is not a property of one nostril. It sits at the base of the skull, which both nasal passages share.

Suction the drainage away and then insert the nasopharyngeal airway: Clearing fluid before you place a device is good habit, and clear drainage looks like something you should be able to suction away. That fluid is a sign of the injury, not an obstruction to get past, and suctioning it changes nothing about where the device would travel.

Hold a manual jaw thrust for the rest of the transport: A jaw thrust is exactly right for a patient who fell from a ladder, because it opens the airway without extending the neck, so this option gets the positioning half correct. It leaves the tongue unsupported for the whole transport and occupies a provider who will be needed elsewhere. Use the jaw thrust and place the adjunct this patient can take.

With the tip toward the roof of the mouth, rotating it 180 degrees: This is the adult technique, and it is right for an adult: tip toward the palate, advance, then flip 180 degrees so the curve follows the tongue. In a 5-year-old the full flip drags hard plastic across a soft palate that tears, and the small mouth leaves no room to spin the device without pushing the tongue back into the pharynx, which is the obstruction the device exists to relieve.

With the tip toward the roof of the mouth, advanced to the flange without rotating: Advancing with the tip toward the palate and never turning leaves the tip pressed against the soft palate with the curve pointed the wrong way. The device never gets behind the tongue, so nothing is held open, and the tip sits on the one surface in the mouth most likely to bleed.

Straight back with the head extended as far as it will go: More extension does feel like more airway, and it is the reflex that head-tilt training builds. In a child it does the opposite: the trachea is soft enough that pushing the head back kinks it closed, so the head stays neutral for a child this age. It also answers a different question than how the device goes in.

Perform a blind finger sweep to remove the object: A blind finger sweep is appropriate once you can actually see the object in an unresponsive patient's mouth. Nothing here confirms the object is visible; the failed ventilation attempts only prove an obstruction exists. Sweeping blindly risks pushing it deeper, so the look-first step inside the compression cycle replaces guessing.

Insert a supraglottic airway in an attempt to bypass the obstruction: A supraglottic airway suits an unresponsive, apneic patient whose airway below the glottis is open, like cardiac arrest. It seats above the cords and ventilates through the glottic opening, so it cannot bypass an obstruction there. The two repositioned attempts with no chest rise show the blockage sits at that level, and placing one skips the compressions instead.

Remove the object with Magill forceps under direct laryngoscopy: Removing an object with Magill forceps under direct laryngoscopy is a paramedic skill for a foreign body you can visualize, and it happens once someone qualified is on scene. It falls outside AEMT scope, and compressions start now because they both pressurize the airway and perfuse the patient while that resource is arranged.

Continue the current BVM technique: Continuing is correct when the mask is working, and the absent waveform proves it is not. Repeating a technique that has already been optimized and still delivers no ventilation costs the patient every minute it continues.

Intubate the trachea to secure the airway: Endotracheal intubation is above the AEMT scope of practice and cannot be the action regardless of how difficult the airway is. The supraglottic airway is the AEMT-level answer to the same problem.

Insert a nasopharyngeal airway and continue: A nasopharyngeal airway addresses obstruction by the tongue and soft tissue, which the oropharyngeal airway already in place is doing. It does nothing about a mask that will not seal, so the leak and the absent chest rise continue.

Seal the neck opening and keep ventilating the mouth and nose: A patient with a neck opening can be ventilated from above by covering the opening so the delivered breaths are not vented out through it, which is correct when the upper airway is still connected to the lungs. The question states the larynx was surgically removed, so the mouth and nose no longer reach the trachea and sealing the opening closes off the only route that does.

Suction the neck opening before attempting to ventilate through it: Absent chest rise through a neck opening looks like it is plugged with secretions. Suctioning the stoma is the step for a patient who cannot be ventilated through it, and no breath has yet been delivered through this stoma; the question states the opening is clear of secretions, so there is nothing to remove and suctioning only delays the first breath that can actually reach the lungs.

Perform a jaw-thrust maneuver and keep ventilating the mouth and nose: Absent chest rise usually means the tongue is obstructing and a jaw thrust is the fix. In a patient whose larynx has been removed, the mouth and nose no longer connect to the trachea, so no manual maneuver on the upper airway will move air into the lungs.

The airway was placed in the smaller nostril: The airway does belong in the larger nostril, which makes a sizing error the easy thing to reach for. The question states the airway met no resistance going in and that the flange rests against the nostril, and the corpus attaches the vagal bradycardia and the gastric distention to a device that is too long, not to the choice of nostril.

The airway has become obstructed by mucus: A nasal airway with a small diameter can be obstructed by mucus, blood, or vomitus. An obstructed airway would show as reduced airflow and poorer chest rise, and the question states chest rise is unchanged, so air is still reaching the lungs at the same volume.

The bag is being squeezed with too much force: Forceful ventilation is the usual reason a stomach fills with air. The question states ventilations are continuing at the same rate and volume as before the airway was inserted, so the technique did not change; what changed was the device now sitting in the airway.