10 free AEMT practice questions: Ventilation and Oxygenation Support

Continuous compressions with one breath every 3 seconds: One breath every 3 seconds is 20 breaths a minute. That rate is for an infant or a child. In an adult, breathing that fast raises the pressure inside the chest. Higher chest pressure cuts down the blood your compressions send back to the heart.

Continuous compressions with one breath every 10 seconds: One breath every 10 seconds is only 6 breaths a minute. Six breaths a minute is too slow to clear the carbon dioxide your compressions bring to the lungs. This patient is in cardiac arrest and is not breathing, so nothing makes up the difference.

Cycles of 30 compressions to 2 breaths, continued as before: Cycles of 30 to 2 are right until an advanced airway goes in. This supraglottic airway is in and confirmed. Staying at 30 to 2 keeps every pause for breaths, and every pause stops blood flow.

Each breath is delivering a lower oxygen concentration: A bag without a reservoir does give much less oxygen. The oxygen concentration from the bag depends on the flow and the reservoir, not on how often you squeeze. A change in oxygen concentration also would not drop a blood pressure in two minutes.

The fast rate is raising the carbon dioxide and dropping the pressure: Carbon dioxide does change with your ventilation rate, and carbon dioxide does affect the blood vessels. Fast ventilation blows off more carbon dioxide, so the level goes down, not up. A falling carbon dioxide level is not what dropped this pressure.

The shortened breaths are making the patient hypoxic: Fast, shallow breaths can leave a patient hypoxic, and you see that in patients who are breathing on their own. This patient's chest rises fully with each breath, so each breath is delivering a full volume. Hypoxia this early would show up as a falling saturation, not a falling blood pressure.

Squeeze the bag with more force on each breath: More force does move more air when the resistance is in the lungs. Force is also what pushes air into the stomach in the first place. With a leaking seal and a partly closed airway, the extra pressure takes the easier path, out the mask and into the stomach.

Place a supraglottic airway device now: A supraglottic airway does solve a mask seal problem, and this patient may end up with one. The supraglottic airway comes at the end of the recheck list, not the start. Head position and the mask seal cost nothing, take seconds, and fix this problem far more often than the device does.

Switch to a smaller mask and try the same breaths: A mask that does not fit the face is a real cause of a leak. A smaller mask on an adult face usually leaks more, not less. Changing equipment before you fix the head position also skips the step that fixes most of these leaks.

Give an isotonic crystalloid bolus for poor perfusion: A falling carbon dioxide number can mean less blood is reaching the lungs, and a fluid bolus is a treatment for poor perfusion. This patient has a strong pulse at 88 and a blood pressure of 122/74. Perfusion has not changed. The fast rate explains the number without any fluid.

Remove the device and ventilate with a BVM: Pulling a device is the right move when the waveform never shows up at confirmation or when the waveform disappears. This tracing is a clean rectangle that returns to the baseline, and chest rise is good. The device is working.

Increase the oxygen flow running to the bag: More oxygen can seem like a safe move any time a number on the monitor heads the wrong way. Oxygen flow sets the oxygen concentration in the bag and has no effect on the carbon dioxide number. The carbon dioxide number depends on how much air you move and how much blood reaches the lungs.

Reduce the oxygen flow to protect the drive to breathe: Turning the oxygen down is what the crew member suggested, and it is the one thing you do not do. At 86%, this patient is hypoxic. You never withhold or reduce oxygen in a hypoxic patient. Cutting the flow treats a theory instead of the number in front of you.

Switch the patient to a nasal cannula at 2 liters per minute: Low flow for every COPD patient is a common blanket rule. Titration follows the saturation, not the diagnosis. Dropping a hypoxic patient to a nasal cannula at 2 liters per minute is still cutting the oxygen, just with a different device.

Continue oxygen until the SpO₂ reaches 100%: Running oxygen until the SpO₂ reads 100% treats more oxygen as always better. When the baseline is unknown, the target for a COPD patient is 88% to 92%. Pushing past that range means you never titrated at all.

Continue the NRB unchanged and reassess again in five minutes: Reassessing in five minutes fits a patient who is still breathing adequately on the nonrebreather. This patient has already had five minutes at 15 L/min, and the breaths have become shallow. Five more minutes of the same thing only delays the ventilations this patient needs.

Switch to a nasal cannula, which delivers a lower oxygen concentration: A nasal cannula fits mild hypoxia, where a small amount of extra oxygen is enough. This patient is at 85% on a nonrebreather with shallow breaths. A nasal cannula gives less oxygen and does nothing to move more air.

Withhold further intervention, since the patient is still breathing on their own: A patient who is breathing adequately on their own can stay on the nonrebreather without help. This patient is still breathing, but the breaths are shallow. Breathing on their own is not the same as breathing adequately, and shallow breathing calls for a BVM.

The patient is deteriorating and bronchospasm is worsening: Worsening bronchospasm moves less air, not more. The wheeze gets quieter or goes away as the airways close. This patient says breathing is easier, and the capnography waveform got better.

The louder wheeze indicates the treatment failed and a repeat dose is contraindicated: A louder wheeze can mean the treatment failed when the patient is also getting worse or the capnography is flattening. Here the patient is breathing easier and the waveform is improving. Calling this a failure ignores both of those findings and would hold back a repeat dose the patient may need.

The change is unrelated to the treatment and should be disregarded: The wheeze changed right after the albuterol. The change matches the patient's report and the capnography. A change that lines up with the treatment is a treatment effect to track, not noise to ignore.

Asthma exacerbation: Asthma fits a patient with wheezing, a long exhale, and a shark fin shape on the capnography waveform. This patient's lung sounds are clear and equal, and the waveform shape is normal. Asthma also tends to push the EtCO₂ up as the patient tires, not down.

Bacterial pneumonia: Pneumonia builds over a day or two with fever, a productive cough, and rhonchi or diminished sounds over one area. This difficulty breathing started suddenly, at rest. A pneumonia bad enough to drop the SpO₂ to 88% would be something you could hear with your stethoscope.

Cardiogenic pulmonary edema: happens when the left ventricle backs fluid up into the alveoli. Those patients have crackles that start at the bases, trouble breathing when lying flat, and often a history of heart failure. Fluid in the alveoli is loud, and clear, equal breath sounds rule pulmonary edema out here. The pleuritic pain and the recent surgery point to a clot instead.

Increase the CPAP pressure setting to further reduce the work of breathing: Turning the CPAP pressure up is for a patient whose breathing still looks labored. Here the pressure already on is cutting down the blood coming back to the heart. More pressure pushes the blood pressure and the mental status down even further.

Continue CPAP unchanged, since a pressure drop is an expected and desirable response: A drop to 96/60 with new lethargy is not what CPAP is supposed to do. The drop is a complication from less blood returning to the heart. You have to catch it and correct it, not leave the CPAP unchanged as if the drop were normal.

Immediately give a rapid isotonic fluid bolus without reassessing first: A fluid bolus can be the right call for a low blood pressure from low preload. Giving the bolus before you reassess skips checking whether the CPAP is the cause. Taking the CPAP off may fix the drop by itself. A rapid bolus can also make the pulmonary edema worse in this cardiogenic patient.

Cardiogenic pulmonary edema: fits a patient whose left heart is failing and backing fluid up into the lungs. That patient has crackles in both bases, jugular venous distention, and swollen ankles. There is often trouble breathing lying flat and a known heart failure history. This patient has no jugular venous distention and no ankle swelling, and the abnormal sounds are on one side only. Fluid backing up from the heart also does not cause a temperature of 102.4°F.

Pulmonary embolism: fits sudden trouble breathing with clear lungs. There is often chest pain with each breath and low oxygen that seems worse than the lung exam. These patients usually have a risk factor like recent immobility, surgery, or a known clot. This patient got worse slowly over three days and has a cough with thick sputum. A clot causes neither of those, and a clot does not explain the fever or the rhonchi in one lobe.

Asthma exacerbation: An asthma flare fits wheezing in both lung fields, usually with a known asthma history and a trigger. Asthma tightens the airways all through the chest. A problem in every airway cannot stay in one lower lobe while the rest of the chest is clear. Asthma also does not cause fever or thick, infected sputum.