10 free EMT practice questions: Respiratory Emergencies & Airway Management

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's 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: No oxygen fits a patient with no signs of hypoxia and no respiratory distress. This patient says there is no 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: A nasal cannula fits a patient with mild hypoxia. A cannula gives a low flow and a low oxygen concentration. The lips here are already cyanotic, and the patient is losing alertness. Start with the NRB, then turn the oxygen down once the color and the mental status come back.

Assist ventilations with a BVM: A BVM is for inadequate breathing, like breaths that are too slow or too shallow to move enough air. Agonal breathing and no breathing at all are the clearest cases. This patient's rate is 22, the effort is not increased, and the patient speaks in full sentences. Full sentences mean each breath is moving plenty of air. Altered mental status alone does not call for a BVM. A drop in mental status calls for airway care first, like positioning and suction.

Deliver back blows, since the patient is at higher risk due to the underlying lung disease: Back blows are used for a choking infant under 1 year, along with chest thrusts. Some systems also use back blows for a severe obstruction in older patients. This patient still has an effective cough. 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. You still do not step in while the patient is moving air.

Assume the cough is from the patient's baseline COPD and continue the assessment: Blaming the cough on baseline COPD makes sense when nothing has changed. Two details say something changed here. The cough started suddenly on a bite of food. The family knows this patient's usual cough, and says this one sounds different. 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: Abdominal thrusts become the right answer the moment this patient stops moving air. Watch for the patient going silent, not being able to speak, or turning cyanotic. Right now the patient is talking between coughs and the skin is pink. If any of those signs show up, move to abdominal thrusts.

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: Sitting a patient upright for transport fits a responsive patient with a partial obstruction who is still moving air. You let that patient stay in the position they choose and get moving. This child is unresponsive and not breathing. An arrest is worked on a firm, flat surface, not in a seat. Packaging the child first uses up the minutes that matter and delays the compressions that can move the grape.

Assist ventilations with a BVM: A BVM is right for a patient who is unresponsive and not breathing with an open airway. An overdose, a head injury, and a respiratory arrest with a pulse are examples. This child has a grape stuck in the airway, and bystanders saw it happen. Air from the bag has nowhere to go. 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: An oropharyngeal airway holds the tongue off the back of the throat. The tongue is the most common airway obstruction in an unresponsive patient, and an OPA is the fix for the tongue. 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: A BVM is for breathing that is too slow, too fast, or too shallow to move enough air. A lower level of consciousness by itself is not a reason to bag. This patient is breathing 16 times a minute with good, equal chest rise. 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: An oral airway is right for a deeply unresponsive patient with no gag reflex. In that patient, an oral airway holds the tongue forward better than a nasal airway does. This patient still withdraws to pain and makes sounds, so some gag reflex is still there. An oral airway is likely to be gagged out or cause vomiting. Option C also adds ventilations this patient does not need.

Apply an NRB without an airway adjunct: A nonrebreather mask is a good choice for a patient with an open airway who needs more oxygen. Oxygen may well be part of this patient's care. 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: Keeping the same treatment fits a child who is getting better on oxygen. This child's level of consciousness is dropping while the breathing effort goes down. A drop in both means respiratory failure, 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: A mother's reassurance can calm a scared child. 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.

Acute COPD exacerbation with bronchospasm: A COPD flare with bronchospasm happens in a patient with known chronic lung disease, and you hear wheezing. This patient has no lung disease in the history, and the lungs are clear and equal.

Community-acquired pneumonia with pleuritic pain: Pneumonia builds over a day or more, with a fever, a productive cough, and rhonchi in one area. This patient denies cough and fever, and the lungs are clear.

Anxiety attack with hyperventilation syndrome: A panic attack can cause fast breathing, a fast heart rate, and chest tightness. A pulmonary embolism causes fast breathing, a fast heart rate, and anxiety too. Anxiety does not rule out a serious cause. This patient had knee surgery 5 days ago and has barely moved since. Calling this anxiety ignores a clot risk that is right there in the history.