EMT Airway Assessment Scenario with Multiple-Choice Questions
Clinical Scenario
You are an EMT responding to a 911 call for a 58-year-old male found unresponsive in a restaurant. On arrival, bystanders report the patient was eating when he suddenly clutched his throat and collapsed. The patient is supine on the floor, cyanotic, and making no respiratory effort. You have one EMT partner with you.
Question 1: What is your FIRST priority in assessing this patient's airway?
A. Check for a pulse and begin chest compressions
B. Perform a head-tilt chin-lift and look, listen, and feel for breathing
C. Immediately attempt bag-mask ventilation
D. Open the airway and perform a finger sweep to remove any visible obstruction
Correct Answer: B
Rationale: The initial airway assessment must follow a systematic approach starting with opening the airway and assessing for breathing 1. Before initiating any interventions, you must determine if the airway is patent and if the patient has spontaneous respirations 1. The "look, listen, and feel" approach allows rapid assessment of airway patency and breathing adequacy 1. Blind finger sweeps are contraindicated as they may push foreign bodies deeper 1.
Question 2: Upon opening the airway, you see no chest rise and hear no breath sounds. You notice the patient's mouth is partially open with what appears to be food visible in the oropharynx. What is your NEXT step?
A. Immediately begin bag-mask ventilation with high-flow oxygen
B. Suction the oropharynx and remove visible foreign material
C. Insert an oropharyngeal airway and begin ventilations
D. Call for advanced life support and wait for their arrival
Correct Answer: B
Rationale: When visible foreign material or secretions are present in the airway, suctioning and removal must occur before attempting ventilation 1. Attempting to ventilate with an obstructed airway will be ineffective and may push the obstruction deeper 1. The airway must be cleared of blood, secretions, and foreign bodies before effective ventilation can be achieved 1. Assessment should follow a logical sequence: airway patency first, then breathing support 1.
Question 3: After clearing the visible obstruction, you attempt to ventilate with a bag-mask device but meet significant resistance and see no chest rise. What should you do?
A. Increase the force of ventilation to overcome the resistance
B. Reposition the head and neck, ensure proper mask seal, and reattempt ventilation
C. Immediately insert an advanced airway device
D. Begin chest compressions assuming cardiac arrest
Correct Answer: B
Rationale: When bag-mask ventilation is difficult, optimization should include repositioning, ensuring proper mask seal with two-hand technique, and considering oral/nasal airways 1. The 2022 ASA guidelines emphasize optimizing basic techniques (suction, repositioning, two-hand mask grip) before escalating to advanced interventions 1. Poor mask seal and improper head positioning are the most common causes of failed bag-mask ventilation 1, 2. Multiple attempts at any single technique without optimization increases risk of complications 1.
Question 4: You successfully reposition the patient and achieve adequate bag-mask ventilation with visible chest rise. Your partner reports oxygen saturation is now 88% and rising. The patient remains unconscious with no gag reflex. What is the MOST important monitoring consideration during continued bag-mask ventilation?
A. Continuous pulse oximetry only
B. Blood pressure every 5 minutes
C. Continuous pulse oximetry and capnography to confirm ventilation
D. Respiratory rate counting
Correct Answer: C
Rationale: Continuous waveform capnography combined with pulse oximetry is the most reliable method for confirming and monitoring adequate ventilation 1. The 2022 ASA guidelines state that effective ventilation through any device should result in a capnograph waveform 1. Capnography provides immediate feedback on ventilation adequacy, airway patency, and can detect early deterioration 1, 3. Pulse oximetry alone has a significant lag time and does not confirm ventilation 1. The 2010 AHA guidelines emphasize that capnography should be used whenever possible to confirm adequate ventilation 1.
Question 5: During transport, you are maintaining bag-mask ventilation when suddenly you notice the capnography waveform has disappeared and oxygen saturation begins dropping rapidly. What is your FIRST action?
A. Increase the ventilation rate
B. Reassess airway patency: check for obstruction, reposition, ensure mask seal
C. Insert an oropharyngeal airway
D. Call for ALS intercept immediately
Correct Answer: B
Rationale: Loss of capnography waveform during ventilation indicates loss of airway patency or ventilation failure and requires immediate reassessment 1. The systematic approach includes checking for airway obstruction, repositioning the head/neck, ensuring adequate mask seal, and suctioning if needed 1. The 2022 ASA guidelines emphasize that when ventilation fails, optimization of basic techniques (suction, repositioning, two-hand grip) should be the immediate response 1. Persistent capnography waveform confirms adequate ventilation, and its loss demands immediate troubleshooting 1, 3.
Key Learning Points for EMT Airway Assessment
Assessment follows a systematic sequence 1:
- Airway patency evaluation (look for obstruction, secretions, foreign bodies)
- Breathing assessment (rate, depth, chest rise, breath sounds)
- Optimization before escalation (positioning, suctioning, two-hand technique)
Critical monitoring includes 1, 3:
- Continuous pulse oximetry for oxygenation status
- Waveform capnography to confirm ventilation adequacy
- Visual assessment of chest rise bilaterally
Common pitfalls to avoid 1, 2:
- Attempting ventilation without clearing visible obstructions
- Inadequate mask seal leading to ineffective ventilation
- Failure to reposition and optimize before escalating interventions
- Excessive ventilation rate (should be 1 breath every 6-8 seconds or 8-10 breaths/minute once airway secured) 1
- Multiple attempts without changing technique or seeking help
When bag-mask ventilation fails despite optimization, consider 1:
- Supraglottic airway device if trained and available
- Request advanced life support for definitive airway management
- Prepare for potential need for invasive airway if "cannot ventilate, cannot oxygenate" scenario develops