EMT Airway Patency Scenarios - Multiple Choice Questions
Question 1
You arrive on scene to find a 45-year-old unconscious patient lying supine on the ground after a fall. The patient has sonorous respirations and visible chest rise. What is the PRIMARY anatomical cause of upper airway obstruction in this unconscious patient?
A) Posterior displacement of the tongue against the pharyngeal wall
B) Posterior displacement of the epiglottis against the pharyngeal wall
C) Laryngospasm from aspiration
D) Bilateral vocal cord paralysis
Question 2
You respond to a nursing home for a 72-year-old patient with a tracheostomy who is in respiratory distress. Staff report they cannot pass the suction catheter through the tracheostomy tube. The patient is conscious, sitting upright, and has audible stridor. What is your FIRST action?
A) Immediately remove the tracheostomy tube
B) Attempt to pass a suction catheter to assess tube patency
C) Apply high-flow oxygen to both the face and tracheostomy stoma
D) Deflate the tracheostomy cuff
Question 3
A 6-year-old child with a 5-day-old surgical tracheostomy has a visibly displaced tracheostomy tube with subcutaneous emphysema spreading across the neck. The child is conscious but in severe respiratory distress with oxygen saturation of 85%. What is the MOST appropriate immediate action?
A) Attempt to reinsert the displaced tracheostomy tube immediately
B) Remove the tracheostomy tube and reassess both airways
C) Apply a pediatric face mask over the stoma and ventilate
D) Perform immediate oral intubation
Question 4
You are managing an unconscious 8-month-old infant who requires airway positioning. Which positioning technique is MOST appropriate to optimize upper airway patency in this age group?
A) Head-tilt chin-lift with significant neck extension
B) Neutral position with a rolled towel under the shoulders
C) Sniffing position with pillow under the occiput
D) Lateral recovery position
Question 5
A 28-year-old trauma patient requires emergency intubation after a motor vehicle collision. The patient has a GCS of 6, oxygen saturation of 88% on high-flow oxygen, and suspected cervical spine injury. What is the RECOMMENDED method for emergency tracheal intubation in this scenario?
A) Awake fiberoptic intubation
B) Rapid sequence intubation with direct laryngoscopy and manual in-line stabilization
C) Nasotracheal intubation
D) Delayed sequence intubation with ketamine dissociation
Question 6
You arrive at a restaurant where a 35-year-old patient is sitting upright, leaning forward, drooling, and refusing to lie down. The patient has a muffled voice, fever of 103°F, and appears toxic. You suspect epiglottitis. What action is CONTRAINDICATED in this patient?
A) Positioning the patient upright during transport
B) Applying supplemental humidified oxygen
C) Using a tongue depressor to examine the throat
D) Transporting to the nearest emergency department
Question 7
During a difficult airway scenario, you successfully place a supraglottic airway device in an unconscious 50-year-old patient. You observe chest rise with ventilation, but capnography shows an inconsistent waveform with values fluctuating between 15-45 mmHg. What does this finding MOST likely indicate?
A) Proper device placement with adequate ventilation
B) Partial airway obstruction or inadequate seal
C) Esophageal placement of the device
D) Equipment malfunction of the capnography monitor
Question 8
You respond to a patient with a 3-day-old percutaneous tracheostomy that has become completely dislodged. The patient is unconscious and apneic. After removing any remaining tube fragments and applying oxygen to both the face and stoma, what is the MOST appropriate next step?
A) Immediately attempt to reinsert a tracheostomy tube through the stoma
B) Attempt oral intubation with a standard endotracheal tube
C) Apply a pediatric face mask to the stoma and attempt ventilation
D) Perform immediate cricothyrotomy
Question 9
A 4-year-old child is found unconscious in a pool. After opening the airway with a jaw thrust, you assess for breathing by looking, listening, and feeling at both the mouth/nose. The child has occasional gasping respirations at a rate of 4 per minute. What is the underlying PATHOPHYSIOLOGY of these gasping respirations?
A) Normal respiratory effort attempting to clear aspirated water
B) Agonal respirations from severe hypoxia and brainstem dysfunction
C) Laryngospasm preventing adequate air entry
D) Neurogenic pulmonary edema from near-drowning
Question 10
You are managing a 16-year-old with a known difficult airway (previous failed intubations) who is deteriorating from status asthmaticus. The patient is conscious but exhausted with oxygen saturation of 82% despite high-flow oxygen. Using the ASA difficult airway algorithm, which factor ALONE would warrant consideration of awake intubation over post-induction intubation?
A) Suspected difficult mask ventilation
B) Patient anxiety about the procedure
C) Lack of video laryngoscopy equipment
D) Presence of family members requesting to stay
Question 11
During assessment of an unconscious patient, you note the following: no air movement at the mouth/nose, no chest rise, but you can feel air movement at a tracheostomy stoma. What does this finding indicate about the patient's anatomy?
A) The patient has a patent upper airway with tracheostomy in place
B) The patient likely has a laryngectomy with no connection between upper airway and lungs
C) The tracheostomy tube is displaced into subcutaneous tissue
D) The patient has bilateral mainstem bronchus obstruction
Question 12
A 55-year-old patient with a tracheostomy is in respiratory distress. You successfully pass a suction catheter through the tube and obtain thick secretions. After suctioning, the patient remains in distress with poor air movement. What is the NEXT appropriate step?
A) Remove the tracheostomy tube immediately
B) Deflate the tracheostomy cuff
C) Perform repeated suctioning attempts
D) Apply oxygen to the face instead of the tracheostomy
Question 13
You respond to a 2-year-old in respiratory distress. On assessment, you note inspiratory stridor, suprasternal retractions, nasal flaring, and the child is sitting in a tripod position. As you approach with oxygen, the child becomes more agitated. What is the PATHOPHYSIOLOGICAL significance of increased agitation in this scenario?
A) Agitation indicates improving oxygenation and cerebral perfusion
B) Agitation increases oxygen consumption and can worsen airway obstruction
C) Agitation is a normal response and has no clinical significance
D) Agitation indicates the need for immediate sedation
Question 14
During a tracheostomy emergency, you attempt to ventilate through a displaced tracheostomy tube and immediately notice rapid development of subcutaneous emphysema spreading across the chest and neck. What is the MECHANISM causing this complication?
A) Air entering the mediastinum through a tracheal tear
B) Air being forced into subcutaneous tissues through the false tract created by the displaced tube
C) Pneumothorax from barotrauma
D) Air trapping from one-way valve effect in the airway
Question 15
You are managing a pediatric patient who requires airway positioning. You place the child's head in a "sniffing the morning air" position. What is the ANATOMICAL goal of this positioning?
A) Compress the tongue against the hard palate
B) Align the oral, pharyngeal, and laryngeal axes and displace the hyoid anteriorly
C) Increase intrathoracic pressure to improve ventilation
D) Prevent aspiration by closing the epiglottis
ANSWER KEY AND EXPLANATIONS
Question 1: B
Research demonstrates that the epiglottis, not the tongue, is the main cause of upper airway obstruction in unconscious patients. When methods displace the hyoid anteriorly (chin-lift, jaw thrust), the epiglottis moves forward, opening the airway 1.
Question 2: B
Initial assessment requires attempting to pass a suction catheter to establish tube patency and perform therapeutic suction. This is the first step in the tracheostomy emergency algorithm before more invasive interventions 2.
Question 3: B
When subcutaneous emphysema is present or worsening, the tracheostomy tube should be removed immediately, then both airways reassessed with oxygen applied to face and stoma. Attempting to ventilate through a displaced tube worsens emphysema 3.
Question 4: B
Children under 2 years require a more neutral position, and a pillow or rolled towel under the shoulders improves airway patency and access 2.
Question 5: B
Rapid sequence intubation with direct laryngoscopy remains the recommended method for emergency tracheal intubation in trauma, with succinylcholine as the preferred neuromuscular blockade agent 4.
Question 6: C
Never use a tongue depressor to examine the throat in suspected epiglottitis, as this can trigger sudden complete airway obstruction. Patients should remain upright and leaning forward 5.
Question 7: B
Inconsistent capnography waveforms with fluctuating values indicate partial airway obstruction or inadequate seal. Proper placement shows consistent waveforms with stable end-tidal CO2 values 2.
Question 8: B
A 3-day-old percutaneous tracheostomy tract will have recoiled, making reinsertion extremely difficult. Oral intubation is the most appropriate next step after basic oxygenation measures 2.
Question 9: B
Gasping respirations at 4/minute represent agonal breathing from severe hypoxia and brainstem dysfunction, not effective respiratory effort. This requires immediate ventilatory support 2.
Question 10: A
Any single factor—suspected difficult laryngoscopy/intubation, suspected difficult mask/supraglottic ventilation, increased aspiration risk, or increased rapid desaturation risk—may warrant awake intubation 5.
Question 11: B
Air movement only at the stoma with none at the mouth/nose indicates a laryngectomy where the upper airway has no connection to the lungs. This requires different emergency management 2.
Question 12: B
After suctioning with persistent distress, deflate the cuff as the next step in the algorithm. The inflated cuff may be contributing to obstruction 2.
Question 13: B
Agitation and restlessness indicate hypoxia and increase oxygen consumption, worsening airway obstruction. These are clinical signs of respiratory distress that may become absent as obstruction worsens 2.
Question 14: B
Attempting to ventilate through a displaced tracheostomy forces air into subcutaneous tissues through the false tract, causing subcutaneous emphysema and complicating airway management 2, 3.
Question 15: B
The "sniffing" position aligns the oral, pharyngeal, and laryngeal axes and displaces the hyoid anteriorly, which moves the epiglottis forward to open the airway 2.