Advanced Airway Assessment and Decision-Making - NREMT AEMT Level

1. What does the "O" in LEMON stand for in airway assessment?

   Obstruction (foreign body, swelling, blood, vomitus). Identifying obstructions ensures timely intervention to maintain airway patency and prevent ventilation failure.

2. Identify the best immediate action when BVM ventilations show poor chest rise despite a good mask seal.

   Reposition airway (OPA/NPA, jaw-thrust) and reassess. Repositioning addresses potential tongue or adjunct issues obstructing airflow before escalating interventions.

3. Which sign most strongly suggests esophageal placement after advanced airway insertion?

   Absent ETCO$_2$ waveform with poor chest rise. Lack of CO$_2$ detection and ventilation signs indicate misplacement outside the trachea.

4. What airway assessment mnemonic quickly predicts difficulty with BVM ventilation and intubation?

   LEMON. This mnemonic systematically evaluates potential challenges in bag-valve-mask ventilation and intubation to guide airway management decisions.

5. Which complication is most associated with excessive ventilation rate or volume during BVM use?

   Gastric insufflation with increased aspiration risk. Overventilation forces air into the stomach, potentially causing regurgitation and pulmonary aspiration.

6. What is a standard contraindication to placing an NPA in the field?

   Suspected basilar skull fracture or severe midface trauma. These conditions risk intracranial insertion or worsening injuries, making NPA placement unsafe.

7. What does the "M" in LEMON stand for in airway assessment?

   Mallampati classification (as feasible). This score assesses visibility of oral structures to predict intubation difficulty, adapted for prehospital use when possible.

8. What is the most reliable physiologic indicator of adequate ventilation when capnography is available?

   Waveform capnography (continuous ETCO$_2$ with a waveform). It provides real-time feedback on CO$_2$ exhalation, verifying ventilation effectiveness and detecting issues promptly.

9. Which adjunct is typically preferred for an unconscious patient without a gag reflex?

   Oropharyngeal airway (OPA). It maintains tongue position to prevent upper airway obstruction in deeply unresponsive patients.

10. What is the $3$-$3$-$2$ rule used to evaluate in airway assessment?

    Mouth opening, mandible length, and larynx position. This metric predicts airway difficulty by measuring adequate space for laryngoscope insertion and tube passage.

11. Which airway strategy is most appropriate when you cannot maintain SpO$_2$ with BVM and basic adjuncts?

    Escalate to a supraglottic airway per protocol. Supraglottic devices offer advanced support when basic methods fail to achieve adequate oxygenation.

12. Which finding best confirms effective BVM ventilation during resuscitation?

    Visible chest rise with each ventilation. It directly indicates air entry into the lungs, confirming proper seal and ventilation technique.

13. Which adjunct is typically preferred when the patient has an intact gag reflex or trismus?

    Nasopharyngeal airway (NPA). It provides a patent airway route while tolerating some patient responsiveness without triggering gag.

14. What does the "E" in LEMON stand for in airway assessment?

    Evaluate the $3$-$3$-$2$ rule. The $3$-$3$-$2$ rule assesses anatomical proportions to predict ease of laryngoscopy and intubation.

15. Which clinical situation most strongly favors early advanced airway management over continued basic maneuvers?

    Inability to protect airway (vomiting, decreasing mental status). These signs indicate risk of aspiration, necessitating advanced protection beyond basic adjuncts.

16. Which oxygen delivery approach is preferred for a spontaneously breathing patient with severe hypoxia and adequate ventilation?

    High-flow oxygen, consider CPAP if indicated and not contraindicated. This supports oxygenation without overriding spontaneous efforts, using CPAP to improve alveolar recruitment if appropriate.

17. What does the "L" in LEMON stand for in airway assessment?

    Look externally for facial/neck features suggesting difficulty. External examination identifies anatomical abnormalities like short neck or large tongue that may complicate airway interventions.

18. What does the "N" in LEMON stand for in airway assessment?

    Neck mobility limitations. Assessing neck mobility detects restrictions that could hinder proper positioning for intubation or ventilation.

19. Which action is most appropriate if capnography is lost and the patient deteriorates after airway placement?

    Remove and reattempt ventilation with BVM, then reassess. Immediate removal restores basic ventilation attempts while addressing potential airway displacement.

20. Which head position is preferred to open the airway in a non-trauma patient without C-spine concern?

    Head-tilt chin-lift. This maneuver effectively displaces the tongue forward to relieve obstruction in patients without spinal precautions.

21. Which device is an example of a supraglottic airway commonly used by AEMTs?

    i-gel or King LT (per local protocol). These blind-insertion devices secure the airway above the glottis, suitable for AEMT scope of practice.

22. What is the preferred method to confirm and continuously monitor advanced airway placement in the field?

    Continuous waveform capnography. It offers ongoing verification of tracheal placement and ventilation status in dynamic field conditions.

23. What is the primary indication for suctioning the airway during assessment and management?

    Secretions, blood, or vomitus obstructing ventilation/oxygenation. Suctioning clears these materials to restore airway patency and ensure effective oxygenation.

24. Which head position is preferred to open the airway in a trauma patient with possible C-spine injury?

    Jaw-thrust maneuver with manual stabilization. This technique opens the airway without hyperextending the neck, minimizing risk of exacerbating spinal injuries.

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