NREMT Paramedic Cognitive ExamOperationsEasy
A paramedic is dispatched to a residence for a 72-year-old male experiencing an acute exacerbation of COPD. The patient is alert but anxious, sitting upright, and using accessory muscles to breathe. His respiratory rate is 28 breaths/minute, heart rate is 110 bpm, and SpO2 is 88% on room air. Lung sounds reveal diffuse wheezing and rhonchi. What is the MOST appropriate initial oxygen delivery device for this patient?
- ANon-rebreather mask at 15 L/min
- BVenturi mask at 4 L/min (24%)
- CNasal cannula at 2 L/min
- DBag-valve mask with supplemental oxygen
Show answer & explanationAnswer & explanation
Correct answer: A. Non-rebreather mask at 15 L/min
For a patient with acute COPD exacerbation experiencing significant respiratory distress and hypoxia (SpO2 88%), a non-rebreather mask at 15 L/min provides the highest concentration of supplemental oxygen to rapidly improve oxygenation. While Venturi masks offer precise FIO2, the immediate need is for maximal oxygen delivery.
Why the other options are wrong
- B. A Venturi mask provides precise, but often lower, FIO2. While useful for chronic COPD, it's not the initial choice for acute, severe hypoxia.
- C. Nasal cannula provides low flow and insufficient oxygen concentration for this level of hypoxia.
- D. Bag-valve mask is used for patients with inadequate ventilatory effort or apnea, which is not the case here.
Oxygen Delivery for Hypoxia
The selection of an oxygen delivery device depends on the patient's oxygenation status, respiratory effort, and underlying condition, aiming to achieve adequate tissue oxygenation.
- Non-rebreather mask delivers highest FIO2 (up to 90-100%) for severe hypoxia.
- Nasal cannula provides low flow (1-6 L/min) for mild hypoxia.
- Venturi mask delivers precise FIO2 (24-60%) for controlled oxygen therapy.
- Bag-valve mask assists ventilation in apneic or hypoventilating patients.
Memory trick: O2 Devices: How Much Oxygen Do They Need?