NCTI Block 1 "Airway"

What are the indications for administering albuterol and ipratropium?

Bronchospasm/bronchoconstriction caused by: acute asthma, toxic gas inhalation/OD, allergic reaction/COPD, crush injuries, near drowning, pulmonary edema (not from CHF)

Pursed lip breathing is common in which disease process?

COPD and asthma

What are the signs and symptoms of chronic bronchitis?

Chronic Cough and sputum production, cyanosis "blue bloaters" Shortness of breath Wheezing

What are the indications for an NG tube?

Clenched jaw PT must still be breathing on their own (BAM will whistle to ensure that the tube is in the right place, if it stops whistling adjust)

CHF produces what type of breathing sounds?

Crackles, rhonchi (mucus)

What is the dose and concentration of epinephrine to be given to an asthmatic patient?

0.3-0.5mg IM/SUBQ (1:1,000)

How do you clear a stoma?

1. BSI 2. Inject 3ml of saline through the stoma and into the trachea 3.Instruct pt. To exhale and insert catheter w/out providing suction until resistance is felt( no more than 12 cm) 4. Suction while withdrawing the catheter

How much air do you fill an ET cuff with?

10 cc of air

What is the maximum amount of time you can take to intubate?

30 seconds, in between ventilations

What are the indications for a laryngoscopy?

Absence of gag reflex Traumatic Brain Injury Unresponsive Impending airway compromise Airway control needed due to cardiac arrest, respiratory arrest, or coma Prolonged ventilatory support needed

What are the warning signs of a dislodged ET tube?

Absent Lung sounds + Epigastric sounds No waveform capnography Stomach contents in the tube.

What is the treatment for "shark fin" pattern capnography?

Albuterol (Bronchoconstriction is occuring

What are some potentially deadly upper airway infections?

Anaphylaxis , epiglottitis

What would happen to the patient's trachea if you overinflate the ET cuff?

Damage of the vasculature, cutting off blood-flow to the airway

What are the indications for suctioning an ET tube?

Desaturations. Bradycardia. Tachycardia. Absent or decreased chest movement. Visible secretions in ETT. Increased ETT CO2 or transcutaneous CO2. Irritability. Coarse or decreased breath sounds.

What are the hazards associated with moving an intubated patient?

Displacement of the ET tube

What are the risk factors and treatment for PE?

Embolism is a Blockage, Air or Blood. Pulmonary Embolism is a blockage in the pulmonary arteries. Risk Factors Include: Patients who are inactive or immobile for a long period of time, blood clotting disorders, after surgery, have cancer. Obesity, pregnancy within the last 6 weeks. Treatment would be Oxygen and Fast Transport

Where would you expect to find swelling in a patient who had stridor for lung sounds?

Expect to find swelling in the upper airway. (swelling of epiglottis)

What is the complication of left sided ventricular failure in regards to the alveoli?

Fluid is backed up into lungs, preventing full contraction and gas exchange

What are the indications for intubation?

Inability to maintain airway patency Inability to protect the airway against aspiration Failure to ventilate Failure to oxygenate Anticipation of a deteriorating course that will eventually lead to respiratory failure.

What are the signs and symptoms of a spontaneous pneumothorax?

Sharp chest pain, made worse by a deep breath or a cough. Shortness of breath.

If you have low end tidal CO2 while ventilating a patient, what can you do to correct it?

Slow down Ventilation Rate

What is the treatment for opiate overdose?

Narcan, Airway Management , Titrate narcan to adequate ventilations.

When do you perform a blind finger sweep to clear a patient's airway?

Never! Blind finger sweep is not recommended.

What are the indications for suctioning a tracheostomy?

Obstruction of upper airway (facial trauma, foreign object, laryngeal tumor)

Describe subcutaneous emphysema.

Occurs when air infiltrates the subcutaneous layer of the skin, characterized by crackling sensation when palpated

How is a right mainstem intubation corrected?

Once recognized. Deflate cuff remove one cm re-inflate cuff and repeat until breath sounds are heard equally on both sides. Ensure to note depth of tube each time cuff is re-inflated.

When intubating, when are you able to let go of the tube?

Once tube is secured in place, tube tamer

What is the treatment for respiratory difficulty?

Oxygen and albuterol and atrovent If necessary.

When should you remove an oral airway adjunct?

Patient has gag reflex

What are the indications for a nasotracheal intubation?

Patients with an intact gag reflex, but in respiratory failure. Also for patients with intact breathing but definitive need for airway management to control further deterioration of condition.

What are the indications for nasotracheal intubation?

Perfect for responsive or altered patients with an intact gag reflex, but in respiratory failure. Also for patients with intact breathing but definitive need for airway management to control further deterioration of condition.

Identify characteristics of a patient with possible pneumonia

Pneumonia patients will present with fever, and a productive cough with yellow like sputum, lower lung sounds will be affected by mucus and fluid build up.

What are the signs and symptoms of polycythemia?

Polycythemia : a disease state in which the hematocrit (the volume percentage of red blood cells in the blood) is elevated. S/S - Fatigue, headache, itching, sweating, blurred vision, blind spots, painful burning or numbness in the feet or hands, bleeding in the gums or excessive bleeding in small cuts ****Too much Hemoglobin

Patients that are post-partum are at an increased risk for what respiratory condition?

Pulmonary embolism

When attempting to intubate, the patient's airway suddenly requires suctioning. What should you do?

Suction the airway

What are the indications for (Needle)pleural decompression?

Tension pneumothorax

How does PO2 relate to COPD patients?

The saturation of oxygen in the blood stream. COPD patients body have switched their body chemistry to a hypoxic drive, thus the saturation of oxygen (SPO2) will consistently be lower than a person without COPD.

What is the proper placement for the Macintosh blade?

The tip is inserted into the vallecula. (the space between the base of the tongue and the pharyngeal surface of the epiglottis)

What are the indications for deep tracheal suctioning?

Tracheostomy patients frequently need deep tracheal suctioning due to stoma. Suspected Pneumonia or ARDS.

When intubating, what nerve is stimulated?

Vagus Nerve; resulting in Bradycardia

What happens if you ventilate a patient too fast?

Waveform Capnography will drop below 35. Hyperventilation will cause hypocapnia.

What is the best proof of a successful intubation?

Waveform capnography, see it go through the cords

How will reactive airway disease affect ETCO2?

You would have an increased CO2 reading because the reactive respiratory conditions include chronic COPD, asthma, and other respiratory infections affect your ability to release CO2 through normal respiration.

If air movement is heard over the epigastrium, what should you expect?

Gastric distention. Your tube is in the esophagus rather than the trachea.

What are the signs and symptoms of cystic fibrosis?

Genetic disorder. it is caused by a faulty gene that disrupts the movement of salts and water in the bodies cells, making the mucus in people with cf thicker and stickier. The sticky mucus mainly causes problems in the lungs. Patients with cystic fibrosis have excessive mucus build-up in lungs and digestive tract. This leads to many respiratory and digestive issues. Patients tend to have long history of respiratory or digestive problems. Infants-tend to have odd-smelling, pale stools. Expect oxygen therapy and deep suctioning.

What should you do if someone is choking?

Heimlich maneuver & encourage coughing

When assessing an airway for the first time, when do you suction?

If necessary, Immediately

What treatment should you anticipate for a patient who has an airway burn?

RSI. Although they could be moving air and talking to start, most will require to be intubated.

At what respiratory rate should you start using a BVM on a patient?

Range varies on situation. But typically above 30 breaths/min or below 10 breaths/min

What is the treatment for a hyperventilating patient?

Reassurement, talking to the patient and breathing techniques with patient; coaching

If an initial ventilation is unsuccessful, what should you do?

Reposition Manual airway maneuvers Then airway adjuncts

What should you do if your first ventilation is not successful?

Reposition airway (head tilt, chin lift or jaw thrust)

What are the differences between respiratory & metabolic acidosis. As well as respiratory and metabolic alkalosis?

Respiratory Acidosis: Blood pH of <7.35 due to a respiratory issue or cause (Hypoventilation) Metabolic Acidosis: Blood pH of <7.35 due to a metabolic cause (DKA, Lactic Acidosis, Renal tubular acidosis) Respiratory Alkalosis: Blood pH of >7.45 due to respiratory cause(Hyperventilation) Metabolic Alkalosis: Blood pH of >7.45 due to metabolic cause. This is the result of decreased H+ concentration, leading to increased bicarbonate or alternatively a direct result of increased bicarbonate concentrations. Respiratory acidosis is caused by ventilation problem which leads CO2 build up. Metabolic acidosis is caused by kidney failure which cannot control bicarb production Respiratory acidosis can be treated with breathing changes, Metabolic

What causes stridor?

Results due to foreign body aspiration, infection, swelling, disease,or trauma immediately above the glottic opening. (narrowing of upper airway)

What are the indications for administering Flumazenil (Romazicon)?

Romazicon is used as a reversal for diazepam and midazolam, which are used for muscle relaxants and mild sedation. Not often used in the prehospital setting. Reversal of benzodiazepine overdose

What are the signs and symptoms of acute respiratory distress syndrome?

S/S - Shortness of breath, Tachypnea , cyanosis , coughing, hypercapnia, fatigue

What are the signs and symptoms of a pneumothorax?

chest pain and respiratory distress, often with an increased heart rate (tachycardia) and rapid breathing (tachypnea) quieter breath sounds on one side of the chest, low oxygen levels and blood pressure, and displacement of the trachea away from the affected side. Sharp chest pain followed by increasing Dyspnea after they cough **Tension Pneumothorax Decreased or absent lung sounds Hemodynamic instability Altered mental status

What concern(s) would you have with signs of recent vomit found on an unconscious/unresponsive patient?

possible aspiration/ may be airway compromise or blockage

What are the indications for a BVM?

respiratory failure, hypoxic respiratory failure, apnea, or altered mental status with the inability to protect the airway