Airway EMT
which one of the following statements shows that the EMT knows how to correctly position the BVM on the patients face?"\
"I place the narrow part of the mask over the bridge of the nose, and the bottom part in the cleft above the chin"
While a 61-year-old female in cardiac arrest receives emergency care, you note that her abdomen grows larger with each ventilation provided from a bag-valve mask. What instructions should you provide?
"Let's slow the ventilation rate to 10 per minute, providing each breath over one second"
which one of the following statements made by an emt shows that she understands how to suction patients in a field setting?
"i only activate the suction device when I am withdrawing the suction catheter"
which one of the following statements made by an EMT shows he understands the use of the pocket mask
"in comparison to the bag valve mask, the pocket mask can deliver just as good, if not better tidal volume" `
the EMT exhibits an accurate understanding of breathing when he states
"inhalation requires energy, while exhalation for most patients is a passive process"
you arrive at a residence to assist another crew with a patient in cardiac arrest. as you enter the room, a brand new EMT informs you that hr is having difficulty maintaining the mask seal to the patients face while ventilating with the BVM. which one of the following responses shows that you understand and can help with the problem
"let me maintain the face-to-mask seal while you squeeze the bag"
which one of the following statements indicates that the EMT has a correct understanding of the use of 02 in the prehospital setting?
"oxygen should never ever be witheld from a patient you think may need it"
how long will your o2 last tank factor: D: E: M:
(pressure in tank- safe residual) x tank factor = time in minutes divided by flow rate (in minutes) D: 0.16 E: 0.28 M: 1. 56
severe airway obstruction
- Patients cannot breathe, talk, or cough. -Patient may use the universal distress signal, begin to turn cyanotic, and have extreme difficulty breathing.
the Spo2 should be less than 96% indicates 90% or lower In conditions of MI's or stroke, apply o2 when it goes below
-98-100% while breathing room air -hypoxemia -requires treatment -94%
Respiration (pp 396-397)
-Actual exchange of oxygen and carbon dioxide in the alveoli and tissues of the body -Cells take energy from nutrients through metabolism.
inadequate ventilation
-Altered mental status -Inadequate minute volume -Excessive accessory muscle use and fatigue
Supplemental oxygen therapy (pp 416-425)
-Always give oxygen to patients who are hypoxic. -Never withhold oxygen from any patient who might benefit from it, especially if you must assist ventilations.
kussmaul respiration
-Deep, rapid respirations -Common in patients with metabolic acidosis
Jaw Thrust
-For suspected spine injured patients -Displacing mandible forward pulls tongue forward
safety consideration with supplemental oxygen
-Handle gas cylinders carefully. -Make sure the correct pressure regulator is firmly attached before transport. -A puncture hole in a tank can turn it into a deadly missile. -Secure cylinders when stored on the ambulance and when in use during transport.
bronchi
-Supported by cartilage -Distribute oxygen to the lungs
Discuss the basics of how oxygen is stored and the various hazards associated with its use. (pp 416-422)
-The oxygen you will give to patients is usually supplied as a compressed gas in green, seamless, steel or aluminum cylinders. -Newer cylinders are often made of lightweight aluminum or spun steel; older cylinders are much heavier. -Handle compressed gas cylinders carefully because their contents are under great pressure. ---Do not handle the cylinder by the neck assembly alone. -a puncture or hole in the tank can cause the cylinder to become a deadly missile. -
oxygenation
-The process of loading oxygen molecules onto hemoglobin molecules in the bloodstream. -Required for internal respiration to take place -Ventilation without oxygenation can occur in settings where oxygen levels have been depleted
indications for the oral airway
-Unresponsive patients without a gag reflex -Any apneic patient being ventilated with a BVM
maintaining the airway
-Use the recovery position. -Used to help maintain a clear airway in an unconscious patient who is not injured and is breathing on his or her own
nasopharyngeal airway indication: contraindication:
-Used with a patient with a gag reflex who is unable to maintain the airway spontaneously -Semiconscious or unconscious patients with an intact gag reflex, Patients who will not tolerate an oropharyngeal airway C: Severe head injury with blood in the nose, History of fractured nasal bone
exhilation
-does not require muscular effort. the diaphragm and the intercostal muscles relax. -Smaller thorax compresses air out of the lungs -Air enters and leaves via the trachea
Describe the indications for use of a humidifier during supplemental oxygen therapy. (p 425)
-ems systems provide humidified o2 patients for conditions such as croup -Humidified oxygen is usually indicated only for long-term oxygen therapy. -Dry oxygen is not considered harmful for short-term use. -An oxygen humidifier consist of a small single-patient-use bottle of water through which the oxygen leaving the cylinder becomes moisturized before it reaches the patient.
how to listen to lung sounds
-hurried, muffled, absent speech -abnormal sounds -feel breath against your ear
artificial air
-mouth to mouth -mouth to nose -16% o2 -o2 enrichment not feasible -"cooties"
inhilation
-muscular part of breathing. when a person inhales, the diaphragm and intercostal muscles contract, allowing air to enter the body and travel to the lungs -Requires the movement of the chest and supporting structures to expand -Focuses on delivering oxygen to alveoli -Oxygen and carbon dioxide diffuse until their partial pressures in the air and blood are equal.
Where to listen to lung sounds
-second or third intercostal space -midclevicular line -fourth and fifth intercostal space -fourth and fifth space on maxillary line
failure
-tear off mask and freak out -decreased heart rate -ALOC -Spo2 decreases -Co2 above 60
What is in the larynx?
-thyroid cartilage -cricoid cartilage -glottis
pressure regulator
-usually 40-70 psi
trachea
-windpipe. conduit for air entry into the lungs. 10-12 cm in length. -Conduit for air entry into the lungs -Divides at the carina into two main stem bronchi, right and left
child ventilation rate
1 breath every 3 to 5 seconds
infant ventilation rate
1 breath every 3 to 5 seconds
adult ventilation rate
1 breath every 5-6 seconds
Bag-Valve Mask
1. 15MM connection 2. 1600 mL capacity 3. near 100% o2 - reservoir c 4. < tidal volume 5. pop off valve 6. single emt use? not recommended
primary assessment
1. C/C 2. LOC A: (airway) open/patent, head tilt chin lift, jaw thrust B: breathing RR: 12-20. Rate, rhythm, quality C: (circulation) skin, major bleeding, pulse (RRQ) decides if sick or not sick
how to suction:
1. Check the unit for proper assembly of its parts. 2. Test the suction unit to ensure vacuum pressure of more than 300 mm Hg. 3. Select and attach the appropriate suction catheter to the tubing. 4. Maximum suction duration per attempt: 15 seconds for adult patients 10 seconds for children 5 seconds for infants. 5. Suctioning can result in hypoxia. 6. Repeat suctioning only after patient has been reoxygenated.
tracheostomy
1. Covers the tracheostomy hole 2. Strap secures the device around the patient's neck 3. Improvise by using a face mask over the stoma.
assisting breathing with a BVM
1. Explain the procedure to the patient. 2. Place the mask over the nose and mouth. 3. Squeeze the bag each time the patient breathes. 4. After the initial 5 to 10 breaths, deliver an appropriate tidal volume. 5. Maintain an adequate minute volume.
complications of positive-pressure ventilation
1. Increased intrathoracic pressure reduces the blood pumped by the heart. 2. More volume is required to have the same effects as normal breathing. 3. Air is forced into the stomach, causing gastric distention.
CPAP mechanism
1. Increases pressure in the lungs 2. Opens collapsed alveoli 3. Pushes more oxygen across the alveolar membrane 4. Forces interstitial fluid back into the pulmonary circulation
Describe how to perform the jaw-thrust maneuver. (pp 406-407)
1. Kneel above the patient's head. Place your fingers behind the angles of the lower jaw, and move the jaw upward. Use your thumbs to help position the lower jaw to allow breathing through the mouth and nose. 2. The completed maneuver should open the airway with the mouth slightly open and the jaw jutting forward.
Describe how to perform mouth-to-mouth or mouth-to-mask ventilation. (pp 427-428)
1. Kneel at the patient's head. OPen the airway using the head tilt-chin lift maneuver or the jaw-thrust maneuver if trauma is suspected. Insert an oral or nasal airway, if possible to help maintain airway patency. Connect the one-way valve to face mask and lace the mask on the patient's face. Make sure the top is over the bridge of the nose and the bottom is in the groove between the lower lip and the chin. Hold the mask in position by placing your thumbs over the top part of the mask and your index fingers over the bottom half. Grasp the lower jaw with the remaining three fingers on each hand, making an airtight seal by pulling the lower jaw into the mask. Maintain an upward and forward pull on the lower jaw with your fingers to keep the airway open. This methods of securing the mask to the patient's face is known as the EC-clamp method. 2. Take a deep breathe and exhale through the open port of the one-way valve. Breathe slowly into the patient's mask until you observe adequate chest rise. 3. Remove your mouth, and watch for the patient's chest to fall during passive exhalation.
Describe how to measure and insert a nasopharyngeal (nasal) airway. (pp 413-416)
1. Measure from the tip of the patient's nose to the earlobe. 2. insert the lubriacted airway into the larger nostril with the curvature following the floor of the nose. if using the right nare, the bevel should face the septum. if using the left nare, insert the airway with the tip of the airway pointing upward, which will allow the bevel to face the septum 3. gently advance the airway. if using the left nare, insert the nasoph. airway 180 degrees into position. this rotation is not required if using the right nostril. 4. continue until the flange rests against the nostril. if you feel any resistance or obstruction, remove the airway and insert it into the other nostril.
Order of Preference for Ventilating a Patient Best to least
1. Mouth-to-mask 2. Person Bag-Valve-Mask 3. Flow restricted oxygen powered ventilation device 4. Person Bag-Valve mask
CPAP contraindication
1. Patient in respiratory arrest 2. Signs and symptoms of pneumothorax or chest trauma 3. Patient who has a tracheostomy 4. Active gastrointestinal bleeding or vomiting 5. Patient who is unable to follow verbal commands
CPAP indications:
1. Patient is alert and able to follow commands 2. Patient displays obvious signs of moderate to severe respiratory distress 3. Patient is breathing rapidly Pulse oximetry reading is less than 90%
mild airway obstruction
1. Patients can still exchange air, but will have respiratory distress. 2. Noisy breathing, wheezing, coughing 3. With good air exchange, do not interfere with the patient's efforts to expel the object on his or her own. 4. With poor air exchange (increased difficulty breathing, stridor, cyanosis), treat immediately.
Describe the use of a one- or two-person bag-valve mask (BVM), and a manually triggered ventilation (MTV) device. (pp 428-435)
1. Select the proper size mask and assemble your equipment. Kneel above the patient's head. Maintain the patient's neck in an extended position unless you suspect a cervical spine injury. Stabilize the patient's head and neck and use the jaw-thrust maneuver. Have your partner hold the head, or if you are alone, use your knees to stabilize the head. 2. Open the patient's mouth, and suction as needed. Insert an oral or nasal airway to maintain airway patency. 3. Place the mask on the patient's face. Make sure the top is over the bridge of the nose and the bottom is in the groove between the lower lip and the chin. If the mask has a large, round cuff around the ventilation port, center the port over the patient's mouth. Inflate the collar to obtain a better fit and seal to the face as necessary. 4. Create a seal by holding your index finger over the lower part of the mask and your thumb over the upper part of the mask. Then use your remaining fingers to pull the lower haw into the mask. 5. Bring the lower jaw up to the mask with the last three fingers of your hand. This will help to maintain a open airway. Make sure you do not grab the fleshy part of the neck, as you may compress structures and create an airway obstruction. 6. Squeeze the bag with your other hand until you see adequate chest rise. Perform this in a rhythmic manner once every 5 seconds for an adult and once every 3 seconds for infants and children. In patient's with ongoing CPR and an advanced airway in place, such as an endotracheal tube, a laryngeal mask airway, or a King airway, use a simplified ventilation rate of 1 breathe every 6 seconds, without pausing chest compression.
CPAP complications
1. Some patients may find CPAP claustrophobic. 2. Possibility of pneumothorax 3. Can lower a patient's blood pressure 4. If the patient shows signs of deterioration, remove CPAP and begin positive-pressure ventilation using a BVM.
signs of mild to moderate hypoxia:
1. Tachypnea (increased respiratory rate) 2. Dyspnea (shortness of breath) 3. Pale, cool, clammy skin (early) 4. Tachycardia 5. Restlessness and agitation (from hypoxic brain cells) 6. Disorientation and confusion
. Explain how to measure and insert an oropharyngeal (oral) airway. (pp 411-413)
1. To select the proper size, measure from the patient's earlobe or angle of the jaw to the corner of the mouth. 2. keep the tongue from blocking the upper airway 3. open the patients mouth with the cross finger technique. hold the airway upside down with your other hand. insert the airway with the tip facing the roof of the mouth 4. rotate the airway 180 degrees. when inserted properly, the airway will rest in the mouth with the curvature of the airway following the contour of the anatomy. the flange should rest against the lips or teeth, with the other end opening into the pharynx. 5. be careful of injuring the hard palate as you insert the airway
Describe how to perform the head tilt-chin lift maneuver. (pp 405-406)
1. With the patient in a supine position, position yourself beside the patient's head. 2. Place the heel of one hand on the patient's forehead, and apply firm backward pressure with your palm to tilt the patient's head back. This extension of the neck will move the tongue forward, away from the back of the throat, and clear the airway if the tongue is blocking it. 3. Place the fingertips of your other hand under the lower jaw near the bony part of the chin. Do not compress the soft tissues under the chin, as this may block the airway. 4. Lift the chin upward, bringing the entire lower jaw with i, helping to tilt the head back. Do not use your thumb to lift the chin. Lift so that the teeth are nearly brought together, but avoid closing the mouth completely. Continue to hold the forehead to maintain the backward tilt of the head.
2. Recognizing abormal breathing
1. an adult who is awake, alert, and talking to you generally has no immediate airway or breathing problems 2. > 12 bpm should be evaluated for inadequate breathing by assessing the depth of respirations 3. working hard to breathe: labored breathing 4. irregular rhythm- series of deep breaths followed by apnea 5. reduced flow of expired air at the nose and mouth 6. unequal chest expansion 7. increased effort in breathing 8. shallow depth 9. skin that is pale, cyanotic, cool or moist 10. retractions: skin pulling in around the ribs or above the clavicles during inspiration
Give the signs of inadequate breathing. (p 401)
1. an adult who is awake, alert, and talking to you generally has no immediate airway or breathing problems 2. > 12 bpm should be evaluated for inadequate breathing by assessing the depth of respirations 3. working hard to breathe: labored breathing 4. irregular rhythm- series of deep breaths followed by apnea 5. reduced flow of expired air at the nose and mouth 6. unequal chest expansion 7. increased effort in breathing 8. shallow depth 9. skin that is pale, cyanotic, cool or moist 10. retractions: skin pulling in around the ribs or above the clavicles during inspiration
3. Assessment of Respiration
1. be aware of the patients environment and assess the quality of ambient air when approaching the patient 2. Patients level of consciousness may not have adequate and skin color are good indicators of respiration 3. Pallor: poor perfusion 4. pulse oximetry '
Contraindications for the airway include the following
1. conscious patients 2. any patient (conscious or unconscious)
NPA (nasopharyngeal airway)
1. for use with patients who cant tolerate OPA 2. Measure carefully 3. may still cause gagging 4. semi conscious 5. tip of the nose to the earlobe 6. not good for children under 8 7. use right side to get it down earlier
OPA (oropharyngeal airway)
1. holds the tongue away from the back of the airway 2. use for patients with NO gag reflex 40-110 to measure
BPAP
1. indication: 2. contraindication 3. pathophysiology 4. administering better than CPAP because releases pressure on respiration and makes breathing easier
CPAP
1. indications 2. contraindications: must be awake and able to breathe on their own 3. pathophysiology: have to have an adequate 4. administering:
how to look at lung sounds
1. inspect chest 2. general appearance 3. breathing pattern 4. observe nostrils
Assess breathing
1. look 2. listen 3. feel 4. auscultate
Providing good ventilation considerations
1. maintain good seal 2. deliver adequate volume 3. o2 port 4. BSI
Explain the importance and techniques of suctioning. (pp 408-411)
1. make sure the suctioning unit is properly assembled and turn it on. clamp the tubing, and make sure that the unit generates a vacuum of more than 300 mm HG 2. measure the catheter from the corner of the mouth to the earlobe or angle of the jaw 3. turn the patients head to the side (unless there you suspect cervical spine injury), open the mouth using the cross finger technique or tongue-jaw lift, and insert the catheter to the predetermined depth without suctioning 4. apply suction in a circular motion as you withdraw the catheter. do not suction an adult for more than 15 seconds
emergency medical care for foreign body airway obstruction
1. perform the head tilt chin lift maneuver to clear an obstruction that has been caused by the tongue and throat muscles relaxing back into the airway in any person who is found unconscious. 2. this should be performed on unresponsive patients with adequate or inadequate breathing who are not suspected of having spinal trauma. 3. if spinal trauma is suspected, open the airway with a jaw thrust maneuver 4. Large pieces of vomited food, mucus, loose dentures, or blood clots in the mouth should be swept forward and out of the mouth with your gloved index finger. when available, use suction to maintain a clear airway.
cricoid pressure
1. sellick maneuver 2. reduces gastric inflation, regurgitation and aspiration
severe hypoxia
1. tachypnea 2. dyspnea 3. cyanosis 4. tachycardia 5. confusion 6. head bobbing 7. slow reaction time 8. altered mental state status
alveoli
1. terminal air sacs 2. nutrient/waste exchange through alveolar capillary membrane 3. good air exchange is essential for oxygenation 4. hemoglobin
Opening the airway
1. the patient should be log rolled as a unit 2. kneel beside the patient. make sure you kneel far away enough so they dont fall in your lap. 3. have your partner place his or her hands in the patients far shoulder and hip 4. as you call the count to control movement, have your partner turn the patient toward you by pulling on the far shoulder and hip. control the head and neck so they move as a unit, apply a c collar 4. once the patient is positioned, maintain an open airway and check for breathing
BVM technique-- fill in. pic on phonethumbs
1. thumbs on top of mask 2. forefingers on bottom of mask 3. 3rd-4th fingers under mandible to bring jaw up to mask 4. maintain tight seal 5. squeeze bag until chest rises 6. ventilate at appropriate rate 7. one person BVM technique: tiring, difficulty with seal, <tidal volume
1. Recognizing adequate breathing
1. unless you are directly assessing the patients airway, you should not be able to see or hear a patient breathe. 2. normal rate: 12-20 bpm regular pattern of inhilation and exhilation 3. clear and = lung sounds on both sides of the chest 4. regular and = chest rise and fall 5. adequate depth
Give the signs of adequate breathing. (p 400)
1. unless you are directly assessing the patients airway, you should not be able to see or hear a patient breathe. 2. normal rate: 12-20 bpm regular pattern of inhilation and exhilation 3. clear and = lung sounds on both sides of the chest 4. regular and = chest rise and fall 5. adequate depth
head tilt-chin lift maneuver
1. with the patient in a supine position 2. Place the heel of one hand on the forehead, and apply firm backward pressure with the palm. 3. Place the fingertips of the other hand under the lower jaw. 4. Lift the chin upward, with the entire lower jaw.
An adult at rest should have a respiratory rate that ranges between:
12-20
children RR
15-30 bpm
which one of the following patients should the EMT recognize as being mildly hypoxic
18 year old male who is restless and breathing shallowly at 16 times per minute with no cyanosis
the pressure of gas in a full cylinder of o2 is approx
2000 psi
1L per minute 02:
24%
venturi mask not reccommended
24-50% of o2
infants
25-50 bpm
2L per minute
28%
how many lobes
3 on right, 2 lobes on left
size M oxygen cylinder
3,000
which one of the following patients is most likely to lose neurological control and regulation of the respiratory system
31 year old with a severe injury to the head
3L/minute
32%
simple face mask
35-60%(O2 5-10lpm)
size D oxygen cylinder
350L
4L/minute
36%
which one of the following patients should benefit from the head tilt, chin lift airway maneuver?
39 year old male who just had a seizure and has snoring respirations
5L/minute
40%
6L/ minute
44%
At a flow rate of 6 L/min, a nasal cannula can deliver an approximate oxygen concentration of up to:
44%
size jumbo D oxygen cylinder
500
size G oxygen cylinder
5300
.mouth to mask o2 delivery
55%
size H,A,K oxygen cylinder
6,900
size E oxygen cylinder
625
With a good mask-to-face seal and an oxygen flow rate of 15 L/min, the nonrebreathing mask is capable of delivering up to ______% inspired oxygen.
90
bilateral
A body part or condition that appears on both sides of the midline.
nonrebreathing mask
A combination mask and reservoir bag system that is the preferred way to give oxygen in the prehospital setting; delivers up to 90% inspired oxygen and prevents inhaling the exhaled gases (carbon dioxide). 10-15 L
gastric distention
A condition in which air fills the stomach, often as a result of high volume and pressure during artificial ventilation.
oxygen toxicity
A condition of excessive oxygen consumption resulting in cellular and tissue damage.
hypoxia
A dangerous condition in which the body tissues and cells do not have enough oxygen.
bag valve mask
A device with a one-way valve and a face mask attached to a ventilation bag; when attached to a reservoir and connected to oxygen, it delivers more than 90% supplemental oxygen.
manually triggered ventilation device
A fixed flow/rate ventilation device that delivers a breath every time its button is pushed; also referred to as a flow-restricted, oxygen-powered ventilation device.
manually triggered ventilation device def: contraindication:
A fixed flow/rate ventilation device that delivers a breath every time its button is pushed; also referred to as a flow-restricted, oxygen-powered ventilation device. -Contraindicated with COPD or suspected cervical spine or chest injuries -use with caution in pediatric patients -also known as flow-restricted, oxygen powereed ventilation devices
Describe the indications for using a nasal cannula rather than a nonrebreathing face mask. (p 423)
A nasal cannula delivers oxygen through two small, tubelike prongs that fit into the patient's nostrils. Flow rate of 1 to 6 L/min and oxygen delivered between 24% and 44%.Pulse oximetry: 90s
pneumothorax
A partial or complete accumulation of air in the pleural space.
diffusion
A process in which molecules move from an area of higher concentration to an area of lower concentration.
american standard safety system
A safety system for large oxygen cylinders, designed to prevent the accidental attachment of a regulator to a cylinder containing the wrong type of gas.
recovery position
A side-lying position used to maintain a clear airway in unconscious patients without injuries who are breathing adequately.
pin indexing system
A system established for portable cylinders to ensure that a regulator is not connected to a cylinder containing the wrong type of gas.
pin-indexing system
A system established for portable cylinders to ensure that a regulator is not connected to a cylinder containing the wrong type of gas. -Prevents the oxygen regulator from connecting to anything but an oxygen cylinder
poor air exchange
A term used to describe the degree of distress in a patient with a mild airway obstruction. With poor air exchange, the patient often has a weak, ineffective cough, increased difficulty breathing, or possible cyanosis and may produce a high-pitched noise during inhalation (stridor).
good air exchange
A term used to distinguish the degree of distress in a patient with a mild airway obstruction. With good air exchange, the patient is still conscious and able to cough forcefully, although wheezing may be heard.
automatic transport ventilator (ATV)
A ventilation device attached to a control box that allows the variables of ventilation to be set. It frees the EMT to perform other tasks while the patient is being ventilated.
Describe the signs associated with adequate and inadequate artificial ventilation. (p 434)
Adequate: - Visible and equal chest rise and fall with ventilation. - Ventilations delivered at the appropriate rate -10 to 12 breaths/min for adults -12 to 20 breaths.min for infants and children - In patients with ongoing CPR and an advanced airway in place, 1 breathe every 6 seconds - Heart rate returns to normal range - Patient's color is improving (pink) Inadequate: - Minimal or no chest rise and fall - Ventilations are delivered too fast or too slowly for patient's age - Heart rate does noes not return to normal range - Patient's color remains cyanotic, mottled, or deteriorates.
A V P U
Alert, Verbal, Pain, Unresponsive
Describe the importance of giving supplemental oxygen to patients who are hypoxic. (p 416)
Always give supplemental oxygen to patients who are hypoxic because not enough oxygen is being supplied to the tissues and cells of the body. Never withhold oxygen from any patient who might benefit from it, especially if you must assist ventilations. When ventilating any patient in cardiac or respiratory arrest, use high-concentrations supplemental oxygen.
pulse oximetry
An assessment tool that measures oxygen saturation of hemoglobin in the capillary beds. measurement of hemoglobin saturated with oxygen- spo2. suspected hypoxia
nasal canula
An oxygen-delivery device in which oxygen flows through two small, tubelike prongs that fit into the patient's nostrils; delivers 24% to 44% supplemental oxygen, depending on the flow rate. 1-6L
Describe the assessment and care of a patient with apnea. (p 402)
Apnea is the absence of spontaneous breathing. Patients with inadequate breathing have inadequate minute volume and to be treated immediately.
Concerning the use of humidified oxygen, which of the following is true? A. The water reservoir should be changed on a weekly basis. B. It is not of great benefit during short transports but can make the patient more comfortable. C. The water in the reservoir should be treated with chlorine tablets to prevent the growth of bacteria. D. It should only be used when assisting ventilations with a bag-valve-mask device.
B
labored breathing
Breathing that requires greater than normal effort; may be slower or faster than normal and usually requires the use of accessory muscles.
intrapulmonary shunting
Bypassing of oxygen-poor blood past nonfunctional alveoli to the left side of the heart.
jaw-thrust maneuver
CERVICAL SPINE INJURY: 1. Kneel above the patient's head. 2. Place your fingers behind the angles of the lower jaw. 3. Move the jaw upward. 4. Use your thumbs to help position the jaw.
Describe the use of continuous positive airway pressure (CPAP). (pp 435-439)
CPAP is a noninvasive means of providing ventilatory support for patients experiencing respiratory distress.. 1. take standard precautions. confirm BP. check your equipment, then connect the circuit to the CPAP generator. make sure you generator is connected to an o2 source 2. connect the face mask to the circuit tubing. once the system is connected, check to see if there is an on/off button. some of the newer models have this feature. make sure the device is set in the on position 3. connect the tubing to the oxygen tank 4. confirm the device is working, and place the mask over the patients mouth and nose, creating as much of an airtight seal as possible. this can be a rather difficult task depending on your patient. many patients will resist the application of a mask to their face while in severe respiratory distress. explain the application to the patient and coach them through the application of the mask. allowing the patient to hold the mask to their face may initially be beneficial in alleviating some of the stress. 5. once the mask is on the face, use the strapping mechanism to secure it to the patients head, making sure the seal between the mask and the face remains. 6. adjust the pressure valve and the FIO2 accordingly to maintain adequate oxygenation and ventilation. with CPAP in place, the patients oxygenation should improve and the work of the breathing should decrease. constant reassessment of patients for signs of deterioration is essential
Distress
Distress: positioning: tripod, -pursal lip breathing -excessory muscle use -cool, clammy skin -tachypnea -increase HR -mental status - ALOC altered -tear off mask and freak out: moves to distress -Spo2: normal to decrease -complaints of SOB
cricothyroid membrane
Elastic tissue that connects the thyroid cartilage to the cricoid ring
The respiratory and cardiovascular systems work together:
Ensure a constant supply of oxygen and nutrients is delivered to cells Remove carbon dioxide and waste products
Internal R. (pp 396-397)
Exchange of gases between blood cells and tissues
suction units
Fixed: devices on the truck Portable: goes with you Suction: 80-120 mmHG when testing. no more than 10-15 seconds measure: jaw to ear Ominous sign: bad sign
aspiration
In the context of airway, the introduction of vomitus or other foreign material into the lungs.
hypercarbia
Increased carbon dioxide level in the bloodstream.
example:
MV= 200 mL x 12 per minute MV= 2400 mL REMEMBER: 150 mL will fill the dead space. the rest will be available for gas exchange
aerobic metabolism
Metabolism that can proceed only in the presence of oxygen.
retractions
Movements in which the skin pulls in around the ribs during inspiration.
assessment findings of a 28 year old male asthmtic patient include being alert and oriented , patent airway, RR of 24 bpm, strong pulse and cool, diaphoretic skin. depth of breathing is adequate and breath sounds are significant for wheezing throughout the lungs. vital signs. pulse 124- BP: 146/82. o2 should be administered by
NRB
which one of the following oxygen administration systems will provide the patient with the greatest amount of o2
NRB face mask at 15 L per minute of o2
a patient who is suspected of being hypoxic and is breathing adequately should be given supplemental o2 with a
NRB mask
phrenic nerve
Nerve that innervates the diaphragm; necessary for adequate breathing to occur.
Explain how to recognize and care for a foreign body airway obstruction. (pp 440-442)
Obstruction from a foreign body can result in a mild airway obstruction or a severe airway obstruction. The patient will usually have noisy breathing and may be coughing. You may hear wheezing between coughs which is a mild lower airway obstruction. With poor air exchange, the patient has a weak ineffective cough and may have increased difficulty breathing, stridor, and cyanosis. Patient's with a severe airway obstruction cannot breathe, talk, or cough.
what is necessary prior to suctioning any patient
PPE, face shield, standard precautions
Carina
Point at which the trachea bifurcates (divides) into the left and right mainstem bronchi.
you are assessing a patient with altered mental status. which assessment finding contraindicates the use of the non-rebreather mask?
RR of 18, with poor tidal volume
assessment of breathing
Rate, rhythm, quality -Minute volume: depth (tidal volume) x rate -Decrease in either may lead to a decrease in minute volume
passive ventilation
The act of air moving in and out of the lungs during chest compressions.
residual volume
The air that remains in the lungs after maximal expiration.
upper airway function
The main function of the upper airway is to warm, filter, and humidify air as it enters the body.
oxygen saturation (SpO2)
The measure of the percentage of hemoglobin molecules that are bound in arterial blood
anaerobic metabolism
The metabolism that takes place in the absence of oxygen; the principle product is lactic acid.
Explain the use of a nonrebreathing mask and the oxygen flow requirements for its use. (p 423)
The nonrebreathing mask is the preferred way of giving oxygen in the prehospital setting to patients who are breathing adequately but are suspected of having or showing signs of hypoxia. Flow rate of 15 L/min and oxygen delivered is up to 95%. pulse oxim: high 80's
dead space
The portion of the tidal volume that does not reach the alveoli and thus does not participate in gas exchange.
Explain the use of the recovery position to maintain a clear airway. (p 416)
The recovery position is used to help maintain a clear airway in an unconscious patient who is not injured and is breathing on his or her own with a normal respiratory rate and adequate tidal volume (depth of breathing). The recovery position will prevent the aspiration of vomitus. 1. roll the patient onto either side so that the head, shoulders, and torso move at the same time without twisting. 2. extend the patients lower arm and place the upper hand under his or her cheek.
Discuss the physiology of breathing. (pp 392-397)
The respiratory and cardiovascular systems work together to ensure that a constant supply of oxygen and nutrients is delivered to every cell in the body and carbon dioxide and waste products are removed from every cell.
glottis
The space in between the vocal cords that is the narrowest portion of the adult's airway; also called the glottic opening.
partial pressure
The term used to describe the amount of gas in air or dissolved in fluid, such as blood.
alveolar minute volume
The volume of air moved through the lungs in 1 minute minus the dead space; calculated by multiplying tidal volume (minus dead space) and respiratory rate.
minute volume
The volume of air moved through the lungs in 1 minute; calculated by multiplying tidal volume and respiratory rate; also referred to as minute ventilation.
alveolar ventilation
The volume of air that reaches the alveoli. It is determined by subtracting the amount of dead space air from the tidal volume.
Explain how to assess for adequate and inadequate respiration, including the use of pulse oximetry. (pp 402-405)
There are external factors that may disrupt the process of respiration. A patient's level of consciousness and skin color are excellent indicators or respiration. The pulse oximeter measures the percentage of hemoglobin saturation.
Explain how to assess for a patent airway. (p 405)
You need to quickly assess for a pulse and breathing; if the patient has a pulse, you need to determine whether breathing is adequate. To most effectively open the airway and assess breathing, the unresponsive patient should be in a supine position. The patient should be log rolled as a unit so the head, neck, and spine all move together without twisting.
which of the following is true regarding the BVM
a 15/22 mm adapter allows the device to be attached to the king LTD and LMA
in which of the following patients would the head titlt chin would be the most app method
a 37 year old female unconscious in her bed
esophagus
a collapsible tube that extends from the pharynx to the stomach:
oxygen toxicity
a condition of excessive o2 consumption resulting in cellular and tissue damage
which pf the following patients is breathingn adedquately
a conscjous male with respirations of 19 and pink skin
pulmonary capillaries
a network of tiny blood vessels that surround the alveoli and carry the co2 from the body to the lungs and the 02 from the lungs to the body.
Canography
a noninvasive method to quickly and efficiently provide information on a patients ventilatory status, circulation, and metabolism. effectively measures the concentration of carbon dioxide in expired air over time
In which of the following patients would a nasopharyngeal airway be contraindicated?
a patient who fell 20 feet and landed on his or head
when considering CPAP, the patient must exhibit
ability to breathe on their own
Gas exchange in the lungs is facilitated by:
adequate amounts of surfactant.
You are artificially ventilating an adult male patient who is in respiratory arrest with a bag-valve mask. Which one of the following shows that you are ventilating this patient properly?
adequate chest rise and fall
which of the following would best indicate adequate ventilations of an unconscious adult patient who is being artificially ventilated with a BVM
adequate chest rise and fall
which of the following statements regarding the one-person bag mask device technique is correct
adequate tidal volume is often difficult to achieve when one EMT is operating the BVM
in the presence of oxygen, the mitochondria of the cells convert glucose into energy through a process called
aerobic metabolism
What occurs when a patient is breathing very rapidly and shallowly? A. air is forcefully drawn into the lungs due to the negative pressure created by the rapid respirations B. the majority of tidal volume reaches the lungs and diffused across the alveolar capillary membrane C. air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchangne D. minute volume increases bc of a marked increase in both tidal volume and respiratory rate
air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchange
When a person's diaphragm contracts and the intercostal muscles pull the ribs upward, which one of the following will occur?
air will flow into the lungs
when a diaphragm and the intercostal muscles contract, which of the following will occur
air will flow into the lungs
end-tidal co2
amount of co2 present at the end of an exhaled breath. measured by capnometry
partial pressure
amount of gas in air or dissolved in fluid such as blood
A patient is found unconscious after falling from a third floor window. His respirations are slow and irregular. You should:
assist his breathing with a bag-valve mask.
You are delivering oxygen to a patient with a nasal cannula at 4 L/min when he begins to complain of a burning sensation in his nose. You should:
attach an oxygen humidifier.
ominous sign
bad sign
Mediastinum
between the lungs. contains the heart, great vessels, esophagus, trachea, major bronchi, and many nerves.
pleura space
between the parietal pleura and the visceral pleura
what body system or structure is responsible for the control and regulation of a persons breathing
brain
breathing is controlled by an area in the
brain stem
external respiration
breathing fresh air into the respiratory system and exchanging o2 and co2 between the alveoli and the blood in the pulmonary capillaries
in a healthy person, the primary stimulus to breathe is
carbon dioxide
the primary waste product of aerobic metabolism is
carbon monoxide
the structure that lies between the trachea and bronchi is
carina
the jaw thrust maneuver is used to open the airway of patients with suspected
cervical spine injuries
Inadequate ventilation
chest doesn't rise or fall, RR too slow
Providing good ventilation effectiveness
chest rise and fall
to select the proper size OPA, you should measure from the
corner of the mouth to the earlobe
the ____ cartilage is a firm ring that forms the inferior part of the larynx
cricoid
What is a late sign of hypoxia?
cyanosis
assessment findings on an elderly patient with CHF indicate that her failing heart is causing fluid to collect and fill her alveoli. based on this pathophysiology, for which pulmonary complication should the EMT treat the patient?
decreased gas exchange
a 52 year old male with a brain tumor has gone into respiratory arrest. you assign the task of artificially ventilating the patient with the bag valve mask to a new EMR. how will you instruct him to ventilate the patient
deliver one breath every 5-6 seconds, with each ventilation lasting one second
Minute volume=
depth (tidal volume) x rate
respiration
diffusion or gas exchange happening all over the body
Despite coaching and explaining the benefits of a nonrebreather face mask, a female patient with chest pain panics and states that she cannot tolerate the mask over her face. The more that she panics, the worse the chest pain becomes. Your best course of action is to:
disconnect the NRB and replace it with a nasal cannula
a 16 year old patient presents labored breathing and increased RR, increased heart rate and leaning forward with his hands on his knees. his skin i s pink and his accurate pulse ox is 96. the patient is suffering from respiratory
distress
Larynx and trachea
epligottis, vocal cords, thyroid cartilage, cricoid cartilage
which of the following best describes an OPA
even with proper insertion, vomiting or spasm of the vocal cords are still a risk
internal respiration
exchange of 02 and co2 between the systemic circulatory system and the cells of the body
internal respiration
exchange of gases between blood and tissues
External R (p 396)
exchange of gases between the lungs and the blood cells in the pulmonary capillaries. also called pulmonary respiration
Your medical director is holding an in-service focusing on the prehospital management of adult patients with respiratory complaints. He asks the group to explain how they can determine if the pateint is breathing adequately. Which one of the following responses is most appropriate?
for an adult patient to be breathing adequately the rate should be within 8-24 bpm with a full chest rise with each breath
your paramedic partner has applied CPAP to a patient in a respiratory distress from CHF. you realize that this should beneift the patient by
forcing fluid in the lungs back into the bloodstream
2. Oropharynx
forms the posterior portion of the oral cavity. extends vertically from the back of the mouth to the esophagus and trachea.
phrenic nerve
found in the thorax. innervates the diaphragm muscle, allowing it to contract
you are checking the D oxygen tank in the ambulance and note that the reading on the pressure regulator reads 1,000 psi. you should recognize that the tank is
half full
If an injured patient has lost all use of his diaphragm, the EMT should recognize that the patient:
has lost a major portion of his ability to breathe
While eating dinner, your partner suddenly grabs his throat and has a panicked look on his face. He has a weak cough, faint inspiratory stridor, and cyanosis around the lips. You should:
have him in a supine position and assess the airway
CPAP is indicated for patients who:
have pulmonary edema and can follow verbal commands.
you are watching an EMT prepare the ambulance for the upcoming shift. in regards to 02 cylinders and equipment, which one of the following requires immediate intervention
he cleans a dirty oxygen tank with a petroleum based agent
which one of the following actions indicated that the EMT is correctly using a NRB face mask on an adult patient
he fully inflates the reservoir prior to placing it on the patient
lungs: right lobe: left lobe:
held in place by the trachea. 3 2
The normal stimulus to breathe is stimulated by the chemoreceptors that measure the change of what two gases?
high carbon dioxide and low oxygen
you are caring for a 46-year-old male patient who is unresponsive. which one of the following statements made by your partner indicates the need to immediately stop suctioning the patients airway and resume positive pressure ventilation
his heart rate is 48 beats per minute
If ventilation is impaired, carbon dioxide levels in the bloodstream will increase. This condition is called:
hypercarbia
the most significant complication associated with OPA suctioning is
hypoxia due to prolonged suction attempts
aerobic metabolism
in the presence of o2, cells convert glucose into energy
hypoxia
inadequate amount of 02 in the cells. you die in 4-6 minutes without oxygen
Hypoxia is defined as:
inadequate oxygen to the body's cells and tissues.
you are called to the scene of a 52 year old patient has overdosed on both street drugs and alcohol. the patient is responsive to painful stimuli and is breathing 6 times a minute, but exhibits no cyanosis. which of the following statements best describes the patients condition and would be the most appropriate next steps
inadequate respirations, initiate positive pressure ventilation with supplemental oxygen
you have been called for a patient who has overdosed on drugs and alcohol. the patient is responsive to painful stimuli and is breathing and is breathing shallowly at 8 timer per minute, but exhibits no cyanosis. you should recognize and do which one of the following
inadequate respirations, start positive pressure ventilation with supplemental oxygen
In an otherwise healthy individual, the primary stimulus to breathe is a(n):
increased level of carbon dioxide in the blood
all of the following will help minimize the risk of gastric distention when ventilating an apneic patient with a bag mask device, except
increasing the amount of delivered tidal volume
oropharyngeal airway indication: contraindication:
indications: Unresponsive patients without a gag reflex, -Apneic patients being ventilated with a bag-valve mask (BVM) contraindication: Any patient with an intact gag reflex
which of the following best describes adequate breathing
inhalation requires energy expenditure while exhalation is a passive process
a 21 year old female has overdosed on an unknown drug. she has snoring respirations and an intact gag reflex. she has a weak respiratory effort and is slightly cyanotic. given these assessment findings, your care should include:
insertion of a nasal airway
you have been dispatched to a residence for a 13 year old complaining of SOB, as you enter the living room she is conscious laying down, what action is most approp
introduce yourself and your partner
Cheyne-Stokes
irregular respiratory pattern in which the patient breathes with an increasing rate and depth of respirations that is followed by a period of apnea
ataxic respirations
irregular, ineffective respirations that may or may not have an identifiable pattern. may follow serious head injuries
larynx
is a complex structure formed by many independent cartilaginous structures. marks where the upper airway ends and the lower airway begins
Why is the jaw-thrust maneuver indicated for a patient with a possible spinal injury?
it manipulates the head and cervical spine less than the head-tilt, chin lift
apnea
lack of breathing
vocal cords
lateral boarders of the glottis. white bands of thin muscle tissue are partially separated at rest and serve as the primary center for speech production.
You are ventilating an apneic woman with a bag-mask device. She has dentures, which are tight-fitting. Adequate chest rise is present with each ventilation, and the patient's oxygen saturation reads 96%. When you reassess the patency of her airway, you note that her dentures are now loose, although your ventilations are still producing adequate chest rise. You should:
leave them in and recheck the airway to make sure they dont cause an obstruction
cricoid cartilage
lies inferiorly to the thyroid cartilage. it forms the lowest portion of the larynx. the first ring of the trachea and the only lower air structure that forms a complete ring
parietal pleura
lines the inside of the thoracic cavity
when providing an in service on ventilating the geriatric patient, you should emphasize which one of the following in regards to a patient who has
loose appliances should be removed if they interfere with the airway or seal between the mask and face
the EMT would recognize that administering CPAP at too high of a pressure can cause"
lung collapse
carbon dioxide is excreted from the body by what structure
lungs
When using a pocket mask to ventilate an unresponsive adult patient, the EMT must remember to always:
maintain the head tilt chin lift or jaw thrust maneuver
What do you monitor during suctioning
monitor for decrease in pulse or heart rate. stop suctioning and begin ventilation. means you have hypoxia and you need to stop and ventilate
chemoreceptor
monitor of the levels of 02, co2, and pH of the cerebrospinal fluid and then provide feedback to the respiratory centers to modify the rate and depth of breathing based on the bodys needs at any given time.
tidal volume is delivered as the volume of air that
moves into or out of the lungs in a single breath
what organ or tissue can last the longest without o2
muscle
when inserting a NPA, the EMT should remeber that
nasal mucosa may bleed even with proper insertion
Airway anatomy (pp 388-392) 1. Nasopharynx
nasopharynx: lined with a ciliated mucous membrane. -Filters out dust and small particles -Warms and humidifies air as it enters the body -above the roof of the mouth and soft palate)
BVM 02 delivery
nearly 100%
you are transporting a 30 year old hispanic male with carbon monoxide poisoning to a specialized facility for treatment with a transport time of 1.5 hours. the patient is on a NRB with flow of 15L. cylinder constant 2.41 with 1100 psi. what is the most appropriate
no action necessary, it should last
head tilt-chin lift maneuver Pediatrics
no suspected spine injury, temporary maneuver. Tongue comes off the back of the throat ped: place head in neutral position, consider pad under shoulders, don't hyperextend
eupnea
normal breathing
hemoglobin delivers 97% of the oxygen delivered to the body's tissues:
o2 saturation id an excellent indication of 02 available to the end organs
the emt should assess a patients tidal volume by
observing for adequate chest rise.
agonal gasps
occasional, gasping breaths that occur after the heart has stopped
which of the following statements, made by an EMT, reflects correct knowledge regarding the use of 02 in patient care
oxygen administration is no longer considered standard therapy for ems
positive pressure ventilation vs negative pressure
p: generated by a device forces air into the chest cavity. n: , the diaphragm contracts and negative pressure is generated in the chest cavity.
when assessing the airway, breathing and circulation, which of the following best indicates that the patient has an open airway.
patient speaks with ease
P E E P
peak end expiratory pressure
the emt is correctly performing the jaw-thrust airway maneuver when she
places her hands on the side of the patients head and lifts the jaw upward
a listless and lethargic 84 year old male responds to stimuli with garbled speech. his respirations show poor effort and are rapid and labored with a room air sp02 is 84%. additionally, you cannot appreciate breath sounds in his right lung. the best form of oxygen therapy for this patient would be
positive pressure ventilation
oxygenation
process of loading 02 molecules onto hemoglobin molecules in the blood stream
Epligottis
protects the opening of the trachea. allows air to pass into the trachea. helps separate the digestive system from the respiratory system. Function: prevent food and liquid from entering the larynx during swallowing.
positioning the patient for airway control
recovery position, for patients with no suspected injury
you are assessing an unresponsive patient who overdosed on a narcotic pain medication. given the situation, what is the greatest concern regarding potential airway occlusion
relaxation of the tongue
while inserting an OPA, the patient begins to gag. which of the following is the next appropriate action
remove the airway and maintain the airway ising the head tilt
While the EMT is inserting an oropharyngeal airway, the patient gags. The EMT should:
remove the airway and maintain the head tilt
you arrive at work and note that the portable o2 tanks in the ambulance are now yellow instead of green as during the previous shift. as a knowledgeable EMT you should
remove the tank and retrieve a green cylinder
You and your partner are ventilating an apneic adult when you notice that his stomach is becoming distended. You should:
reposition his head
you have opened the airway using a head-tilt chin lift and are ready to ventilate an apneic patient with a pocket mask. the first ventilation you attempt is unsuccessful. you should immediately
reposition the head
An unconscious patient found in a prone position must be placed in a supine position in case he or she:
requires CPR
prior to applying a NRB mask on a patient, you must ensure that the
resevoir bag is fully inflated
the difference between respiration and ventilation is best described as
respiration describes the exchange of 02 and co2 while ventilation describes the movement of air that carries them `
opening the mouth
scissor technique 1. Place the tips of your index finger and thumb on the patient's teeth. 2. Push your thumb on the lower teeth. 3. Push your index finger on the upper teeth. 4. The index finger and thumb cross over each other.
you are starting to ventilate a patient with a laryngectomy and a stoma. as you provide the first few ventilations, you note that the air passes easily into the patient, but does not cause the chest to rise. your next action should be to
seal the patients mouth and nose
the EMT has just placed an OPA in a patient. by doing so, which one of the following has the EMT accomplished?
secured the tongue away from the back of the airway
a paramedic has asked you to place the patient on a NRB mask at 15 L. to administer at o2 at this flow rate you should
select 15 on the oxygen therapy regulator
Signs of adequate breathing in the adult include all of the following, except:
shallow chest rise
you arrive at the scene of a fall, where a 42 yearold woman fell backwards off of a stepladder while cleaning windows in her kitchen, she is lying on the floor complaining of pain to her ankle and states "blah blah"what is apparent
she is alert with an open airway
thyroid cartilage
shield-shaped structure formed by two plates that join in a V shape anteriorly to form the laryngeal prominence known as the adams apple
obstructions
snoring, crowing, gurgling, stridor
glottis
space between the vocal cords and the narrowest portion of the adults airway
an 10 year-old female patient has been stung by a bee and state her throat is closing up, she says shes allergic and can only speak a few words. what respiratory sound indicates the patient has swelling in the airway
stridor
on arrival at a lethargic patients side, you note her to have gurgling respirations. the best treatment for this condition is:
suction
You must suction frothy secretions from the mouth and pharynx of a 31-year-old male patient whose respiration rate is 4 breaths per minute. Which one of the following interventions is most appropriate given the patient's condition?
suction for no more than 15 seconds at a time followed by 2 minutes of positive pressure ventilation
after a near-drowning submersion injury, a 31 year old female is breathing 4 times a minute and requires suctioning of copius secretions from the mouth and pharynx, which of the following interventions is most appropriate given the patients condition
suction should be performed for no more than 10 seconds at a time followed by 2 minutes of positive pressure ventilation
you arrive at a residence for a male who is unresponsive. as you enter the room, you observe an obese male lying on a recliner. his eyes are closed, and he has gurgling respirations. while your partner quickly performs
suction the airway
you have arrived at home of a 17 year old male who reportedly had a seizure. he is apneic with vomitus in the airway. a radial pulse is palpated and the skin is cool and diaphoretic. immediate action:
suction the airway
you have arrived next to a patient who reportedly had a seizure. assessment reveals him to be apneic with vomitus in the airway. he has a radial pulse, and his skin is cool and diaphoretic. which one of the following should you do immediately
suction the airway
stoma
surgical opening in the front of the neck. laryngectomy and tracheostomy
compliance
the ability of the alveoli to expand when air is drawn in during inhilation
respiration
the actual exchange of 02 and co2 in the alveoli as well as the tissues of the body
which of the following is true regarding the form or function of the alveoli
the alveoli permits gas exchange between the lungs and the bloodstream.
end-tidal CO2
the amount of c02 present at the end of an exhaled breath
metabolism
the biochemical processes that result in production of energy from nutrients within the cells
You are using an automatic transport ventilator (ATV) for a patient who has a poor respiratory effort. Which one of the following is the best indicator of adequate ventilation?
the chest rises and falls
external respiration
the exchange of gases between the lungs and the blood cells in the pulmonary capillaries; also called pulmonary respiration
anareobic metabolism
the metabolism that takes place in the absence of oxygen; the principal product is lactic acid
ventilation
the physical act of moving air into and out of the lungs
you note that the portable o2 tank in the ambulance is yellow instead of green. what do you do
the tank should be removed and a green cylinder retrieved
what is the most common cause of airway obstruction in an unconscious patient
the tongue
bronchioles
thin, hollow tubes made of smooth muscle. the smaller bronchioles connect to the alveoli. dilate and constrict as oxygen passes through them. o2 is transported back to the heart and distributed to the rest of the body
visceral pleura
thin, slippery outer membrane that covers the lungs
3. pharynx
throat. muscular tube that extends from the nose and mouth to the level of the esophagus and trachea. Composed of the nasopharynx, oropharynx, and the laryngopharynx
function of the lower airway and consists of q
to deliver oxygen to the alveoli. Includes: Trachea Bronchi Lungs
During insertion of an oropharyngeal airway into an unconscious patient, she begins to vomit. The first thing you should do is:
turn the patient on the side
the EMT should use the jaw thrust maneuver to open the airway for the patient with which one of the following
unresponsive after falling from a porch
For which one of the following patients is placement of an oropharyngeal airway indicated
unresponsive patient who has no gag or cough reflex
When ventilating an apneic adult with a bag-valve mask, you should squeeze the bag:
until visible chest rise is noted.
NRB o2 delivery
up to 95%
tracheostomy tube
ventilate with BVM. suction may be required with soft catheter
Diaphragm
voluntary and involuntary muscles. divides the thorax from the abdomen and is pierced by the great vessels and the esophagus. acts as a voluntary muscle when you take a deep breath, cough, or hold your breath. contraction of this brings air into the lungs. relaxation allows air to be expelled from the lungs.
which of the following statements regarding positive pressure ventilation is correct
with PPV, more minute volume is required to have the same effects as normal breathinga
2 person BVM ventilation
you should hold the mask in place while your partner squeezes the bag with two hands until the patients chest rises adequately.
