Chapter 15 Respiratory emergencies. Emergency care and transport of the sick and injured 11ED
adventitious breathing sounds
abnormal breathing sounds
True or false. Do not administer humidified oxygen to a patient with an upper airway infection
false
True or false. Pneumothorax is always caused by trauma
false
True or false. Side effects of inhalers used for shortness of breath include increased pulse rate, nervousness and muscle tremors
false
True or false. When assessing breathing sounds the stethoscope should be placed over the scapula
false
True or false. the distinction between hyperventilating and hyperventilation syndrome is straightforward and should guide the EMTs treatment choices.
false
True or false. the pulse oximeter can help you determine the severity of the respiratory component of the patients problem
false
___________ is a life threatening inflammatory disease that causes the epiglottis to swell blocking the airway 1. Epiglottitis 2. Croup 3. Respiratory syncytial virus 4. Influenza
one
SOB, wheezing, coughing, fever, dehydration, tachypnea, tachycardia are signs and symptoms of 1. Bronchiolitis 2. Bronchitis 3. Diphtheria 4. Emphysema
one
Wheezing is indicative of a 1. lower respiratory obstruction 2. upper respiratory obstruction
one
Wheezing upon inspiration/expiration and bronchospasms are signs and symptoms of 1. Asthma 2. Anaphylaxis 3. Common cold 4. Croup
one
Which of the following drugs could you use for asthma, bronchitis, and COPD? 1. Singulair 2. Intal 3. Atrovent 4. Advair Diskus
one
Which of the following drugs is an anti inflammatory and reduces swelling 1. Flovent diskus 2. Intal 3. Atrovent 4. Advair Diskus
one
Which of the following is a common MDI drug? 1. Alupent 2. Acetylsalicylic acid 3. Methylprednisolone 4. Nitroglycerin
one
Which of the following should be assisted by an inhaler and promptly transported to the ED 1. COPD 2. Hay fever 3. Spontaneous pneumothorax 4. Pleural effusion
one
A prolonged asthma attack that is unrelieved may progress into a condition known as 1. pleurel effusion 2. status epilepticus 3. status asthmaticus 4. reactive airway disease
three
Asthma produces a characteristic _____ as patients attempt to exhale through partially obstructed air passages. 1. rhonchi 2. stridor 3. wheezing 4. rattle
three
Cough, fever, sore throat, fatigue are signs and symptoms of 1. Congestive heart failure 2. Epigolottitis 3. Influenza 4. Pulmonary embolus
three
Cough, runny nose and sore throat are signs and symptoms of 1. Asthma 2. Anaphylaxis 3. Common cold 4. Croup
three
True or false. The problem with asthma is getting air out of the lungs, not into them.
true
True or false. pulmonary edema is commonly associated with CHF
true
embolus
A clot that breaks lose and travels through the bloodstream.
cystic fibrosis
A genetic disorder that is present at birth and affects both the respiratory and digestive systems.
True or false. A CPAP is indicated for patients who are in respiratory arrest and are unable to follow commands
false
True or false. A patient with epiglottitis must lay supine to keep the airway open
false
True or false. All patents who have a pulmonary edema have heart disease
false
True or false. COPD is characterized by long inspiration times
false
pneumonia
Bacterial infection of the lungs
What are some common risk factors for a pulmonary embolism
Being overweight or obese. Smoking cigarettes. Being pregnant or having given birth in the previous six weeks. having recent surgery bed rest
True or false. Croup is often seen in adult patients
false
PASTE
Progression Associated chest pain Sputum Talking tiredness Exercise tolerance
True or false. A patient in the tripod position will want to sit up.
True
True or false. Inhalation injuries can cause pneumonia and eventual pulmonary edema.
True
True or false. Patients with long standing COPD would benefit from low flow oxygen to start vs high flow oxygen
True
True or false. Respiratory syncytial virus is highly contagious
True
True or false. Sitting is the best position to assess breathing sounds.
True
COPD
chronic obstructive pulmonary disease
pulmonary embolism
clot or other material lodges in vessels of the lung
A conscious and alert 29-year-old female with a history of asthma complains of difficulty breathing that began after her morning jog. The temperature outside is 40°F (5°C). On exam, you hear bilateral expiratory wheezing. After providing supplemental oxygen, you should: 1. place her in a recumbent position to facilitate breathing. 2. contact medical control and administer an antihistamine. 3. call medical control and ask how to proceed with treatment. 4. determine if she has been prescribed a beta-agonist inhaler.
four
At the onset of an acute asthma attack, patients commonly experience difficulty breathing and: 1. audible stridor. 2. rales and rhonchi. 3. profound cyanosis. 4. expiratory wheezing.
four
Atelectasis can be defined as: 1. lack of oxygen in the body's cells and tissues. 2. the backup system to control breathing. 3. oxygenation. 4. collapsed alveoli.
four
Barrel chest, pursed lip breathing, dyspnea on exertion, cyanosis and wheezing are signs and symptoms of 1. Bronchiolitis 2. Bronchitis 3. Diphtheria 4. Emphysema
four
Fever, barking cough, Stridor usually seen in pediatric patients are signs and symptoms of 1. Asthma 2. Anaphylaxis 3. Common cold 4. Croup
four
The brain stem senses the level of carbon dioxide in the arterial blood. If the level of carbon dioxide drops below the normal level, how will this affect the patient's respiratory rate and depth? 1. Respiratory rate increases; depth of respirations is less. 2. Respiratory rate slows; depth of respirations is greater. 3. Respiratory rate increases; depth of respirations is greater. 4. Respiratory rate slows; depth of respirations is less.
four
The low pitched rattling sound caused by secretions or mucus in the larger airway. 1. Wheezing 2. Crackles 3. Stridor 4. Rhonchi
four
The primary stimulus that triggers a patient to breathe is the carbon dioxide level in the arterial blood. Some patients who suffer from chronic carbon dioxide retention will utilize a secondary stimulus, or drive, to breathe. What is this secondary stimulus known as? 1. Hypoxemia 2. Hyperventilation 3. COPD 4. Hypoxic drive
four
Which condition is frequently found in end-stage chronic obstructive pulmonary disease? 1. Pneumonia 2. Pneumothorax 3. All of these answers are correct. 4. Hypoxic drive
four
Which of the following drugs decreases secretions. 1. Singulair 2. Intal 3. Atrovent 4. Advair Diskus
four
Which of the following requires oxygen and transport followed by removal of fluids collected outside of the lung by a physician. 1. COPD 2. Hay fever 3. Spontaneous pneumothorax 4. Pleural effusion
four
You are assessing a patient with respiratory distress and are unsure if the cause is congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). Which of the following clinical signs would be the MOST helpful in determining whether the patient has CHF or COPD? 1. Rapid breathing 2. Cyanosis of the skin 3. Altered mental status 4. Jugular vein distention
four
You are attending to a 6-year-old female patient. Her parents tell you that she has been sick for the last three days with the respiratory infection that has been going around her school. They became concerned when she stopped drinking fluids, and they could not get her to take in any liquids. The patient is showing signs of significant dehydration. Based on this information, your patient is most likely suffering from: 1. bronchiolitis. 2. acute asthma. 3. epiglottitis. 4. respiratory syncytial virus (RSV) infection.
four
_______________ is a collection of fluid outside the lung on one or both sides of the chest. it compresses the lung or lungs and causes SOB 1. Acute pulmonary edema 2. Hay fever 3. Spontaneous pneumothorax 4. pleural effusion
four
________________ is a slow process of dilation and disruption of the airways and alveoli 1. Acute pulmonary edema 2. bronchiolitis 3. Pertussis 4. Chronic obstructive pulmonary disease
four
coughing, wheezing, fever and dehydration are signs and symptoms of 1. pertussis 2. tension pneumothorax 3. pneumonia 4. Respiratory syncytial virus
four
sharp chest pain, sudden onset, dyspnea and tachycardia signs and symptoms of 1. Congestive heart failure 2. Epigolottitis 3. Influenza 4. Pulmonary embolus
four
A patient who has just had a severe asthma episode is now very sleepy. This indicates that the patient: 1. might stop breathing. 2. has recovered from the attack. 3. does not need transport. 4. is probably having a drug reaction.
one
Dependent edema. crackles, orthopnea, paroxysmal nocturnal dyspnea are signs and symptoms of 1. Congestive heart failure 2. Epigolottitis 3. Influenza 4. Pulmonary embolus
one
Pink frothy sputum is indicative of 1. fluid in the lungs 2. respiratory infection 3. pulmonary edema
one
_____________ occurs when the heart muscle is injured and the left side cannot remove blood from the lung as fast as the right side delivers it causing a fluid buildup in the alveoli 1. Acute pulmonary edema 2. bronchiolitis 3. Pertussis 4. Influenza
one
constriction or inflammation in the bronchus, commonly heard in patients with asthma and sometimes COPD 1. Wheezing 2. Crackles 3. Stridor 4. Rhonchi
one
coughing spells, whooping sound, fever are signs and symptoms of 1. pertussis 2. tension pneumothorax 3. pneumonia 4. Respiratory syncytial virus
one
pulmonary edema can develop quickly after a major 1. heart attack 2. episode of syncope 3. brain injury 4. trauma
one
CPAP (continuous positive airway pressure)
pressurized air delivered to lungs to keep them expanded during exhalation
A disease in the lungs in which extreme dilation and eventual destruction of the pulmonary alveoli with poor exchange of oxygen and carbon dioxide. it is a form of COPD 1. Tuberculosis 2. RSV 3. Emphysema 4. Pulmonary edema
three
Difficulty breathing and swallowing, sore throat, thick gray buildup in the throat and nose and fever are signs and symptoms of 1. Bronchiolitis 2. Bronchitis 3. Diphtheria 4. Emphysema
three
Dyspnea, chills, fever, cough, green/red sputum and localized wheezing are signs and symptoms of 1. pertussis 2. tension pneumothorax 3. pneumonia 4. Respiratory syncytial virus
three
High pitched sound heard on inspiration as air tries to pass through an obstruction in the upper airway 1. Wheezing 2. Crackles 3. Stridor 4. Rhonchi
three
When suctioning an adults mouth do not withhold oxygen for more than _____ seconds 1. 5 2. 10 3. 15 4. 20
three
Which of the following causes blowing off to much carbon dioxide. alkalosis build up of excess base (lack of acids in the bodys fluids) 1. Acute pulmonary edema 2. Hay fever 3. Hyperventilation 4. pleural effusion
three
Which of the following requires supplemental oxygen and transport and can become critical requiring the support of airway and respirations and CPR 1. COPD 2. Hay fever 3. Spontaneous pneumothorax 4. Pleural effusion
three
Which of the following statements regarding pulse oximetry is correct? 1. The pulse oximeter is a valuable assessment tool that measures the percentage of red blood cells that contain hemoglobin molecules. 2. Caution must be exercised when using the pulse oximeter on a patient with carbon monoxide poisoning because falsely low readings are common. 3. Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen, but does not measure the actual hemoglobin content of the blood. 4. Most otherwise healthy patients can maintain adequate oxygenation and good skin color with oxygen saturation readings as low as 70% to 80%.
three
You are attending to a 28-year-old female patient in severe respiratory distress. The patient has had a high fever all day, and the respiratory distress came on very quickly. Your patient is now sitting in a chair, leaning forward with her hands on her knees. She is making high-pitched sounds with each breath and does not seem to be moving very much air. Based on this information, your patient is likely suffering from: 1. bronchiolitis. 2. acute asthma. 3. epiglottitis. 4. foreign body airway obstruction.
three
__________ is an acute spasm of the bronchioles associated with excessive mucus production and swelling of the mucous lining of the respiratory passages. 1. Acute pulmonary edema 2. bronchiolitis 3. Asthma 4. Chronic obstructive pulmonary disease
three
___________ causes infection in the lungs and breathing passages and can lead to other illnesses such as bronchiolitis and pneumonia 1. Epiglottitis 2. Croup 3. Respiratory syncytial virus 4. Influenza
three
_____________ is a partial or complete accumulation of air in the pleural space 1. Acute pulmonary edema 2. Hay fever 3. Spontaneous pneumothorax 4. Anaphylactic reaction
three
________________________ primarily affects children under the age of 6, the patient will be feverish and exhibit a whooping sound after a coughing attack 1. pneumonia 2. bronchiolitis 3. Pertussis 4. Influenza
three
cough, fever, fatigue and productive/bloody sputum are signs and symptoms of 1. pertussis 2. tension pneumothorax 3. Tuberculosis 4. Respiratory syncytial virus
three
pulmonary edema may be produced by 1. cigarette smoking 2. seasonal allergies 3. inhaling toxic fumes 4. carbon monoxide poisoning
three
True or false. A CPAP is appropriate for a patient who has moderate to severe respiratory distress, such as a pulmonary edema
true
True or false. A patient requires ventilatory support if their mental status is declining or if they are in moderate to sever respiratory distress
true
True or false. Adults breathing more than 20 breath/min or less than 12 breaths/min need high flow oxygen
true
True or false. COPD patients typically have dry lung sounds while congestive heart failure patients will have wet sounds
true
True or false. Lung sounds can help tell the difference between signs and symptoms of COPD and congestive heart failure
true
True or false. Many strains of TB are immune to antibiotics
true
True or false. Snoring sounds are indicative of an upper airway obstruction
true
A young female is unconscious after intentionally ingesting a large amount of aspirin. You will MOST likely find her respirations: 1. slow and deep. 2. deep and rapid. 3. slow and shallow. 4. rapid and shallow.
two
Chronic cough (with sputum production), wheezing, cyanosis and tachypnea are signs and symptoms of 1. Bronchiolitis 2. Bronchitis 3. Diphtheria 4. Emphysema
two
Dyspnea, fever, stridor, drooling, difficulty swallowing, severe sore throat and tripod positioning are signs and symptoms of 1. Congestive heart failure 2. Epigolottitis 3. Influenza 4. Pulmonary embolus
two
Harsh, high-pitched inspiratory sounds are characteristic of: 1. rales. 2. stridor. 3. rhonchi. 4. wheezing.
two
The respiratory distress that accompanies emphysema is caused by: 1. repeated exposure to cigarette smoke. 2. chronic stretching of the alveolar walls. 3. massive constriction of the bronchioles. 4. acute fluid accumulation in the alveoli.
two
The sound of air trying to pass through fluid in the lungs. 1. Wheezing 2. Crackles 3. Stridor 4. Rhonchi
two
Which of the following drugs cannot be used for all three of the following asthma, bronchitis, and COPD? 1. Singulair 2. Intal 3. Proventil 4. Xopenex
two
Which of the following is NOT a trade name for albuterol. 1. Proventil 2. Intal 3. Ventolin 4. Volmax
two
Which of the following signs will help distinguish COPD from congestive heart failure 1. dyspnea 2. dependent edema 3. wheezing 4. skin color changes
two
__________ is caused by inflammation and swelling of the pharynx, larynx and trachea. 1. Epiglottitis 2. Croup 3. Respiratory syncytial virus 4. Influenza
two
____________ Causes cold like symptoms and is caused by an allergic response 1. Acute pulmonary edema 2. Hay fever 3. Asthma 4. Anaphylactic reaction
two
________________________ results in severe inflammation of the bronchioles filling them with mucus 1. pneumonia 2. bronchiolitis 3. Respiratory syncytial virus 4. Influenza
two
severe SOB, decreased/altered LOC, neck vein distention, tracheal deviation and hypotension are signs and symptoms of 1. pertussis 2. tension pneumothorax 3. pneumonia 4. Respiratory syncytial virus
two
wheezing/stridor, flushed skin, generalized edema and decreased blood pressure are signs and symptoms of 1. Asthma 2. Anaphylaxis 3. Common cold 4. Croup
two