FISDAP AIRWAY study guide

Reactive airway disease is characterized by:

bronchospasm, edema, and mucus production.

Placing a suction catheter past the base of the tongue

may cause the patient to gag or vomit

Hyperventilating an apneic patient:

may decrease venous return to the heart.

Patients with decompensated asthma or COPD who require positive-pressure ventilation:

may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.

In contrast to negative-pressure ventilation, positive-pressure ventilation:

may impair blood return to the heart.

The barrel chest appearance classically seen in emphysemic patients is secondary to

Air trapping in the lungs

The trachea and mainstem bronchi:

are lined with beta-2 receptors that result in bronchodilation when stimulated

An ET tube that is too large for a patient

can be difficult to insert and may cause trauma

Compared to mouth-to-mouth ventilation, mouth-to-mask ventilation is more advantageous in that it:

can be used in conjunction with supplemental oxygen.

Capnography is a reliable method for confirming proper ET tube placement because

carbon dioxide is not present in the esophagus

The By-product of cellular respiration is:

carbon dioxide.

Hyperpnea and tachypnea

cause an increase in minute ventilation

Hyperpnea and tachypnea:

cause an increase in minute volume.

Pulmonary edema

caused by CHF, where heart can't pump blood away as fast as it collects in pulmonary arteries. So you have edema in lungs. 1. difficulty breathing w/ exertion 2. sudden attack of respiratory distress 3. suffocation feeling 4. cold sweats 5. tachycardia 6. cool, diaphoretic, cyanotic kin 7. adventitious breath sounds like crackles/wheezing 8. tachycardia 9. hypertension initially then hypotension

COPD is characterized by:

changes in pulmonary structure and function that are progressive and irreversible.

All of the following are complications associated with orotracheal intubation, EXCEPT

necrosis of the nasal mucosa

If you must insert the ET tube in the patient's left nostril, you should

Rotate the tube 180 degrees as its tip enters the nasopharynx

CPAP is NOT appropriate for patients with

Slow, shallow respiratory effort

When replacing a dislodged tracheostomy tube, it is MOST important that you

Take appropriate standard precautions

Unlike bronchodilator therapy, corticosteroid therapy

Takes a few hours to reduce bronchial edema

The Hering-Breur reflex is a protective mechanism that

Terminates inhalation and prevents lung overexpansion

What is the primary driver of respiration? (Why would we increase/decrease RR?)

The CSF in the brain has chemoreceptors sensitive to CO2. When there is too much CO2. The pH changes. These sensors feed back to the medulla oblongata, which stimulates the phrenic nerve which innervates the diaphragm. They cause an increase in activity of the diaphragm. This increases the RR which causes us to increase tidal volume. This means more CO2 is exhaled. And brings our pH back to normal. We also have the less sensitive hypoxic drive

Carina

The branching area of the left and right bronchi

When performing an open cricothyrotomy, you will MOST likely avoid damage to the jugular veins if

The cricothyroid membrane is incised vertically

What muscles are involved in inhalation?

The diaphragm, cervical muscles (neck), intercostals, abdominal muscles, and pectoral muscles.

Oxygen that is entirely devoid of moisture

Will dry the patient's mucous membranes quickly

The king airway should NOT be used in patients

With known esophageal disease

The nasal cannula is of MOST benefit to patients

With mild hypoxemia and claustrophobia

You encounter an unconscious pt. They have a pulse but inadequate breathing. What should you do if they are a) found in their bed or b) found underneath a tree?

You need to open the airway. If head trauma is suspected, use a jaw thrust. If head trauma is not suspected, use a head-tilt-chin-lift maneuver

You encounter an unconscious pt. They have a pulse but inadequate respirations. You open the airway and find vomit. What should you do?

You should suction the pt

You encounter an unconscious pt. They have a pulse but inadequate respirations. You open the airway and find vomit. What should you do?

You should suction the pt using

The Venturi mask is MOST useful in the prehospital setting when:

a COPD patient requires a long-range transport

You should be MOST suspicious of tube misplacement following an open cricothyrotomy if

a crackling sensation is noted when palpating the neck

Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT

a decreased expiratory phase

Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT:

a decreased expiratory phase.

Atelectasis occurs when:

a deficiency of surfactant causes alveolar collapse.

Surfactant is:

a phospholipid compound that decreases surface tension on the alveolar walls.

A person who experience sharp chest pain following an increasing dyspnea after her or she coughs most likely has

a pneumothorax

Person who experiences sharp chest pain followed by increasing dyspnea after he or she coughs MOST likely has:

a pneumothorax.

An otherwise healthy adult whose normal hemoglobing level is 12 to 14 g/dL typically will begin to exhibit cyanosis when

about 5 g/dL of hemoglobin is desaturated

Otherwise healthy adult whose normal hemoglobin level is 12 to 14 g/dL typically will begin to exhibit cyanosis when:

about 5 g/dL of hemoglobin is desaturated.

If a patient's hemoglobin level is 8 g/dL due to a hemorrhage and all of the hemoglobin molecules are attached to oxygen, the patient's oxygen saturation would MOST likely read

above 95%

Patient's hemoglobin level is 8 g/dL due to hemorrhage and all of the hemoglobin molecules are attached to oxygen, the patient's oxygen saturation would MOST likely read:

above 95%.

All of the following conditions will cause an increase in the circulating levels of carbon dioxide in the blood, EXCEPT:

acute hyperventilation.

Indications for CPAP include

acute pulmonary edema

Dispatched to a residence for a young woman with difficulty breathing. When you arrive, you find the patient sitting in a tripod position, noticeably dyspneic and tachypneic. She tells you that she experienced a sudden sharp pain to the left side of her chest and then started having trouble breathing. She denies any past medical history and states that she only takes birth control pills. Based on this patient's clinical presentation, you should be MOST suspicious for:

acute pulmonary embolism

An intubated 33 year old man is becoming agitated and beings moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should

administer a sedative medication

21-year-old man experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. He is noticeably dyspneic, has an oxygen saturation of 93% on room air, and has diminished breath sounds to the upper right lobe. The MOST appropriate treatment for this patient involves:

administering high-flow supplemental oxygen and transporting at once.

Negative-pressure ventilation occurs when:

air is drawn into the lungs when intrathoracic pressure decreases.

In contrast to negative-pressure ventilation, positive-pressure ventilation occurs when:

air is forced into the lungs.

Barrel-chest appearance classically seen in emphysemic patients is secondary to:

air trapping in the lungs.

A 28-year-old patient is experiencing Dyspnea and wheezing which medication should you request from medical control?

albuterol inhaler

Compared with an open cricothyotomy, needle cricothyrotomy

allows for subsequent attemts to intubate the patient

A young woman experiences massive facial trauma after being ejected from her car when it struck a tree. She is semiconscious, has blood draining from her mouth, and has poor respiratory effort. The MOST appropriate initial airway management for this patient involves

alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2 minutes until you can definitively secure her airway

Pulmonary surfactant is decreased:

alveolar surface tension increases.

What is the tidal volume?

amount of air moved in/out of lungs in single breath. Usually 500 ml in adult

Patient who is coughing up thick pulmonary secretions should NOT take:

an antitussive

Biot respirations are characterized by:

an irregular pattern of breathing with intermittent periods of apnea

Diazepam and midazolam provide all of the following therapeutic effects, EXCEPT

analgesia

Patient who is experiencing an allergic reaction states that his tongue feels thick and speaks at a low volume. You should immediately evaluate for:

angioedema

Open cricothyrotomy is generally contraindicated in all of the following situations, EXCEPT

any patient who is younger than 16 years of age

Drugs such as vecuronium bromide (Norcuron) and pancuronium bromide (Pavulon) are MOST appropriate to administer when

Extended periods of paralysis are needed

A patient with respiratory splinting

Is breathing shallowly to alleviate chest pain

Intubation of a patient with severe asthma

Is often the last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces

When correctly placed, the distal tip of the Cobra perilaryngeal airway (CobraPLA)

Is proximal to the esophagus and seals the hypopharynx

The cricothyroid membrane

Is relatively avascular and is covered by skin and minimal subcutaneous tissue

Which of the following statements regarding field extubation is correct

It is generally better to sedate the patient rather than extubate

In order for a tracheostomy tube to be compatible with a mechanical ventilator or bag mask device

It must be equipped with a 15/22 mm proximal adaptor

Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because

It must be performed on spontaneously breathing patients

What is intrapulmonary shunting? What is the cause of it?

It's when blood enters lungs from right side of heart bypasses alveoli and return to left side of heart in unoxygenated state. Can be caused by nonfunctional alveoli due to diseases

What does it mean if someone says they are "keeping the airways patent"?

Keeping airway patent = maintaining open airway so air can enter/leave lungs freely

Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia

Kussmaul respirations

Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia?

Kussmaul respirations

The use of accessory muscles and nasal flaring are signs of what type of breathing?

Labored The use of accessory muscles is a sign of respiratory distress or failure. Nasal flaring is the body's response in effort to increase the size of the airway and attempt to draw in more air with each breath. Expect to initially see an increased respiratory rate and heart rate with labored breathing. As the patient begins to tire, the respiratory rate and quality will begin to decrease, which worsens the problem.

The procedure in which the vocal cords are visualized for placement of an ET tube is called direct

Laryngoscopy

Colorimetric ETCO2 detector turns purple during the exhalation phase through an ET tube, approximately how much carbon dioxide is being exhaled?

Less than 0.5%

If a colormetric ETC02 detector turns purple during exhalation phase through an ET tube, approximately how much carbon dioxide is being exhaled

Less than 0.5%

The MOST effective way to minimize the risk of hypoxia while intubating a child is to

Limit your intubation attempt to 20 seconds

The BURP maneuver usually involves applying backward, upward and rightward pressure to the

Lower third of the thyroid cartilage

Uncontrollable coughing and hemptysis in a cigarette smoker are clinical findings MOST consistent with

Lung cancer

Emphysema is caused by:

chronic destruction of the alveolar walls.

Pneumonitis is especially common in older patients with

chronic food aspiration

Pneumonitis is especially common in older patients with:

chronic food aspiration.

Digital clubbing is MOST indicative of

chronic hypoxia

Digital clubbing is MOST indicative of:

chronic hypoxia.

The hypoxic drive stimulates breathing in patients with:

chronically decreased PaO2 levels.

Hay Fever

coldlike symptoms, caused by allergic response.

Pleural Effusion

collection of fluid outside lung on one or both sides that compresses lung/lungs and causes dyspnea. Lung sounds = decreased breath sounds from lungs where fluid is. Pt's feel better sitting upright, but only treatment is fluid removal in hospital

Spacer device in conjunction with a metered-dose inhaler:

collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment.

Patient's initial presentation makes you suspicious about a particular respiratory condition, you must:

confirm your suspicions with a thorough assessment.

Polycthemia is a condition in which:

excess red blood cells are produced in response to chronic hypoxia.

Polycythemia is a condition in which

excess red blood cells are produced in response to chronic hypoxia.

What muscles are involved in expiration?

none, expiration (if done passively) is achieved by the relaxation of the diaphragm.

Intrapulmonary shunting occurs when:

nonfunctional alveoli inhibit pulmonary gas exchange.

What are the structures of the upper airway?

nose, mouth, tongue, jaw, pharynx and larynx

Airway management and treatment of opioid overdose

(862) Opioids can cause respiratory an CNS depression and produce severe hypotension and bradycardia, can be reversed with Naloxone (narcan)

Signs and symptoms of chronic bronchitis

(942) Excessive mucus production with a productive cough, typically a heavy smoker, overweight, congested, blue complexion, hypercapnia, hypoxemia

Hay fever (allergic rhinitis)

- coldlike symptoms, caused by allergic response (pollen, dust mites, pet dander etc) - pt likely has other allergies

COPD

- smokers* - chronic inflammatory lung disease that causes obstructed airflow from the lungs - breathing difficulty; pursed lips* - chronic cough - mucus (sputum) production - wheezing* - Hypoxic drive frequently found - 3rd leading cause of death

Inserting a nasopharyngeal airway in a patient with CSF drainage from the nose following head trauma may:

. cause the device to enter the brain through a hole caused by a fracture.

What are the critical periods in which a cell needs O2?

0-1 minute: cardiac irritability 0-4 minute: brain damage not likely 4-6 minute: brain damage possible 6-10 minute: brain damage likely more than 10: irreversible brain damage

In some cases, atropine sulfate, in a dose of ____, may be given to children to prevent vagal-induced bradycardia during ET intubation

0.02 mg/kg

1

1

Which of the following statements regarding anemia is correct?

Anemia results in a decreased ability of the blood to carry oxygen.

A patient who is experiencing an allergic reaction states that his tongue "feels thick" and speaks at a low volume. You should immediately evaluate for

Angioedema

What type of medication dries secretions in the airway and prevents the cilia from removing them effectively

Antihistamine

What type of medication dries secretions in the airway and prevents the cilia from removing them effectively?

Antihistamine

An obese man complains of sever difficulty breathing. His skin is cool and moist and breathing 22 times per minute. He indicates he never goes to the doctor and often feels dizzy after walking. You should?

Apply a nonrebreather mask at 10 liters/min

An alert 32 year old female complains of difficulty breathing. She speaks in 2-3 word sentences and has oxygen saturation of 92%. What should you do?

Apply high flow oxygen. -She is alert and her respirations are still effective without the need for assisting ventilations. She only complains of shortness of breath, so applying high flow oxygen should be the first treatment.

Retractions of the sternum or ribs during inhalation

Are especially common in infants and small children

Mediastinum

Area between the lungs which is surrounded by tough connective tissue. Contains heart, great vessels, esophagus, trachea, major bronchi and nerves.

The __ are pyramid like structures that form the posterior attachment of the vocal cords

Arytenoid cartilages

An unresponsive trauma patient is gurgling. When you suction the oropharynx with a rigid catheter, the patient gags. You should?

Assess insertion depth of the catheter

Ipratropium (Atrovent) - RESPIRATORY DRUG

DULT/PED Dose Same: 500 mcg in 2-3 mL NS via nebulizer, 0.5 mg in 2.3 mL NS via nebulizer, 1 time dose (usually given in conjunction with Albueterol.) Class: Anticholinergic bronchodilator MOA: Dries secretions and causes bronchodilation Indications: bronchospasms, asthma, COPD, emphysema chronic bronchitis, allergic reaction involving the airway. (Wheezing) Contraindications: hypersensitivity (allergic), peanuts

Removal of a dental appliance after intubating a patient is

Dangerous and may cause dislodgement of the tube

Hypoventilation causes a(n) ____ and leads to ____

Decreased minute volume, hypercarbia

As the diaphragm and intercostal muscles relax, the chest cavity?

Decreases in size, causing exhalation

What are Kussmaul respirations? What do they indicate?

Deep, rapid respirations Seen in pt's with metabolic acidosis, or those with diabetes

What is inspiratory reserve volume?

Deepest breath you can take after normal respiration

An 8 year old child in cardiac arrest has been intubated. When ventilating the child, the paramedic should

Deliver 8 to 10 breaths per minute

A 45 year old female is complaining of breathing difficult. Her lung sounds are clear but she is becoming cyanotic on the lips

Deliver oxygen via nonrebreather at 15 lmp

Carbon dioxide and oxygen exchange at the alveolar level by which process?

Diffusion

Hypoventilating patients

Become hypercapneic and acidotic

You are transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should

Begin assisting his ventilations with a bag-mask and 100% oxygen

After opening an unresponsive patient's airway, you determine that his respirations are rapid, irregular, and shallow. You should

Begin positive pressure ventilations

____ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea

Biot

An unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have ____ respirations

Bradypneic

Use of an automated transport ventilator is NOT appropriate for patients who are

Breathing spontaneously

What are the structures that brach off the trachea into the lower airway?

Bronchi The trachea splits at the carina into the left and right bronchus. The bronchi get smaller and smaller until it reaches the terminal bronchioles where the alveoli are located.

An 18 year old febrile patient complains of malaise for several days. He is taking an oral antibiotic for an upper respiratory infection. Vital signs are bp 128/72, P118 and weak, R22 with rhonchi

Bronchitis

Reactive airway disease is characterized by

Bronchospasm, edema, and mucus production

A disadvantage of ET intubation is that it

Bypassess the upper airway's physiologic functions of warming, filtering and humidifying

Frothy sputum that has a pink tinge to it is MOST suggestive of

CHF

How would you differentiate COPD and CHF?

COPD emphysema - thin w/ barrel chest, pink puffer, tripod position, flat neck veins, dry lungs, shortness of breath on exertion, rhonchi, wheezing, no mucus bronchitis - obese, difficulty w/ expiration, flat neck veins, blue bloat, lungs wet, shortness of breath on exertion, rhonchi, wheezing, frequent/chronic cough, excessive thick mucous CHF - abdominal distention, edema (sacral/pedal), tachycardia, increased RR, anxiety, inability to lie flat, cyanotic, confused LOC, blue skin, wet lungs, shortness of breath all the time, sudden onset of shortness, crackles, wheezing, coughing may be present, pink frothy sputum

Thin 54 year old male with a nonproductive cough complains of difficulty breathing. Sitting upright with hands on his knees and you see retractions. Notice oxygen tubing around the house. You should suspect medical history of?

Chronic Bronchitis

A 65 year old male is having trouble breathing. He is moderately overweight and has been coughing up yellowish phlegm. He smokes two packs of cigarettes a day and reports having episodes like this for many years

Chronic bronchitis

A male complains of mild respiratory distress. He smokes 4 packs of cigarettes a day and reports a consistent cough and frequent respiratory infections. Chest sounds reveal bilateral rhonci. What should you suspect?

Chronic bronchitis (sounds like snoring, excess mucus) Excessive mucus and pus production leads to obstructed airways. The consistent cough is the bodys response to clear the airway obstruction.

Emphysema is caused by

Chronic destruction of the alveolar walls

Epinephrine (adrenaline) - RESPIRATORY DRUG ETC.

Class: Sympathomimetic MOA: Alpha-1 vasoconstriction, Beta-1 Inotropic, Chronotropic and Dromotropic effects, Beta-2 bronchial smooth muscle relaxation. Indications: Initial drugs used in cardiac arrest (asystole, PEA, V-fib, V-tach) an alternative to Dopamine, allergic reaction (anaphylaxis), and severe asthma. Contraindications: hypertension, hypothermic, hypovelemic shock. Adult Dose: cardiac arrest - 1.0mg (1:10,000 solution) IV/IO every 3-5 minutes, follow each dose with 20mL flush and elevate extremity. Alternative to Dopamine - add 1.0mg of Epi 1:1,000 solution into 500mL NS bag (yields 2mcg/mL), administer and infusion rate of 1-10mcg/min, titrate to effect. Mild allergic reaction and severe asthma - 0.3-0.5mg (0.3-0.5mL 1:1,000 solution) SC/IM Anaphylaxis- 0.1mg (1mL of 1:10,000 solution) IV *supplied 1mg in 10mL of solution.

Rhonchi

Coarse, low-pitch rattling sounds caused by secretions or obstructions larger airway/ in bronchial airways (lower/mid airway). Resemble snoring respirations. Associated with chest infection, for example pneumonia. Associated w/ COPD, cystic fibrosis, chronic bronchitis

Use of a spacer device in conjunction with a metered dose inhaler

Collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment

Unresponsive 16 year old male has snoring respirations after diving in a pond and nearly drowning. You should?

Compressions

Laryngotracheitis (croup)

Condition characterized by stridor, hoarseness and a barking cough that most commonly occurs in infants and children

The reason for assessing the radial and the carotid pulse simultaneously is to?

Confirm Cardiac Rhythm Problem

If a patient's initial presentation makes you suspicious about a particular respiratory condition, you must

Confirm your suspicions with a thorough assessment

A 73 year old male is dyspneic. You note jugular vein distension and dependent edema. Vital signs are BP 158/93, P 130 R 36. What should you suspect?

Congestive Heart Failure

Which of the following patients is LEAST likely in need of positive pressure ventilation?

Conscious 36 year old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin

During a long transport you are administering oxygen

Consider using a humidified oxygen

The classic presentation of chronic bronchitis is

excessive mucus production and a chronic or recurrent productive cough

Classic presentation of chronic bronchitis is:

excessive mucus production and a chronic or recurrent productive cough.

In contrast to a curved laryngoscope blade, a straight laryngoscope blade is designed to

extend beneath the epiglottis and lift it up

The exchange of oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries is called:

external respiration.

Pickwickian syndrome is a condition in which respiratory compromise results from:

extreme obesity.

Which statement indicates that the patient is suffering from a CHF rather than Pneumonia?

feels like I'm drowning when I sleep

Normally, an adult at rest should have respirations that:

follow a regular pattern of inhalation and exhalation.

The oropharynx:

forms the posterior portion of the oral cavity.

Following an optimal inspiration, the amount of air that can be forced from the lungs in a single exhalation is called the:

functional reserve capacity.

A patient with orthopnea

has dyspnea while lying flat

A patient with orthopnea:

has dyspnea while lying flat.

In contrast to the right lung, the left lung:

has two lobes.

It would be appropriate to insert a nasopharyngeal airway in patients who

have an altered mental status with an intact gag reflex

It would be appropriate to insert a nasopharyngeal airway in patients who:

have an altered mental status with an intact gag reflex.

After confirming that an intubated patient remains responsive enough to maintain his or her own airway, you should first

have the patient sit up or lean slightly forward

The paramedic should be especially dilligent when confirming tube placement following blind nasotracheal intubation because

he or she did not visualize the tube passing between the vocal cords

MOST likely observe a grossly low respiratory rate and volume in a patient who overdosed on:

heroin

The diaphragm of the stehoscope is designed to auscultate

high pitched sounds

Diaphragm of the stethoscope is designed to auscultate:

high-pitched sounds.

Once you have confirmed that the lighted stylet ET tube combination has entered the trachea, you should

hold the stylet in place and advice the tube about 2-4 cm into the trachea

Where are the Beta-2 receptors located? What is their effect?

location - lungs (beta-2 is beta-tube) effect - bronchodilation (more air enters lungs)

Where are the alpha-1 receptors located? What is their effect?

location-blood vessels constricted blood vessels, skin is pale, cool, clammy They essentially increase BP

Where are the Beta-1 receptors located? What is their effect?

location-heart effect- increased HR, increased force of contraction They essentially increase CO since CO = HR x SV

During sleep, the metabolic rate is____ and the number of respirations ____

low, decreases.

Uncontrollable coughing and hemoptysis in a cigarette smoker are clinical findings MOST consistent with:

lung cancer.

Oxygen that is dissolved in the blood plasma:

makes up the partial pressure of oxygen

Endotracheal intubation is MOST accurately defined as

passing an ET tube through the glottis opening and sealing off the trachea

When administering oxygen via a nonrebreathing mask, you must ensure that the

patient has adequate tidal volume

When administering oxygen via a nonrebreathing mask, you must ensure that the:

patient has adequate tidal volume.

A 36 year old man experienced significant burns to his face, head, and chest following an incident with a barbeque pit. Your assessment of his airway reveals severe swelling. After administering medications to sedate and paralyze the patient, you are unable to intubate him. Furthermore, bag mask ventilations are producing minimal chest rise. The quickest way to secure a patent airway in this patient is to

perform a needle cricothyrotomy

When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should:

perform the test three times and take the best rate of the three readings.

A patient with status asthmaticus commonly presents with

physical exhaustion and inaudible breath sounds

Patient with status asthmaticus commonly presents with:

physical exhaustion and inaudible breath sounds.

Either side of the glottis, tissue forms a pocket called the:

piriform fossae.

A 76 year old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prlonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to

place her in a position that facilitates breathing

76-year-old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prolonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to:

place her in a position that facilitates breathing.

If you suspect that an unconscious patient has experienced a spinal injury, you should open his or her airway by

placing your fingers behind the angle of the jaw and lifting the jaw forward

The volume of air that is moved into or out of the respiratory tract in one breath is called:

tidal volume.

Corrective action for low or high etCO2 when ventilating

• Low etCO2 = ventilating to fast High etCO2= ventilating to slow

Signs and symptoms of hyperventilation syndrome

• Rapid respiratory rate, carpopedal spasms

What factors can impair respiration?

1. air (too little O2, too much CO2, toxins like CO) 2. impaired movement of gas across cell membrane (due to fluid in alveoli, mucus or other secretions) 3. Blood vessels become clogged (pulmonary embolism)

Emphysema

1. barrel chest 2. pursed lip breathing (pink puffers) 3. dyspnea on exertion 4. cyanosis 5. wheezing/decreased breath sounds Most common form of COPD. Loss of elastic material in lungs

Emphysema

1. barrel chest 2. pushed lip breathing (pink puffers) 3. dyspnea on exertion 4. cyanosis 5. wheezing/decreased breath sounds Most common form of COPD. Loss of elastic material in lungs

If the distance between the hyoid bone and the thyroid notch is at least ___ cm wide, the difficulty of intubation should be low

2

What is the alveolar minute volume of a patient with a respiratory rate of 12 breaths/min, a tidal volume of 450 mL, and a dead space volume of 135 mL?

3,780 mL

What is the alveolar minute volume of a patient with a respiratory rate of 12 breaths/min, a tidal volume of 450 mL, and a deal space volume of 135 mL

3,780 mL

Most complications caused by intubation induced hypoxia

are subtle and occur gradually

What two areas of the brain are involved in respiration?

medulla-controls rhythm, initiates inspiration, sets base pattern for respirations, and stimulates diaphragm to contract. pons-changes depth of inspiration, expiration or both.

Hepatojugular reflux occurs when:

mild pressure placed on the patient's liver further engorges the jugular veins.

During initial assessment of an adult's respiratory status, you should?

Evaluate both the respiratory rate and the rise and fall of the chest

During initial assessment of an adult's respiratory status, you should?

Evaluate both the respiratory rate and the rise and fall of the chest ALWAYS: Rate, Rhythm, Quality

Intubation of a patient with severe asthma:

"is often a last resort, because asthmatics are difficult to ventilate and are prone to Pneumothoraces

When performing nasotracheal intubation, you should use an ET tube that is

1 to 1.5 mm smaller than you would use for orotracheal intubation

Murphy's eye, an opening on the distal side of an ET tube, allows ventilation to occur

Even if the tip of the tube is occluded by blood or mucus

Bronchitis

1. Chronic cough w/ sputum production 2. Wheezing 3. cyanosis 4. Tachypnea Type of COPD, can be due to tobacco. When excess mucus created.

Bronchitis Signs and Symptoms

1. Chronic cough w/ sputum production 2. Wheezing 3. cyanosis 4. Tachypnea Type of COPD, can be due to tobacco. When excess mucus created.

CHF

1. Dependent edema 2. Crackles (pulmonary edema) 3. Orthopnea 4. Paroxysmal nocturnal dyspnea

CHF

1. Dependent edema 2. Crackles (pulmonary edema) 3. Orthopnea 4. Paroxysmal nocturnal dyspnea 5. JVD - risk factors: HTN, CAD, AFib - most common cause of ER visits

Epiglottitis

1. Dyspnea 2. High fever 3. stridor 4. drooling 5. difficulty swallowing 6. severe sore throat 7. tripod/sniffing position Life threatening, caused by bacterial infection of epiglottis in children, risk of complete airway obstruction. Try to keep them from crying. Do not put anything in mouths. Provide quick transport to ER, focus on maintaining patent airway

Bronchiolitis

1. Dyspnea 2. wheezing 3. Coughing 4. fever 5. dehydration 6. Tachypnea 7. Tachycardia - Often due to RSV infection* -severe bronchiole inflammation* - Occurs most frequently in infants, especially boys* -Provide O2 therapy, allow pt to remain in comfortable position - Reassess frequently and be prepared to manage airway/positive pressure ventilation

Bronchiolitis signs and symptoms?

1. Dyspnea 2. wheezing 3. Coughing 4. fever 5. dehydration 6. Tachypnea 7. Tachycardia Often due to RSV infection, severe bronchiole inflammation. Occurs most frequently in infants, especially boys. Provide O2 therapy, allow pt to remain in comfortable position. Reassess frequently and be prepared to manage airway/positive pressure ventilation

Anaphylaxis

1. Flushed skin/hives (urticaria) 2. Generalized edema 3. hypotension 4. laryngeal edema w/ dyspnea 5. wheezing/stridor Most rxns occur w/in 30 mins, administer epi using epipen. O2 also helps

Anaphylaxis Signs and Symptoms?

1. Flushed skin/hives (urticaria) 2. Generalized edema 3. hypotension 4. laryngeal edema w/ dyspnea 5. wheezing/stridor Most rxns occur w/in 30 mins, administer epi using epipen. O2 also helps

What can cause an inaccurate pulse ox?

1. Hypovolemia 2. Severe peripheral vasoconstriction (chronic hypoxia, smoking or hypothermia) 3. Time delay in detecting respiratory insufficiency 4. Dark/metallic nail polish 5. Dirty fingers 6. CO poisoning

Name the characteristics of normal breathing

1. Normal rate (12-20) 2. regular pattern of inhalation/exhalation 3. clear bilateral lung sounds 4. regular and equal chest rise/fall 5. adequate depth (tidal volume)

What happens in the body when there is respiratory compromise?

1. O2 levels fall and CO2 levels rise 2. Brain detects increase in CO2 3. Body increases RR to try to manage CO2 levels 4. If increased respiration does not clear CO2, then blood is acidic 5. Blood o2 levels begin to fall, activating hypoxic drive 6. Cells that are able switch to anaerobic metabolism, producing lactic acid which further drops pH

What factors can impair ventilation?

1. Obstruction a. foreign objects - toys, food, teeth tongue etc b. physiological - induced by asthma, allergic rxns, infection 2. Impairment a. brain injury - to medulla/pons b. breathing muscles - diaphragm, c. nerves - neuromuscular disease like cerebral palsy can affect phrenic nerve 3. Other factors a. drugs - opioids can reduce RR b. loss of consciousness - can cause impaired ventilation c. trauma to chest wall - impair expansion of lungs

You arrive on scene with a pt that is conscious but experiencing respiratory distress. What are two devices that can assess their respiration?

1. Pulse oximetry (measures O2 bound to hemoglobin) 2. Capnography device (measures end tidal CO2)

What are the types of normal breath sounds?

1. Vesicular 2. Bronchol-vesicular 3. Bronchial (tubular)

How would you use a pulse oximeter?

1. clean pt's finger, and remove nail polish as needed. Place finger into probe and turn on. 2. Palpate radial pulse to ensure accuracy and correlation w/ pulse ox Normal reading between 98-100. Less than 90% pt requires treatment unless chronic condition. Oxygen applied when SPO2 drops below 94%

TB

1. cough 2. fever 3. fatigue 4. productive/bloody sputum bacterial infection, can be dormant for years. High prevalence for people living in close contact. Need to wear gloves, eye protection, N-95 respirator

Flu

1. cough 2. fever 3. sore throat 4. fatigue

TB

1. cough 2. fever* 3. fatigue* 4. productive/bloody sputum* 5. Night sweats/weight loss - bacterial infection, can be dormant for years - High prevalence for people living in close contact (prison, nursing homes, homeless shelters) - Need to wear gloves, eye protection, N-95 respirator

Common Cold

1. cough 2. runny/stuffy nose 3. sore throat

Respiratory syncytial Virus (RSV)

1. cough 2. wheezing 3. fever 4. dehydration Look for signs of dehydration, infants w/ RSV often refuse liquids. Humidified O2 can be helpful

Pertussis

1. coughing spells 2. whooping sound 3. fever airborne bacterial infection, coughing spells can last for a minute where pt turns red. May vomit/want to avoid eat/drink

Pertussis

1. coughing spells 2. whooping sound* (insp) 3. fever - airborne bacterial infection, highly contagious - affects kids 6 & under - coughing spells can last for a minute where pt turns red - May vomit/want to avoid eat/drink

What are the types of adventitious lung sounds?

1. crackles (rales) 2. gurgles (rhonchi) 3. friction rub 4. wheeze 5. stridor

Diphtheria

1. difficulty breathing/swallowing 2. sore throat 3. thick gray buildup in throat/nose 4. fever

Pneumonia

1. dyspnea 2. chills/fever 3. cough 4. green, red or rust colored sputum 5. localized wheezing or crackles Infection of lungs, often secondary infection. Affects people who are chronically/terminally ill. May hear wheezing, crackles, friction rubs or rhonchi. Provide airway support, supplemental O2

Pneumonia

1. dyspnea 2. chills/fever 3. cough 4. green, red or rust colored sputum* 5. localized wheezing or crackles - Infection of lungs, often secondary infection - Affects people who are chronically/terminally ill (nursing home, hospitalization, chemo, COPD etc.) - May hear wheezing, crackles, friction rubs or rhonchi. Provide airway support, supplemental O2

Croup

1. fever 2. barking cough 3. stridor 4. mostly seen in pediatric patients inflammation/swelling of pharynx, larynx and trachea. Typically seen in young children Treat w/ humidified O2

Carbon Monoxide Poisoning

1. flu like symptoms 2. headache 3. dizziness 4. fatigue 5. nausea 6 . vomiting 7. chest pain remove them from scene, administer high flow o2 by nonrebreathing mask. May need full airway control w/ airway adjunct and bvm ventilation

Carbon Monoxide Poisoning

1. flu like symptoms* 2. headache 3. dizziness 4. fatigue 5. nausea 6 . vomiting 7. chest pain on exertion 8. Confusion/hallucination - remove them from scene, administer high flow o2 by nonrebreathing mask - May need full airway control w/ airway adjunct and bvm ventilation

What are the two purposes of inserting an OPA?

1. lift the tongue 2. Make it easier to suction oropharynx

What factors can lead to hypoxia due to circulatory compromise?

1. obstruction of blood flow due to a. pulmonary embolism b. pneumothorax c. heart failure d. cardiac tamponade 2. Decreased ability of blood to carry O2 a. blood loss b. anemia c. shock (vasodilatory shock)

Tension Pneumothorax

1. severe shortness of breath 2. decreased/altered level of consciousness 3. neck vein distension 4. tracheal deviation (late sign) 5. hypotension, signs of shock (late sign)

tension pneumothorax

1. severe shortness of breath 2. decreased/altered level of consciousness 3. neck vein distension 4. tracheal deviation (late sign) 5. hypotension, signs of shock (late sign)

pulmonary embolus

1. sharp chest pain 2. sudden onset 3. dyspnea 4. tachycardia 5. clear breath sounds initially 6. hemoptysis (coughing up blood) 7. tachypnea

Pulmonary Embolus

1. sharp chest pain* 2. sudden onset* 3. dyspnea* 4. tachycardia 5. clear breath sounds initially 6. hemoptysis (coughing up blood)* 7. tachypnea

pneumothorax

1. sudden chest pain w/ dyspnea 2. decreased breath sounds on affected side 3. subcutaneous emphysema 4. JVD Effects tall and thin people more. Caused when air leaks into pleural space from opening in chest/lung surface. Lung collapses and pleural spaces no longer contact

Asthma

1. wheezing on expiration* 2. Bronchospasm 3. Cyanosis and or resp arrest can develop quickly

Asthma Signs and Symptoms?

1. wheezing on inspiration/expiration 2. Bronchospasm

16 asthmatic female is in tripod position complains of increased shortness of breath. SPO2 is 79% you should administer oxygen at

10 lpm via nonrebreather

You have inserted an OPA for a 21 year old apneic male. How many times per minute should you ventilate him with a BVM?

10 to 12

Approximately how far should you insert a 5.0 mm ET tube in a 4 year old child?

15 cm

When ventilating patient with BVM, what is the appropriate oxygen flow rate?

15 liters/min

When ventilating patient with BVM, what is the appropriate oxygen flow rate?

15 liters/min (15 - 25(max) L/m)

Approximately ____ mL of air remains in the anatomic dead space of an adult with a tidal volume of 500 mL.

150

Furosemide (Lasix) - RESPIRATORY DRUG ETC.

Adult Dose: 0.5 - 1.0 mg/kg over 1-2 minutes. Typical dose is 40-120 mg for test purposes street dosage typically 30-40 mg *lung sounds rales/crackles *orange vial or syringe Class: Loop Diuretic MOA: inhibits the absorption of sodium (Na+) or chloride at the loop of Henle causing increased urine output. Indications: CHF, pulmonary edema, hypertensive crisis, *They have to have had a diagnosis of CHF Contraindications: allergic, hypovelemia, hypotension, suspect electrolyte imbalance, fever Side effects: orthostatic hypotension (vital signs change with a change in body position.

Typically, ETCO2 is approximately

2 to 5 mm Hg lower than the arterial PaCO2

Benzocaine spray (Hurricane) - RESPIRATORY DRUG

Adult Dose: 0.5-1.0 second spray, repeat as needed. Repeat as needed. Class: topical anesthetic MOA: suppresses the pharyngeal and tracheal gag reflex Indications: intact gag reflex Contraindications: allergy, suppressed gag reflex Adverse reaction: methemoglobinemia (causes an inability of oxygen to bind to hemoglobin and prevents oxygen that is already bound to hemoglobin to be released at the cellular level, can cause cellular hypoxia) Pediatric Dose: 0.25-0.5 second spray. Repeat as needed.

Respiratory alkalosis is the result of

Excess carbon dioxide elimination

Polycythemia is a condition in which

Excess red blood cells are produced in response to chronic hypoxia

Complications of aspiration include all of the following, EXCEPT

Excess surfactant production

The average depth of ET tube insertion for adult patients is

21 to 25 cm

Signs and symptoms of cystic fibrosis

2289) Produce thick mucus in their respiratory and digestive tract, which makes them susceptible to recurrent respiratory infections. Salty skin, impairs respiration disrupts digestion of food, meconium, nausea, anorexia, constipation, pancreatitis, distendend abdomen • Pneumonia, pneumothorax, persistent cough, respiratory distress, respiratory failure

A full (2,000 psi) D cylinder will last approximately ______ minutes if you are administering oxygen at 12 L/min.

24

A mouth opening width of less than ____ cm indicates a potentially difficult airway

3

The function of the lower airway is to

Exchange oxygen and carbon dioxide

When suctioning blood, fluid, and mucous from the oropharynx, the most appropriate device is?

A rigid tip suction catheter

Bumetanide (Bumex) - RESPIRATORY DRUG

Adult Dose: 0.5-1.0mg IV over 1-2 minutes. IM 2-2.5 times stronger than Lasix. Class: Loop diuretic MOA: a potent loop diuretic with a rapid onset and short duration. Blocks the reabsorption of sodium and chloride at the Loop of Henle. Indications: CHF, pulmonary edema. Won't be used for hypertensive crisis. Contraindications: allergic, hypovelemic, hypotension, suspect electrolyte imbalance. Side effects: orthostatic hypotension Pediatric Dose: Safety and effectiveness in pediatric patients is not established.

A length based resuscitation tape measure can be used to determine the most appropriate size of bag mask device for pediatric patients who weigh up to

34 kg

The normal alveolar volume in a healthy adult is

350 mL

What is the amount of air that normally reaches the alveoli in an adult?

350 mL The average adult ventilation is 500 mL, but there is an area of dead space that traps 150 mL of air. 350 mL effectively reaches the alveoli for oxygen and carbon dioxide exchange.

The normal alveolar volume in a healthy adult is:

350 mL.

How many lobes are in the lungs?

5 3 on the right and two on the left.

How often should you ventilate a patient who is apneic and has a pulse?

5-6

What size ET tube would be MOST appropriate to use for a 4 year old child?

5.0mm

If a patient's hemoglobin level is only 10g/dL, ___% would have to be desaturated before he or she would appear cyanotic

50

Patient's hemoglobin level is only 10 g/dL, ___ % would have to be desaturated before he or she would appear cyanotic.

50

The average peak expiratory flow rate in a healthy adult is approximately:

550 mL.

The average peak expiratory flow rate in a healthy adult is approximately

550ml

When administering a nebulized bronchodilator, the oxygen flow rate should be set to at least ____ liters per minute

6

When administering a nebulized bronchodilator, the oxygen flow rate should be set to at least _______ liters per minute.

6

Which patient would be classified as "immediate" during and MCI?

8 year old female with no respirations after 5 positive pressure ventilations.

The Venturi Mask is MOST useful in the prehospital setting when

A COPD patient requires a long range transport

Why are children more prone to croup when they acquire a viral infection that adults infected with the same virus?

A child's airway is narrower than an adult's and even minor swelling can result in obstruction

Why are children more prone to croup when they acquire a viral infection than adults infected with the same virus?

A child's airway is narrower than an adult's, and even minor swelling can result in obstruction.

Surfactant is

A phospholipid compound that decreases surface tension on the alveolar walls

Oxygen that is entirely devoid of moisture:

A. will dry the patient's mucous membranes quickly.

Which of the following interventions is NOT appropriate when treating an unresponsive patient whose airway is obstructed by a dental appliance

Abdominal thrusts

Prescribed inhalers are helpful for patients with an obstructive pulmonary disease because they?

Activate Beta 2 receptors

A patient presents with a sudden onset of shortness of breath crackles, hypertension, and jugular distension. You Should suspect?

Acute Pulmonary Edema

All of the following conditions will cause an increase in the circulating levels of carbon dioxide in the blood, EXCEPT

Acute hyperventilation

A foreign body airway obstruction should be suspected in a child who presents with

Acute respiratory distress without fever

Negative pressure ventilation occurs when

Air is drawn into the lungs when intrathoracic pressure decreases

An 18-year-old male complains of shortness of breath. He has a history of asthma and self administered two doses of his prescribed metered dose inhaler with no relief. Vital signs are P104 R 22 SP02 91% what should you do?

Administer oxygen by non-rebreather mask

20 year old male complains of sudden onset shortness of breath. He is breathing at 24 times per minute and his pulse oximetry is 85% you should?

Administer oxygen via non-rebreather mask 15 lpm

A 21-year old man experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. He is noticeably dyspneic, has an oxygen saturation of 93% on room air, and has diminished breath sounds to the upper right lobe. The MOST appropriate treatment for this patient involves

Administering high-flow supplemental oxygen and transporting at once

In which of the following situations would ET intubation of pediatric patient be LEAST necessary?

Administration of certain resuscitative medications

Terbutaline (Brethine)

Adult Dose: .25mg SC, may repeat in 30 minutes. Administered to the abdominal cavity. Class: beta-2 agonist, bronchodilator MOA: relaxes the smooth muscles of the bronchial tree and peripheral vasculature with minimal cardiac affects Indications: asthma, bronchospasms, COPD, emphysema, chronic bronchitis Contraindications: allergic, tachycardia Pediatric Dose: not recommended for children younger than 12 years of age. 0.25 mg SC may repeat in 15-30 minutes to a maximum of 0.5 mg in a 4 hour period.

Pancuronium (Pavulon)

Adult Dose: 0.06-0.1mg/kg slow IV/IO On Set: 30 Seconds Peak: 3.5 Minutes Duration: 45-60 Minutes Binds with Acetylchoine Class: non depolarizing neuromuscular blocking agent MOA: fast acting long lasting Indications: paralytic for RSI Contraindications: Allergy, acute narrow-angle glaucoma, penetrating eye injury, inability to control airway with positive pressure ventilation Pediatric Dose: 0.04 to 0.1 mg/kg slow IV/IO

Vecuronium (Norcuron)

Adult Dose: 0.1-0.2mg/kg IV/IO On Set: 1-3 Minute Peak: Varies Duration: 45-90 minutes Class: Nondepoarizing neuromuscular blocking agent MOA: fast acting, long lasting Indications: RSI Contraindications: acute narrow angle glaucoma, penetrating eye injury, renal failure, an inability to control the airway and support ventilation system with O2 and positive pressure

Metaproterenal (Alupent) - RESPIRATORY DRUG

Adult Dose: 0.2-0.3mL of a 5% solution in 2.5mL of NS Class: beta-2 agonist, bronchodilator MOA: relax smooth muscles of bronchial tree Indications: asthma, bronchospasms, chronic bronchitis, COPD Contraindications: allergy, tachycardia Side effects: tachycardia, palpitations, nausea, vomiting.

Etomidate (Amidate)

Adult Dose: 0.2-0.6 mg/kg IV/IO over 30-60 seconds (typical dose 20mg) Class: nonbarbituate hypnotic, sedative MOA: short acting hypnotic Indications: medication for RSI Cardioversion Contraindications: allergic, labor delivery Side effects: respiratory depression, hypotension

Naloxone (Narcan)

Adult Dose: 0.4-2.0 mg IM/SQ/IV/IO, may repeat every 5 minutes up to a total of 10 mg Class: opioid antagonist, antidote MOA: Blocks narcotic receptors, reverses respiratory depression secondary to opiate drugs Contraindications: use with caution in narcotic dependent patients *Prevent patients from having to be intubated.

Succinylcholine (Anactine)

Adult Dose: 1-1.5 mg/kg rapid IV/IO, repeat as needed. On Set: 1 Minute Peak: 1-3 Duration: 5-10 Class: DEPOLARIZING neuromuscular blocking agent MOA: ultra short acting and short lasting Acetylcholine Binds with Cholinergic Receptors. Indication: RSI use Contraindications: acute narrow angle glaucoma, malignant, hypothermia, inability of responder to control airway or support ventilation with oxygen and positive pressure ventilation system,penetrating eye injury. Side effects: increased intraocular pressure Note: a sedative such as Etomidate, Valium, or Versed should be used in any conscious patient before undergoing a neuromuscular blocking agent.

Levalbueterol (Xoponex) - RESPIRATORY DRUG

Adult Dose: 1.25-2.5mg in 3mL NS by nebulizer up to 3 doses. Class: Sympathomimetic bronchodilators MOA: stimulates beta-2 receptors resulting in smooth muscle relaxation of the bronchial tree and peripheral vasculature. Indications: Acute bronchospasms in patients with COPD and asthma. Contraindications: allergy, Tachycardia 160>

Levalbuterol (Xoponex)

Adult Dose: 1.25mg -2.5mg in 3ml Route Nebulizer Sympathomimetic Bronchodilator, It can treat or prevent brochospasm. Indications: Treatment for acute bronchospasms, COPD, Asthma Contra: Hypersensitivity to the drug, Angioedema, Severe Cardiac Arrest Adverse Effects: Headaches, Anxiety, dizziness, tachycardia, angina, nausea, vomiting and tremors.

Fentanyl (Sublimaze)

Adult Dose: 1mcg/kg slow IV/IM/IO (max single dose of 100mcg) Class: Opiod analgesic (schedule II narcotic) MOA: pain relief with less cardiovascular effects. Indication: moderate to severe pain Contraindications: allergic, head injury, hypotension Side effects: CNS depression, hypotension, respiratory depression. Note: may cause chest wall rigidity when pushed rapidly.

Dexamethasone (Decadron) - RESPIRATORY DRUG

Adult Dose: 1mg/kg slow IV (typical dose 10-100mg). Class: corticosteroid, Antiimflammatory MOA: suppresses acute and chronic inflammation Indications: anaphylaxis, asthma, croup, spinal cord injury Contraindications: allergy, suspected sepsis Pediatric Dose: 0.25 -1.0 mg/kg (IV/IM/IO)

Midozolam (Versed)

Adult Dose: 2-2.5mg IV/IM/IO up to 10mg *2-2 1/2 times stronger than Valium. Class: Benzodiazepine sedative, anticonvulsant MOA: short/ intermediate sedative/hypnotic Indications: seizure, extreme anxiety and agitation, sedation for medical procedures (RSI, Cardioversion) Contraindications: allergic, acute narrow angle glaucoma, shock, alcohol intoxication, overdose affecting CNS, depressed vital signs (respiration RR, hypotensive) Side effects: respiratory depression, hypotension

Albueterol (Proventil, Ventolin) - RESPIRATORY DRUG

Adult Dose: Adult 2.5mg in 2-3 mL NS via nebulizer Class: sympathomimetic dilator MOA: Beta-2 agonist that causes bronchodilation. Relaxes the smooth muscles of the bronchial tree. Indications: bronchospasms, asthma, COPD, emphysema chronic bronchitis,allergic reaction involving the airway. (Wheezing) Contraindications: hypersensitivity (allergic), precaution : heart rate greater than 150 HR>150 Side effects: tachycardia, palpitations, lightheadedness, tremors, mucous production. Pediatric Dose: <20 kg: 1.25 mg/dose via hand nebulizer over20 minutes. >20 kg 2.5 mg/dose via hand nebulizer over 20 minutes.

Morphine Sulfate (MSO4)

Adult Dose: acute MI (STEMI) , CHF, pulmonary edema: 2-4mg slow IV every 5-15 minutes to max 10 mg Moderate/ severe pain: 2-10mg slow IV Class: Opiod analgesic (schedule II narcotic) MOA: alleviates pain through CNS action, increases peripheral vasodilation and decreases preload. Indications: severe CHF, pulmonary edema, chest pain associated with an acute MI, moderate to severe pain. Contraindications: allergic, significant head injury, depressed respiratory drive, hypotension, undiagnosed abdominal pain, decreased Loc Side effects: sedation, CNS depression, respiratory depression, hypotension, nausea and vomiting.

Epi Racemic (Micronefrin) - RESPIRATORY DRUG

Adult Dose: mix 0.5 mg of Epi 1:1000 in 5 mL of NS by nebulizer. One time dose only. Class: sympathomimetic MOA: stimulates beta-2 receptors in the lungs causing bronchodilation, reduces airway resistance, reduces laryngeal edema. Indications: asthma, Croup (laryngotrachealbronchitis), laryngeal edema Contraindications: hypertension, cardiovascular disease, epiglotitis, allergy Side effects: tachycardia, nausea, vomiting, anxious, palpitations

Diazepam (Valium) - SEDATIVE

Adult Dose: seizure activity, anxiety, agitation, cocaine induced SVT's, acute alcohol withdrawal: 5-10mg slow IV/IM every 10-15 minutes as needed (PRN) Premedication for RSI, Cardioversion: 5-15mg slow IV On Set: 1-5 minutes Peak: 15 minutes Duration: 20-50 Minutes Class: benzodiazepine sedative/ hypnotic, anticonvulsant MOA: Long acting sedative / hypnotic, controls seizure threshold Indications: Extreme anxiety, agitation, acute alcohol withdrawal, seizure activity, sedation for medical procedures (RSI, Cardioversion), cocaine induced SVT Contraindications: allergic, acute narrow angle glaucoma, respiratory depression, hypotension Side effects: respiratory depression, hypotension a Pediatric Dose: Not recommended in prehospital setting.

Magnesium Sulfate - RESPIRATORY DRUG ETC.

Adult Dose: syringe (Eclampsia 1-4g IV over 3 minutes); cardiac (refractory to Amiodarone) 1-2g IV,IO; Torsades 1-2g IV,IO; infusion (respiratory) 1-2g in 100mL NS 5-10 minutes 10 gtts/mL set Pink top, supplied 1g/ 2mL Class: Electrolyte, Anti Inflammatory MOA: anti Inflammatory, relaxes muscles Indications: Asthma, Emphysema, COPD, Chronic Bronchitis, Eclampsia (seizures of pregnancy), Torsades De Pointes (issue in v-tach), Hypomagnasemia, cardiac arrest (v-fib, v-tach) refractory to amiodarone Contraindication: allergy, heart block Side effects: hypotensive, CNS depression

Nitroglycerin (NTG, Nitrostat, Nitrobid)

Adult Dose: tablet or spray (1 spray) 0.4mg SL to max of 3 doses every 5 minutes Paste:0.5-2.0 inches topical ug/kg/min IV, IO titrated by 1 ug/kg/min (max dose: 5 ug/kg/min). Class: vasodilator MOA: dilation of arteriol and peripheral veins, reduce preload and after load, decrease the workload of the heart and reduce myocardial oxygen demand Indications: acute angina, ischemic chest pain, hypertension, CHF/ pulmonary edema Contraindications: allergic, hypotension (<100 systolic), intracranial bleeding and head injury, erectile dysfunction medications used within 24-72 hours. Side effects: hypotension, headache Supplied: tablets, spray, paste form Pediatric Dose: Not Recommended. IVinfusion: 0.25 -0.5 *note: if 12 lead reveals inferior infarction (II,III, AVF), perform right sided 12 lead (move v4 lead under right nipple) now called v4r to rule out right sided MI. Prior to NTG administration. Don't give nitro (NTG) prior to performing 12 lead Nitro decomposes when it is exposed to light and heat

Which of the following patients may benefit from CPAP?

Alert patient with respiratory distress following submersion in water

Which of the following medications does NOT possess hypnotic properties

Alfentanil

If the amount of pulmonary surfactant is decreased

Alveolar surface tension increases

A patient who is coughing up thick pulmonary secretions should NOT take

An antitussive

A patient who is coughing up purulent sputum is MOST likely experiencing

An infection

Patient who is coughing up purulent sputum is MOST likely experiencing:

An infection.

Biot respirations are characterized by

An irregular pattern of breathing with intermittent periods of apnea

Which of the following statements regarding anatomic dead space is correct

Anatomic dead space is about 1 mL per pound of body weight

Which of the following statements regarding anatomic dead space is correct?

Anatomic dead space is about 1 mL per pound of body weight.

Which of the following statements regarding anemia is correct

Anemia results in a decreased ability of the blood to carry oxygen

A 42 year old male complains of shortness of breath after being sprayed with super-heated steam. He has burns to his face, neck and upper chest. Vital signs are BP 112/66, P 124, R 28 shallow and labored. What should you do?

Assist his ventilations He is in respiratory failure. His breathing is ineffective because his respirations are fast and shallow. Shallow respirations do not allow for adequate oxygen exchange because the air is not drawn down far enough into the lungs. Assisting his breathing with positive pressure ventilations will help reduce any pulmonary edemy from the lower airway burns.

A 36 year old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should

Assist his ventilations and establish vascular access

A known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow and his pulse is slow and weak. You should

Assist ventilations with a bag mask device, administer naloxone, and reassess his ventilatory status

How is regulation of breathing different in those with COPD? What does research indicate about assisting in respiration with COPD sufferers?

COPD sufferers have difficulty removing CO2 from body. Overtime, respiratory control centers in brain adjust to this new baseline of CO2. In late stage COPD hypoxic drive is activated. Some research suggests that providing high flow O2 could negatively affect body's drive to breathe.

Which of the following clinical findings would be of LEAST significance in a patient experiencing respiratory distress?

BP of 148/94 mm Hg

A 50 year old is not breathing and has a faint pulse. You should?

BVM

What is hypoxic drive?

Backup system to control respiration. Chemoreceptors in brain, aorta, and carotid arteries. But they are "satisfied" by a small amount of O2, which means it is not as sensitive as pH control of CO2

Which of the following statements regarding pediatric ET intubation in the prehospital setting is correct

Bag mask ventilation can be as effective as intubation for EMS systems that have short transport times

An unresponsive 43 year old male is cool, pale, diaphoretic, and breathing 6 times a minute. Which device should you use to administer oxygen?

Bag-valve mask He is unresponsive and breathing too slow. This is a "Sick" patient and assisting his ventilations should be the first intervention. You can increase his respiratory rate with a bag valve mask, which is why it is the most correct choice.

Because the high pressure ventilator used with needle cricothrotomy would cause an increase in intrathoracic pressure, ____ and ____ may result

Barotrauma, pneumothorax

Which of the following assessment findings should cause you to suspect a history of COPD?

Barrel shaped chest

An adult patient with an abnormal respiratory rate should

Be evaluated for other signs of inadequate ventilation

A 13 year old female watching a horror movie states she can't catch her breath and her fingers are numb. Respirations are 30 and deep with Sp02 of %100. She is speaking in clear sentences, has clear and equal breath sounds. You should?

Calmly reassure her, encouraging her to calmly slow her rate of breathing. (She is hyperventilating. Only treatment is to attempt to calm the patient)

How do you use suction equipment?

Can use rigid (Yankauer/tonsil tips) or nonrigid (french/whistle-tip). Use rigid unless you are suctioning a stoma or suctioning nose/liquid at back of mouth. Make sure to measure for proper size. Don't touch back of throat, don't want to activate gag reflex. Turn on to at least 300 mmHg. Attach appropriate tubing. Suction for no more than 15 seconds for adults, 10 seconds for children, and 5 seconds for infants. Rinse with water.

The by-product of cellular respiration

Carbon dioxide

Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading

Carboxyhemoglobin

A 40 year old man named Jose fell 20 ft from a tree while trimming branches. Your assessment reveals that he is unresponsive. you cannot open his airway effectively with the jaw thrust maneuver. You should

Carefully open his airway with the head tilt chin lift maneuver

What is the name of the cartilaginous Ridge in the trachea at which the right and left lungs split?

Carina Located beneath the sternum.

Cellular respiration (Metabolism)?

Cells take energy from nutrients through series of chemical processes.

COPD is characterized by

Changes in pulmonary structure and function that are progressive and irreversible

What are the characteristics of inadequate breathing (adults)?

Chapter 6 1. labored breathing (activating accessory muscles of respiration) 2. 12< or >20 breaths/minute 3. muscle retractions above clavicles or between ribs and below rib cage 4. pale/cyanotic skin 5. cool, damp, clammy skin 6. tripod position Chapter 10 1. 12< or 20> 2. irregular rhythm 3. diminished, absent or noisy auscultated breath sounds 4. reduced flow of expired air at nose/mouth 5. unequal or inadequate chest expansion 6. labored breathing 7. shallow depth 8. pale, cyanotic, cool or moist skin 9. retractions around ribs or above clavicles

56 year old female struggling to breathe with wheezing. She is unable to hold her head up or follow commands. What should you do?

Check airway for foreign body obstructions

As the diaphragm relaxes, the intercostal muscles and the chest cavity?

Chest Cavity decreases in size. Diaphragm relaxes and moves upward into chest cavity and the intercostal muscles relax pulling ribs back into neutral position decreasing the size of the chest cavity.

CPAP

Continous Positive Airway Pressure increases pressure in lungs, opens collapsed alveoli, pushes more oxygen across alveolar membrane, and forces interstitial fluid back into pulmonary circulation. indications - alert pt able to follow commands, obvious signs of moderate to severe respiratory distress, pt is breathing rapidly (over 26 breaths/min), pulse oximetry is less than 90 contraindications - pt who is in respiratory arrest, Si/sx of pneumothorax or chest trauma, pt who has a tracheostomy, active Gi bleeding/vomiting, pt unable to follow verbal commands

What happens to your diaphragm during inhalation?

Contracts The diaphragm contracts in a downward motion drawing air into the lungs.

Neuromuscular blocking agents

Convert a breathing patient with a marginal airway into an apneic patient with no airway

The ____ cartilage forms a complete ring and maintains the trachea in an open position

Cricoid

What ring shaped structure forms the lower portion of the larynx?

Cricoid Cartilage The inferior portion of the larynx is a cartilaginous ring. It is located directed inferior of the Thyroid cartilage.

One of the hallmarks of a pulmonary embolism is

Cyanosis that does not resolve with oxygen therapy

On a capnographic waveform, point ___ is the maximal ETC02 and is the best reflection of the alveolar C02 level

D

Which of the following shows a sign of lower respiratory tract problem?

Expiratory wheezes and long expiration

A patent airway

Does not equate to adequate ventilation

The main disadvantage of the LMA is that it

Does not provide protection against aspiration

Isoetherine (Bronchosol) - RESPIRATORY DRUG

Dosage: 2.5-5.0mg in 3mL of NS by nebulizer. Class: sympathomimetic MOA: beta-2 agonist, relaxes bronchioles Indications: asthma, bronchospasms especially in COPD Contraindications: allergy, cardiovascular disease. *use caution in patients with diabetes Side effects: tachycardia, palpitations, nausea, vomiting

Flumazenil (Romazicon)

Dose: 0.2 mg IV/IO over 15 seconds. Second dose: 0.3 mg over 30 seconds. Class: Benzodiazepine antagonist, antidote MOA: Reverses the action of benzodiazepines on the central nervous system. Indication: Respiratory depression from benzodiazepine overdose

Rocuronium (Zemuron)

Dose: 1.0meq/kg slow IV/IO, repeat every 10 minutes at 0.5meq/kg On Set: 1-2 Minutes Peak: Varies Duration: 45-120 ANTAGONIZES ACETYLCHOLINE Class: alkalizing agent MOA: hydrogen ion buffer, buffers metabolic acidosis and lactic acid build up in the body caused by anaerobic metabolism. Indications: cardiac arrest, hyperkalemic, tricyclic antidepressant and aspirin overdose, crushing injury. Contraindications: metabolic or respiratory alkalosis, hypokalemia. *note: repeat in tricyclic antidepressant overdose as needed until the QRS narrows. Always flush IV/IO well after administering.

Promethezine (Phenegran)

Dose: 12.5-25.0 mg IV Classification:Antiemetic Indications: Nausea/ vomiting, motion sickness Contraindications: Allergic, CNS depression from alcohol, barbiturates or narcotics Side Effect: Sedation

Midazolam

Dose: 2-2.5mg Max 1mg/KG IV Benzo Class IV On Set: 1-3 Minutes Peak: Varies Duration: 2-6 Hours May cause severe breathing problems (eg, respiratory depression, respiratory arrest). Works in the central nervous system (brain) to cause sleepiness, muscle relaxation, and short-term memory loss, and to reduce anxiety.

Lorazepam (Ativan)

Dose: 2-4mg Benzo, Schedule IV Drug On Set: 1-5 Minutes Peak: 6-8 Hours Duration: Varies Contra: Drug OD, Glaucoma

Diphenhydramine (Benadryl) - RESPIRATORY DRUG

Dose: 25-50 mg IV, IM Class: Antihistamine, Anticholinergic MOA: Blocks cellular histamine receptors Indications: Allergic reactions, acute days tonic reactions Contraindications: hypersensitivity

Odansetron (Zofran)

Dose: 4 mg IV/IM may repeat in 10 minutes Classification: Antiemetic MOA: Blocks action of serotonin, which is a natural substance that causes nausea & vomiting Indications: Nausea/ Vomiting Contraindications: allergic

Methylprednisone (Solu-medrol)

Dose: Adult 1-2 mg/kg given IV/IM/IO. Typical dosage is 125 mg given IV/IM/IO. *has to be mixed prior to use Class: Corticosteroid, anti inflammatory, smooth muscle relaxer, Synthetic MOA: Antiimflammatory Indications: asthma, COPD, emphysema,chronic bronchitis, allergic reaction involving the airway. Acute spinal cord injury to help reduce swelling Contraindications: Allergic Side effects: negligible

An increase in the number of EMS calls for patients with chronic respiratory problems most commonly occurs

During sudden weather changes

Which term best describes respiratory difficulty?

Dyspnea

A 66 year old woman is found to be unresponsive and apneic. Her carotid pulse is weak and rapid. When ventilating this patient, you should deliver

Each breath over 1 second at a rate of 10 to 12 breaths/min

Signs and symptoms of Hypoxia?

Early 1. Restlessness 2. Irritability 3. apprehension 4. tachycardia 5. anxiety Late 1. mental status changes 2. weak (thready) pulse 3. cyanosis 4. Dyspnea

If used properly, and under the correct circumstances, sedation during airway management

Effectively increases patient compliance, thus making definitive airway management safer to perform

When regard to intubation difficulty, neck mobility problems are MOST commonly associated with

Elderly patients

A thin 75 year old male complains of difficulty breathing. He states he has smoked "3 packs of cigarettes a day for 30 years." He has bilateral wheezes

Emphysema

A 77 year old female has dyspnea, speaks in short word burst, and breathes with pursed lips. Lung sounds are diminished, distant, and clear. Vital signs are BP 152/90, P 86 and irregular, R 23. What should you suspect?

Empysema Emphysema is a chronic destructive process of the alveoli. The alveoli regenerate but they are misshaped and consist of scar tissue. The scar tissue inhibits gas exchange. She has pursed lips because she is attempting to keep the alveoli open. Without the extra effort her alveoli will collapse due to increased surface tension.

A 50-year old woman presents with acute respiratory distress while eating. Upon your arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals that her skin is pink and moist. In addition to transporting her to the hospital, you should

Encourage her to cough and closely monitor her condition

A 34 year old man is saying he is choking, You note stridor and hoarseness in his voice. What should you do?

Encourage him to cough

A 34 year old man is saying he is choking, You note stridor and hoarseness in his voice. What should you do?

Encourage him to cough Stridor is upper airway obstruction. Coughing is the body's attempt to clear the obstruction. Stridor is always coupled with hoarseness

Supplemental oxygen given to a patient with an acute myocardial infarction

Enhances the body's compensatory mechanisms during the cardiac event

Which of the following is NOT a step that is performed during nasotracheal intubation?

Ensuring that the patient's head is hyperflexed

Patients with COPD typically experience an acute exacerbation of their condition because of

Environmental changes such as weather or the inhalation of trigger substances

Which condition could be considered an upper airway obstruction?

Epiglottitis

Which of the following statements regarding epiglottitis is correct

Epiglottitis has become relatively rare in children due to vaccinations against haemophilus influenza type b bacterium

Which of the following statements regarding epiglottitis is correct?

Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium.

What hormones activate the sympathetic nervous system?

Epineprhine and norepineprhine, which are released from he adrenal gland after stimulation by the sympathetic nervous system. These hormones stimulate heart and blood vessels.

Which of the following is NOT an appropriate method for confirmed proper ET tube placement in a 15 kg child

Esophageal bulb or syringe

Which of the following medications is safest to use in patients with borderline hypotension or hypovolemia?

Etomidate

What is the difference between external and internal respiration?

External - process of breathing fresh air into respiratory system and exchanging O2 and CO2 between alveoli and blood in pulmonary capillaries internal - exchange of oxygen and CO2 between systemic circulatory systems and cells of body

The exchange of oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries is called

External respiration

Pickwickian syndrome is a condition in which respiratory compromise results from

Extreme obesity

True or false: the lungs are completely equal in the midsaggital plane.

False, right lungs has 3 lobes, left lung only has 2 lobes. Together they have 5 total. Also, the right bronchi is inferior to the left bronchi.

True or false: the lungs use muscles found in the lateral lobes to expand and contract?

False: the lungs are hollow organs and contain no muscles. When the diaphragm contracts it expands the thoracic cavity. The pleural space has a negative pressure and the lungs expand. This results in a slightly negative pressure (compared to the atmosphere) and air rushes in.

True or false: The parietal pleura lines the lungs and the visceral pleura lines the lungs. The space between is called the anterior pleura.

False: the visceral pleura lines the lungs, the parietal pleura lines the body cavity and the pleural space is the space in between both where body fluid allows for both to smoothly glide.

Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD

Fever and localized crackles

Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD?

Fever and localized crackles

How should you insert a nasopharyngeal airway?

First step is to face the bevel towards the septum. Apply a water soluble lubricant, do not use an oil based lubricant.

A 14 year old female Is short of breath. She has a history of cystic fibrosis. Lung sounds reveal coarse rhonchi. What is the most likely cause of her condition?

mucous secretions

The oropharynx

Forms the posterior portion of the oral cavity

Describe the anatomy of the larynx.

From superior to inferior. Thyroid cartilage, cricothyroid membrane, and cricoid membrane. The thyroid cartilage and cricoid cartilage are anterior to the larynx, and the cricothyroid membrane is posterior to both structures.

When determining the correct sized nasogastric tube for a patient, you should measure the tube

From the nose to the ear and the xiphoid process

Paralytic medications exert their effect by

Functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine

_____ cells are found in the lining of the airways and produce a blanket of mucus that covers the entire lining of the conducting airways

Goblet

In contrast to the right lung, the left lung

Has two lobes

When a patient is given a paralytic without sedation

He or she is fully aware and can hear and feel

Stretch receptors in the lungs are responsible for the ___ reflex, which causes you to cough if you take too deep a breath

Hering-Breuer

Stretch receptors in the lungs are responsible for the _______ reflex, which causes you to cough if you take too deep a breath.

Hering-Breuer

You would MOST likely observe grossly low respiratory rate and volume in a patient who overdosed on

Heroin

20 year old female unable to cath breath after minor car crash, numbness and tingling to hands and face. Vitals are P 118, R 24. What should you do?

High flow oxygen with a nonrebreather mask

What is the V/Q ratio?

How much gas is being moved effectively, versus how much blood is flowing around the alveoli where gas exchange (perfusion occurs) example - pt w/ pulmonary embolism might have regular ventilation, but blockage might impair exchange or perfusion. So Q is compromised.

The MOST significant complication associated with digital intubation is

Hypoxia

When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of Mallampati Class

III

When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of a Mallampati Class:

III.

What is respiratory compromise?

Inability of body to move gas effectively. Can result in decreased O2 (hypoxia) and increased CO2 (hypercarbia)

While transporting an intubated 8 year old boy, he suddenly jerks his head and becomes cyanotic shortly thereafter. His oxygen saturation and capnometry readings are both falling, and he is becoming bradycardic. You attempt to auscultate breath sounds, but are unable to hear because of the drone of the engine. What has MOST likely happened

Inadvertent extubation

Indications/contraindications for OPA?

Indications a. unresponsive pt's w/o gag reflex b. any apneic pt ventilated w/ a BVM Contraindications a. conscious pt's b. any pt (conscious or unconscious) w/ BVM

Indications/contraindications for OPA?

Indications a. unresponsive pt's w/o gag reflex b. any apneic pt ventilated w/ a BVM Contraindications a. conscious pt's b. any pt (conscious or unconscious) w/ gag reflex

When checking the cuff of the LMA prior to insertion, you should

Inflate the cuff with 50% more air than is required

After inserting the combitube to the proper depth, you should next

Inflate the pharyngeal cuff with 100 mL of air

Which of the following conditions would MOST likely cause laryngeal spasm and edema

Inhalation injury

When a patient's respirations are too rapid and too shallow

Inhaled air may only reach the anatomic dead space before being exhaled

A semi-conscious 34 year old male begins to gag after insertion of an OPA

Insert an NPA

Proper insertion of the LMA involves

Inserting the LMA along the roof of the mouth and using your fingers to push the airway against the hard palate

Which of the following medications is a parasympathetic bronchodilator?

Ipratropium

What are Cheyne-Stokes Respirations? What do they indicate?

Irregular respiration where pt breathes w/ increasing rate/depth that is followed by apnea, followed again by period of increasing rate/depth of respiration. Can occur in people with strokes/head trauma

It would NOT be appropriate to place a patient in the recovery position if he or she

Is breathing shallowly

The King LT airway can be used to

Maintain a patent airway in spontaneously breathing patients

Oxygen that is dissolved in the blood plasma

Makes up the partial pressure of oxygen

You respond to a residence for a possible overdose. The patient, a young man, is unresponsive with slow, snoring respirations. There are obvious needle track marks on his arms. Your first action should be to

Manually open his airway

The anterior portion of the palate is formed by the

Maxilla and palatine bones

A hyperventilating patient

May be acidotic and is trying to decease his or her pH level

Patients with decompensated asthma or COPD who require positive-pressure ventilation

May develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly

In contrast to negative pressure ventilation, positive pressure ventilation

May impair blood return to the heart

Hepatojugular reflex occurs when

Mild pressure placed on the patient's liver further engorges the jugular veins

What is minute volume? What does it measure?

Minute volume = RR x tidal volume. Volume of air moving through lungs in 1 minute. Can be estimated quickly. Count RR rate. If normal check to see chest rise and fall (tidal volume). If chest rise and fall is weak and/or little air coming out of nose, then the person has small minute volume.

In which of the following conditions would you be LEAST likely to encounter pulse paradoxus

Moderate asthma attack

In which of the following conditions would you be LEAST likely to encounter pulsus paradoxus?

Moderate asthma attack

During tracheobronchial suctioning, it is MOST important to

Monitor the patient's cardiac rhythm and oxygen saturation

Which sequence correctly traces the path oxygen takes from the atmosphere to the lungs?

Mouth, Pharynx, trachea, bronchi, alveoli.

Which sequence correctly traces the path oxygen takes from the atmosphere to the lungs?

Mouth, Pharynx, trachea, bronchi, alveoli. I don't remember the choices on the test but the full order is: Nose/mouth, pharynx, Larynx (L-for LAST part of the upper airway), trachea, divides into two hollow bronchi tubes

All of the following factors would increase a person's respiratory rate, EXCEPT

Narcotic analgesic use

Intrapulmonary shunting occurs when

Nonfuctional alveoli inhibit pulmonary gas exchange

During ventilation with the LMA, the paramedic should

Observe the patient for signs of inadequate ventilation

Needle cricothyrotomy is contraindicated in patients with

Obstruction above the catheter insertion site

Difficulty with exhalation is MOST characteristic of

Obstructive lung disease

During forceful inhalation, the vocal cords

Open widely to provide minimum resistance to air flow

Which of the following represents the correct dequence for managing a patient's airway

Open, clear, assess, intervene

Physiologic effects of CPAP include

Opening of collapsed alveoli

What is directly posterior to the mouth?

Oropharynx

Which of the following statements regarding orotracheal intubation is correct

Orotracheal intubation is the most common method of performing ET intubation

The MOST obvious risk associated with extubation is

Overestimating the patient's ability to protect his or her own airway

Which of the following statements regarding oxygen is correct?

Oxygen supports the process of combustion.

Proper technique to suction patient's airway includes?

Oxygenating and ventilating before and after suctioning.

Proper technique to suction patient's airway includes?

Oxygenating and ventilating before and after suctioning. Cannot exceed more than 30 seconds between ventilations. So when administering adjunct, oxygen, and mask delivery, you must complete administration before the 30 seconds are up.

Fentanyl (Sublimaze) is a

narcotic analgesic

Chemoreceptors located in the carotid bodies and aortic arch sense minute changes in the ______ and send signals to the respiratory centers via the _______________ nerves.

PaCO2, glossopharyngeal and vagus

What is dead space? What structures are considered part of dead space?

Part of respiratory system not involved in active respiration. Air moves through here but little to no respiration occurs. Mouth, trachea, bronchi and bronchioles considered dead space

What is the term used to describe the amount of gas in air or dissolved in fluid? How is this relevant to ventilation? How is this relevant to respiration?

Partial pressure of gas, measured in mmHg. When lungs expand, partial pressure of air is less than that in atmosphere. Air rushes in during ventilation. Inhalation In oxygen rich lungs, PO2 > PO2 oxygen poor blood. O2 diffuses across alveoli into blood. In CO2 rich blood, PCO2 > PCO2 of lungs so CO2 diffuses from blood to lungs, and then is exhaled out

In which group of patients are you likely to encounter "see-saw" breathing?

Pediatrics

In which group of patients are you likely to encounter "see-saw" breathing?

Pediatrics See-saw refers to the child's chest movement. Belly breathing and chest breathing like a see-saw

Hepatomegaly and jugular venous distention are MOST suggestive of

Right heart failure

A 19-year-old female began choking after eating a hot dog. When you first arrived on scene, she was coughing and drooling.Now, she is drowsy, slow to respond, and unable to cough. You should?

Perform abdominal thrusts

If chest compressions and repositioning of the airway are unsucessful in removing a severe airway obstruction in an unconscious patient, you should

Perform laryngoscopy and use Magill forceps

When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should

Perform the test three times and take the best rate of the three readings

What is the name of the passageway shared by the digestive tract and the respiratory systems for air and food?

Pharynx The pharynx is also known as the throat. The nasal cavity and a mouth share this passage way. Air moves down the larynx and food travels into the esophagus.

What is the most common location for an airway obstruction

Pharynx This passage way is shared by air and food so it is a common site for a partial or complete obstruction, which could be food or a flaccid tongue

What nerve primarily controls respiration?

Phrenic

On either side of the glottis, tissue forms a pocket called the

Piriform fossae

A 42 year old asthmatic patient complains of chest pain, shortness of breath and a violent cough that produces brownish sputum. What is the most likely cause?

Pneumonia

A febrile 2 year old male in respiratory distress with crackles in the lower left lung field. You should suspect?

Pneumonia

An 89 year old patient complains of difficulty breathing and a productive cough that has gotten worse over the past 12 hours. You should suspect?

Pneumonia

Bedridden patients with excessive pulmonary secretions are MOST prone to developing

Pneumonia

Which of the following conditions would LEAST likely present with an acute onset of respiratory distress?

Pneumonia

A febrile 44 year old male complains of shortness of breath and has dull chest pain. He has been coughing up "rusty" sputum for the last three days. What is the most likely cause?

Pneumonia Pneumonia is an infection of the lung tissue and the "rusty" sputum (spit) is a sign of lower airway infection. He is febrile (fever) from an immune response to the infection, and the "dull" chest pain is a common symptom at the location of the infection.

Patients with pneumonia often experience a coughing fit when they roll from one side to the other because

Pneumonia often occurs in the lung bases, typically on only one side

The involuntary control of breathing originates in the

Pons and medulla

Which of the following findings is MOST clinically significant in a 30 year old woman with difficulty breathing and a history of asthma

Prior ICU admission for her asthma

Which of the following findings is MOST significant in a patient with acute respiratory distress?

Prior ICU admission for the same problem

The MOST clinically significant finding when questioning a patient with a chronic respiratory disease is

Prior intubation for the same problem

The major advantage of ET intubation is that it

Protects the airway from aspiration

What are agonal gasps? What should you do if a pt has agonal gasps?

Pt in cardiac arrest has occasional gasping breaths because respiratory center in brain continues to send signals to breathing muscles. Artificial ventilations and chest compressions.

What is labored breathing? How do you tell someone has it?

Pt with inadequate breathing may appear to be working hard to breathe. Look for use of accessory muscles which are not used during normal breathing

a 75 year old female complains of a sudden onset of right sided chest pain and dyspnea. She is recovering from a recent hip surgery. What should you expect?

Pulmonary embolism A pulmonary embolism is typically the result of a clot that has formed in the lower extremity with poor circulation. Hip surgery requires a patient to be immobilized for an extended period of time which can permit a clot to form in the distal portion of an extremity. The sudden unilateral chest pain is the lung with the clot. Any lung tissue distal of the clot will not allow for adequate oxygen exchange.

After tracheobronchial suctioning is complete, you should

Reattach the bag-mask device, continue ventilations, and reassess the patient

Cor pulmonale is defined as

Right heart failure secondary to chronic lung disease

66-year-old man with chronic bronchitis presents with severe respiratory distress. The patient's wife tells you that he takes medications for high blood pressure and bronchitis, is on home oxygen therapy, and has recently been taking an over-the-counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of this patient's respiratory distress?

Recent antitussive use

A 66 year old man with chronic bronchitis presents with severe respiratory distress. The patient's wife tells you that he takes medications for high blood pressure and bronchitis, is on home oxygen therapy, and has recently been taking an over the counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of the patient's respiratory distress?

Recent antitussive use

You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically searching. You should

Recognize that he is experiencing end stage COPD, begin assisting ventilations, and contact medical control as needed

After obtaining a peak expiratory flow reading of 200 mL, you administered one bronchodilator treatment to a 21 year old woman with an acute episode of expiratory wheezing. The next peak flow reading is 400 mL. You should

Recognize that the patient's condition has improved

A bourdon gauge oxygen flowmeter

Reduces the high pressure in the oxygen cylinder to a safe pressure

If using a bulb style esophageal detector device to assist you in confirmed proper ET tube placement, you should expect the bulb to

Refill briskly in the tube is in the trachea

Wheezing is resolved with medication that

Relax the smooth muscle of the bronchioles

What is residual volume?

Remaining gas in lungs after exhalation. This is to keep lungs inflated

Semiconscious patient's dentures completely loosened. You should?

Remove dentures

A whistle tip suction catheter is MOST often used to

Remove secretions from an ET tube

You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should

Remove the CPAP unit, assist his ventilations with a bag mask device and prepare to intubate him

An airway obstruction secondary to a severe allergic reaction

Requires specific and aggressive treatment

What is the difference between respiration and ventilation?

Respiration refers to the exchange of gases in the alveoli, ventilation refers to the movement of air into the lungs. Respiration is needed to provide O2 to cells and remove waste products. Also regulates pH of blood.

A 53 year old male is sleepy, diaphoretic, difficult to arouse, and breathing 8 times a minute. What should you suspect?

Respiratory Failure This rate is too slow and the fact that he is sleepy and difficult to arouse shows that he is in respiratory failure. An adult with a respiratory of 8 is too slow for adequate gas exchange.

Undersedation of a patient during airway management would likely result in all of the following, EXCEPT

Respiratory depression

A sudden increase in end tidal C02 may be the earliest indicator of

Return of spontaneous circulation

A patient has a history of COPD. Before assisting him in self-administering his inhaler you should?

Shake vigorously

What is Dyspnea?

Shortness of breath

A morbidly obese man called 9-1-1 because of difficulty breathing. When you arrive, you find the 39 year old patient lying supine in his bed. He is in marked respiratory distress and is only able to speak in two-word sentences. He has a history of hypertension, but denies any respiratory conditions. What should you do FIRST?

Sit him up or place him on his side

Morbidly obese man called 9-1-1 because of difficulty breathing. When you arrive, you find the 39-year-old patient lying supine in his bed. He is in marked respiratory distress and is only able to speak in two-word sentences. He has a history of hypertension, but denies any respiratory conditions. What should you do FIRST?

Sit him up or place him on his side.

When intubating a 3 year old child, you would MOST likely use a

Size 2 straight blade

You are transporting an intubated patient and note that the digital capnometry reading has quickly fallen below 30 mm Hg. You should

Slow your ventilation rate to see if the ETC02 reading decreases.

Glottis

Space between vocal cords and narrowest portion of adult's airway. Lateral borders of glottis are the vocal cords. They contain defense reflexes that protect lower airway, and spasm to prevent foreign substances from entering trachea

Which of the following is NOT a contraindication for nasotracheal intubation

Spinal injury

An 18 year old male is cyanotic and complains of sharp chest pain and difficulty breathing after lifting weights. Vital signs are BP 110/66, P 88, R 22. What is the most likely cause?

Spontaneous pneumothorax Performing strenuous activites can, on occasion, cause a collapsed (spontaneous pnemothorax) He has stable vital signs so you should suspect a S.P. If he had been hypotensive (88/40), you should suspect that the S.P had developed into a tension pneumothorax.

From the atmosphere, what structures does air pass through during ventilation?

Starts in atmosphere, then nose, nasopharyngeal space/orophargyneal space (if mouth breather), then pharynx, larynx, trachea, bronchi, bronchioles, alveoli

Which is an indication of an upper airway obstruction?

Stridor

What is the term for abnormal breath sounds that result from an obstructed airway?

Stridor Stridor is an UPPER airway obstruction caused by the tissue swelling around the trachea, larynx, or epiglottis during INSPIRATION.

What is pathophysiology?

Study of how normal physiologic processes are affected by disease

An elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a "water pill" and vasotec for high blood pressure. You should

Suspect acute right heart failure and administer oxygen

With regard to pulse oximetry, the more hypoxic a patient becomes

The faster he or she will desaturate

Digital intubation can be performed on trauma patients because

The head does not have to be placed in a sniffing position

What structure is considered a landmark that divides the upper airway from lower?

The larynx, anything above is upper. The larynx and below are lower.

All of the following factors would increase a person's respiratory rate, EXCEPT:

narcotic analgesic use.

36-year-old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should:

assist his ventilations and establish vascular access.

29-year-old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should:

apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.

Patients with a partial laryngectomy

are called partial neck breathers because they breathe through both a stoma and the nose and mouth

Retractions of the sternum or ribs during inhalation:

are especially common in infants and small children.

The trachea and mainstem bronchi

are lined with beta-2 receptors that result in bronchodilation when stimulated

Intrapulmonary shunting is defined as

The return of unoxygenated blood to the left side of the heart

Which of the following statements regarding the tonsils is correct?

The tonsils are comprised of lymphatic tissue and help to trap bacteria.

The presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates

Thick secretions in the large airways

The most obvious external landmark of the larynx is the

Thyroid cartilage

Which of the following patients has the lowest minute volume

Tidal volume of 350 mL; respiratory rate of 12 breaths/min

Which of the following patients has the lowest minute volume?

Tidal volume of 350 mL; respiratory rate of 12 breaths/min

What is the purpose of the nasal passages and nasopharynx?

To warm/humidify air as it passes through

What is the Name of the hollow, semi flexible tube that carries in held air from the larynx to the lungs?

Trachea The trachea is a tube like structure that allows air passage from the upper airway into the lungs

Using the DOPE mnemonic, which of the following interventions would you MOST likely have to perform if you suspect "O" as the cause of acute deterioration in the intubated child?

Tracheobronchial suctioning

Several attempts to orotracheally intubate an unresponsive, apneic young man have failed. You resume bag mask ventilations and begin transport to a hospital located 25 miles away. En route, you begin having difficulty maintaining an adequate mask to face seal with the bag mask device. Assuming that you have the proper equipment, which of the following techniques to secure a patent airway would be MOST appropriate?

Transillumination intubation

True or false: arteries bring oxygenated blood to organs/capillaries

True in most cases with one exception. Arteries (away) bring blood away from the heart. Usually this is oxygenated blood. But the pulmonary arteries bring oxygen poor blood away from the heart, to the lungs to be oxygenated.

True or false: Air rushes into the lungs because of negative pressure.

True, when the lungs expand, they are creating a vacuum because they are expanding the volume of the container. This increase in volume causes influx of air into the container until the pressure is equalized with the atmosphere.

When using a straight blade, a major mistake of new paramedics is to

Try to pass the ET tube down the barrel of the blood

A 64 year old male complains of dyspnea and is coughing up blood tinged sputum. Upon auscultation you note cracks bilaterally. What should you suspect?

Tuberculosis

A 64 year old male complains of dyspnea and is coughing up blood tinged sputum. Upon auscultation you note cracks bilaterally. What should you suspect?

Tuberculosis Persistent cough + chronic fatigue + fever + weight loss + coughing up blood + chest pain + 𝒄𝒐𝒂𝒓𝒔𝒆 𝒄𝒓𝒂𝒄𝒌𝒍𝒆𝒔 𝑵𝒐𝒕𝒆: i don't quite remember this question 100% so please be cautious on this one

The MOST significant complication associated with the use of multilumen airways is

Unrecognized displacement of the tube into the esophagus

The _____ is an anatomic space located between the base of the tongue and the epiglottis

Vallecula

An adult is breathing at a rate of 6 beats per minute. You should?

Ventilate the patient via bag-valve mask

The process of moving air into and out of the lungs is called

Ventilation

Which of the following statements regarding translaryngeal catheter ventilation is correct?

Ventilation is achieved by the use of a high pressure jet ventilator

Patient with obvious respiratory failure require immediate

Ventilation support

The external jugular veins run ______ and are located ____ to the cricothyroid membrane

Vertically, lateral

_______ breath sounds are the MOST commonly heard breath sounds, and have a much more obvious inspiratory component.Â

Vesicular

Alveolar Minute Volume

Volume of air moved through lungs in 1 minute minus the dead space. Alveolar Minute Volume = (tidal volume - dead space) x RR

Alveolar Ventilation

Volume of air that reaches alveoli. Alveolar ventilation = tidal volume - dead space

What function do the nasal turbinates serve?

Warming and humidifying inhaled air

According to the most current guidelines for emergency cardiac care, the MOST reliable method for monitoring correct ET tube placement is

Waveform capnography

What is the sound of a lower airway obstruction?

Wheezing

What is the term for high-pitched whistling sounds heard during expiration?

Wheezing Wheezing is a high pitched whistling sound heard on EXHALATION. Wheezing suggest there is a LOWER airway OBSTRUCTION or CONSTRICTION. Exhalation is a passive process, and the wheezing noise is air passively leaving constricted bronchioles.

A 56 year old female has a complete airway obstruction from a piece of food. She becomes unconscious while you asses her. What should you do?

When a patient has a completely obstructed airway and become unconscious the first thing you should do is start chest compressions.

What are ataxic respirations?

When pt has irregular ineffective respirations that may or may not have identifiable pattern

Known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should:

assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

Abnormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the:

bases of the lungs.

Person who is not bedridden, most pulmonary infections occur in the:

bases of the lungs.

An adult patient with an abnormal respiratory rate should

be evaluated for other signs of inadequate ventilation.

An adult patient with an abnormal respiratory rate should:

be evaluated for other signs of inadequate ventilation.

Hyproventilating patients:

become hypercapnic and acidotic.

Transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should:

begin assisting his ventilations with a bag-mask and 100% oxygen.

The hypoxic drive is a phenomenon in which

bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance

Hypoxic drive is a phenomenon in which:

bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.

Unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have __________ respirations.

bradypneic

Automated transport ventilator is NOT appropriate for patients who are:

breathing spontaneously.

Inspiratory and expiratory _____ sounds are both loud, but the inspiratory sounds are shorter than the expiratory sounds

bronchial

Inspiratory and expiratory _______ sounds are both loud, but the inspiratory sounds are shorter than the expiratory sounds.

bronchial

Mainstem bronchus ends at the level of the:

bronchioles

The mainstem bronchus ends at the level of the

bronchioles

What are the structures of the lungs in order of ventilation?

bronchioles, and alveoli

The primary treatment of bronchospasm is

bronchodilator therapy

Primary treatment of bronchospasm is:

bronchodilator therapy.

Frothy sputum that has a pink tinge to it is MOST suggestive of:

congestive heart failure.

When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear

crackles in the bases of the lungs at the end of inspiration

When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear:

crackles in the bases of the lungs at the end of inspiration.

_________ cartilage forms a complete ring and maintains the trachea in an open position.

cricoid

Where is Sellick's Maneuver applied?

cricoid cartilage Sellicks maneuver is also called cricoid pressure. It inhibits gas entering the stomach during assisted ventilations.

The King LT-D airway features a

curved tube with ventilation ports located between two inflatable cuffs

One of the hallmarks of a pulmonary embolism is:

cyanosis that does not resolve with oxygen therapy.

When ventilating an apneic adult with a pulse with a bag-mask device, you should:

deliver each breath over 1 second at a rate of 10 to 12 breaths/min.

What is directly posterior to the nose?

nasopharynx The nasopharynx connects the opening of the nostrils to the soft palate? Which is located at the back of the mouth. This passage is designed to warm up and held air in filter out fine particulate matter.

Stridor

description - A harsh vibrating noise when breathing, caused by obstruction of the windpipe or larynx. cause - Obstruction or narrowing of the upper airway. location - Less than severe stridor can be auscultated over the larynx. Severe stridor can be heard without a stethoscope. associated w/ - Obstruction in Larynx, Obstruction in Trachea, Croup, Epiglottitis Laryngeal edema

Wheeze

description - Continuous, high-pitched, squeaky musical sounds. Best heard on expiration. Not usually altered by coughing. cause - Air passing through a constricted bronchus as a result of secretions, swelling, tumors location - Heard over all lung fields associated w/ - Asthma, Allergic reaction, Airway obstruction, COPD

Friction rub

description - Superficial grating or creaking sounds heard during inspiration and expiration. Not relieved by coughing. cause - Rubbing together of inflamed pleural surfaces location - Heard most often in areas of greatest thoracic expansion (e.g., lower anterior and lateral chest) associated w/ - Pleuritis, Pulmonary embolism, COPD, Pneumonia

What are gurgles (rhonchi)?

description - continuous low pitched gurgling sounds w/ moaning/snoring quality. Best heard on inspiration but can be heard on both. Can be altered by coughing. cause - Air passing through narrowed air passages as a result of secretions, swelling, tumors location - Loud sounds can be heard over most lung areas, but predominate over the trachea and bronchi associated w/- Secretions, Obstructions, Pneumonia, Bronchitis, COPD

What are crackles?

description - fine short, interrupted crackling sounds, best approximated by rolling hair between fingers. Best heard on inspiration but can be heard on both. May not be cleared by coughing cause - air passing through fluid/mucous in air passageway location - most often heard in lower lung lobes associated w/ - pulmonary edema, CHF, pneumonia, pulmonary fibrosis, bronchitis

What are bronchial (tubular) lung sounds?

description - high pitched, loud harsh sounds created by air moving through trachea location - anteriorly over trachea, generally not heard over lung tissue characteristics - louder than vesicular sounds, have short inspiratory phase and long expiratory phase (1:2 ratio)

What are bronchiole-vesicular sounds?

description - moderate intensity and moderate pitch blowing sounds, created by air moving through larger bronchi location - between scapula and lateral to sternum characteristics - equal inspiratory and expiratory

What are vesicular breath sounds?

description - soft pitched, low intensity gentle sighing location - over peripheral lung, best heard at base characteristics - best heard on inspiration (5:2) ratio

If intubation of a child is unsuccessful after two attempts, your MOST appropriate action is to

discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately

Patent airway:

does not equate to adequate ventilation.

An artificial airway adjust

does not obviate the need for proper head positioning

Increase in the number of EMS calls for patients with chronic respiratory problems MOST commonly occurs:

during sudden weather changes.

In contrast to needle cricothyrotomy, an open cricothyrotomy

enables the paramedic to provide greater tidal volume

A 50-year-old woman presents with acute respiratory distress while eating. Upon your arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals that her skin is pink and moist. In addition to transporting her to the hospital, you should:

encourage her to cough and closely monitor her condition.

A 34-year-old male says he's choking. You note Stridor and hoarseness in his voice what should you do?

encourage him to cough

Critical step when using a CPAP unit to treat a patient with severe respiratory distress is:

ensuring an adequate mask seal with minimal leakage.

Patients with COPD typically experience an acute exacerbation of their condition because of:

environmental changes such as weather or the inhalation of trigger substances.

Respiratory alkalosis is the result of:Â

excess carbon dioxide elimination.Â

Oropharynx and nasopharynx meet in the back of the throat at the:

hypopharynx

CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases by

improving patency of the lower airway through the use of positive and expiratory pressure

CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases by:

improving patency of the lower airway through the use of positive-end expiratory pressure.

Transillumination-guided intubation can be difficult or impossible to perform

in a brightly lit environment

Orotracheal intubation should be performed with the patient's head

in the sniffing position

Signs of clinical improvement during CPAP therapy include

increased ease of speaking

Indications/contraindications for NPA?

indications a. semiconscious/unconscious pt w/ intact gag reflex b. pat's who otherwise will not tolerate OPA contraindications a. severe head injury w/ blood draining from nose b. history of fractured nasal bone

After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then

inflate the distal cuff with 5 to 10 mL of air

You are intubating a 60 year old man in cardiac arrest and have visualized the ET tube passing between the vocal cords. AFter removing the laryngoscope blade from the patient's mouth, manually stabilizing the tube, and removing the stylet, you should

inflate the distal cuff with 5 to 10 mL of air

When a patient's respirations are too rapid and too shallow:

inhaled air may only reach the anatomic dead space before being exhaled.

The dorsal respiratory group is primarily responsible for:

initiating respiration based on information received from the chemoreceptors.

A 36-year old man experienced significant burns to his face, head, and chest following an incident with a barbeque pit. Your assessment of his airway reveals severe swelling. After administering medications to sedate and paralyze the patient, you are unable to intubate him. Furthermore, bag-mask ventilations are producing minimal chest rise. The quickest way to secure a patent airway in this patient is to

insert an LMA

After inserting the needle into the cricothyroid membrane, you should next

insert the needle about 1 cm farther and then aspirate with the syringe

After properly positioning the patient's head for intubation, you should open his or her mouth and insert the blade

into the right side of the mouth and sweep the tongue to the left

Which of the following medications is a parasympathetic bronchodilator

ipratropium

The anterior portion of the palate is formed by the:

maxilla and palatine bones.

What is expiratory reserve volume/Vital Capacity?

maximum amount you can breathe out after normal breath.

Hyperventilating patient:

may be acidotic and is trying to decrease his or her pH level.

A patient with respiratory distress who is willing to lie flat

may be acutely deteriorating

Patient with respiratory distress who is willing to lie flat:

may be acutely deteriorating.

A patient with a suppressed cough mechanism:

is at serious risk for aspiration.

Cricothyroid membrane:

is relatively avascular ( having few or no blood vessels) and is covered by skin and minimal subcutaneous tissue.

In contrast to the nasogastric tube, the orogastric tube

is safer to use in patients with severe facial trauma

Contrast to negative-pressure ventilation, positive-pressure ventilation:

is the forcing of air into the lungs.

Digital intubation is absolutely contraindicated if the patients

is unconscious but breathing

From an airway management perspective, the MOST important anatomic consideration regarding an adult's tongue is:

its tendency to fall back and occlude the posterior pharynx.

When present at low levels, oxygen binds easily to hemoglobin molecules, resulting in:

large changes in oxygen saturation when small changes in PaO₂occur.

The ___ is the lowest portion of the pharynx and opens into the larynx anteriorly and the esophagus posteriorly

laryngopharynx

What part of the respiratory system contains the vocal chords?

larynx This structure is directly above the trachea the vocal cords are located here it is also known as the voice box

What are the structures of the lower airways?

larynx (includes adam's apple/thyroid cartilage, cricothyroid membrane, cricoid cartilage), trachea, bronchi, bronchioles, alveoli

Which of the following medications has been shown to blunt the increase in intracranial pressure associated with suctioning and laryngeal stimulation?

lidocaine

Where are the muscarinic receptors located? What is their effect?

location - heart effect - decreased HR, decreased force of contraction Muscarinic is parasympathetic system and do complete opposite of Beta-1 which is sympathetic

Difficulty with exhalation is MOST characteristic of:

obstructive lung disease.

Asymmetric chest wall movement is characterized by

one side of the chest moving less than the other

During forceful inhalation, the vocal cords:

open widely to provide minimum resistance to air flow.

Hyperventilation

over breathing to the point of arterial CO2 falls below normal. Alkalosis of blood occurs. 1. anxiety 2. dizziness 3. numbness 4. tingling of hands/feet 5. painful spasms of hand/feet 6. Pt's feel they cannot catch breathe occurs when someone experiences psychological distress. Maybe be as high as 40 breaths/min or low as 20. Verbally instruct pt to slow breathing, and if that doesn't work, give supplemental O2 and provide transport

Hyperventilation

over breathing to the point of arterial CO2 falls below normal. Alkalosis of blood occurs. 1. anxiety* 2. dizziness* 3. numbness 4. tingling of hands/feet* 5. painful spasms of hand/feet 6. Pt's feel they cannot catch breathe - Hyperventilation syndrome occurs when someone experiences psychological distress -Maybe be as high as 40 breaths/min or low as 20. Verbally instruct pt to slow breathing, and if that doesn't work, give supplemental O2 and provide transport

Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the

pH of the CSF decreases

Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the:

pH of the CSF decreases.

Changes in the rate and depth of breathing are regulated primarily by the:

pH of the CSF.

When performing an open circothyrotomy, you should FIRST

palpate the V notch of the thyroid cartilage and stabilize the larynx

Dispatched to a residence for a 59-year-old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. This patient is MOST likely experiencing:

pneumonia

You are dispatched to a residence for a 59 year old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. The patient is MOST likely experiencing

pneumonia

Patients with pneumonia often experience a coughing fit when they roll from one side to the other because:

pneumonia often occurs in the lung bases, typically on only one side.

Bedridden patients with excessive pulmonary secretions are MOST prone to developing:

pneumonia.

Which of the following can be present with a sudden onset of difficult breathing and diminished breath sounds

pneumothorax

The involuntary control of breathing originates in the:

pons and medulla.

MOST clinically significant finding when questioning a patient with a chronic Respiratory disease is:

prior intubation for the same problem.

The pressure relief valve on an automatic transport ventilator may lead to unregonized hypoventilation in patients with all the following conditions EXCEPT

prolonged apnea

Physiologic dead space increases with:

pulmonary obstructions.

Testing of the skin under the jaw often occurs when airway devices are inadvertently inserted into the

pyriform fossae

Respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should:

recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed. </li>

The use of phenylephrine hydrochloride ( Neo-Synephrine) during nasotracheal intubation will

reduce the likelihood and severity of nasal bleeding

A Bourdon-gauge oxygen flowmeter:

reduces the high pressure in the oxygen cylinder to a safe pressure.

Wheezing is resolved with medications that

relax the smooth muscle of the bronchiole

Transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should:

remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.

An increasing peak expiratory flow reading in a patient with respiratory distress suggests that the patient is

responding to bronchodilator therapy

An increasing peak expiratory flow reading in a patient with respiratory distress suggests that the patient is:

responding to bronchodilator therapy.

Sudden increase in end-tidal CO 2 may be the earliest indicator of:

return of spontaneous circulation.

Cor pulmonale is defined as:

right heart failure secondary to chronic lung disease.

Hepatomegaly and jugular venous distention are MOST suggestive of:

right heart failure.

The nasal cavity:

s extremely delicate and has a rich blood supply.

You are assessing a young woman who was struck in the head with a baseball bat. The patient is semiconscious and has slow, irregular respirations. Further assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood in her mouth, but clenches her teeth and becomes combative when you attempt to suction her oropharynx. The MOST appropriate airway management for this patient involves

sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea

In contrast to decreased P02 levels, increased PC02 levels typically manifest as

sedation or sleepiness

Contrast to decreased PO2 levels, increased PCO2 levels typically manifest as: .

sedation or sleepiness.

A patient with orthopnea

seeks a sitting position when short of breath

Patient with orthopnea:

seeks a sitting position when short of breath.

A patient with quiet tachpnea is MOST likely experiencing

shock

A patient with quiet tachypnea is MOST likely experiencing

shock

Patient with quiet tachypnea is MOST likely experiencing:

shock

Apneustic breathing is characterized by

short, brisk inhalations with a long pause before exhalation

Apneustic breathing is characterized by:

short, brisk inhalations with a long pause before exhalation.

If an unresponsive patient does not have a gag reflex, an oropharyngeal airway

should be inserted whether the patient is breathing or not

If an unresponsive patient does not have a gag reflex, an oropharyngeal airway:

should be inserted whether the patient is breathing or not.

The ____ are formed by the cranial bones and prevent contaminants from entering the respiratory tract

sinuses

The ________ are formed by the cranial bones and prevent contaminants from entering the respiratory tract.

sinuses

COPD

slow process of dilation/disruption of airways/alveoli caused by chronic bronchial obstruction

The MOST significant complication associated with the use of an oropharyngeal airway is:

soft-tissue trauma with oral bleeding.

Nondepolarizing neuromuscular blocking agents include all of the following EXCEPT

succinylcholine chloride

A 64-year-old woman with a complete laryngectomy is in respiratory arrest you should?

suction the stoma completely

The fraction of inspired oxygen (FIO2) increases with

supplemental oxygen

The fraction of inspired oxygen (FIO2) increases with

supplemental oxygen.

Elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a “water pill†and Vasotec for high blood pressure. You should:

suspect acute right heart failure and administer oxygen.

Common effects of gag reflex stimulation include all of the following, EXCEPT:

tachycardia

Unlike bronchodilator therapy, corticosteroid therapy:

takes a few hours to reduce bronchial edema.

Which of the following conditions is most likely to cause decreased compliance while ventilating via bag valve mask?

tension pneumothorax

The Hering-Breuer reflex is a protective mechanism that:

terminates inhalation and prevents lung overexpansion.

If the ET tube has been positioned properly in the trachea

the bag-mask device should be easy to compress and you should see corresponding chest expansion

Paradoxical respiratory movement is characterized by

the epigastrium and thorax moving in opposite directions

Paradoxical respiratory movement is characterized by:

the epigastrium and thorax moving in opposite directions.

With regard to pulse oximetry, the more hypoxic a patient becomes:

the faster he or she will desaturate.

When administering CPAP therapy to a patient, it is important to remember that

the increased intrathoracic pressure caused by CPAP can result in hypotension

Rigorous tube confirmation protocol must be following after performing digital intubation because

the procedure of digital intubation is truly a blind technique

Intrapulmonary shunting is defined as:

the return of unoxygenated blood to the left side of the heart.

Presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates:

thick secretions in the large airways.

Anatomically, the ________ is directly anterior to the glottic opening.

thyroid cartilage

Most obvious external landmark of the larynx is the:

thyroid cartilage.

A surgical opening into the trachea is called a

tracheostomy

You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see

two white fibrous bands that lie vertically within the glottic opening

Digital intubation should be performed only on a patient who has a bite block inserted in his or her mouth and who is ____ and ____

unconscious, apneic

When ventilating a patient with a bag valve mask device you should?

use two rescuers whenever possible

Bag Valve Mask

use w/ or w/o oxygen. Use for pt's in respiratory arrest, cardiopulmonary arrest, and respiratory failure.

What is the recovery position?

used to help maintain clear airway in unconscious pt who is not injured and is breathing on his or her own w/ normal respiratory rate and adequate tidal volume

Anatomically, the _____ is directly anterior to the glottis opening

vallecular space

Patients with obvious respiratory failure require immediate:

ventilation support

The process of moving air into and out of the lungs is called:

ventilation.

A patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she

was previously intubated for his or her condition

Patient with a history of asthma is at GREATEST risk for respiratory arrest if HE or SHE

was previously intubated for the condition.

Before performing orotracheal intubation, it is MOST important for the paramedic to

wear gloves and facial protection

A size 3 or 4 LMA

will accomodate the passage of a 6.0 mm ET tube

A pulse oximetry reading would be LEAST accurate in a patient

with poor peripheral perfusion

Pulse oximetry reading would be LEAST accurate in a patient:

with poor peripheral perfusion.

Signs and symptoms of Polycythemia

• (1306) ALOC, hypoxia, respiratory distress, change in peripheral pulses, pulse rate, skin color, tachycardia is the most common change in heart rhythm, purplish skin with red hands and feet, uncontrolled itching, changes in skin temperature,

Treatment for benzodiazepine OD

• (1420)Assess and manage the airway, establish IV, cardiac monitor Pulse ox and capnography, consider flumazenil (Romazicon), consider activated charcoal

Respiratory acidosis vs alkalosis

• (780) Alkalosis (Hypoventilation)-Pt compensates breathing becomes slow and shallow in attempt to retain CO2. Acidosis (Hyperventilate)-Pt compensates breathing becomes rapid to waste CO2

Diagnostic tools for assessing respiration and perfusion

• (787) Pulse oximetry measures minute by minute how well hemoglobin is saturated with O2 • (789) Peak expiratory flow measurement used to evaluate bronchoconstriction by measuring the peak rate of a forceful exhalation. Increasing peak flow indicates response to treatment (bronchodilation) a decreasing peak flow indicates patient condition is deteriorating • (790) Arterial blood gas analysis, blood is obtained from superficial artery (radial or femoral) the blood is then analyzed for pH, Paco2, Pao2, Hco3-, base excess, Sao2 • (790) ETCO2 detect the presence of carbon dioxide in exhaled air, important for determining the adequacy of ventilators and proper placement of advanced airways • (790) Colorimetric CO2 detector is attached to ET tube and ventilation device, does not assign a numeric value. Adequate perfusion will change the color from purple in 6-8 ventilations. Device might give false positive if CO2 is trapped in the stomach from carbonated beverages. Sensitive to extreme temperatures and humidity and if secretions get inside the device. Should be used temporarily for spot check replaced with a device more reliable • (791) Capnometer provides quantitative data making in more reliable than the colorimetric CO2 detector, provides real time information by displaying a numeric reading of exhaled CO2 levels • (791) Capnographer provides a graphic representation of exhaled CO2. Same function as the capnometer. Two types waveform and digital waveform • (791) Waveform capnography provides quantitative real time information regarding the patients exhaled Co2. Displays graphic waveform and numeric reading. Can detect bronchospasms, hypoventilation and hyperventilation. Recommended method of monitoring initial and ongoing placement of an advanced airway device, can also determine the effectiveness of chest compressions and detect ROSC. Normal range between 35-45 mm HG

Shark finning

• (792) indicates bronchospasms. Appears as an upsloping phase 2 (B-C) signifies difficulty during the exhalation phase with incomplete alveolar emptying

Basic management techniques

• (795) Head tilt chin lift. Preferred method of opening airway in non-traumatic patients • (795) Jaw Thrust. Preferred method to open airway with a suspected C-spine injury • (796) tongue jaw lift. Used with the purpose of suctioning or inserting OPA, not used to ventilate patient. • (799) manually opening of airway, suctioning as needed. OPA designed to hold the tongue away from the posterior pharyngeal wall, makes it easier to use BVM. Effective as a bite block preventing intubated patient from biting down on ET tube. • (801) NPA is inserted through the nose into the posterior pharynx behind the tongue

Indications for airway suctioning

• (797) When the patients mouth or throat becomes filled with vomit, blood, secretions, and or hear gurgling. Ventilating a patient with secretions will force material into the lungs resulting in airway obstruction or aspiration.

Treatment for a FBAO

• (804) If large foreign bodies are visible sweep them forward and out of the mouth. Use suctioning as needed. • Abdominal thrust maneuver (Heimlich maneuver) is the most effective method of dislodging and forcing a foreign object out of the airway of a responsive adult or child. Aims to create an artificial cough forcing residual air out of the persons lungs to expel the object. Should be performed on any responsive child or adult with severe airway obstruction until the obstruction is expelled or until the patient becomes unresponsive. If patient is late stages of pregnancy or morbidly obese then perform chest thrusts. • If patient becomes unresponsive lay them supine and begin chest compressions (30 single provider, 15 dual provider and the patient is an infant or child) and then open the airway and look in the mouth only attempt to remove object if you can see it. If you are able to remove object attempt to ventilate. If you cannot see the object continue compressions • If basic techniques do not work proceed with direct laryngoscopy for the removal of the foreign body using Magill forceps

Indications for direct laryngoscopy and Magill forceps

• (805) If you are unable to relieve a severe airway obstruction in an unresponsive patient with basic techniques

Complications of to fast or forceful BVM ventilation

• (815) Gastric distention (associated risks of vomiting and aspiration) decreased venous return to the heart (preload) due to increased intrathoracic pressure

Use of nasogastric tube in an intubated patient

• (821) Reduces gastric distention by removing the contents with suction which decreases pressure on the diaphragm, eliminates the risk of regurgitation and aspiration

Assessment and management of patients with stomas

• (824) Patients with stoma's may require suctioning of thick secretions, Pt's stoma may become occluded with mucous plugs. Patients with laryngectomy may have less efficient cough and therefore have a difficult time clearing the stoma. • Limit suctioning to 10 seconds • No need for head tilt chin lift/ jaw thrust for ventilation • Patients with stoma's may be less tolerant of brief periods of hypoxia

Assessment and management of patients with tracheostomy tubes

• (825) Patients with tracheostomy tubes who experiences sudden shortness of breath often have thick secretions in the tube, if this occurs suction through the tracheostomy tube • (825) if Pt's Tracheostomy tube becomes dislodged stenosis may occur, if this happens you may be unable to replace the tube and may have to place an ET tube into the stoma before it becomes totally occluded

Potential complications for endotracheal intubations

• (831) Bleeding, hypoxia, laryngeal swelling, laryngospasms, vocal chord damage, mucosal necrosis and barotrauma

Potential effects of orotracheal intubation

• (831) Secure airway • Protection against aspiration • Bleeding, hypoxia, Laryngeal swelling, laryngospasms, vocal chord damage, mucosal necrosis, Barotrauma

Anatomical placement of Miller blade

• (833) Tip extends beneath the epiglottis and directly lifts it up

Anatomial placement of Macintosh blade

• (837) Curve conforms to tongue and pharynx. The tip of the curved blade is placed in the vallecula

Surfactant

• Reduces surface tension and helps keep the alveoli expanded. After all type II cells in alveolus have been destroyed, they cannot create anymore surfactant. Surfactant can be washed out by pulmonary edema, submersion, shock, they are more likely to collapse

Indications for positive pressure ventilation

• Respiratory arrest, anyone who isn't breathing, Acute pulmonary edema, obstructive lung disease, and acute bronchospasms

Signs and symptoms of CHF left side

• Restlessness, anxiety, high resp rate, high hr, pulse alternans, crackles, cough with frothy sputum, third heart sound, retractions, labored breathing, tripod, sweating, limited word sentences, fatigue, DOB, orthopnea • (lecture) Paroxysmal nocturnal dyspnea Referred to as cardiac asthma

Signs and symptoms of right mainstem intubation

• Right sided chest rise, lung sounds only over the right side

Procedure for placing endotracheal tube

• (837)Preoxygenate an apneic or hypoventilating patient for 2-3 minutes aim for 100% SpO2 • Place patient in the sniffing position by elevating head 1-2 inches or until the earlobes are at the level of the sternum. • Hold the laryngoscope with your left hand as far down the handle as possible insert the blade into the right side of the patient's mouth use the flange of the blade to sweep the tongue to the left side of the mouth while moving the blade into the midline (critical) • Continue to advance the blade until you identify the uvula, you should now be visualizing the posterior pharynx • Continue to advance the blade until the epiglottis comes into view (critical) • Place curved blade in vallecular space, straight blade directly under epiglottis • Lift until the glottic opening comes into view • If you can only see the epiglottis use a bougie to feel the ridges of the tracheal wall and guide the ET tube • After visualizing the glottic opening pick up the ET tube with your right hand with two fingers (like a pencil) insert the tube from the right corner of the mouth. As you see the tube pass trough the vocal chords rotate the tube to the right and direct the tip of the tube downward allowing it to descend into the trachea • Advance the ET tube .5 .75 inches (1-2cm) past the vocal chords. If you cannot see the vocal chords then do not insert the tube • The only way to be certain the tube has passed through the vocal chords is to see it pass through • Remove blade while holding the tube securely and remove stylet gently to avoid extubating patient • Inflate distal cuff 5-10 ML of air. • Note ET tube depth in CM at the patient's teeth • Attach BVM at the end of the ET tube with end title capnography and begin to ventilate • Look at the patient's chest to ensure that it rises with each ventilation at the same time listen with a stethoscope over lungs and stomach

Volume of distal cuff ET tube

• (838) 5-10ml

When to extubate a patient

• (839) A patient who is unreasonably intolerant of the ET tube (Combative, gagging, or retching) sedition is safer

Correct tube placement confirmation

• (839) Visualizing tube passing between vocal chords (1st and most reliable method of confirming tube entered trachea) • Auscultation (unequal or absent breath sounds suggest esophageal placement, Right mainstem placement, pneumothorax, or bronchial obstruction. Bilateral absent breath sounds or gurgling over the epigastrium indicates intubation of the esophagus.

Potential effects of moving an intubated patient

• (841) With a firmly secured tube the tip of the et tube can move as much as two inches during head flexion and extension, if the head is hyperflexed the tube can be pulled from the trachea completely, if hyperextended the tube could be pushed further into the trachea. Consider C-collar to keep the head in a neutral position • (858) reconfirm tube placement after any major movement

Indications for nasotracheal intubation

• (847) Patients who are breathing spontaneously but require definitive airway management. Pt's with ALOC intact gag reflex who are in respiratory failure because of conditions such as COPD, Asthma, or pulmonary edema

Indications for tube suctioning

• (858) Tracheobronchial suctioning involves placing suction catheter into the ET tube to remove pulmonary secretions. Preoxygenate prior to suctioning. Only perform if secretions are so massive that that interfere with ventilation

Airway management for trauma patient

• (878)For patients with massive maxillofacial trauma, Open cricothyrotomy is indicated especially if you do not have protocols for RSI

Signs and symptoms of subcutaneous emphysema

• (879) Air underneath the tissue, crackling sensation when palpated

Indications for needle cricothyrotomy

• (883) The inability to intubate a Pt by less invasive, facial trauma, inability to open Pt mouth and uncontrolled oropharyngeal bleeding

Hyperventilation syndrome

• (910) Patient breathing in excess of metabolic need, expelling more carbon dioxide then normal resulting in alkalosis. As Co2 dips pH rises. When its triggered by emotional distress or a panic attack it is referred to as hysterical hyperventilation or hyperventilation syndrome. Falling CO2 levels may make the person feel short of breath. If persist could result in tingling and numbness in the hands feet and mouth, chest pain and then carpopedal spasms. These symptoms frighten the patient even more resulting in loss of consciousness. Hyperventilation that is not caused by a metabolic crisis is self limiting

Signs and symptoms of reactive airway disease

• (940)Bronchospasms when exposed to certain triggers, increased mucus production, edema, inflammation of the airway

Treatment of asthma patient

• (941) Bronchospasms respond well to aerosol bronchodilators, Bronchial edema is much less responsive to aerosol bronchodilators and usually show significant response to corticosteroids, excessive mucus secretions can be treated with fluids

Respiratory drive copd Pt

• (943) Hypoxic drive is a state when a patient's stimulus to breathe comes from a decrease in Pao2 rather than from normal stimulus, in increase in Pao2 when. Fools the brain into thinking that the acid and base are in balance, the respiratory center might switch to hypoxic drive.

Signs and symptoms of acute respiratory distress syndrome

• (948) Caused by diffuse damage to the alveoli, perhaps as a result of shock, aspiration, pulmonary edema, barotrauma, or hypoxic event • Not usually seen in the field Difficult to ventilate due to stiff alveoli high concentrations of o2 can cause more damage

Signs and symptoms of spontaneous pneumothorax

• (948) JVD, no breath sounds on one side, Sharp pain followed with increased shortness of breath • Blebs are weak spots that can rupture under stress, such as coughing or aggressive BVM

Signs and symptoms and treatment of pulmonary embolism

• (949) Early presentation might reveal normal breath sounds. Classic presentation is sudden shortness of breath and cyanosis and possible sharp chest pain. Cyanosis does not resolve with O2.

Time limit to intubate

• (Lecture) 30 Seconds

Gold standard for successful intubation

• (Lecture) End title CO2

Signs and symptoms of emphysema

• Barrel chest, tachypneic, Pursed lip breathing, increased I/E ratio, abdominal muscle use, JVD

Indications for albuterol nebulizer

• Bronchospasms

Signs and symptoms and treatment of airway burns

• Coughing, wheezing, swelling of upper airway tissue, stridor

Dope mnemonic

• Dislodged, Obstruction, Pneumothorax, equipment failure

Potential effects of over inflation of the distal cuff

• Inflating the distal cuff with excess pressure may cause tissue necrosis of the tracheal wall.

Signs and symptoms of epiglottitis

• Severe, rapidly progressive inflammation of the epiglottis, may be fatal due to sudden airway obstruction. Sore throat, fever, drooling, hoarseness, purposeful hyperextension of the neck

Signs and symptoms of aspiration

• Sudden onset of difficulty of breathing, fever and cough several hours later

External respiration

• The exchange of gases between the alveoli of the lungs and the RBC's traveling through the pulmonary capillaries. As air reaches the alveoli it comes into contact with surfactant, which facilitates the exchange of oxygen and carbon dioxide

Signs and symptoms of pneumonia

• Weakness, productive cough, fever sometimes chest pain that worsens with coughing, shaking chills, crackles in the lungs, tactile fremitus, sputum production

Signs and symptoms for bronchoconstriction's and treatment

• Wheezing, shortness of breath, tripod, bronchodilators