Chapter 15 Respiratory Emergencies

carbon monoxide

An odorless, colorless, tasteless, and highly poisonous gas that results from incomplete oxidation of carbon in combustion.

What is atelectasis?

Atelectasis is the collapse of the alveolar air spaces of the lungs.

What is the most appropriate method for oxygen delivery to an adult patient experiencing breathing difficulty?

In an adult patient with breathing difficulty, you should administer high-flow oxygen at 15 L/min through a nonrebreathing mask.

In a healthy individual, the brain stem stimulates breathing on the basis of:

increased carbon dioxide levels

Treatment for spontaneous pneumothorax

Provide supplemental oxygen and prompt transport to the hospital. Patients are usually more comfortable sitting up

Albuterol is a generic name for:

Ventolin; Proventil

influenza type A

Virus that has crossed the animal/human barrier and has infected humans, recently reaching a pandemic level with the H1N1 strain.

Which of the following is MOST characteristic of adequate breathing?

24 breaths/min with bilaterally equal breath sounds and pink skin

When assisting an asthmatic patient with a small-volume nebulizer attached to oxygen, what is the appropriate flow rate for the oxygen?

6 L/min

pleural effusion

A collection of fluid between the lung and chest wall that may compress the lung.

embolus

A blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage.

pulmonary embolism

A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing a sudden blockage of the pulmonary artery and an obstruction of blood flow

tuberculosis

A chronic bacterial disease, caused by Mycobacterium tuberculosis, that usually affects the lungs but can also affect other organs such as the brain and kidneys; it is spread by cough and can lie dormant in a person's lungs for decades and then reactivate.

Carbon Dioxide Retention

A condition characterized by a chronically high blood level of carbon dioxide in which the respiratory center no longer responds to high blood levels of carbon dioxide.

Hypoxic Drive

A condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive; seen in patients with chronic lung diseases.

Hypoxia

A dangerous condition in which the body's tissues and cells do not have enough oxygen.

Epiglottitis

A disease in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction

emphysema

A disease of the lungs in which there is extreme dilation and eventual destruction of the pulmonary alveoli with poor exchange of oxygen and carbon dioxide; it is one form of chronic obstructive pulmonary disease.

stridor

A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope.

Wheezing

A high-pitched, whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of the lower airways; occurs in asthma, bronchiolitis, and chronic obstructive pulmonary disease.

metered-dose inhaler (MDI)

A miniature spray canister through which droplets or particles of medication may be inhaled through the mouth and into the lungs.

Pneumothorax

A partial or complete accumulation of air or gas in the pleural space.

small-volume nebulizer

A respiratory device that holds liquid medicine that is turned into a fine mist. The patient inhales the medication into the airways and lungs as a treatment for conditions such as asthma

chronic obstructive pulmonary disease (COPD)

A slow process of dilation and disruption of the airways and alveoli caused by chronic bronchial obstruction.

allergens

A substance that causes an allergic reaction.

Respiratory syncytial virus

A virus that causes an infection of the lungs and breathing passages; can lead to other serious illnesses that affect the lungs or heart, such as bronchiolitis and pneumonia; highly contagious and spread through droplets.

adventitious breath sounds

Abnormal breath sounds such as wheezing, stridor, rhonchi, and crackles.

croup

An inflammatory disease of the upper respiratory system that may cause a partial airway obstruction and is characterized by a barking cough; usually seen in children.

Which of the following medications can be used for the treatment of an acute asthma attack?

Albuterol

Medications typically administered by small-volume nebulizer include, but are not limited to

Albuterol Metaproterenol Epinephrine

Medications that may be administered via a metered-dose inhaler (MDI) include:

Albuterol (Proventil, Ventolin) Albuterol/ipratropium (Combivent) Metaproterenol (Alupent, Metaprel) Terbutaline (Brethine)

Which of the following is a common MDI drug?

Alupent

In what area of the lungs does respiration occur?

Alveoli

Asthma

An acute spasm of the smaller air passages, called bronchioles, associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages.

pertussis

An airborne bacterial infection that affects mostly children younger than 6 years, in which the patient is feverish and exhibits a "whoop" sound on inspiration after a coughing attack; highly contagious through droplet infection.

hay fever

An allergic response usually to outdoor airborne allergens such as pollen or sometimes indoor allergens such as dust mites or pet dander; also called allergic rhinitis.

Anaphylaxis

An extreme, life-threatening, systemic allergic reaction that may include shock and respiratory failure.

pneumonia

An infectious disease of the lung that damages lung tissue; its cause can be bacterial, viral, or fungal.

Patients with COPD:

Are usually older than 50 years Will often have a history of recurring lung problems Are almost always long-term active or former cigarette smokers Often have a barrel-like appearance in the chest Use accessory muscles to breathe Exhale through pursed lips as a strategy to keep airways open longer

While auscultating an elderly woman's breath sounds, you hear low-pitched "rattling" sounds at the bases of both of her lungs. This finding is MOST consistent with which of the following conditions?

Aspiration pneumonia

Which of the following statements is true regarding asthma?

Asthma is an acute spasm of the smaller air passages, called bronchioles, associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages.

Pulmonary embolism treatment

Because a considerable amount of lung tissue may not be functioning, supplemental oxygen is mandatory in a patient with a pulmonary embolism

crackles

Crackling, rattling breath sounds signaling fluid in the air spaces of the lungs; formerly called rales.

In addition to asthma, which of the following conditions is associated with wheezing?

Bronchitis

Treatment for acute pulmonary edema

CPAP

CPAP is generally used for which condition?

CPAP is a noninvasive means of providing ventilatory support for patients experiencing respiratory distress associated with obstructive pulmonary disease and acute pulmonary edema.

Which of the following is a genetic disorder that predisposes the patient to repeated lung infections?

Cystic fibrosis

Bronchitis Signs and Symptoms

Chronic cough (with sputum production) wheezing cyanosis tachypnea (increases breathing rate)

rhonchi

Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways

Congestive Heart Failure Signs and Symptoms

Dependent edema Crackles (pulmonary edema) Orthopnea Paroxysmal nocturnal dyspnea

Diphtheria Signs and symptoms

Difficulty breathing and swallowing Sore throat Thick, gray buildup in throat or nose Fever

Ventilation

Exchange of air between the lungs and the environment, spontaneously by the patient or with assistance from another person, such as an EMT.

The most common form of COPD is______.

Emphysema

Decreased, absent, or abnormal breath sounds are also called vesicular breath sounds.

FALSE

Snoring sounds are indicative of a partial lower airway obstruction, usually in the bronchioles.

FALSE

Bronchiolitis

Inflammation of the bronchioles that usually occurs in children younger than 2 years and is often caused by the respiratory syncytial virus.

The two processes that occur during respiration are:

Inspiration and Expiration

You are assessing a patient with respiratory distress and are unsure if the cause is congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). Which of the following clinical signs would be the MOST helpful in determining whether the patient has CHF or COPD?

Jugular Vein Distention

Which of the following must be assessed in every respiratory patient?

Lung sounds

vesicular breath sounds

Normal breath sounds made by air moving in and out of the alveoli.

bronchial breath sounds

Normal breath sounds made by air moving through the bronchi.

The upper airway consists of all anatomic airway structures above the level of the vocal cords, including:

Nose Mouth Jaw Oral cavity Pharynx Larynx

OPQRST

O-onset;P-provocation or palliation; Q-Quality, R-radiating/region, S-Severity, T-time

A 60-year-old male presents with acute respiratory distress. He is conscious and alert, has pink and dry skin, and has respirations of 22 breaths/min with adequate depth. Which of the following treatments is MOST appropriate for this patient?

Oxygen via nonrebreathing mask and a focused secondary assessment

PASTE

P-progression A-associated chest pain S-Sputum T-Talking tiredness E-Exercise tolerance

Which of the following statements regarding pulse oximetry is correct?

Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen, but does not measure the actual hemoglobin content of the blood.

hyperventilation

Rapid or deep breathing that lowers the blood carbon dioxide level below normal; may lead to increased intrathoracic pressure, decreased venous return, and hypotension when associated with BVM use.

Hyperventilation treatment

Reassuring the patient in a calm, professional manner Supplying supplemental oxygen Providing prompt transport to the ED

The hypoxic drive _______.

Secondary Respiratory drive

pleuritic chest pain

Sharp, stabbing pain in the chest that is worsened by a deep breath or other chest wall movement; often caused by inflammation or irritation of the pleura.

Treatment with continuous positive airway pressure (CPAP) would MOST likely be contraindicated in which of the following situations?

Shortness of breath and a blood pressure of 76/56 mm Hg

Dyspnea

Shortness of breath or difficulty breathing.

A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and pleuritic chest pain following a forceful cough. Your assessment reveals that he has a barrel-shaped chest, unilaterally diminished breath sounds, and tachycardia. What is the MOST likely cause of this patient's condition?

Spontaneous pneumothorax

Adult patients breathing more than 20 breaths/min or fewer than 12 breaths/min should receive high-flow oxygen.

TRUE

acidosis

The buildup of excess acid in the blood or body tissues that results from a primary illness; a pathologic condition that results from the accumulation of acids in the blood and body tissues.

alkalosis

The buildup of excess base (lack of acids) in the body fluids.

Respiratory system structures include

The diaphragm The muscles of the chest wall The accessory muscles of breathing The nerves from the brain and spinal cord to those muscles

oxygenation

The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs; the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream

hyperventilation syndrome (panic attack)

This syndrome occurs in the absence of other physical problems. The respirations of a person who is experiencing this syndrome may be as high as 40 shallow breaths/min or as low as only 20 very deep breaths/min.

Environmental/industrial exposure treatment

Treat with oxygen, adjuncts, and suction on the basis of presentation, level of consciousness, and level of distress that is observed in your patient.

Pleural effusion treatment

Treatment of pleural effusion consists of removal of fluid collected outside the lung, which must be done by a physician in a hospital setting. Provide oxygen and other routine support measures to these patients.

Which of the following filters, warms, and humidifies air during inhalation?

Upper airway

Which type of breath sound are you more likely to hear in a person with congestive heart failure?

You are more likely to hear crackles in a patient with congestive heart failure.

Crackles (rales) are caused by _________.

air passing through fluid

When auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds. This means that the patient has:

abnormal breath sounds.

pandemic

an outbreak that occurs on a global scale

Treatment for COPD

assist with prescribed inhaler if available

The respiratory system consists of the structures of the body that contribute to the _____________process

breathing

His parents tell you that their son has had a chest infection for the past two days and when they took him to their family doctor, they were told it was likely due to the respiratory syncytial virus (RSV). They have kept him well hydrated, but the infection seems to have gotten worse. On auscultation, you hear decreased air entry bilaterally with fine expiratory wheezes and the occasional coarse wet crackle. Based on this information, your patient is most likely suffering from:

bronchiolitis.

The respiratory distress that accompanies emphysema is caused by:

chronic stretching of the alveolar walls.

Atelectasis

collapse of the alveolar air spaces of the lungs

You arrive at a residence where you find a woman in her early 60s. She is anxious, tachycardic, and her fingertips and lips are blue. As you assess her, she coughs up frothy sputum, and you hear crackles and some wheezing as you check for breath sounds. What condition do these findings indicate?

congestive heart failure

A young female is unconscious after intentionally ingesting a large amount of aspirin. You will MOST likely find her respirations:

deep and rapid

A conscious and alert 29-year-old female with a history of asthma complains of difficulty breathing that began after her morning jog. The temperature outside is 40°F (5°C). On exam, you hear bilateral expiratory wheezing. After providing supplemental oxygen, you should:

determine if she has been prescribed a beta-agonist inhaler.

You are attending to a 28-year-old female patient in severe respiratory distress. The patient has had a high fever all day, and the respiratory distress came on very quickly. Your patient is now sitting in a chair, leaning forward with her hands on her knees. She is making high-pitched sounds with each breath and does not seem to be moving very much air. Based on this information, your patient is likely suffering from

epiglottis

A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past medical history and takes no medications. During your assessment, you hear wheezing over all the lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him high-flow oxygen, the MOST important treatment for this patient is:

epinephrine.

At the onset of an acute asthma attack, patients commonly experience difficulty breathing and:

expiratory wheezing.

A pleural effusion is MOST accurately defined as:

fluid accumulation outside the lung.

Your patient has a chronic respiratory condition. His stimulus to breathe is triggered by low oxygen levels in the blood. This is known as the ___________.

hypoxic drive

Asthma is caused by a response of the:

immune system.

Snoring sounds

indicative of a partial upper airway obstruction, usually in the oropharynx.

You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient takes a deep breath and depresses the inhaler, you should:

instruct him to hold his breath for as long as he comfortably can.

Pulmonary Edema

is the collection of fluid buildup in and around the alveoli.

Your patient is complaining of fatigue. She is breathing at 18 breaths per minute, has equal chest rise and fall, and has clear lung sounds. She is presenting with signs of ___________.

normal breathing

In order for efficient pulmonary gas exchange to occur:

oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.

You are attending to a 5-year-old male patient who has had a cold and fever for the last two days. His parents became concerned when he started having coughing spells that would last for over a minute, during which he would turn blue. After the coughing attack, his parents reported that he seemed to be sucking the air back in. Based on this information, your patient is most likely suffering from:

pertussis

A ________ is a collection of fluid between the lung and chest wall that may compress the lung.

pleural effusion

Your elderly patient recently had surgery. She now complains of a sudden onset of dyspnea and sharp chest pain. You should suspect ___________.

pulmonary embolus

"PASTE" is an alternate assessment tool for ___________.

respiratory patients

You are attending to a 6-year-old female patient. Her parents tell you that she has been sick for the last three days with the respiratory infection that has been going around her school. They became concerned when she stopped drinking fluids, and they could not get her to take in any liquids. The patient is showing signs of significant dehydration. Based on this information, your patient is most likely suffering from:

respiratory syncytial virus (RSV) infection.

Which of the following conditions would be LEAST likely to result in hypoxia?

severe anxiety

In the mnemonic PASTE, what does the "S" stand for?

sputum

Harsh, high-pitched inspiratory sounds are characteristic of:

stridor

During the primary assessment, you determine your patient has a life-threatening emergency. You should now:

transport rapidly

You are attending to a 54-year-old female patient in a homeless shelter. The patient tells you that she had the flu a couple of weeks ago, and she has not gotten over it. She has been tired and keeps waking up at night, sweating. She has been coughing up green sputum occasionally and has been experiencing episodes of chest pain that get worse when she breathes. Based on this information, your patient is most likely suffering from:

tuberculosis.

You are attending to a 3-year-old male patient who is presenting with severe shortness of breath. His parents report that he has had a cough and cold with a low grade fever for the past two days. They became worried today, as his level of distress has increased dramatically. On assessment, the patient is sitting upright and making high-pitched noises with each breath. Based on this information, the patient is most likely suffering from:

viral infection of the upper respiratory tract.