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Critical Care Paramedic > 2-1: Respiratory > Flashcards

2-1: Respiratory Flashcards

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1
Q

Which nerve innervates the diaphragm and where does it originate?

A

the phrenic nerve, originating at C3-C5

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2
Q

What are factors that can affect oxygen’s affinity for hemoglobin?

A
  • oxygen levels
  • carbon dioxide levels
  • temp
  • 2, 3 - DPG
  • pH
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3
Q

What does 2, 3 - DPG do to the oxygen?

A

it encourages it to offload from the hemoglobin

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4
Q

What does a left shift in the ODC mean for oxygen delivery?

A

hgb holds tighter to oxygen and there is less oxygen released to the tissues

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5
Q

What does a right shift in the ODC mean for oxygen delivery?

A

hgb releases oxygen easier resulting in more oxygen released to the tissues

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6
Q

What is the V/Q ratio and what does a V/Q mismatch most commonly cause?

A
  • the balance between ventilation in the lungs and perfusion in the body
  • mismatch is the most common cause of respiratory failure
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7
Q

What does a low V/Q look like?

A
  • poor ventilation
  • there is adequate blood flow, but the alveoli aren’t inflated to capacity to exchange gas
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8
Q

What does a high V/Q look like?

A
  • good ventilation
  • poor blood flow to alveoli makes them less able to get rid of what they need to get rid of
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9
Q

What is FiO2?

A

the concentration of oxygen in the gas mixture

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10
Q

What is PEEP?

A

Positive end-expiratory pressure (PEEP) is the alveolar pressure above atmospheric pressure that exists at the end of expiration. There are two types of PEEP:

●Extrinsic PEEP – PEEP that is provided by a mechanical ventilator is referred to as applied PEEP

●Intrinsic PEEP – PEEP that is secondary to incomplete expiration is referred to as intrinsic PEEP or auto-PEEP

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11
Q

What is the normal tidal volume for an adult?

A

400-500 mL

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12
Q

What are the indications for using oxygen?

A
  • saturation of <92%
  • known or expected anemia (trauma, GI bleed)
  • altitude sickness
  • paraquat/diquat, CO, or cyanide
  • abruptio placenta or prolapsed cord
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13
Q

What is COPD

A

a condition which results in a decreased forced expiratory volume per second

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14
Q

COPD - Chronic Emphysema
what happens physiologically and what can happen?

A
  • permanent enlargement of the air spaces that are distal to the terminal bronchioles
    • destruction of the alveolar walls
    • partial collapse of terminal
      bronchioles
    • loss of elastic recoil of the lungs
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15
Q

What are some abnormalities associated with emphysema?

A
  • increased air trapping
  • loss of recoil
  • loss of alveolar surface area due to alveolar and capillary destruction
  • bullae formation
  • increased dead space
  • increased work of breathing
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16
Q

What might you hear upon auscultation of a pt with emphysema?

A

distant, diminished breath sounds and diffuse wheezing

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17
Q

What will the radiograph of a pt with emphysema show?

A

flattened, low diaphragm
hyperlucent lung fields
wide intercostal spaces
long, narrow heart shadow

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18
Q

What is the clinical definition of chronic bronchitis?

A

the presence of a productive cough for three months out of the year for two years in a row.

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19
Q

What is the pathophysiology of chronic bronchitis?

A

chronic irritation results in hyperplasia of the tracheobronchial mucus glands and goblet cells
this results in an increase in mucus production

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20
Q

What will you hear when listening to the chest of someone with chronic bronchitis?

A

course crackles, wheezing over smaller airways, ronchi over larger airways

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21
Q

What circumstances will cause hyperglycemia in a pt with chronic bronchitis? What will cause hypoglycemia?

A

hyperglycemia:
- stress response/elevated cortisol levels
- use of B-agonists/corticosteroids

hypoglycemia:
- increased work
- poor stores

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22
Q

When should you consider RSI for your COPD patient?

A
  • respiratory failure
  • fatigue
  • AMS
  • worsening respiratory acidosis
  • hypoxemia refractory to supplemental O2 administration
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23
Q

What are your vent settings for a COPD patient?
TV:
Rate:
Mode:
FiO2:

A

TV: 5-8 mL/kg
Rate: 12-18/min
Mode: VC or PRVC
FiO2: 1.0 (1.0 means 100% oxygen, 0.8 means 80% oxygen, and so on…)

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24
Q

How long do corticosteroids such as methylprednisolone take to have effect?

A

6-8 hours

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25
Q

what does AMS in the asthma patient indicate?

A

severe hypoxia and impending respiratory arrest

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26
Q

What might you hear when listening to the lungs of an asthma patient?

A

diffuse wheezing
ronchi may be heard if mucus present
“silent chest” ominous finding

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27
Q

Treatment for an asthma patient is similar to that for a COPD patient EXCEPT?

A
  • asthmatics don’t require antibiotics
  • mag sulfate used more in asthma
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28
Q

What is pulmonary arterial hypertension?

A

the pulmonary arteries have a higher-than-normal pressure, causing an increased workload for the right side of the heart.

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29
Q

What are factors that can cause PAH?

A
  • decreased prostacyclin
  • increased thromboxane
  • vasoconstriction —> thrombosis
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30
Q

less severe PAH patients can be managed with what medications (3)?

A

calcium channel blockers, endothelin antagonists, and phosphodiesterase inhibitors

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31
Q

More severely ill PAH patients require what kind of therapy?

What are some other meds?

A

prostacyclin therapy

flolan
veletri (epoprostinol)
remodulin (treprostinil)
ventavis (Iloprost)

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32
Q

What two things should you NEVER do when transporting a patient with PAH on a med pump?

A
  • NEVER titrate infusion without med control
  • NEVER flush the IV line in which the med is being administered
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33
Q

What is the second most common cause of sudden unexpected natural death at any age?

A

pulmonary embolus (second to CAD)

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34
Q

What is a pulmonary embolism?

A

the occlusion of the pulmonary artery or one of its branches by an embolus carried by the bloodstream.

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35
Q

What type of V/Q mismatch do we see in patients with a PE?

A
  • blood flow decreased to the alveoli
  • ventilation unaffected
36
Q

What does a PE do to the RV afterload?

A

increases it

37
Q

What are the most common symptoms of a PE?

A
  • dyspnea
  • pleuritic chest pain
  • cough
  • hemoptysis
38
Q

What is the most important diagnostic tool in the investigation of a pulmonary embolism?

A

the history

39
Q

What is the gold standard diagnostic test for identifying a PE?

A

CT scan or CT angiography

40
Q

What do the early and late radiographs of a PE show?

A

early: initially normal
late:
- atelectasis
- westermark sign (pulmonary vessel dilation and a sharp cutoff)
- pleural effusion

41
Q

How do we feel about using ABGs in the setting of a PE?

A

don’t use em, they can be unreliable

42
Q

What are the most common EKG abnormalities seen with PE?

A
  • sinus tachycardia
  • non-specific ST changes

the ABSENCE of EKG abnormalities doesn’t mean anything in the setting of a PE

43
Q

What can happen if you give fluids to someone with a massive PE?

A

a drop in BP

44
Q

What is the priority after securing the airway and ensuring adequate ventilation in someone with a massive PE?

A

eliminating the clot and preventing further thrombosis

45
Q

What can cause ARDS?

A

any condition that produces a systemic inflammatory response:
- increased ICP
- sepsis (most common)
- COVID
- prolonged hypotension/shock
- and more

46
Q

Is ARDS an inflammation process or an infection process?

A

inflammation

47
Q

How might you describe the lungs in the acute phase of ARDS?

A

congested and heavy

48
Q

Which study findings will point towards a clinical diagnosis of ARDS?

A

gas exchange values and radiograph

49
Q

Is a radiograph reliable for distinguishing ARDS?

A

No, don’t know if the bilateral infiltrates are from ARDS or cardiogenic pulmonary edema

50
Q

What happens if the vented ARDS pt is positioned laying supine and why?

A

the ventral alveoli are over-inflated and the dorsal alveoli are collapsed under the weight of the fluid in the lungs.

51
Q

Why are vented ARDS patients put in the prone position?

A

gravity causes the fluid to shift into the ventral aspect of the lungs, which doesn’t affect as many of the lung fields
more alveoli are recruited

52
Q

What are the two types of pneumonia?

A
  1. community-acquired
  2. hospital-acquired
53
Q

What are some risk factors associated with aspiration pneumonia?

A
  • stroke with deficits
  • esophageal motility/swallowing disorders
  • seizures/syncope
  • intubation
54
Q

What are some risk factors associated with bacteremia pneumonia?

A

indwelling devices:
- vascular devices
- GI/GU devices
- intrathoracic devices

55
Q

What will auscultation of the pneumonia pt sound like?

A

crackles, ronchi, diminished breath sounds

56
Q

The head of the bed should be elevated ____ degrees for pneumonia patients?

A

30

57
Q

What does iatrogenic mean?

A

illness caused by a medical treatment or procedure

58
Q

What things might cause a spontaneous and iatrogenic pneumothorax?

A
  • PPV
  • mechanical ventilation
  • central line placement
  • NG tube placement
  • tracheostomy
  • bronchoscopy
  • CPR
59
Q

What disease is most commonly associated with spontaneous pneumothorax?

A

COPD

60
Q

What is the pathophysiology of a pneumothorax

A
  • air in the intrapleural space
  • there are negative pressures in the intrapleural space and greater pressures in the alveoli
  • in a pneumo, air moves from the alveoli into the pleural space
  • as the lung collapses, the pneumo increases
61
Q

How do young and healthy people usually tolerate a pneumothorax?

A

“quite well” with mild tachycardia and tachypnea

62
Q

Which types of patients are at risk for developing a simple pneumothorax?

A
  • mechanically ventilated patients
  • patients flown at altitude
63
Q

What diagnostic studies are required for the dx of tension pneumo?

A

none

64
Q

what is the immediate treatment of a tension pneumothorax?

A

needle decompression

65
Q

What is a tube thoracostomy used for?

A

removal of abnormal accumulations:
- blood
- air
- fluid

66
Q

What position should the head of the bed be raised for a stable patient receiving a tube thoracostomy?

A

30 - 60 degrees

67
Q

Where is a tube thoracostomy placed when the goal is air removal? what size tube?

A

2nd intercostal space at the midclavicular line

  • 16-20 Fr
68
Q

Where is a tube thoracostomy placed when the goal is fluid removal?
What size tube?

A

4th/5th intercostal space at the midaxillary line

  • 20-36 Fr
69
Q

If unsure of the patient’s anatomy, it is better to place a thoracostomy tube ______ (high or low). Why?

A

High
too low may result in:
- injury to the diaphragm
- intra-abdominal placement

70
Q

what are the contraindications to tube thoracostomy?

A

none in the unstable trauma patient

71
Q

What is the valve in a tube thoracostomy called and why is it used?

A

Heimlich valve
- one way valve allows for flow outside of the chest, prevents air from entering the chest

72
Q

What is the mnemonic for assessing the drainage unit of a chest tube?

A

FOCAL
F- fluctuation (height of fluid level in drainage tube fluctuates with respiration)
- Absence of fluctuation indicates that the system is blocked or the lung is fully expanded
O- output (assess amount and consistency)
C- color
A- air leak (if present, repair)
L- levels
Ensure adequate water levels in the chambers and proper negative pressure levels

73
Q

What are some ways you can troubleshoot a tube thoracostomy

A
  • look/listen for air leak
  • make sure all connections are tight
  • make sure all distal fenestrations of the tube are within the thorax
  • tape connections where a leak is possible
  • clamp tube to the chest
74
Q

What is the difference between anaphylaxis and anaphylactoid

A

Anaphylaxis is immune-mediated (by Ig-E) and anaphylactoid is a similar reaction but is not immune-mediated

75
Q

What is a normal inspiration to expiration (I:E) ratio?

A

1:2 - expiration is 2x as long as inspiration

76
Q

what is characterized by increased air trapping secondary to bronchiole collapse and loss of recoil and reduction of total alveolar-capillary membrane surface area secondary to alveolar and capillary destruction?

A

Chronic emphysema

77
Q

Which disease is characterized by cyanosis and peripheral edema, giving rise to the “blue bloater” phrase?

A

chronic bronchitis

78
Q

What are three pathological changes that contribute to airflow obstruction in the asthmatic

A
  • mucous plugging
  • bronchospasm
  • airway inflammation and edema
79
Q

What is the number 1 cause of ARDS?

A

Sepsis

80
Q

What skills do prehospital providers do that may result in an iatrogenic pneumothorax?

A
  • CPR
  • PPV
  • NG tube placement
81
Q

What are the s/s of a pneumo in a mechanically vented patient?

A
  • fighting the vent
  • tachycardia
  • hypotension
  • hypoxia
  • acute increase in the inspiratory and/or static airway pressure
  • cardiovascular collapse
82
Q

what methods can be used to confirm chest tube placement?

A
  • drag a finger along length of tube as finger is removed from pleural space
  • observe condensation in the tube
  • free flow of blood or fluid
  • ability to rotate tube freely
  • pt is improving
  • auscultation of lung sounds
  • chest radiograph
83
Q

Will a vented COPD patient require higher or lower vent rates and why?

A

lower, to prevent breath stacking

84
Q

What is the reason for death occurring in a tension pneumothorax?

A

due to decreased preload leading to decreased cardiac output

85
Q

What is the typical amount of wall suction required for a chest tube?

A

20 cmH2O

Critical Care Paramedic (20 decks)

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