8 - Respiratory Emergencies

Question 1

When a patient’s respiratory system is functioning on the hypoxic drive, what may be the result of administering too much oxygen to the patient?

Answer 1

Decrease in respiratory effort

Question 2

How does pulmonary edema affect the respiration process of breathing?

Answer 2

Build up of fluids causes the alveoli to become submerged, which causes the exchange of O2 and CO2 to become poor

Question 3

The text describes two situations, “wet lungs” vs. “dry lungs”. The text also gives an example of what may cause each of these situations. List an example of each.

Answer 3

Wet lungs: CHF, pulmonary edema, crackles

Wet lungs are in patients with pulmonary edema; it means there is excess fluid in the lungs.

Dry lungs: COPD, Bronchitis, emphysema, wheezing, stridor, rhonchi

Dry lungs are commonly found in COPD patients. They are dry due to inflammation and irritation.

Question 4

You are assessing a 13-year old patient who is exhibiting signs of tachypnea and anxiety. She is presenting dizziness, with numbness and tingling in her hands and feet. What is your working diagnosis?

Answer 4

Hyperventilation Syndrome

Question 5

When a COPD patient is utilizing the hypoxic drive, their impulse to breath is:

Answer 5

Triggered by low O2 levels

Question 6

Briefly explain the pathophysiology of emphysema.

Answer 6

Atelectasis: alveoli lose elasticity, diminishing their ability to exchange gases

Question 7

You are treating a 45-year old who is presenting chest pain. The patient states, the pain came on suddenly, it hurts when they move in any direction, it is sharp in nature, does not radiate and is a 9/10 on the pain scale. What is your working diagnosis?

Answer 7

Spontaneous pneumothorax

S/S: Pleuritic chest pain, sudden onset, does not radiate

(644)

*Need to double check

Question 8

List two life-threatening illnesses that would cause a patient to present with hyperventilation.

Answer 8

Diabetic - w/ a high glucose level (Hyperglycemia)

Severe infection - i.e. sepsis

Question 9

A 62-year old with a history of emphysema is presenting dyspnea. During your assessment, you notice the patient is unable to follow commands, is cyanotic and has severely labored respirations. How would you treat?

Answer 9

Place in a position of comfort

Supply high flow O2 using a BVM

Rapid Transport

Question 10

What is pleural effusion?

Answer 10

The collection of fluid outside the lungs on one or both sides of the chest. Limits lung expansion

(644)

Question 11

What is the treatment for an unconscious patient with a complete severe airway obstruction?

Answer 11

30/2 Chest compressions

Check for visible obstructions, clear if possible

Give oxygen with BVM

Question 12

The Hallmark signs of croup are what two signs? Croup is commonly seen in what age group?

Answer 12

Seal barking cough
Stridor

6 months to 3 years

(634)

Question 13

What are the three most common upper airway obstruction sounds?

Answer 13

Stridor,
Gurgling
Snoring

Question 14

During your assessment of a semiconscious patient, you discover the patient has overdosed on fentanyl. There are gurgling sounds present, and respirations are slow with poor tidal volume. Outline the appropriate treatment for this patient.

Answer 14

Clear and maintain the airway using a suction device to clear fluids.

Since the patient is semiconscious, consider the use of an NPA to help maintain.

Administer Narcan via nasal inhalant then provide high flow O2 using a BVM.

Repeat dosing of Narcan until patient is responsive.

Transport to hospital promptly while checking vitals and giving high quality O2.

Question 15

Your assessment of an alert 55-year-old with a history of emphysema and CHF reveals facial cyanosis with severely labored respirations. Upon auscultation of the lungs, you hear crackles bi-laterally. Which is the MOST appropriate treatment for this patient? What is your working diagnosis for this patient?

Answer 15

Acute Pulmonary Edema

CPAP, Rapid transport to cardiac center

Question 16

You are evaluating a 22-year-old who is severely dyspneic. The patient is complaining of a sudden onset of stabbing pain in the left chest that gets worse during inspiration and expiration, the pain is a 10/10 on the pain scale. Upon further assessment, you note bandages on the chest from a recent surgery. These findings are most indicative of what condition?

Answer 16

Pulmonary Embolism

Question 17

Naloxone
(Pharmacological Description)

Answer 17

Indication - reversal of opioid overdose
Contraindication - known hypersensitivity to drug
Action - opioid antagonist, bonds to opioid receptors
Route - Intranasal
Dose - 2 mg per dose, given every 2-3 minutes as necessary
Side Effect - nausea, vomiting, sweating, tachycardia, increased BP, tremors

Question 18

What is atelectasis?

Answer 18

Collapse of the alveoli

Question 19

Give an example of what might cause carbon dioxide levels to drop, in a healthy patient.

Answer 19

If a person is hyperventilating

Question 20

A 68-year-old patient with a history of COPD complains of dyspnea. There are signs of cyanosis around the lips, the RR is 28, HR is 90, BP is 158/94 and the SpOz is 90%. You decide to administer oxygen at 15 l/m via a non-rebreather mask. Explain what complications may arise from this treatment.

Answer 20

Vasoconstriction (extremely high bp, possible cardiac arrest)

Question 21

Explain how emphysema causes breathing complications.

Answer 21

Loss of elasticity in the alveolar membrane causes inadequate respiration to occur.

Question 22

A 23-year-old is exhibiting signs of tachypnea and anxiety. The RR is 34, HR is 114, BP is 128/78, with an SpOz of 96%. The patient is c/o dizziness, with painful spasms in the hands and feet. What is your working diagnosis

Answer 22

Hyperventilation syndrome (646)

Question 23

List two different signs that would help an EMT select pertussis as a diagnosis for a patient c/o dyspnea?

Answer 23

Strong cough (whooping cough)
Age (common in children)

Question 24

What are the three most common lower airway adventitious breath sounds and related conditions?

Answer 24

Crackles / Rales: Pulmonary edema
Wheezing: Asthma / COPD
Rhonchi: Pneumonia

Question 25

Which mnemonic is best used for a patient c/o dyspnea?

Answer 25

PASTE

Progression
Associated chest pain
Sputum
Talking tiredness
Exercise tolerance

Dyspnea: Shortness of breath

Question 26

You are assessing a patient who is c/o SOB. Your assessment reveals a fever, chronic coughing, night sweats, and recent weight loss. The HR is 102, BP is 114/68, RR is 36 with an SpO2of 98%. Upon learning these findings what should be your next action? What is your working diagnosis for this patient?

Answer 26

Tuberculosis

Wear n95 mask and give patient surgical mask and rapid transport with patient in position of comfort

Question 27

You are responding to a residence for a patient c/o dizziness. Upon arrival, the scene is safe and the patient states that the entire family is complaining of dizziness, headaches and nausea. Your management of these complaints should include:

Answer 27

carbon monoxide poisoning

Moving the patient’s away from the environment

Question 28

You are treating a 78-year-old with a history of emphysema and HTN. Your assessment reveals a patient that is anxious, cyanotic and has severely labored respirations with poor tidal volume. The HR is 98, BP is 182/126, RR is 36 with an SpO2 of 89%. The MOST appropriate treatment for this patient is:

Answer 28

CPAP

Question 29

You are treating a 14-year-old asthma patient who appears frightened, is frantically trying to breathe with no lung sounds heard on auscultation. The patient is cyanotic around the mouth and is lethargic. What is the MOST effective treatment for this patient? What is your working diagnosis?

Answer 29

Status asthmaticus

Call for ALS, Ventilations with BVM, treat with broncodilatador (Albuteral)

Question 30

You are evaluating a 22-year-old patient who is severely dyspneic. She is complaining of a sudden onset of stabbing pain in her left chest that gets worse during inspiration and expiration. She rates the pain 10/10 on the pain scale. Upon further assessment, you note bandages on her chest from a recent surgery. These findings are most indicative of what condition?

Answer 30

Pulmonary embolism

Question 31

Albuterol

Answer 31

Indication - Asthma attack

Contraindication - Patient exceeded dosage amount (3)

Action - Beta2 Agonist - Bronchodilator

Route - Inhalation

Dose - Up to three sprays per use

Side Effect - Dizziness