Airway and Breathing Flashcards
Which of the following acid-base abnormalities would cause a patient to present with a slowing of the respiratory rate? A. Respiratory alkalosis B. Metabolic alkalosis C. Metabolic acidosis D. Respiratory acidosis
Answer: B
Metabolic alkalosis occurs any time there is an excess loss of acid from the body. For example, excessive intake of antacids can result in metabolic alkalosis. The body’s compensatory system for metabolic alkalosis is the respiratory system. To correct the reduced acid level, slowing of the respirations (bradypnea) occurs in order to retain carbon dioxide and increase the levels of circulating acids. Metabolic acidosis would cause an increase in the respiratory rate (tachypnea) in an attempt to eliminate excess acids from the body. Respiratory acidosis is caused by hypoventilation; it does not cause hypoventilation. Respiratory alkalosis is caused by hyperventilation.
Which process occurs during normal breathing?
A. Negative intrathoracic pressure allows blood to be pulled back to the heart.
B. The walls of the airway are forced out of their normal anatomic shape.
C. Increased pressure in the chest cavity impairs venous return to the heart.
D. Inhalation forces the esophagus open, which allows air to enter the stomach.
Answer: A During normal (unassisted) breathing, negative pressure is created in the thoracic cavity during inhalation; this allows blood to naturally be pulled back to the heart. By contrast, positive-pressure ventilation (ie. BVM) forces air into the chest cavity and has the opposite effect of negative-pressure ventilation.
Positive pressure ventilation causes an increase in intrathoracic pressure, which impairs venous return to the heart (preload) and can cause a decrease in cardiac output. Because positive-pressure ventilation requires more volume to have the same effect as normal breathing, the walls of the airway are forced out of their normal anatomic shape. During normal breathing, esophageal opening pressure is not affected. During positive-pressure ventilation however, the esophagus is forced open, which allows air to enter the stomach (gastric distention).
The low normal partial pressure of oxygen in arterial blood is:
A: 80 mm Hg.
B: 60 mm Hg.
C: 120 mm Hg.
D: 100 mm Hg.
Answer: A
Arterial blood should have a high partial pressure of oxygen (PaO2) because it has been reoxygenated in the lungs. The normal partial pressure of arterial blood should range between 80 and 100 mm Hg. A PaO2 less than 80 mm Hg indicates hypoxia.
After your initial attempt to provide artificial ventilations to an unresponsive apneic patient, you note a significant decrease in compliance with no movement of the chest. You should:
A: suction the oropharynx and reattempt ventilations.
B: provide the second breath with greater volume.
C: insert an oral airway and reattempt to ventilate.
D: reevaluate the position of the patient’s head.
Answer: D
If your initial attempt to ventilate an unresponsive patient is met with resistance and the chest does not visibly rise, you should first reposition the patient’s head and reattempt to ventilate. Remember that the most common cause of airway obstruction in unresponsive patients is the tongue. If manual repositioning of the head is unsuccessful, you should assume that a severe (complete) foreign body airway obstruction is present and begin chest compressions. If you are able to make the chest visibly rise with your ventilations, you should insert an oral or nasal airway (or both) to help maintain airway patency. Suctioning is indicated if there are secretions in the airway, as evidenced by gurgling breathing.
A 49-year-old woman complains of chest pressure. She is conscious and alert; is breathing without difficulty; and has pink, warm, dry skin. You apply the pulse oximeter and obtain a reading of 84%. Which of the following conditions could cause this?
A: Chronic anemia.
B: Vasodilation.
C: Clear nail polish.
D: Polycythemia.
Answer: A
When assessing a patient’s oxygen saturation with a pulse oximeter, it is important to recall that pulse oximetry is an adjunct, not a replacement, to a good clinical assessment. The patient in this scenario is not showing signs of hypoxemia (cyanosis, altered mental status, and so forth), even though her oxygen saturation is low. Conditions that can cause inaccurate pulse oximetry readings include anemia; peripheral vasoconstriction; dark or metallic fingernail polish; dirty fingers; and abnormal hemoglobin binding (carbon monoxide poisoning). Polycythemia is an increase in red blood cell production; if anything, you would expect the pulse oximeter to produce a high reading in patients with this condition.
Immediately after inserting a King LT airway to the proper depth, you should:
A: place a bite block in between the patient’s molars.
B: ensure that the base of the connector is 1 inch above the teeth.
C: inflate the cuffs with the recommended amount of air.
D: attach the bag-mask device and begin to ventilate.
Answer: C
The King LT airway is inserted until the base of the connector is aligned with the teeth or gums. After inserting the device, inflate both cuffs with the recommended amount of air. The cuffs are inflated simultaneously using a common inflation port; the amount of air used is dictated by the size of the airway device. It is normal to see the King LT airway retract slightly out of the mouth during inflation of the cuffs. After inflating the cuffs, attach the bag-mask device and begin ventilating the patient. You can consider placing a bite block in between the patient’s molars.
A 21-year-old man is found semiconscious with shallow, gurgling respirations. After opening his airway, you should:
A: assess his oxygen saturation.
B: begin assisting his ventilations.
C: insert a King LT airway.
D: suction his oropharynx.
Answer: D
To manage a patient’s airway effectively, you must ensure that it is open and clear of foreign bodies, blood, or other secretions. The presence of gurgling indicates that the airway contains large amounts of fluid; this is an immediate threat to the airway and must be treated before proceeding with further airway assessment. Turn the patient onto his side and suction his oropharynx for up to 15 seconds. After his airway is clear of secretions, you should then assist his shallow ventilations with a bag-mask device and high-flow oxygen, and assess his oxygen saturation with pulse oximetry. The King LT airway, as with any supraglottic or multilumen airway device, is contraindicated in patients with an intact gag reflex; a semiconscious patient likely has an intact gag reflex.
A patient with respiratory distress has a pH of 7.29, a PaCO2 of 58 mm Hg, and a PaO2 of 60 mm Hg. These laboratory values are consistent with:
A: metabolic alkalosis.
B: respiratory alkalosis.
C: respiratory acidosis.
D: metabolic acidosis.
Answer: C
A pH of 7.29 indicates acidosis. A decreased ( 45 mm Hg) PaCO2 indicates that the patient is retaining carbon dioxide. The “ROME” mnemonic (respiratory opposite, metabolic equal) is useful for determining whether the problem is of a respiratory or metabolic origin. If the pH and PCO2 are going in opposite directions (increased pH and decreased PCO2 or decreased pH and increased PCO2), the patient’s problem is of a respiratory origin. If the pH and PCO2 are going in the same (equal) direction (increased pH and increased PCO2 or decreased pH and decreased PCO2), the patient’s problem is of a metabolic origin. Because this patient’s pH is decreasing and his PaCO2 is increasing (going in opposite directions), you can conclude that his problem is of a respiratory origin. Because his pH is less than 7.35, you can further conclude that he has a respiratory acidosis.
An unresponsive patient with slow, shallow breathing would be expected to have:
A: decreased pH, increased PaCO2, and decreased PaO2.
B: increased pH, increased PaCO2, and normal PaO2.
C: increased pH, decreased PaCO2, and normal PaO2.
D: decreased pH, decreased PaCO2, and increased PaO2.
Answer: A
Inadequate ventilation (slow rate of breathing, shallow depth of breathing [reduced tidal volume]) initially leads to respiratory acidosis if not treated with ventilatory assistance. Any form of acidosis presents with a decreased pH, which indicates an increase in hydrogen ion concentration in the blood. Remember that hydrogen ion concentration and pH are inverse; where one goes, the other goes in the opposite direction. Respiratory acidosis stems from an inability to breathe in enough oxygen, which causes a decrease in the partial pressure of oxygen (PaO2). If the patient is not breathing in enough oxygen, carbon dioxide elimination decreases, resulting in an increase in the partial pressure of carbon dioxide (PaCO2).
When you transport a patient with a nasal cannula for a prolonged period of time, you should:
A: set the flow rate to no greater than 2 L/min.
B: ensure that the patient is supine.
C: set the flow rate to at least 4 L/min.
D: attach an oxygen humidifier.
Answer: D
Because oxygen delivered by nasal cannula can cause drying and irritation of the nasal mucosa, especially over a prolonged period of time, an oxygen humidifier should be attached during long-range transports. The appropriate oxygen flow rate for a nasal cannula is 1 to 6 L/min. The patient should be placed in the position in which they are most comfortable.
Which of the following describes the process of pulmonary respiration?
A: The transfer of carbon dioxide from the alveoli into the bloodstream is facilitated by a process called diffusion.
B: Gases exchanged in the lungs always move from an area of greater concentration to an area of lesser concentration.
C: Blood that returns to the lungs from the right side of the heart has a slightly lower level of carbon dioxide than oxygen.
D: The partial pressure of oxygen in the alveoli is typically between 40 and 50 mm Hg at the end of a maximal inhalation.
Answer: B
Gases exchanged in the lungs (pulmonary respiration) always move from an area of greater concentration to an area of lesser concentration by a process called diffusion. Blood that enters the lungs from the right side of the heart has a PaO2 of approximately 40 mm Hg and a PaCO2 of approximately 46 mm Hg. Within the lungs, carbon dioxide diffuses from the bloodstream into the alveoli, whereas oxygen diffuses from the alveoli into the bloodstream. The partial pressure of oxygen within the alveoli is near 100 mm Hg, whereas the partial pressure of carbon dioxide is near 0 mm Hg.
Which of the following conditions is the LEAST likely to skew the pulse oximetry reading?
A: Fingernail polish
B: Peripheral vasoconstriction
C: Carbon monoxide poisoning
D: Severe hypertension
Answer: D
Hypertension typically does not affect the pulse oximeter reading. Fingernail polish, especially thick red polish, does not allow the beam of light from the pulse oximeter to penetrate the nail bed. Carbon monoxide, which increases the carboxyhemoglobin level, turns the blood bright red; this is often misinterpreted by the pulse oximeter as a falsely high oxygen saturation. By contrast, peripheral vasoconstriction shunts blood away from the skin; as a result, the pulse oximeter may not even detect a pulse or it may provide a falsely low reading. Always use pulse oximetry in conjunction with a careful clinical assessment of the patient.
Which of the following statements regarding agonal respirations is correct?
A: Agonal respirations are commonly observed after cardiac arrest occurs
B: In most cases, agonal respirations are caused by diabetic ketoacidosis
C: Agonal respirations are characterized by a slow, deep, regular pattern
D: Agonal respirations increase and then decrease, with apneic periods
Answer: A
Agonal respirations (also called agonal gasps) are slow, irregular, or occasional gasping breaths that are the result of cerebral anoxia. Agonal respirations may be seen for a short period of time after a patient’s heart has stopped. Clearly, agonal respirations are not effective and require positive-pressure ventilation support. The respiratory pattern commonly observed in patients with diabetic ketoacidosis is Kussmaul respirations; they are characterized by a deep, rapid pattern of breathing. A patient with agonal respirations may require advanced airway management. The pattern of breathing in which the respirations increase and then decrease with intermittent periods of apnea is called Cheyne-Stokes respirations.
Normal tidal volume in the average adult male is approximately:
A: 8 to 10 mL/kg.
B: 2 to 4 mL/kg.
C: 10 to 12 mL/kg.
D: 5 to 7 mL/kg.
Answer: D
The average tidal volume, the amount of air inhaled or exhaled per breath, for an average adult male is approximately 5 to 7 mL/kg. This equates to an average of 500 mL per breath.
You are providing continuous positive airway pressure (CPAP) therapy to a patient in respiratory distress, and have the positive end-expiratory pressure (PEEP) valve set at 7.5 cm H2O. When you reassess him, you note that his respiratory rate has markedly decreased, he is not following verbal commands, and his oxygen saturation has fallen to 75%. You should:
A: decrease the PEEP setting to 5 cm H2O and reassess him.
B: increase the PEEP setting to 10 cm H2O and reassess him.
C: remove the CPAP device and ventilate with a bag-mask device.
D: auscultate his breath sounds to rule out a pneumothorax.
Answer: C
CPAP is an excellent tool to use for patients experiencing respiratory distress secondary to obstructive lung disease or pulmonary edema. However, not all patients improve with CPAP therapy. CPAP is contraindicated in patients who are in respiratory failure or arrest, patients with signs of a pneumothorax, and patients who are unable to follow verbal commands. The patient in this scenario has signs of respiratory failure (markedly decreased respiratory rate, not following verbal commands, and low oxygen saturation), despite CPAP therapy. Therefore, you should remove the CPAP device and begin ventilating him with a bag-mask device. After you have restored adequate minute volume, you should assess his breath sounds.
The Hering-Breuer reflex is a protective mechanism of the respiratory system that:
A: increases the respiratory rate in response to hypoxia.
B: causes laryngospasm to prevent aspiration into the lungs.
C: limits the expiratory phase to retain carbon dioxide.
D: prevents overexpansion of the lungs during inhalation.
Answer: D
The Hering-Breuer reflex is a protective mechanism of the respiratory system in which stretch receptors in the lungs sense the degree of inhalation and send messages to the respiratory centers in the brain via the vagus nerve. This stops the inhalation process and prevents overexpansion of the lungs.
Snoring respirations in an elderly woman found unresponsive in her bed are MOST rapidly and effectively managed by:
A: inserting a supraglottic airway device.
B: manually maneuvering her head.
C: suctioning the oropharynx.
D: inserting an oral or nasal airway.
Answer: B
Snoring respirations indicate partial airway obstruction by the tongue. When a person becomes unresponsive, the tongue falls back into the posterior pharynx and partially occludes the glottic opening. The quickest and most effective way to treat this is by manually maneuvering the patient’s head (head tilt-chin lift or jaw-thrust maneuver). After opening the airway manually, an oral or nasal airway can be inserted to assist in maintaining airway patency. Suctioning is not indicated unless the patient has gurgling respirations or you can clearly see secretions in the oropharynx. The unresponsive patient may require a supraglottic airway device (ie, King LT, LMA, CobraPLA), but not before first establishing a patent airway and ensuring adequate ventilation and oxygenation with basic maneuvers.
A selective beta-2 adrenergic agonist produces which of the following physiologic effects?
A: Bronchodilation
B: Decreased parasympathetic tone
C: Increased inotropy
D: Increased vascular resistance
Answer: A
Selective beta-2 adrenergic agonists, such as albuterol (Ventolin, Proventil) and metaproterenol (Alupent), stimulate beta-2 receptors, which are found primarily in the lungs. When stimulated, beta-2 receptors cause bronchodilation, which makes them the ideal drug to use for patients with certain airway diseases that are associated with bronchospasm (asthma, bronchitis, or bronchiolitis). Stimulation of beta-1 receptors results in an increase in heart rate (chronotropy) and cardiac contractility (inotropy). Increased vascular resistance (vasoconstriction) occurs when alpha-1 adrenergic receptors are stimulated.
While auscultating the lungs of a 60-year-old man who complains of shortness of breath, you hear fine, moist crackles in all lung fields. These sounds indicate:
A: mild to moderate bronchospasm.
B: fluid in the small lower airways.
C: mucous plugs in the alveoli.
D: fluid in the large lower airways.
Answer: B
Crackles, formerly called rales, are fine, moist, thin sounds. They represent fluid in the smaller lower airways and often indicate early pulmonary edema. Rhonchi are loud rattling sounds that can often be heard without a stethoscope and indicate fluid in the larger airways. Bronchospasm (constriction of the bronchioles) produces a characteristic whistling sound called wheezing. Thick mucous plugging of the alveoli would likely manifest with diminished breath sounds.
You are ventilating an apneic patient with a pocket face mask and one-way valve. Which of the following is a disadvantage of this method of ventilatory support?
A: Hyperventilation can result in the rescuer who is providing ventilations.
B: Smaller amounts of tidal volume are delivered to the patient.
C: An adequate mask-to-face seal is difficult to maintain.
D: It is only effective if used in conjunction with the jaw-thrust maneuver.
Answer: A
Using the pocket mask device for a prolonged period of time can result in hyperventilation of the rescuer providing the ventilations because he or she is ventilating the patient with his or her own breaths. Ease in maintaining an adequate mask-to-face seal makes the pocket mask an effective method of providing artificial ventilations. Because it is relatively easy to maintain an effective mask-to-face seal with the pocket face mask, ventilation by this method provides greater tidal volume than the one-rescuer bag-mask device technique. The pocket face mask can be used with either the head tilt-chin lift or jaw-thrust maneuvers.
Kussmaul respirations indicate that the:
A: respiratory system is attempting to eliminate ketoacids from the blood.
B: brain stem is significantly injured because of increased intracranial pressure.
C: respiratory centers are increasing the rate and depth of breathing to bring in more oxygen.
D: pH of the blood is elevated and the patient is hypoventilating to retain carbon dioxide.
Answer: A
Kussmaul respirations, a pattern of deep, rapid breathing accompanied by a fruity or acetone breath odor, are observed in patients with diabetic ketoacidosis. They represent the respiratory system’s attempt to eliminate ketoacids from the blood. Central neurogenic hyperventilation, which is also characterized by deep and rapid breathing, is seen in patients with brain stem injury secondary to increased intracranial pressure; unlike Kussmaul respirations, however, they are not accompanied by a fruity or acetone breath odor. In metabolic alkalosis, such as what may occur after ingestion of a large amount of base (eg, antacids), the patient may hypoventilate to increase the carbon dioxide content of the blood and drive the pH down. Hypoxia is a very powerful stimulus to breathe; if the chemoreceptors sense low blood oxygen levels, the respiratory centers increase the rate and depth of breathing accordingly.
Your uninjured patient is unresponsive, is breathing at a rate of 14 breaths/min with adequate depth, and has heart rate of 90 beats/min and irregular. His oxygen saturation is 94% on room air. You should:
A: ventilate him with a bag-mask device and high-flow oxygen until his oxygen saturation reaches 100%.
B: keep the patient supine in case you need to suction his airway and administer high-flow oxygen by nonrebreathing mask.
C: insert a supraglottic airway device, assist his ventilations, and request a paramedic to perform tracheal intubation.
D: insert an oral or nasal airway, place him on his side, and give high-flow oxygen by nonrebreathing mask.
Answer: D
If an uninjured, unresponsive patient is ventilating adequately (adequate rate and depth), you should insert a simple airway adjunct (oral or nasal airway) to help maintain airway patency; apply oxygen in a quantity sufficient to maintain an oxygen saturation of greater than 94%; and position him on his side (recovery position) to facilitate drainage if he vomits. Monitor his breathing adequacy carefully and be prepared to assist his ventilations if he begins to hypoventilate (decreased rate, shallow depth [reduced tidal volume]). If you must assist his ventilations, a supine position is required. An advanced airway is not necessary at this point; however, if his condition deteriorates, a supraglottic airway device (ie, LMA, CobraPLA, King LT) should be considered.
Which of the following assessment findings is MOST consistent with adequate ventilation?
A: Tachypnea
B: Bradypnea
C: Warm, dry skin
D: Cyanotic oral mucosa
Answer: C
Of the choices listed, warm and dry skin is the most consistent with adequate ventilation. Respirations that are too slow (bradypnea) or too fast (tachypnea) are commonly associated with inadequate ventilation, especially in the presence of reduced tidal volume (shallow breathing). Hypoxemia caused by inadequate ventilation results in cyanotic or cool, clammy skin. The oral mucosa may also become cyanotic. It is important to note, however, that the absence of cyanosis does NOT rule out hypoxemia or inadequate ventilation.
After inserting a King LT airway into a cardiac arrest patient, you meet resistance when you attempt to ventilate. Your initial action should be to:
A: remove the King LT and resume bag-mask ventilations.
B: withdraw the airway slightly while continuing to ventilate.
C: auscultate both sides of the chest and over the epigastrium.
D: deflate the cuffs of the King LT and reassess ventilation.
Answer: B
It is relatively common for the ventilation ramp at the distal end of the King LT airway to push the epiglottis over the glottic opening, resulting in difficulty in ventilating the patient. Therefore, if you meet resistance after inserting the device, your initial action should be to withdraw the tube slightly while continuing to ventilate; do NOT deflate the cuffs to do this. If this does not correct the situation, you should then deflate the cuffs, remove the King LT, insert an oral or nasal airway, and resume bag-mask ventilations. Auscultation of lung and epigastric sounds is typically performed after an advanced airway device is inserted, and initial ventilations are provided without difficulty.
A decrease in pulmonary surfactant results in:
A: enhanced gas diffusion through thinning of the alveolar wall.
B: decreased alveolar surface tension and enhanced respiration.
C: increased alveolar surface tension and ineffective respiration.
D: easier expansion and recoil of the alveoli during respiration.
Answer: C
Surfactant, a substance that lines the alveolar walls and acts as a lubricant, functions by decreasing alveolar surface tension. This effect allows the alveoli to expand and recoil, thus facilitating the process of respiration (the exchange of oxygen and carbon dioxide). If pulmonary surfactant is decreased, alveolar surface tension increases; this creates a barrier to diffusion, which impairs pulmonary (external) respiration.
During transport of a 50-year-old man in severe respiratory distress, the patient suddenly gets off of the stretcher, stands up, and pulls the oxygen mask from his face. What should you do?
A: Apply a nasal cannula and try to calm the patient.
B: Call for a paramedic to administer Valium to the patient.
C: Allow the patient to remain standing throughout transport.
D: Place the patient supine and assist ventilations.
Answer: A
This patient is obviously experiencing severe respiratory distress and is hypoxic, as evidenced by his extreme restlessness. You should attempt to calm the patient and offer oxygen with a less oppressive device, such as a nasal cannula. Should the patient’s level of consciousness decrease, you should assist his ventilations with a bag-mask device. Central nervous system depressants, such as diazepam (Valium), should be avoided in hypoxic patients with respiratory distress because they may cause respiratory arrest. For obvious reasons, it is not safe to allow a patient to stand up in the back of a moving ambulance.
What is the MOST appropriate initial action to take when a previously breathing adult patient suddenly becomes unresponsive, apneic, and bradycardic?
A: Insert a Combitube and begin ventilating
B: Begin ventilating with a bag-mask device
C: Suction the oropharynx for up to 15 seconds
D: Open the airway with a manual maneuver
Answer: D
If any patient suddenly becomes unresponsive, apneic, and experiences an increase or decrease in his or her heart rate, your initial action should be to manually open the airway with the head tilt-chin lift or jaw-thrust maneuver. In some cases, this may be all that is needed to restore adequate breathing. Remember, when a person loses consciousness, the tongue often falls back into posterior pharynx and occludes the airway. Suctioning is indicated if there are secretions in the patient’s mouth, whether he or she is breathing or not. If after opening the airway with a manual maneuver the patient is still not breathing, begin rescue breathing with a bag-mask or pocket face mask device. An advanced airway (Combitube, CobraPLA, or King LT) may be indicated, but not before ventilating with basic means first.
Which of the following statements regarding ventilation and respiration is correct?
A: Ventilation is the exchange of gases in the body.
B: Respiration is the process of moving air into the lungs.
C: Ventilation can occur despite inadequate respiration.
D: Respiration can occur in the absence of ventilation.
Answer: C
Ventilation is the physical act of moving air into and out of the lungs. Respiration is defined as the exchange of gases between the body and its environment. It is possible for ventilation to occur despite inadequate or absent respiration. For example, if a patient is trapped in an environment that is devoid of oxygen (trench, grain silo, structural fire), he or she may continue to move air into and out of the lungs; however, the exchange of oxygen and carbon dioxide in the lungs (pulmonary [external] respiration) is impaired. Another example is a pulmonary embolism; the patient may continue to ventilate, but reoxygenation of blood in the lungs is impaired. Although it is possible for ventilation to occur without respiration, it is not possible for respiration to occur without ventilation.
Before applying a nonrebreathing mask on a conscious patient with respiratory distress, you should
A: ensure that the reservoir bag is fully inflated.
B: place the patient in the recovery position in case he or she vomits.
C: ask the patient to exhale fully and then hold his or her breath.
D: set the oxygen flowmeter to no more than 10 L/min.
Answer: A
Before placing a nonrebreathing mask on a patient, you must ensure that the reservoir bag is completely filled. If the reservoir bag is not prefilled, the patient will not receive the maximum percentage of oxygen that the device can deliver. The appropriate oxygen flow rate for a nonrebreathing mask is 12 to 15 L/min.
Prehospital treatment for a patient with respiratory distress and diffuse wheezing should focus on:
A: ventilating the patient with a bag-mask device.
B: relieving bronchospasm and improving ventilation.
C: determining the underlying cause of the problem.
D: rapid transport with a paramedic intercept en route.
Answer: B
Patients with respiratory distress and wheezing, such as what is seen in patients with an acute asthma attack, have two problems: bronchospasm and hypoxemia. In the prehospital setting, your primary focus should be on relieving the bronchospasm by administering or assisting the patient with an inhaled bronchodilator (albuterol [Proventil, Ventolin]). Inhaled bronchodilators open the bronchioles, thereby facilitating airflow and improving ventilation and oxygenation. Asthma is but one cause of respiratory distress and wheezing; therefore, you should focus on treating his or her symptoms, not diagnosing his or her problem. Some patients may require assisted ventilation; however, your goal is to improve ventilation, which may be accomplished by simply administering a bronchodilator. If the patient’s condition does not improve, transport immediately and consider a paramedic intercept en route.
