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Emergency Medical Technician > Airway Management - CPAP, Stomas, Obstructions, & ALS Assist > Flashcards

Airway Management - CPAP, Stomas, Obstructions, & ALS Assist Flashcards

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Royal College: Emergency Medicine flashcards USMLE® Step 1 flashcards
1
Q

Alveolar collapse

A

Atelectasis

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2
Q

What does the CPAP do?

A

Increases pressure in the lungs, opens collapsed alveoli and prevents further alveolar collapse, pushes more oxygen across the alveolar membrane, and forces interstitial fluid back into the pulmonary circulation

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3
Q

Desired effect of the CPAP

A

Improve pulmonary compliance and make spontaneous ventilation easier for the patient

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4
Q

Many CPAP systems use ___ as the driving force to deliver positive ventilatory pressure

A

Oxygen

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5
Q

Some CPAP units can empty a D cylinder in ___

A

5 to 10 minutes

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6
Q

CPAP pressure relief valve determines ___

A

The amount of pressure the patient must breathe against and overcome

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7
Q

The amount of pressure the patient must breathe against and overcome

A

Expiratory positive airway pressure

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8
Q

EPAP

A

Expiratory positive airway pressure

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9
Q

CPAP EPAP setting typically ranges between ___

A

5 and 20 cm H2O

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10
Q

As a patient breathes against the EPAP, positive pressure is redirected to the ___

A

Lower airway

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11
Q

Patients benefit the most from CPAP during ___

A

Exhalation rather than inhalation

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12
Q

CPAP lowers the ___ of the heart

A

Cardiac output

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13
Q

CPAP is for ___

A

Patients experiencing respiratory distress in which their own compensatory mechanisms are not enough to keep up with the oxygen demand

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14
Q

General indications for using CPAP

A
  1. Patient is alert and able to follow commands
  2. Patient is displaying obvious signs of moderate to severe respiratory distress from an underlying pathology, such as pulmonary edema or obstructive pulmonary disease, or bronchospasm
  3. Respiratory distress occurs after a submersion incident
  4. Patient is breathing so rapidly that it affects overall minute volume
  5. Pulse oximeter reading is less than 90%
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15
Q

General contraindications for using CPAP

A
  1. Patient is in respiratory arrest or has agonal respirations
  2. Patient is hypoventilating
  3. Patient cannot speak
  4. Patient is unresponsive or otherwise unable to follow verbal commands
  5. Patient cannot protect their own airway
  6. Patient has hypotension
  7. Signs and symptoms of pneumothorax or chest trauma are present
  8. Patient has a tracheostomy
  9. Active gastrointestinal bleeding, nausea, or vomiting is present
  10. Patient has experienced facial trauma
  11. Patient is in cardiogenic shock
  12. Patient cannot sit upright
  13. CPAP system mask and strap cannot properly fit
  14. Patient cannot tolerate the mask
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16
Q

If CPAP is on a patient who deteriorates ___

A

Initiate positive-pressure ventilation with a bag-mask device attached to high-flow oxygen

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17
Q

CPAP units generally comprise a ___

A
  1. Generator
  2. Mask
  3. Circuit with corrugated tubing
  4. Bacteria filter
  5. One-way valve
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18
Q

The CPAP generator creates resistance that creates ___

A

Back pressure into the airways that pushes open the smaller airway structures as the patient exhales

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19
Q

CPAP pressure of __ is a generally acceptable therapeutic range

A

7.0 to 10.0 cm H2O

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20
Q

A typical CPAP unit will deplete a full D cylinder of oxygen in ___

A

15 to 30 minutes

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21
Q

The rate a CPAP oxygen bottle is depleted depends on ___

A

The fraction of inspired oxygen (FIO2) setting

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22
Q

Position for patient when using CPAP mask

A

High Fowler position

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23
Q

Valve to adjust CPAP

A

PEEP valve

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24
Q

PEEP valve

A

Positive end-expiratory pressure valve

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25
Q

The high pressure of the CPAP could cause a ___

A

Pneumothorax

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26
Q

A patient with a tracheostomy may have numerous holes in the neck, you should ignore any opening other than the ___

A

Midline tracheal stoma

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27
Q

If a patient has a tracheostomy tube, ventilate ___

A

Through the tube with a bag mask device and 100% oxygen attached directly to the device

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28
Q

If a patient has a stoma and no tube is in place ___

A

Use an infant or child mask to make a seal over the stoma, and seal the patient’s mouth and nose with one hand. Release the seal on the mouth and nose for exhalation

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29
Q

If you are unable to ventilate a patient with a stoma, try ___

A

Suctioning the stoma and the mouth with a French or soft-tip catheter before giving artificial ventilation through the mouth and nose

30
Q

If you seal the stoma during ventilation via the nose or mouth, the ability to ___

A

Ventilate the patient may be improved, or it may help to clear any obstructions

31
Q

An otherwise healthy child sho has supine difficulty breathing should be assumed to have ___

A

A foreign body airway obstruction

32
Q

Difference between mild and severe airway obstruction

A

Severe completely blocks the airway

33
Q

With good air exchange, the patient can ___

A

Cough forcefully, may hear wheezing

34
Q

Production of whistling sounds during respiration

A

Wheezing

35
Q

Wheezing is usually indicative of ___

A

A mild lower airway obstruction

36
Q

With poor air exchange, the patient has ___

A

A weak, ineffective cough and may have increased difficulty breathing, stridor, and cyanosis

37
Q

High-pitched noise heard primarily on inspiration

A

Stridor

38
Q

Stridor is an indication of ___

A

A mild upper airway obstruction

39
Q

For patients with a mild airway obstruction with poor air exchange, ___

A

Treat immediately as if there is a severe airway obstruction

40
Q

Patients with a ___ are still able to exchange air but will have varying degrees of respiratory arrest

A

Mild airway obstruction

41
Q

Patients with a ___ cannot breathe, talk, or cough

A

Severe airway obstruction

42
Q

Most effective method to dislodge and force an object out of the airway of a conscious person

A

Abdominal thrusts

43
Q

Use abdominal thrusts until __

A

The object dislodges or the patient becomes unconscious

44
Q

For an unresponsive patient with severe foreign body airway obstruction, after the 30 compressions, perform ___

A

A tongue-jaw lift by grasping the jaw with your thumb and index finger. Place your thumb onto the tip of the patient’s lower teeth and tongue while placing your index finger under the body portion of the chin. Pull jaw/mouth open and look at the back of the oropharynx for foreign objects, and remove it if seen

45
Q

Dental appliance that do not stay in place during ventilations should be ___

A

Removed

46
Q

If dentures become dislodged ___

A

Place them in a container and transport them with the patient

47
Q

Because blood supply to the face is so rich, injuries to the face can result in ___

A

Severe tissue swelling and bleeding into the airway

48
Q

EMT role while ALS partner performs advanced airway intervention

A
  1. Help set up the procedure
  2. Perform BLS airway and ventilation maneuvers
  3. Help monitor the patient
49
Q

The insertion of a tube into the trachea to maintain and protect the airway

A

Endotracheal (ET) intubation

50
Q

The ET tube can be inserted through ___

A

The mouth or nose

51
Q

The ET tube passes directly through the ___ and then into the ___

A
  1. Larynx between the vocal cords
  2. Trachea
52
Q

First step in preparing a patient for ET intubation

A

Oxygenation

53
Q

The process of providing oxygen, often in combination with ventilation, prior to intubation to raise the oxygen levels

A

Preoxygenation

54
Q

A technique in which oxygen administered via a high-flow nasal cannula is left in place during an intubation

A

Apneic oxygenation

55
Q

Visualization of the vocal cords with a laryngoscope

A

Direct laryngoscopy

56
Q

Visualization of the vocal cords using a video camera and monitor

A

Video laryngoscopy

57
Q

Intubation equipment sets include ___

A
  1. PPE
  2. Suction unit with rigid, tonsil-tip (Yankauer) and nonrigid, whistle-tip (French) catheters
  3. Laryngoscope handle and blade
  4. Magill forceps
  5. ET tube
  6. Stylette or tube introducer (Gum elastic bougie)
  7. Water-soluble lubricant
  8. 10-mL syringe
  9. Confirmation device, including waveform end-tidal CO2 monitors and/or colorimetric device
  10. Commercial ET tube securing device
  11. Alternate airway management devices
58
Q

Six critical steps for ET intubation

A

B: perform Bag-mask pre oxygenation
E: Evaluate for airway difficulties

M: Manipulate the patient
A: Attempt first-pass intubation
GI: use a supraGlottic airway if unable to intubate
C: Confirm successful intubation/Correct any issues

59
Q

Do not ___ the patient during the pre oxygenation phase of intubation

A

Hyperventilate

60
Q

Ideal position for patient for intubation

A

Patient’s ear canal is on the same horizontal plane as their sternal notch

61
Q

Patient’s ear canal is on the same horizontal plane as their sternal notch

A

Sniffing position

62
Q

A cervical collar will need to be ___ before intubation typically

A

Undone

63
Q

When the ALS provider is ready to begin the intubation attempt ___

A

Remove the oral airway and disconnect the mask from the bag in preparation for connecting the bag to the ET tube

64
Q

When the ALS provider is attempting intubation, always keep ___ at hand

A

Mask and airway and suction equipment

65
Q

A successfully intimated patient should have ___

A

End-tidal CO2 waveform, bilateral breath sounds present, and gastric (or epigastric) sounds absent

66
Q

An intubated patient end-tidal CO2 waveform suddenly disappears is an indication of ___

A

The ET tube may have shifted out of the proper position

67
Q

An intubated patient SpO2 levels begin to drop is an indication of ___

A

The ET tube may have shifted out of the proper position

68
Q

ET tube is mistakenly placed in the esophagus rather than the trachea

A

Esophageal intubation

69
Q

Esophageal intubation results in ___

A

Gastric distention as air is pumped into the stomach

70
Q

An intubated patient has increasing resistance while ventilating indicates ___

A

Possible esophageal intubation

71
Q

What to monitor with an intubated patient

A
  1. End-tidal CO2 level
  2. SpO2 level
  3. Ventilation resistance
  4. Physical signs of poor ventilation and perfusion
  5. Improper positioning or dislodgment of the ET tube

Emergency Medical Technician (100 decks)

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