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Emergency Medical Technician > Airway Management - Oxygen & Ventilation > Flashcards

Airway Management - Oxygen & Ventilation Flashcards

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

Always give oxygen to patients who are ___

A

Hypoxic

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2
Q

When ventilating any patient in cardiac or respiratory arrest, use ___

A

High-concentration supplemental oxygen

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3
Q

Oxygen is usually stored as ___

A

Compressed gas in green, seamless, steel or aluminum cylinders

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4
Q

Aluminum cylinders are tested every ___

A

5 years

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5
Q

Composite cylinders are tested every ___

A

3 years

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6
Q

Two common sizes of oxygen cylinders

A

D (or jumbo D): Can be carried
M: Remains onboard your unit as the main supply tank

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7
Q

Less common sizes of oxygen cylinders

A

A, E, G, H, & K

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8
Q

New naming convention for oxygen cylinders

A

M (for medical) followed by a number

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9
Q

Liquid oxygen cylinders need to be stored ___

A

Upright

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10
Q

Volume of D cylinder

A

350 L

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11
Q

Volume of Jumbo D cylinder

A

500 L

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12
Q

Volume of E cylinder

A

625 L

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13
Q

Volume of M (MM) cylinder

A

3000 L

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14
Q

Volume of G cylinder

A

5300 L

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15
Q

Volume of H, A (M4), K cylinder

A

6900 L

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16
Q

Computing oxygen cylinder flow duration

A

((Gauge pressure - Safe residual pressure) x Cylinder constant) / Flow rate in L/min = Duration of flow in minutes

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17
Q

Do not handle an oxygen cylinder by ___

A

The neck alone

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18
Q

When oxygen cylinders are on the ambulance, store them ___

A

In brackets

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19
Q

A system established for portable cylinders to ensure that a regulator is not connected to a cylinder containing the wrong type of gas

A

Pin-indexing system

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20
Q

The outlet valves on portable oxygen cylinders are designed to accept ___

A

Yoke-type pressure-reducing gauges, which conform to the pin-indexing system

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21
Q

A safety system for large oxygen cylinders, designed to prevent the accidental attachment of a regulator to a cylinder containing the wrong type of gas

A

American Standard Safety System

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22
Q

How does the American Standard Safety System prevent attaching the wrong regulator valve to the wrong cylinder?

A

The thread pitches are different in different cylinders

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23
Q

Pressure of oxygen in a full cylinder

A

About 2000 psi

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24
Q

Pressure regulators typically reduce the pressure to ___

A

40 to 70 psi

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25
Q

After the pressure is reduced, the final attachment for delivering the oxygen to the patient is usually ___

A
  1. A quick-connect female fitting that will accept a quick-connect male plug from a pressure hose or ventilator/resuscitator
  2. A flowmeter that will permit the regulated release of gas measured in L/min
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26
Q

Flowmeters are usually permanently attached to ___

A

Pressure regulators on emergency medical equipment

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27
Q

Two types of flowmeters

A
  1. Pressure-compensated flowmeters
  2. Bourdon-gauge flowmeters
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28
Q

Incorporates a float ball within a tapered calibrated tube. The flow of gas is controlled by a needle valve located downstream of the float ball

A

Pressure-compensated flowmeter

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29
Q

A pressure-compensated flowmeter must be kept ___

A

Upright

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30
Q

A pressure gauge that is calibrated to record flow rate

A

Bourdon-gauge flowmeter

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31
Q

Newer flowmeters incorporate a ___

A

Fixable setting with either a dial or a knob that sets the flow, making the bourdon gauge not necessary

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32
Q

If the cylinder was commercially filled, it will have a ___

A

Plastic seal around the valve stem covering the opening in the stem

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33
Q

Purpose of cracking the cylinder open briefly before use

A

Make sure that dirt particles and other possible contaminants do not enter the oxygen flow

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34
Q

On one side of the valve stem, you will find ___

A

Three holes, the larger one on top is the true opening

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35
Q

What is found at the oxygen outlet on the valve stem?

A

A metal-bound elastomeric sealing washer

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36
Q

Most EMS systems consider a cylinder with a pressure less than ___ to be too low to keep in service

A

500 to 1000 psi

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37
Q

The flowmeter will have a second gauge or selector dial that indicates the ___

A

Oxygen flow rate

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38
Q

Damage to cellular tissue due to excessive oxygen levels in the blood

A

Oxygen toxicity

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39
Q

Increased cellular oxygen levels contribute to the production of ___

A

Oxygen free radicals

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40
Q

Free radicals may lead to ___

A

Tissue damage and cellular death in some patients

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41
Q

Some patients that may react negatively to excessive supplemental oxygen include ___

A

COPD, cerebral vascular incidents, and myocardial infarction

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42
Q

Oxygen may be administered to patients experiencing signs of a myocardial infarction when they ___

A

Have signs of heart failure, are short of breath, or have a room air oxygen saturation less than 94%

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43
Q

Patients experiencing signs of shock should be placed on ___

A

Oxygen

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44
Q

Hypoxemia is immediately life-threatening, whereas oxygen toxicity ___

A

Is not

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45
Q

When in doubt, or if unable to measure oxygen saturation, supplemental oxygen should be ___

A

Administered

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46
Q

Exceptions to the minimum oxygen saturation of 94%

A

Patients who have been exposed to CO, patients with potential anemia, or patients with shock

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47
Q

Oxygen delivery equipment used in the field should be limited to ___

A

Nonrebreathing masks, bag-mask devices, and nasal cannulas

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48
Q

Nasal cannula flow rate

A

1 - 6 L/min

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49
Q

Nonrebreathing mask with reservoir flow rate

A

10 - 15 L/min

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50
Q

Bag-mask device with reservoir flow rate

A

15 L/min

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51
Q

Nasal cannula oxygen delivered

A

24% to 44%

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52
Q

Nonrebreathing mask with reservoir oxygen delivered

A

Up to 90%

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53
Q

Bag-mask device with reservoir oxygen delivered

A

Nearly 100%

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54
Q

Used to administer high concentrations of oxygen to significantly hypoxemic patients who are otherwise breathing adequately

A

Nonrebreathing mask

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55
Q

When using a nonrebreathing mask, you must ___

A

Make sure the reservoir bag is full before the mask is placed on the patient

56
Q

How to adjust the nonrebreathing mask

A

Adjust the flow rate so that the bag does not fully collapse when the patient inhales, to about 2/3 of the bag volume, or 10 - 15 L/min

57
Q

Delivers oxygen through two small, tubelike prongs that fit into the patient’s nostrils

A

Nasal cannula

58
Q

Typically, the nasal cannula is used in patients with ___

A

Mild hypoxemia

59
Q

With the nasal cannula, if you anticipate long transport time, consider the use of ___ to prevent ___

A
  1. Humidification
  2. Causing dryness or irritating the mucous membrane lining the nose
60
Q

Humidification may be associated with an increased generation of ___

A

Aerosolized droplets of fluid that may increase the degree to which the patient can transmit disease to other people in the same space

61
Q

The partial rebreathing mask is similar to a nonrebreathing mask except that ___

A

There is no one-way valve between the mask and the reservoir

62
Q

Ideal mask for patients who are experiencing hyperventilation syndrome

A

Partial rebreathing mask

63
Q

The partial rebreathing mask is useful if you want to increase the patient’s ___

A

PaCO2

64
Q

With a partial rebreathing mask, the patient will rebreathe a ___

A

Small amount of their exhaled air

65
Q

Has a number of attachments that enable you to vary the percentage of oxygen being delivered to the patient while a constant flow is maintained from the regulator

A

Venturi mask

66
Q

Venturi mask oxygen delivery

A

24% to 40%

67
Q

The main advantage of the Venturi mask

A

The use of its fine adjustment capabilities in the long-term management of physiologically stable patients

68
Q

When you need to adjust oxygen concentration in an emergency, it is typically done by ___

A

Adjusting the flow rate or changing the delivery device

69
Q

If you do not have a tracheostomy mask, you can improvise by ___

A

Placing a face mask over the stoma

70
Q

An oxygen humidifier consists of ___

A

A small single-patient-use bottle of sterile water through which the oxygen leaving the cylinder becomes moisturized before it reaches the patient

71
Q

A patient who is not breathing needs ___

A

Artificial ventilation and 100% supplemental oxygen

72
Q

Fast, shallow breathing moves air primarily in the ___ and does not allow for ___

A
  1. Larger airway passages (dead air space)
  2. Adequate exchange of air and CO2 in the alveoli
73
Q

Patients with inadequate breathing require ___

A

Assisted ventilations with some form of positive-pressure ventilation

74
Q

Two treatment options for a patient in severe respiratory distress or respiratory failure and not breathing adequately

A
  1. Assisted ventilation
  2. CPAP
75
Q

CPAP

A

Continuous positive airway pressure

76
Q

Signs of altered mental status and shallow breathing are indications for ___

A

Assisted ventilation

77
Q

Excessive accessory muscle use and fatigue from labored breathing are signs of potential ___

A

Respiratory failure

78
Q

Steps to assist a spontaneously breathing patient’s ventilations with a bag-mask device

A
  1. Explain the procedure to the patient
  2. Place the mask over the patient’s nose and mouth
  3. Squeeze the bag each time the patient breaths, maintaining the same rate as the patient
  4. After the initial 5 to 10 breaths, slowly adjust the rate and deliver an appropriate tidal volume
  5. Adjust the rate and tidal volume to maintain an adequate minute volume
79
Q

Once you determine a patient is not breathing, begin ___ immediately

A

Artificial ventilation

80
Q

Methods to provide artificial ventilations

A
  1. Mouth-to-mask technique (only in non-work situations when a bag-mask is not available)
  2. One- or two-person bag-mask device technique
81
Q

When providing positive-pressure ventilations, this affects ___

A

Drawing venous blood back to the heart

82
Q

When positive-pressure ventilation is initiated, more air is needed to ___

A

Achieve the same oxygenation and ventilatory effects of normal breathing

83
Q

During positive-pressure ventilation, the increase in airway wall pressure causes the walls of the chest cavity to ___, resulting in ___

A
  1. Push out of their normal anatomic shape
  2. An increase in the overall intrathoracic pressure
84
Q

The intrathoracic pressure increase affects the ___

A

Return of venous blood to the heart

85
Q

Reduced venous return results in ___

A

Reduced cardiac output

86
Q

It is imperative that you ___ of artificial ventilations to help prevent the drop in cardiac output

A

Regulate the rate and volume

87
Q

The amount of blood ejected by the left ventricle in one minute

A

Cardiac output

88
Q

Ventilation rate for apneic adult with a pulse

A

1 breath every 6 seconds

89
Q

Ventilation rate for apneic infant or child with a pulse

A

1 breath every 2 to 3 seconds

90
Q

Barrier devices don’t provide protection from ___

A

Diseases transmitted by airborne pathogens or aerosolized droplets such as SARS-CoV2 or TB

91
Q

Mouth-to-mouth ventilations with or without a barrier device should be provided only in ___

A

Extreme situations

92
Q

What is safer than a barrier device for mouth-to-mouth ventilations?

A

Pocket mask containing a one-way valve with an adequate filter

93
Q

Mouth-to-mouth ventilations should only be used when ___

A

The EMT is off-duty, and no bag-mask device is available

94
Q

Air movement with normal ventilation

A

Air is sucked into the lungs due to the negative intrathoracic pressure created when the diaphragm contracts

95
Q

Air movement with positive-pressure ventilation

A

Air is forced into the lungs through a means of mechanical ventilation

96
Q

Blood movement with normal ventilation

A

Normal breathing allows blood to naturally be pulled back to the heart

97
Q

Blood movement with positive-pressure ventilation

A

Intrathoracic pressure is increased as air is driven into the lungs, which can reduce blood return to the heart and therefore reduce the amount of blood pumped by the heart

98
Q

Airway wall pressure with positive-pressure ventilation

A

More volume is required to have the same effects as normal breathing. As a result, the walls are pushed out of their normal anatomic shape

99
Q

Esophageal opening pressure with positive-pressure ventilation

A

Air may be forced into the stomach, especially with aggressive ventilation, causing gastric distention that could result in vomiting and aspiration

100
Q

Overventilation with positive-pressure ventilation

A

Too much volume and/or a fast ventilation rate results in increased intrathoracic pressure, gastric distention, and decrease in cardiac output, resulting in hypotension

101
Q

The bag-mask device provides less ___ than mouth-to-mask ventilation; however, is delivers a higher ___

A
  1. Tidal volume
  2. Oxygen concentration
102
Q

If you have difficulty ventilation a patient with a bag-mask device, you should ___

A

Immediately switch to an alternative method, such as the mouth-to-mask technique

103
Q

Components of an adult bag-mask device

A
  1. Disposable self-inflating bag
  2. No pop-off valve
  3. Outlet valve that is a true valve for nonrebreathing
  4. Inline viral filter
  5. Oxygen reservoir
  6. One-way, no-jam inlet valve system that provides a maximum of 15 L/min with standard 15/22-mm fittings for face mask and endotracheal tube connection
  7. Transparent face mask
  8. Ability to perform under extreme environmental conditions
104
Q

Total volume of an adult bag-mask

A

1200 to 1600 mL

105
Q

Total volume of a pediatric bag-mask

A

500 to 700 mL

106
Q

Total volume of an infant bag-mask

A

150 to 240 mL

107
Q

The volume of air delivered to the patient is based on one key observation

A

Chest rise and fall

108
Q

How much to squeeze the bag in the bag-mask device?

A

Enough to cause a noticeable rise of the chest, about 600 mL (about 6 to 7 mL/kg) over one second

109
Q

By delivering just enough tidal volume to see the chest rise, and not ventilating at a rate that is too fast, ___

A

The risks of gastric distention and cardiac compromise are reduced

110
Q

With a bag-mask, for a patient with ongoing CPR and an advanced airway in place, use a ventilation rate of ___

A

1 breath every 6 seconds (10 breaths/min), without pausing chest compressions

111
Q

When using the bag-mask device during a pandemic or if the patient is highly contagious, ___

A

A HEPA filter should be placed between the mask and the bag

112
Q

Inflation of the stomach with air

A

Gastric distention

113
Q

Gastric distention most commonly affects ___

A

Children

114
Q

Gastric distention is most likely to occur when ___

A
  1. Ventilate too forcefully or rapidly with a bag-mask device or pocket mask
  2. Air way is obstructed as a result of a foreign body or improper head position
115
Q

Gastric distention can reduce lung volume by ___

A

Elevating the diaphragm, especially in children and infants

116
Q

If gastric distention makes it impossible to ventilate the patient and an ALS provider is not available to perform ___, consider ___

A
  1. Orogastric tube or nasogastric tube decompression
  2. Positioning the patient onto their side and applying manual pressure over the upper abdomen (anticipate vomiting and have suction ready)
117
Q

Manual decompression should be used only as ___

A

A last resort and is reserved for extreme circumstances

118
Q

The act of air moving into and out of the lungs during chest compressions

A

Passive ventilation

119
Q

Passive ventilation is also called ___

A

Passive oxygenation or apneic oxygenation

120
Q

Prior to and during placement of an endotracheal tube (by and ALS provider), consider ___

A

Applying a nasal cannula and setting the flow rate at 15 L/min to initiate the process of preoxygenation and denitrogenation

121
Q

Attempts to replace alveolar nitrogen with oxygen

A

Denitrogenation

122
Q

Goal of denitrogenation

A

Increase oxygen reserve in the lungs, minimizing risk of oxygen desaturation during periods of forced apnea during an intubation attempt

123
Q

Indications that artificial ventilation is adequate

A
  1. Visible and equal chest rise and fall
  2. Ventilations delivered at the appropriate rate
  3. Heart rate returns to normal range
  4. Patient’s color improves (pink)
  5. Oxygen saturation increases
124
Q

Indications that artificial ventilation is inadequate

A
  1. Minimal or no chest rise and fall
  2. Ventilations are delivered too fast or slow for patient’s age
  3. Heart rate does not return to normal range
  4. Patient’s color remains cyanotic, mottled, or deteriorates
  5. Oxygen saturation does not increase or decreases
125
Q

When you are performing chest compressions, passive ventilation can be enhanced by ___

A

Inserting and oropharyngeal airway and providing supplemental oxygen to the patient

126
Q

You can improve oxygenation during passive ventilation by ___

A

Applying supplemental oxygen with a nasal cannula or a nonrebreathing mask

127
Q

A ventilation device attached to a control box that allows the variables of ventilation to be set

A

Automatic transport ventilator

128
Q

ATV

A

Automatic transport ventilator

129
Q

An EMT must be ___ to use an ATV

A

Approved and credentialed by the medical director

130
Q

Most models of ATV have adjustments for ___

A

Tidal volume and rate

131
Q

ATV respiratory rate is set to ___

A

Midpoint or average for the patient’s age

132
Q

ATV tidal volume is calculated by ___

A

6 to 7 mL/kg of ideal body weight

133
Q

The tidal volume of the ATV can be adjusted based on ___

A

The patient’s chest rise and physiologic response

134
Q

The ATV is ___ powered

A

Oxygen

135
Q

The ability of the alveoli to expand when air is drawn in during inhalation

A

Compliance

136
Q

When ventilating a patient, you would recognize poor lung compliance by ___

A

Noting an increase in resistance when you attempt to ventilate

137
Q

___trauma can occur in patients being ventilated

A

Baro

Emergency Medical Technician (100 decks)

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