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PARAMEDIC SCHOOL > BLOCK 6: RESPIRATORY EMERGENCIES > Flashcards

BLOCK 6: RESPIRATORY EMERGENCIES Flashcards

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1
Q

who first described pneumonia

A

Hippocrates in 400BCE

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2
Q

what is one of the most common fatal illnesses in developing countries

A

pneumonia

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3
Q

intrinsic respiratory disease factors

A

genetics, cardiac disease, stress

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4
Q

extrinsic respiratory disease factors

A

smoking, environmental pollutants

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5
Q

what airway structure acts as a pathway for air exchange

A

trachea

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6
Q

American College of Chest Physicians recommend transition to tracheostomy by ___

A

3 weeks

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7
Q

where does the tracheal cartilage bifurcate

A

carina

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8
Q

where is the carina located

A

5th intercostal space

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9
Q

where do ET tubes advanced too far and aspirated foreign bodies usually go and why

A

right main stem bronchus because it branches at a less acute angle than the left

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10
Q

all airways that do not participate in gas exchange represent what

A

dead space

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11
Q

where is gas transfer most efficient

A

alveoli

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12
Q

what structures make up the lung parenchyma

A

terminal bronchioles and alveoli

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13
Q

bronchodilator medications have little effect below the ____

A

subsegmental level

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14
Q

which number branches are the terminal bronchioles

A

16-24

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15
Q

what is the area in the middle of the chest between the lungs with the heart and large blood vessels called

A

mediastinum

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16
Q

what is pneumomediastinum

A

mediastinum widening with blood from a ruptured aorta or trapping air from a traumatic injury

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17
Q

which part of the lung has a greater number of capillaries and therefore has more gas exchange

A

the bases have more than the apices

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18
Q

what happens to the blood in patients with chronic lung disease or hypoxia

A

generate surplus of RBCs making their blood thick

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19
Q

what happens to the blood in patients with polycythemia

A

viscous blood

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20
Q

what is cor pulmonale

A

right-sided heart failure that occurs because of chronic lung disease

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21
Q

which patients have an impaired ability to transport oxygen and CO2

A

anemic (low hemoglobin level) and hypovolemic

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22
Q

which sided heart failure progresses much faster than the other

A

left-sided is faster (AMI)

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23
Q

the right side of the heart does what? the left side?

A

right side: pumps blood to lungs
left side: receives blood from lungs and pumps to body

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24
Q

what is the body’s immediate response to mild hypoxemia vs severe hypoxia

A

mild: increased HR/tachycardia
severe: bradycardia

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25
Q

what is the amount of air moved each minute called

A

minute ventilation

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26
Q

kidneys receive approximately how much of cardiac output

A

25%

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27
Q

3 conditions that cause upper airway obstruction

A

foreign body obstruction, infection, trauma

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28
Q

4 conditions that cause lower airway obstruction

A

trauma, obstructive disease, increased mucus production, airway swelling

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29
Q

4 conditions that cause chest wall impairment

A

pneumothorax, flail chest, pleural effusion, restrictive disease (scoliosis, kyphosis)

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30
Q

what is pH

A

how many free hydrogen ions are present in a solution

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31
Q

patients who are hypoventilating usually have what

A

respiratory acidosis

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32
Q

as CO2 levels go up, what happens to pH level

A

drops

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33
Q

how to measure oxygenation
how to measure ventilation

A

pulse oximetry (oxygen to tissues)
capnography (eliminating CO2 from body)

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34
Q

what groups of conditions cause patients to hypoventilate

A

conditions that impair lung function, impair mechanics of breathing, impair neuromuscular apparatus, and reduce respiratory drive

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35
Q

what is obesity hypoventilation syndrome and what is it also known as

A

respiratory compromise caused by morbid obesity
Pickwickian syndrome

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36
Q

serious injury to spinal cord above which vertebra may block nerve impulses to stimulate breathing

A

above C5

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37
Q

which nerve controls the diaphragm and breathing

A

phrenic nerve

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38
Q

what is Guillain-Barre syndrome

A

progressive muscle weakness and paralysis starting from feet and moving up body, can lead to ineffective breathing if paralysis reaches diaphragm

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39
Q

what is amyotrophic lateral sclerosis also known as and what is it

A

(ALS) Lou Gehrig disease
causes progressive muscle weakness, causes death from respiratory failure as muscles lose strength to ventilate

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40
Q

what is botulism

A

food poisoning or giving infants raw honey which may be contaminated with spores of bacterium that can cause muscle paralysis and is fatal when it reaches respiratory muscles

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41
Q

respiratory drive vs hypoxic drive

A

respiratory: stimulated by chemoreceptors detecting increased CO2

hypoxic: stimulates breathing from low oxygen levels

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42
Q

hypoventilation crisis most commonly seen by medics is what

A

acute heroin OD

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43
Q

what is the result of hyperventilation

A

alkalosis (increased pH) and low CO2 levels

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44
Q

what is breathing off more CO2 than normal triggered by emotional distress or a panic attack called

A

hysterical ventilation or hyperventilation syndrome

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45
Q

hyperventilation not caused by some metabolic crisis is usually what

A

self-limiting

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46
Q

what does respiratory alkalosis result in

A

numbness/tingling in hands/feet and mouth, ultimately carpopedal spasm

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47
Q

what is carpopedal spasm

A

hands and feet become clenched into a claw-like position from hyperventilating

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48
Q

what should NOT be done for hyperventilating patients

A

rebreathing carbon dioxide

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49
Q

how does the body attempt to compensate for acidosis

A

hyperventilation or Kussmaul respirations

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50
Q

hyperventilation is a diagnosis of ___, meaning what

A

exclusion, cannot presume hyperventilation syndrome until all other medical causes have been ruled out

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51
Q

wear a gown if patient is suspected of having what

A

MRSA (transmitted in their sputum)

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52
Q

most common complaint of patients with respiratory disease

A

dyspnea

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53
Q

the most common cause of dyspnea

A

hypercapnia

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54
Q

what is hypercapnia

A

too much CO2 in the blood

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55
Q

what is paroxysmal nocturnal dyspnea

A

dyspnea that comes on suddenly in middle of night and is an ominous sign of left-side heart failure

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56
Q

immunity by the pertussis vax lasts how long

A

5-10 years

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57
Q

what is the classic presentation of a patient with emphysema

A

barrel chest, muscle wasting, pursed-lip breathing, tachypneic

typically do not present with profound hypoxia and cyanosis

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58
Q

tall, thin young adults are predisposed to what

A

spontaneous pneumothorax

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59
Q

women who smoke and take oral contraceptives are predisposed to what

A

pulmonary embolus

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60
Q

patients with chronic bronchitis usually present how

A

in a chair or recliner sleeping in an upright position with a lot of things they need around them (urinal, meds, cigs)

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61
Q

what is Hickam’s advice

A

patients can have as many disease as they damn well please

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62
Q

increased work of breathing or hypoxia can trigger a sympathetic nervous system response which is characterized by what

A

tachycardia, diaphoresis, and pallor

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63
Q

what movement is an ominous sign of imminent decompensation

A

head bobbing

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64
Q

after intubation, true capno reading comes after the ___ breath

A

sixth

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65
Q

what patients usually get bony retractions with accessory muscle breathing

A

infants and small children

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66
Q

what patients usually get soft-tissue retractions with accessory muscle breathing

A

adults

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67
Q

what is pulsus paradoxus and in what conditions is it usually seen in

A

increased intrathoracic pressure can make peripheral pulse weak during inspiration

seen with cardiac tamponade and severe asthma

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68
Q

what are bony retractions

A

sternum or ribs retract into the chest during inhalation

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69
Q

what are soft-tissue retractions

A

soft tissue drawn in around bones during inhalation

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70
Q

what is tracheal tugging

A

thyroid cartilage is drawn upward and area just above sternal notch is pulled in during inhalation

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71
Q

what is paradoxical respiratory movement

A

epigastrium is pulled in as the abdomen is pushed out, creating a seesaw effect as the two move in opposite directions during inhalation

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72
Q

why do respiratory patients grunt

A

exerts a small amount of pressure that helps keep the alveoli open

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73
Q

what is the formula for minute volume

A

respiratory rate x tidal volume

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74
Q

many pathologic conditions are dependent on what meaning what

A

gravity, meaning most affect lung basees

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75
Q

wheezing is typically distributed how

A

diffuse and spread throughout lung fields

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76
Q

wheezing confined to only one spot may indicate what

A

foreign body or tumor

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77
Q

where to listen to the base of the lungs and the apex of the lungs

A

base: back
apex: anterior chest

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78
Q

best place to listen to confirm ET tube placement

A

mixaxillary line

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79
Q

how are breath sounds made

A

turbulent airflow in large airways

80
Q

sound moves better through ___ than ___

A

fluid, air

81
Q

what is lung consolidation

A

fluid accumulation makes the lungs firm

82
Q

signs of lung consolidation

A

bronchophony, egophony, whispered pectoriloquy

83
Q

what does it indicate if the patient’s words are audible while auscultating lung sounds

A

patient has consolidation from pneumonia or atelectasis

84
Q

sound if single bronchus is vibrating vs many bronchi are vibrating

A

single: monophonic
many: polyphonic

85
Q

how to test for bronchophony

A

when patient says “99”, if its consolidated you can understand the 99, if its a normal lung it sounds like a hum

86
Q

how to test for egophony

A

the patient says “eeee” and you hear “aaaay”. sound may be heard particularly well over pleural effusion

87
Q

how to test for whispered pectoriloquy

A

patient whispers while you are auscultating and you can understand what they said

88
Q

what is “death rattle”

A

low-pitched gurgling sound when patient becomes unable to clear secretions

89
Q

for ICP patients, titrate EtCO2 to what range

A

30-35

90
Q

snoring respirations indicate what

A

partial obstruction of upper airway by tongue

91
Q

gurgling respirations indicate what

A

fluid in the upper airway

92
Q

stridor respirations indicate what

A

narrowing as a result of laryngeal edema

93
Q

quiet tachypnea is indicative of what

A

possible shock

94
Q

how does hydration affect thickness of sputum

A

dehydration makes sputum thicker

95
Q

what is frothy, pink sputum caused by

A

heart failure

96
Q

what is thick sputum caused by

A

dehydration or antihistamine use

97
Q

what is purulent sputum caused by

A

(milky/pus-like) infectious process (pus contains dead WBCs)

98
Q

what is yellow, green, brown sputum caused by

A

older secretions in various stages of decomposition

99
Q

what is clear or white sputum caused by

A

bronchitis

100
Q

what is blood-streaked sputum caused by

A

tumor, TB, pulmonary edema, trauma from coughing

101
Q

what is the classic presentation of pneumonia

A

increased sputum production coupled with fever and chills

102
Q

why does ICP affect breathing

A

squeezes the medulla

103
Q

what is eupnea

A

normal breathing

104
Q

what does sighing do

A

forces open alveoli that routinely close from time to time

105
Q

Cheyne-Strokes breathing if what two criteria are met

A
  1. three consecutive apneas separated by crescendo/decrescendo with cycle length of at least 40secs
  2. five or more apneas per hour over minimum of 2hrs
106
Q

what does polio infection do

A

attacks nerves that supply respiratory muscles

107
Q

what does myasthenia gravis do

A

weaken respiratory muscles

108
Q

what is the hemoglobin level in healthy adults

A

12-14g/dL

109
Q

how much hemoglobin becomes desaturated before cyanosis becomes apparent

A

5g/dL

110
Q

how does cyanosis present in patients with light, yellow, and darker skin tone

A

light: blue
yellow: gray-green
darker: ashen or grey

111
Q

what causes dark brown skin

A

high methemoglobin levels from nitrates and toxic exposures

112
Q

what causes pallor

A

release of catecholamines like epi or norepi

113
Q

asthma with fever that responds to treatment but flares up again is usually caused by what

A

underlying infection such as pneumonia or bronchitis

114
Q

sloping downward of plateau (phase III) on capno shows what

A

history of emphysema

115
Q

why do some patients present with significant pulmonary edema after a trip

A

not wanting to take diuretics while traveling

116
Q

why do you receive increase of respiratory related calls when weather changes

A

bacteria, mold, and fungi grow in heating ducts or AC units during their off season and then are released when turned out due to change of weather

117
Q

what is curare cleft

A

visible inhalation in the middle of the plateau
sedation is wearing off and patient is fighting intubation

118
Q

what do antihistamines do

A

dry out secretions

119
Q

what do antitussives do

A

suppress cough

120
Q

what do expectorants do

A

thin out pulmonary secretions so they can be coughed up

121
Q

what do the most common OTC bronchodilators consist of

A

attenuated (diluted) forms of epi

122
Q

what does decline in PaO2 manifest as

A

restlessness, confusion, and progresses to combative behavior

123
Q

what does increase in PaCO2 manifest as

A

sedative effects

124
Q

what often accompanies a hypoxic effect or cardiac arrest

A

seizure

125
Q

what can cause JVD

A

cardiac tamponade, pneumothorax, heart failure, COPD

126
Q

which is concerning?
A. grossly distended jugular veins despite BP of 80/40 in a trauma patient

or

B. JVD in a 20-year-old lying flat

A

A

127
Q

what is a classic late sign of tension pneumothorax

A

tracheal deviation

128
Q

what is hepatomegaly

A

distended liver

129
Q

what is hepatojugular reflux

A

distention of jugular veins when liver is gently pressed

130
Q

how to assess for hepatojugular reflux

A

press gently on liver while patient is in semi-Fowler position (45 degree angle)

131
Q

what is tactile fremitus and what causes it

A

obvious vibrations from large-airway secretions

132
Q

hemothorax or pneumothorax in chest will have what kind of percussion

A

hypertympanic

133
Q

a chest tumor will have what kind of percussion

A

dull

134
Q

what is a sign of chronic hypoxia

A

digital clubbing

135
Q

what three things are ominous signs of impending arrest in patients with respiratory diseases

A

bradycardia, hypotension, falling respiratory rate

136
Q

what is the relationship between hemoglobin and oxygen saturation

A

inverse

(low hemoglobin, high oxygen - high hemoglobin, low oxygen)

137
Q

people who live in an industrial society have a carbon monoxide level of ___
smokers have one of ____

A

1-2%

3-4%

138
Q

what is the oxyhemoglobin dissociation curve illustrate

A

relationship between oxygen saturation and amount of oxygen dissolved in the plasma (PaO2)

139
Q

what is peak flow

A

max rate at which a patient can expel air from the lungs

140
Q

normal peak flow values

A

350-700L/min

141
Q

peak flow under what value is considered inadequate and signals significant distress

A

less than 150L/min

142
Q

at what percent is oxygen safe to administer to almost anyone

A

50%

143
Q

what did the physician Paracelsus observe

A

it’s the dose of a substance, not its composition, that makes it poisonous

144
Q

most nebulizers need a gas flow of at least ___LPM to generate optimal particle size

A

6

145
Q

respiratory acidosis
-oxygen level
-respirations
-BP level
-what patient feels
-what it can cause
-what causes it

A

hypoxic
rapid, shallow respirations
decreased BP
headache, dyspnea, drowsiness/dizziness
hyperkalemia, dysrhythmias
decreased respiratory stimuli (OD) COPD, pneumonia, atelectasis

146
Q

respiratory alkalosis
-respirations
-BP level
-what patient feels
-what it can cause
-what causes it

A

deep, rapid breathing
decreased or normal BP
numbness/tingling, lethargy, lightheaded, nausea/vomiting
hypokalemia, tachycardia, seizures
hyperventilation from anxiety or improper mechanical ventilation

147
Q

why are spacers used on meter dosed inhalers

A

collects medication as it’s released from canister allowing more to be delivered to lungs and less to be lost to environment

148
Q

why should you rinse your mouth after using corticosteroid inhaler

A

residual corticosteroid in the pharynx can predispose patients to thrush (an annoying fungal infection of pharynx or mouth)

149
Q

an example of dry-powder inhaler medication

A

tiotropium (Spiriva) - anticholinergic med for COPD management

150
Q

what are leukotrienes

A

bronchoconstricting chemicals released in some patients during an allergic response

151
Q

example of leukotriene blocker

A

montelukast (Singulair)

152
Q

what is IV magnesium sulfate used for

side effect?

A

severe asthma attacks to encourage smooth muscle relaxation

hypotension if given too quickly

153
Q

what are corticosteroids used for

A

reduce bronchial swelling

154
Q

what can long-term use of corticosteroids cause and what is it characterized by

A

Cushing syndrome and rapid BGL changes
classic moon face and generalized edema

155
Q

how must corticosteroids be discontinued

A

gradually

156
Q

three components of asthma triad

A

bronchospasm, airway edema, increased mucus production

157
Q

treatment for pulmonary edema

A

promoting vasodilation

158
Q

what is used to help reduce BP and maintain fluid balance in patients with heart failure

A

diuretics

159
Q

what diuretics are most commonly used in emergencies

A

loop (Bumex and furosemide)

160
Q

diuretics cause the loss of fluid and what?

A

potassium

161
Q

do not give diuretics to which patients

A

with pneumonia and dehydrated patients

162
Q

how is CPAP outcome related to patient’s respiratory rate

A

inversely
if resp rate increases, therapy is likely to fail
if resp rate decreases, therapy is likely to succeed

163
Q

conscious patients require up to ___L/min of flow to breathe comfortably, but most transport vents are permanently set to deliver ___L/min. what does that mean?

A

150, 40

making it inadequate for a spontaneously breathing patient

164
Q

patients with asthma are susceptible to what when intubated

A

pneumothoraces

165
Q

what is laryngotracheobronchitis

A

inflammation of the larynx, trachea, and bronchi

166
Q

what is a common cause of croup

A

acute form of laryngotracheobronchitis

167
Q

what is croup

A

characterized by stridor, hoarseness, and barking cough mostly in infants and small children

168
Q

what is the Poiseuille law

A

as diameter of tube increases, resistance to flow increases exponentially

169
Q

is croup caused by bacteria or virus

A

viral

170
Q

what is asthma also referred to as

A

reactive airway disease

171
Q

what is a severe prolonged asthmatic attack that cannot be stopped with conventional treatment

A

status asthmaticus

172
Q

how to treat bronchospasm

A

bronchodilators, magnesium sulfate, epinephrine

173
Q

how to treat bronchial edema

A

anticholinergics (Ipratropium) and corticosteroids

174
Q

how to treat excessive mucus secretions

A

improve hydration and mucolytics

175
Q

what is COPD mainly comprised of

A

emphysema and chronic bronchitis

176
Q

examples of restrictive lung disease

A

severe kyphosis, scoliosis

177
Q

how is chronic bronchitis defined

A

sputum production most days of the month for 3 or more months out of year for more than 2 years

178
Q

what is cardiac asthma

A

diffuse wheezing with acute left-sided heart failure

179
Q

what is bronchiolitis obliterans with organizing pneumonia

A

“BOOP”

inflammation and plugging of the bronchioles resulting in pneumonia distal to the blockages

180
Q

when is lung cancer usually identified

A

when tumors in the large airways bleed causing hemoptysis (coughing up blood in the sputum)

181
Q

what is a common cleaning error that can make someone sick

A

mixing drain cleaner and chlorine bleach which makes chlorine gas

182
Q

what is ammonia

A

highly water soluble, acute upper airway irritation

183
Q

what is chlorine

A

moderately water soluble, effects depend on concentration and amount ranging from coughing to chemical burns

184
Q

what is phosgene

A

minimally water soluble, delayed onset of pulmonary edema

185
Q

two classifications of pulmonary edema

A

high pressure (cardiogenic)
high permeability (non-cardiogenic)

186
Q

where does air collect in a pneumothorax

A

between visceral and parietal pleura

187
Q

what are blebs

A

weak spots that can rupture under stress causing a spontaneous pneumothorax

188
Q

what produces a pleural effusion

A

fluid collecting between the visceral pleura and parietal pleura (from a pneumothorax)

189
Q

what is thoracentesis

A

draining of large effusions

190
Q

what is the classic presentation of a pulmonary embolism

A

sudden dyspnea and cyanosis that does not resolve with oxygen therapy, pinpointed pain in the chest

191
Q

what is the Homan sign

A

calf pain during dorsiflexion of the foot caused by thrombophlebitis in the leg

192
Q

what patients are at high risk for pulmonary embolism

A

patients with thrombophlebitis (inflammation of veins in the legs)

193
Q

where do pulmonary emboli often originate

A

greater saphenous vein or other large veins of the leg

194
Q

what is a saddle embolus

A

exceptionally large pulmonary embolus lodged at the bifurcation of the right and left pulmonary arteries

195
Q

what is cape cyanosis and what is it caused by

A

usually caused by saddle embolus
deep blue color of face, neck, chest, and back despite good CPR and ventilation

196
Q
A

PARAMEDIC SCHOOL (74 decks)

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