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Concise EMT Crash Course > *(Chapter 10) Airway, Respiration, And Ventilation > Flashcards

*(Chapter 10) Airway, Respiration, And Ventilation Flashcards

1
Q

What is auscultation?

A

Listening to sounds from the heart, lungs, or other organs with a stethoscope.

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2
Q

What is external respiration?

A

The exchange of oxygen and carbon dioxide between the lungs and the circulatory system.

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3
Q

What is hypoxia?

A

Inadequate delivery of oxygen to the tissues of the body.

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4
Q

What is internal respiration?

A

The exchange of oxygen and carbon dioxide between the circulatory system and the body’s cells.

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5
Q

What is ventilation?

A

The movement of air in and out of the lungs.

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6
Q

What is the purpose of ventilation?

A

Ventilation is required for oxygenation and respiration but does not ensure them.

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7
Q

What is inhalation?

A
  1. The active part of ventilation, requiring energy.
  2. Air enters the lungs due to contraction of the diaphragm and intercostal muscles, creating negative intrathoracic pressure.
  3. Air travels from the upper airway to the alveoli.
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8
Q

What is exhalation?

A
  1. The passive part of ventilation, requiring no energy.
  2. The muscles of respiration relax, compressing air out of the lungs.
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9
Q

How is ventilation regulated?

A
  1. The rate of ventilation and tidal volume are adjusted based on the body’s oxygen needs.
  2. CO₂ drive regulates breathing by monitoring CO₂ levels in the blood and cerebrospinal fluid.
  3. Hypoxic drive acts as a backup system, monitoring oxygen levels in the plasma, often used in COPD patients.
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10
Q

What are the signs of mild (early) hypoxia?

A
  • Restlessness, anxiety, irritability
  • Dyspnea
  • Tachycardia, tachypnea
  • SpO₂ 90% to 94%
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11
Q

What are the signs of severe (late) hypoxia?

A
  • Altered or decreased LOC
  • Severe dyspnea
  • Cyanosis
  • Bradycardia (especially in pediatric patients)
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12
Q

What is oxygenation?

A

The delivery of oxygen to the blood.

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13
Q

How much oxygen does surrounding air contain?

A

About 21%. Exhaled air contains about 16%.

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14
Q

What are methods to increase oxygen levels?

A

Administration of supplemental oxygen using devices such as nasal cannulas, non-rebreather masks, and CPAP.

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15
Q

What is respiration?

A

The exchange of oxygen and carbon dioxide.

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16
Q

What is external respiration?

A

The exchange of gases between the alveoli and the circulatory system (pulmonary capillaries).

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17
Q

What is internal respiration?

A

The exchange of gases between the circulatory system (systemic capillaries) and the body’s cells.

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18
Q

What are the three steps in the assessment of breathing?

A
  1. Look: For chest rise and fall.
  2. Listen: For breathing, ability to speak, and auscultate lung sounds.
  3. Feel: For air movement and chest rise (place a hand on the chest).
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19
Q

What are the characteristics of adequate breathing?

A
  1. Normal respiratory rate and tidal volume.
  2. Non-labored breathing.
  3. Clear bilateral lung sounds.
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20
Q

What are signs of inadequate breathing?

A
  1. Abnormal respiratory rate (too slow or too fast).
  2. Shallow chest rise.
  3. Accessory muscle use.
  4. Abnormal, diminished, or absent lung sounds.
  5. Paradoxical motion (flail chest).
  6. Dyspnea.
  7. Cyanosis.
  8. Low SpO₂.
  9. Agonal breaths (dying gasps) or apnea (no breathing).
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21
Q

What is auscultation of lung sounds, and why is it important?

A
  • Auscultation of lung sounds is listening to lung sounds, assessed in every patient.
  • It is especially important for respiratory, cardiac, and trauma patients, and those with altered mentation or decreased LOC.
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22
Q

What are the common lung sounds and their characteristics?

A
  1. Normal: Clear sounds heard equally on both sides (‘clear and equal bilaterally’).
  2. Wheezing: High-pitched whistling sound, typically noticeable on expiration.
  3. Crackles/Rales: Wet, crackling sounds, usually heard on inspiration and expiration.
  4. Rhonchi: Low-pitched, congested sounds caused by mucus, usually heard on expiration.
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23
Q

Where should lung sounds be auscultated?

A
  1. Upper lungs (apices): Below the clavicles, midclavicular line.
  2. Middle lungs: Middle chest, midclavicular or posterior.
  3. Lower lungs (base): Lower portion of the thorax, midclavicular, or midaxillary.
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24
Q

What is pulse oximetry (SpO₂), and what is the treatment goal?

A
  • Pulse oximetry measures oxygen saturation in the blood and is part of standard care in prehospital settings.
  • The goal is to maintain SpO₂ at least 95%.
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25
Q

Should oxygen therapy be withheld based on SpO₂ levels?

A

No, SpO₂ should not be used to withhold oxygen from a patient in respiratory distress, shock, or significant illness/injury.

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26
Q

What are the airway management steps?

A
  1. Open the airway.
  2. Suction the airway.
  3. Secure the airway (‘open-suction-secure’).
27
Q

What techniques are used to manually open the airway?

A
  • Head-tilt, chin-lift (no spinal injury suspected).
  • Jaw thrust (suspected spinal cord injury).
28
Q

When is suctioning the airway indicated?

A
  1. When secretions like blood, vomit, or mucus obstruct the airway or interfere with ventilations.
  2. When larger substances (debris, teeth, food) need manual removal.
  3. After manually opening the airway and before inserting an airway adjunct.
29
Q

What are the guidelines for suction units?

A
  • Must have a disposable canister.
  • Must generate a vacuum of 300 mmHg when tubing is clamped.
30
Q

What types of suction catheters exist?

A
  1. Rigid suction catheter: Also called ‘tonsil tip’ or ‘Yankauer,’ for oral suctioning.
  2. French catheter: Flexible, for suctioning the nose, stoma, or advanced airway.
31
Q

What are the suction time limits based on patient type?

A
  • Adults: 15 seconds.
  • Children: 10 seconds.
  • Infants: 5 seconds.
32
Q

What is an oropharyngeal airway (OPA), and when is it used?

A
  • Used only for unresponsive patients.
  • Prevents the tongue from obstructing the upper airway.
  • Should not be used in responsive patients due to the risk of gag reflex, vomiting, and aspiration.
33
Q

How is an OPA sized and inserted?

A
  1. Size by measuring from the corner of the mouth to the earlobe.
  2. Insert upside down, rotating 180° into place.
  3. For children, depress the tongue and insert directly.
34
Q

What is a nasopharyngeal airway (NPA), and when is it used?

A
  • Used in patients who are semi-conscious or unconscious and at risk of airway obstruction.
  • Works well for patients with intact gag reflexes.
35
Q

What are contraindications for NPA insertion?

A
  • Severe head injury or facial trauma.
  • Awake patients capable of protecting their airway.
36
Q

How is an NPA sized and inserted?

A
  1. Size by measuring from the tip of the nose to the earlobe.
  2. Lubricate with water-soluble lubricant.
  3. Insert bevel toward the septum, advancing gently.
37
Q

What is the goal of supplemental oxygen administration?

A

To maintain SpO₂ at 94%-99%.

38
Q

What are the indications for supplemental oxygen?

A
  1. Cardiac or respiratory arrest.
  2. Hypoxia (e.g., dyspnea, cyanosis).
  3. SpO₂ < 95%.
  4. Shock or altered LOC.
39
Q

What are key points about non-rebreather (NRB) masks?

A
  1. Deliver 90% oxygen at 10-15 L/min.
  2. Reservoir must be full before applying.
  3. Never use if the oxygen source is lost.
40
Q

What are nasal cannulas used for, and what is their flow rate?

A
  • Used for low-flow oxygen delivery at 1-6 L/min.
  • Provides 24-45% oxygen, depending on flow rate.
41
Q

What is the purpose of CPAP (Continuous Positive Airway Pressure)?

A
  • Non-invasive ventilation for patients in respiratory distress.
  • Helps keep alveoli open and reduce fluid in the lungs (pulmonary edema).
42
Q

What are contraindications for CPAP use?

A
  • Hypotension.
  • Vomiting or suspected pneumothorax.
  • Apnea or inability to follow commands.
43
Q

What is a Bag-Valve Mask (BVM), and what does it do?

A
  • Provides positive pressure ventilation (PPV).
  • Delivers up to 90% oxygen when connected to a supply.
44
Q

What are the correct ventilation rates using a BVM?

A
  • Adults: 10 breaths/min (1 breath every 6 seconds).
  • Children/Infants: 20-30 breaths/min (1 breath every 2-3 seconds).
  • Newborns: 40-60 breaths/min.
45
Q

What are the complications of hyperventilation during PPV?

A
  • Gastric distension (air in the stomach).
  • Decreased coronary perfusion.
  • Increased intrathoracic pressure, reducing cardiac output.
46
Q

What are the hazards of oxygen administration?

A
  1. Oxygen is combustible—avoid open flames and cigarettes.
  2. Tanks are pressurized and must be handled cautiously.
  3. Never leave an oxygen tank standing unattended.
47
Q

What local protocol should be followed for automated ventilators?

A

Always follow local protocol regarding their use.

48
Q

Why is routine suctioning of neonates at birth not recommended?

A

It can cause bradycardia and apnea.

49
Q

What are the anatomical and physiological differences in pediatric airways compared to adults?

A
  1. The pediatric airway is more easily obstructed (larger tongue).
  2. The pediatric head is larger in proportion to the body; pad under shoulders to align the airway.
  3. Smaller lungs, increasing the risk of hyperventilation.
  4. Pediatric patients have less oxygen reserve and higher metabolic rates, causing rapid hypoxia.
50
Q

How should infants and toddlers be positioned for BVM ventilation?

A

In a ‘sniffing’ position without hyperextension of the neck.

51
Q

What are the signs of respiratory failure in pediatric patients?

A
  • Bradycardia and poor muscle tone.
  • Decreased LOC.
  • Head bobbing and grunting on exhalation.
  • See-saw breathing (chest and abdomen moving oppositely).
52
Q

What is ‘blow-by’ oxygen, and when is it used?

A
  • A method of delivering oxygen near the face without a mask.
  • Used for pediatric patients who resist having a mask on their face.
53
Q

What are considerations for patients with a tracheostomy or stoma?

A
  1. A tracheostomy tube (‘trach tube’) enters the trachea through a stoma.
  2. Supplemental oxygen should be applied over the stoma, not the face.
  3. Use a pediatric mask or seal to ventilate over a stoma without a tube.
  4. Suction stomas regularly to prevent obstruction from mucus.
54
Q

What is the leading cause of airway obstruction?

A

The tongue.

55
Q

What are signs of a complete or nearly complete Foreign Body Airway Obstruction (FBAO)?

A
  1. Inability to cough, speak, or breathe.
  2. Clutching the throat in conscious patients.
  3. Inability to ventilate unconscious patients despite repositioning.
56
Q

How is FBAO managed in conscious adults and children?

A

Perform abdominal thrusts until the obstruction is relieved or the patient loses consciousness.

57
Q

How is FBAO managed in a conscious infant?

A

Alternate between 5 back slaps and 5 chest thrusts until the obstruction is relieved or the patient loses consciousness.

58
Q

How is FBAO managed in unconscious patients?

A
  1. Perform chest compressions.
  2. Inspect the airway for visible obstructions before ventilations.
  3. Remove visible obstructions if possible.
59
Q

How should dentures be managed during ventilation?

A
  1. Leave secured dentures in place.
  2. Remove loose dentures.
  3. Ventilation is easier with secured dentures in place.
60
Q

What are the components of a BVM?

A
  • Self-inflating bag.
  • Oxygen reservoir and tubing.
  • Clear mask of various sizes.
61
Q

What are the indications for assisted ventilation?

A
  1. Inadequate spontaneous breathing.
  2. Breathing <10 or >30 times per minute.
  3. Respiratory or cardiac arrest.
  4. Agonal breathing or severe respiratory distress.
62
Q

What is the purpose of flow meters in oxygen therapy?

A

They control oxygen delivery, measured in liters per minute (L/min).

63
Q

What are the effects of high-flow nasal oxygen (HFNO)?

A
  • Provides CPAP-like support.
  • Reduces the work of breathing but requires large oxygen amounts (40-70 L/min).

Concise EMT Crash Course (8 decks)

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