Chapter 10 | Respiration and Artificial Ventilation Flashcards
• Physiology and pathophysiology of the respiratory system • How to recognize adequate and inadequate breathing • Principles and techniques of positive pressure ventilation • Principles and techniques of oxygen administration
Define:
tidal volume
amount of air moved in one breath
Define:
dead air space
air moved in ventilation not reaching alveoli
Define:
alveolar ventilation
air actually reaching alveoli
Define:
ventilation
both inhaling and exhaling
Define:
diffusion
(respiration)
movement of gases from high concentration to low concentration
Define:
external respiration
exchange of gasses between alveoli and circulating blood
O₂ and CO₂
Define:
internal respiration
cellular respiration
exchange of gases between blood and cells
O₂ and CO₂
Answer:
If a patient is hypoxic, one of three body processes have likely been disrupted. What are they?
- ventilations: mechanics of breathing disrupted
- respirations: gas exchange interrupted
- perfusion: circulation interrupted
Define:
hypercapnia
high carbon dioxide (CO₂) level
Define:
hypercarbia
high carbon dioxide (CO₂) level
Define:
hypocarbia
low carbon dioxide (CO₂) level
Define:
hypocapnea
low carbon dioxide (CO₂) level
List (in order):
stages of respiratory compensation
3 points
- respiratory distress
- respiratory failure
- respiratory arrest
Define:
respiratory distress
body compensating for a respiratory challenge and meeting metabolic needs
List:
assessment findings that align with respiratory distress
7 points (think early asthma attack)
- mental status
- O₂ saturation
- skin condition
- breathing difficulty
- RR
- HR
- patient presentation
- relatively normal mental status
- relatively normal SpO₂ (and end tidal carbon dioxide)
- relatively normal skin color
- dyspnea (shortness of breath)
- increased RR
- increased HR
- accessory muscle use (and position of stress)
Define:
respiratory failure
stage of respiratory compensation that occurs when respiratory challenge overcomes compensation or compensatory steps can no longer continue
(AKA inadequate breathing)
List:
signs of respiratory failure
5 points (think late choking)
- signs of hypoxia
- no/poor air movement
- irregular breathing
- inability to speak
- unusual breathing noises
Define:
respiratory arrest
when breathing completely stops
Define:
positive pressure ventilation (PPV)
forcing air or oxygen into lungs when a patient has stopped breathing or has inadequate breathing
Fill in the blank:
Positive pressure ventilation uses force that is [BLANK].
Positive pressure ventilation uses force that is exactly opposite of how the body normally draws air into the lungs.
List:
negative side effects of positive pressure ventilations
3 points
- hyperventilation
- gastric distention
- decreasing cardiac output and/or dropping blood pressure
Explain:
proper spacing of positive pressure ventilations
1 respiration for every 5-6 seconds
Define:
bag-valve mask (BVM)
handheld ventilation device
used to ventilate patient in respiratory failure/arrest
Explain:
proper squeezage of BVM
just enough for chest to rise
Explain:
how to propely seal BVM on face
E-C clamp
Fill in the blank:
[DO/DON’T] ventilate a patient who is vomiting or has vomitus in airway.
Do not ventilate a patient who is vomiting or has vomitus in airway.
(may force vomitus into lungs)
List:
steps in responding to no chest rise during BVM
4 points
- reposition head
- check for escape around mask (reposition fingers/mask if necessary)
- check airway for obstruction
- use alternative method
Fill in the blank:
A stoma breather has [BLANK].
A stoma breather has a surgical opening in the neck.
Explain:
artificial ventilation of a stoma breather
use pediatric mask to establish seal around stoma
Define:
flow-restricted oxygen-powered ventilation device
manually-triggered ventilation device
Define:
automatic transport ventilator (ATV)
machine which provides automated ventilations
Fill in the blank:
When using an automatic transport ventilator, provider must assure the appropriate [BLANK] for patient’s size and condition.
When using an automatic transport ventilator, provider must assure the appropriate respiratory rate and volume for patient’s size and condition.
Fill in the blank:
Oxygen makes up [BLANK] percent of the atmosphere.
Oxygen makes up 21 percent of the atmosphere.
List:
occassions when providing oxygen may be beneficial
6 points
- respiratory distress
- respiratory/cardiac arrest
- lung diseases
- head injuries
- other serious injuries (trauma)
- shock
List:
parts of pressure regulator
4 points (giving oxygen)
- flowmeter
- high pressure port
- pressure guage
- nipple
Fill in the blank:
When providing oxygen, use [BLANK], [BLANK], and [BLANK] intended for use with oxygen.
When providing oxygen, use pressure gauges, regulators, and tubing intended for use with oxygen.
Fill in the blank:
[DO/DON’T] allow smoking around oxygen or use oxygen equipment around open flame.
Don’t (never) allow smoking around oxygen or use oxygen equipment around open flame.
Fill in the blank:
[DO/DON’T] use grease or adhesive tape on a cylinder.
Don’t (never) use grease or adhesive tape on a cylinder.
Fill in the blank:
[DO/DON’T] test cylinders hydrostatically every 5 years.
Do test cylinders hydrostatically every 5 years.
Define:
nonrebreather mask
best way to deliver high concentrations of oxygen to a breathing patient
Define:
nasal cannula (NC)
best choice for a patient who refuses to wear an oxygen face mask or for titration
Define:
partial rebreather mask
rebreather mask without reservoir bag
uncommon
Define:
venturi mask
mask that delivers specific concentrations of oxygen by mixing with inhaled air
Define:
tracheostomy mask
mask placed over stoma or tracheostomy tube to provide supplemental oxygen
Explain:
purpose of humidifier connected to flowmeter
provides moisture to dry oxygen from supply cylinder
prevents drying out mucus membranes with just oxygen
Define
endotracheal intubation (ET)
intubating a patient through trachea
Explain:
ways EMTs can assist with intubation
4 points
- maximize oxygenation prior to procedure
- position patient in sniffing position
- cricoid pressure (pushing vocal chords into view)
- securing tube in place
Fill in the blank:
[BLANK] can displace an endotracheal tube.
Very little movement can displace an endotracheal tube.
Answer:
Your patient is a 55-year-old man with a history of chronic bronchitis. You have been called to his home today because of an increase in his level of respiratory distress. The patient is on 2 liters per minute of oxygen by nasal cannula at home. Your assessment reveals difficulty speaking due to shortness of breath, leaning forward to breathe, a productive cough, and a respiratory rate of 32 per minute.
What is the best course of action for this patient?
You should increase the patient’s oxygen flow rate to deliver adequate amounts of oxygen to his tissues.
If his respiratory rate decreases, you can assist him with a bag-valve-mask device.
Answer:
The paramedic is intubating a patient and asks you to assist by gently pressing your thumb and index finger to either side of the throat just over the patient’s Adam’s apple. As you press, you gently direct the throat upward and to the patient’s right.
What is the purpose of this maneuver?
It pushes the patient’s vocal cords into the paramedic’s view.
Answer:
Which colors identify an oxygen cylinder?
green and white
Answer:
What is the best device to deliver high-concentration oxygen to a breathing patient?
nonrebreather mask
Answer:
The normal urge to breathe is stimulated by chemoreceptors that measure changing levels of what two gases?
carbon dioxide (CO₂) and oxygen (O₂)
Fill in the blank:
You are attempting to replace the oxygen cylinder in your truck. After removing the regulator from the old cylinder, removing the old cylinder, and placing the new cylinder in the oxygen compartment, you attempt to connect the regulator. The new cylinder is yellow rather than green, but it was stored with the green cylinders. You are unable to get the regulator to seat properly and it will not turn. You should [BLANK].
You should remove the yellow cylinder and get a green cylinder.
Answer:
How could fast respiration decrease minute volume?
The lungs may not have adequate time to fill and exchange gas.
Answer:
On arrival at the emergency scene, you find an adult female patient who is semi-conscious. Her respiratory rate is 7 breaths per minute. She appears pale and slightly blue around her lips.
What immediate actions are necessary? Does this patient require artificial ventilations?
after donning PPE and ensuring the scene is safe, the EMT should first open this patient’s airway
(if necessary) support it with an airway adjunct and suctioning as appropriate
this patient needs immediate respiratory assistance with a BVM and supplemental oxygen
Answer:
On arrival at the emergency scene, you find an adult female patient who is semi-conscious. Her respiratory rate is 7 per minute. She appears pale and slightly blue around her lips.
Is this patient in respiratory failure, and if so, what signs and symptoms indicate this?
Yes, her altered mental status, slow respiratory rate, and cyanosis all point to respiratory failure.
Answer:
On arrival at the emergency scene, you find an adult male patient sitting bolt upright in a chair. He looks at you as you come into the room, but he is unable to speak more than two words at a time. He seems to have a prolonged expiratory phase; you hear wheezes, and his respiratory rate is 36.
What immediate actions are necessary?
(at a minimum) patient needs immediate supplemental oxygen
assess further to determine respiratory failure
Answer:
On arrival at the emergency scene, you find an adult male patient sitting bolt upright in a chair. He looks at you as you come into the room, but he is unable to speak more than two words at a time. He seems to have a prolonged expiratory phase; you hear wheezes, and his respiratory rate is 36.
Is this patient in respiratory failure, and if so, what signs and symptoms indicate this?
further assessment necessary to identify respiratory failure
inability to speak and position certainly signify potential impending failure
Answer:
On arrival at the scene of a motor-vehicle crash, you find an adult female patient pacing outside her damaged vehicle. She appears to be breathing very rapidly but acknowledges you as you approach. Her color seems normal, and her respiratory rate is 48.
What immediate actions are necessary?
Although this patient may just be anxious after the motor-vehicle crash, a thorough assessment must be completed to ensure the fast respiratory rate is not due to an injury.
Answer:
On arrival at the scene of a motor-vehicle crash, you find an adult female patient pacing outside her damaged vehicle. She appears to be breathing very rapidly but acknowledges you as you approach. Her color seems normal, and her respiratory rate is 48.
Is this patient in respiratory failure, and if so, what signs and symptoms indicate this?
Not likely, but further assessment necessary
Rapid respiratory rates can indicate inadequate breathing, but further assessment will be necessary to identify respiratory failure. The information provided (i.e., she is walking around, is alert, and has normal skin color) seems to indicate that at this time the patient is not in respiratory failure and will likely not need artificial ventilations.
Choose:
C
Choose:
D
Choose:
B
Choose:
D
Choose:
D
Choose:
B
narcotics taken in excess can cause respiratory depression and may lead to hypoxia
Choose:
B
hyperventilation can lead to lower BP, vasoconstriction, and limited flow O₂ to brain
Choose:
D
use the jaw-thrust maneuver instead (because it’s a trauma patient)
Choose:
D
BVM should be used with oral airway
reservoir bag and O₂ tank should always be used
Choose:
A
priority is always to treat respiratory distress with high-flow and high-concentration O₂
Choose:
D
Choose:
B
patient has decreased respiratory execution due to rib fractures
higher RR may cause lower tidal volume
reduced tidal volume might prevent adequate O₂ intake
Define:
AMS
(acronym)
altered mental status
Define:
BVM
(acronym)
bag-valve mask
Fill in the blank:
Do not use an NPA on a patient with [BLANK] or [BLANK].
Do not use an NPA on a patient with facial injury or skull fracture.
Answer:
When should you use a BVM on a patient?
3 points
- low RR
- shallow breathing
- agonal breathing
Explain:
What are 2 components that define inadequate breathing? How do we treat them?
low RR or shallow breaths
To treat, provide artificial ventilations (with a BVM)
Fill in the blank:
For normal breathing, air is brought into the lungs through inhalation with a [POSITIVE/NEGATIVE] pressure.
air is brought into the lungs through inhalation with a negative pressure.
Fill in the blank:
When conducting artificial ventilation, air is brought into the lungs through inhalation with a [BLANK] pressure.
air is brought into the lungs through inhalation with a positive pressure.
pushing air out of BVM opposite of how lungs work
Fill in the blank:
For normal breathing, air is pushed out of the lungs through exhalation with a [POSITIVE/NEGATIVE] pressure.
air is pushed out of the lungs through exhalation with a positive pressure.
Fill in the blank:
When conducting artificial ventilation, air is pushed out of the lungs through exhalation with a [BLANK] pressure.
air is pushed out of the lungs through exhalation with a negative pressure.
The pressure filling the BVM is pulling in air the way the lungs would.
Fill in the blank:
Respiratory failure occurs when [BLANK] is no longer effective.
Respiratory failure occurs when respiratory compensation is no longer effective.
Choose:
Which of the following muscles are located within the chest wall and assist with exhalation to the greatest degree?
A. diaphragmatic muscles
B. retroperitoneal muscles
C. intercostal muscles
D. coracobrachialis muscles
C
The intercostal muscles are critical to exhalation. These muscles lie between the ribs and help to bring the ribs closer together. This reduces the size of the chest cavity and allows the natural recoil of the lungs to force air out of the body.
The diaphragm is the other major muscle of respiration. It does not assist with exhalation but rather inhalation. Moving downwards at the base of the chest cavity, this expands the cavity and creates negative pressure which forces air into the lungs.
Choose:
Which phase of respiration does the transfer of oxygen and carbon dioxide between inspired air and the pulmonary capillaries take place?
A. Internal respiration
B. Aerobic respiration
C. External respiration
D. Anaerobic respiration
C
External respiration is the exchange of gases between the alveoli of the lungs and the blood. During the external respiration phase, the transfer inspired air and the pulmonary capillaries take place.
Internal respiration is the exchange of gases between the cells and the blood. Failure of Internal respiration is almost always due to failing external respiration. The few things that affect internal respiration directly are blood loss and cyanide poisoning.
Choose:
You arrive on the scene of a cardiac arrest in which bystanders are performing CPR. The compressions are adequate. They are ventilating the patient via a pocket mask without oxygen.
What is the maximum percentage of oxygen this type of ventilation can deliver to the patient?
A. 10%
B. 13%
C. 16%
D. 21%
C
The maximum amount of oxygen delivered via rescue breathing without supplemental oxygen is 16% because you’re just ventilating with exhaled air. This, on average, is 16% oxygen and is sufficient when no other options are available. However, it should be supplemented with oxygen or replaced with another ventilation method (such as a bag-valve mask) as soon as possible.
Choose:
A respiration rate would be considered within normal limits for an adult at [BLANK] per minute, a school-age child at [BLANK] per minute, and an infant at [BLANK] per minute.
A. 20 - 40 - 60
B. 16 - 25 - 40
C. 22 - 32 - 42
D. 10 - 20 - 40
B
According to multiple sources, normal adult respiratory rates are from 12-20, school-age children (6-12) are 18-30, and infants are 30-60.
Note: Respiratory rates for late adulthood, 61+, is dependent on the patient’s physical and health status.
Choose:
What physiological difference is found with artificial ventilation that is not a concern when a patient has total control over their own ventilation?
A. Positive pressure is created in the chest during inspiration
B. Blood return to the heart is increased
C. The esophagus opening is forced to close by air pressure
D. Negative pressure is created between the pleura during inhalation
A
Artificial ventilation creates positive pressure in the chest during inhalation, as opposed to the negative pressure normally created during natural respiration. The other answers are not created by artificial ventilation. During artificial ventilation, blood return to the heart is decreased because of the pressure in the chest cavity; this decreases cardiac output. The esophagus may be forced open by the air pressure in the nasopharynx; healthcare providers must watch for gastric inflation because of this.
Choose:
You are dispatched to a patient with acute shortness of breath. She is conscious, but confused, and is gasping for air. Your pulse oximeter is reading 74% on room air.
Which of the following is the best respiratory intervention for this patient?
A. 15 liters of oxygen per minute via NRB
B. insert an oral airway and begin positive pressure ventilations
C. assisted positive pressure ventilation with oxygen
D. needle decompression of the bilateral chest
C
This patient has altered mental status, hypoxemia, and gasping breaths, all three of these are warning signs for inadequate ventilation. The combination of the three should lead you to the conclusion that ventilations need to be assisted as opposed to only oxygen being provided.**
Choose:
An unresponsive patient is breathing on his own at 6-8 breaths per minute. He is cyanotic around the nose and mouth. You are unable to palpate a radial pulse.
You should:
A. Initiate chest compressions only
B. Begin assisting ventilations with a BVM and 100% O2 at 10-12 breaths per minute
C. Check responsiveness and initiate CPR
D. Assess the situation further
B
A patient breathing 6-8 times per minute with no radial pulse is not in full cardiac arrest.
Begin immediately assisting his respirations with a BVM and 100% O2 while assessing the situation further. Additionally, you should assess for a carotid pulse. The immediate need is that this patient needs more oxygenated air now!
