Chapter 17: Respiratory Emergencies

Question 1

Inspiration/Inhalation

Answer 1

an active process in which the intercostal (rib) muscles and the diaphragm contract, expanding the size of the chest cavity and causing air to flow into the lungs

Question 2

Expiration/Exhalation

Answer 2

a passive process in which the intercostal (rib) muscles and the diaphragm relax, causing the chest cavity to decrease in size and forcing air from the lungs

Question 3

Adult normal breathing rate

Answer 3

12-20 breaths per minute

Question 4

Child normal breathing rate

Answer 4

15-30 breaths per minute

Question 5

Infant normal breathing rate

Answer 5

25-50 breaths per minute

Question 6

Decision points for inadequate breathing

Answer 6

• Is the pt breathing?
• is the pt breathing?
• Do I have an intervention to help this pt?
• Will this pt benefit from ALS?

Question 7

Inadequate breathing signs in children/infants

Answer 7

• nasal flaring
• grunting
• seesaw breathing
• retractions between the ribs, above the clavicles, and above the sternum

Question 8

Adequate breathing signs

Answer 8

Pt is breathing adequately, but needs supplemental O2 due to a medical or trauma condition

• rate and depth of breathing are adequate
• no abnormal breath sounds
• air moves freely in and out of the chest
• skin color normal

Question 9

Adequate breathing EMT intervention

Answer 9

O2 by nonrebreather mask or nasal canula

Question 10

Inadequate breathing signs

Answer 10

Pt is moving some air in and out, but it is slow or shallow and not enough to live

• pt has some breathing but not enough to live
• rate and/or depth outside of normal limits
• shallow ventilations
• diminished or absent breath sounds
• noises such as crowing, stridor, snoring, gurgling, or gasping
• blue (cyanosis) or gray skin color
• decreased minute volume

Question 11

Inadequate breathing EMT intervention

Answer 11

assisted ventilations (positive pressure vent) with a pocket face mask, BCM, or FROPVD

Question 12

Signs the pt is not breathing at all

Answer 12

• no chest rise
• no evidence of air being moved from the mouth or nose
• no breath sounds

Question 13

EMT intervention for pt not breathing at all

Answer 13

assisted ventilations w/ a pocket face mask, BVM, or FROPVD at 12-15 l/m for an adult and 20/m for a child or infant

Question 14

Adequate artificial ventilation rate

Answer 14

10-12 breaths per minute for adults

20 breaths per minute for an infant or child

Question 15

Wheezes

Answer 15

• high-pitched sounds that will seem almost musical in nature
• the sound is created by air moving through narrowed air passages in the lungs
• it can be heard in a variety of diseases, but is common in asthma and sometimes chronic obstructive lung diseases such as emphysema and chronic bronchitis.
• most commonly heard during expiration

Question 16

Crackles

Answer 16

• a fine crackling or bubbling sound heard on inspiration

- the sound is cause by fluid in the alveoli or by the opening of closed alveoli

Question 17

Rhonchi

Answer 17

• lower-pitched sounds that resemble snoring or rattling
• caused by secretions in larger airways as might be seen with pneumonia or bronchitis or when
• rhonchi are generally louder than crackles

Question 18

Stridor

Answer 18

• high-pitched sound hear on inspiration

- an upper-airway sound indicating partial obstruction of the trachea or larynx

Question 19

Continuous positive airway pressure (CPAP)

Answer 19

a form of noninvasive positive pressure ventilation (NPPV) consisting of a mask and a means of blowing oxygen or air into the mask to prevent airway collapse or to help alleviate difficulty breathing

Question 20

Anatomic-physiologic contraindications for CPAP

Answer 20

• altered mental status
• inability to follow instruction
• lack of a normal, spontaneous respiratory rate
• inability to sit up
• hypotension, less than 90
• inability to get a get and maintain a good mask seal

Question 21

Pathological contraindications for CPAP

Answer 21

• nausea and vomiting
• penetrating chest trauma (pneumothorax especially)
• shock
• upper gastrointestinal bleed or recent gastric surgery
• any condition that would prevent a good mask seal

Question 22

Emphysema

Answer 22

• the walls of the alveoli break down, greatly reducing the surface area for respiratory exchange
• lungs lose elasticity
• those factors combine to allow stale air laden with CO@ to be trapped in the lungs reducing the effectiveness of normal breathing efforts

Question 23

Asthma

Answer 23

the small bronchioles that lead to the air sacs of the lungs become narrowed b/c of contractions of the muscles that make up the airway.

Question 24

Pulmonary Edema Treatment

Answer 24

• high-concentration O2 by mask unless the pt’s breathing is inadequate and you need to ventilate the pt
• keep the pt’s legs in a dependent position (hanging down)
• CPAP could be very useful in these pts since it can physically push the fluid back out of the lungs and into the capillaries where it belongs

Question 25

Pneumonia

Answer 25

an infection of one or both lungs caused by bacteria, viruses, or fungi; results from the inhalation of certain microbes that grow in the lungs and cause inflammation.

Question 26

Spontaneous pneumothorax

Answer 26

• when a lung collapses without injury or any other obvious cause; usually the result of rupture of a bleb, a small section of the lung that is weak
• treat like you would treat anyone with shortness of breath, except CPAP

Question 27

Pulmonary embolism

Answer 27

when something that is not blood – such as a blood clot, air, or fat – tries to go through these blood vessels, it gets stuck and blocks an artery in the lungs

Question 28

Cystic Fibrosis

Answer 28

a genetic disease that causes thick, sticky mucus that accumulates in the lungs and digestive system

Question 29

Bronchoconstriction

Answer 29

constriction, or blockage, of the bronchi that lead from the trachea to the lungs