Chapter 19 | Respiratory Emergencies Flashcards
• How to identify adequate breathing • How to identify inadequate breathing • How to identify and treat a patient with breathing difficulty • Use of continuous positive airway pressure (CPAP) to relieve difficulty breathing • Use of a prescribed inhaler and how to assist a patient with one • Use of a prescribed small-volume nebulizer and how to assist a patient with one
Define:
adequate breathing
breathing sufficient to support life
List:
signs of adequate breathing
3 points (what you see with your eyeballs)
- no obvious distress
- ability to speak in full sentences
- normal skin color and mental status
Define:
inadequate breathing
breathing not sufficient to support life
List:
signs of inadequate breathing
3 points
- rate: abnormal RR
- rhythm: abnormal respiratory rhythm
- quality: poor tidal volume
Explain
treatment for inadequate breathing
assisted ventilations with supplemental oxygen
(pocket face mask, BVM, or other oxygen-powered ventilation device)
Describe:
adequate artificial ventilation rate
(for adults)
10-12 breaths per minute
(1 ventilation every 5-6 seconds)
Describe:
adequate artificial ventilation rate
(for children)
20 breaths per minute
(1 ventilation every 3 seconds)
Define:
“difficulty breathing”
patient’s subjective perception of breathing trouble
True or false:
The amount of breathing distress felt may or may not reflect actual severity of condition.
true
Define:
barrel chest
expansion of chest muscles by constant over-inflation of lungs
(associated with emphysema)
List:
methods used in respiratory assessment
3 points
- observation
- auscultation
- palpation
Define:
sacral edema
(and usual cause)
excess fluid in lower back
(usually caused by laying in bed for too long)
Define:
crackling
fine/coarse cracking sounds caused by fluid in alveoli or by opening of closed alveoli
Define:
CPAP
(abbreviation)
continuous positive air pressure
Define:
continuous positive air pressure (CPAP)
positive pressure to the airways that is maintained throughout the respiratory cycle (during both inspiration and expiration)
Fill in the blank:
CPAP is measured in [BLANK].
(unit of measurement)
CPAP is measured in centimeters of water (cm H₂O).
Fill in the blank:
Start to apply CPAP at [BLANK].
(unit of measurement)
Start to apply CPAP at 5 cm H₂O.
Fill in the blank:
The maximum setting for CPAP should be [BLANK].
(unit of measurement)
The maximum setting for CPAP should be 10 cm H₂O.
List:
common uses for CPAP
6 points (conditions)
- CHF / pulmonary edema
- asthma
- COPD
- drowning
- general respiratory failure
List:
indications of CPAP
3 points (critical findings)
- hypoxia (below 90%)
- high RR (above 25 bpm)
- difficulty breathing
List:
contraindications of CPAP
6 points
- severe AMS (unsafe)
- unsecured airway (unsafe)
- foreign body airway obstruction (counterproductive)
- penetrating chest trauma (ineffective)
- pneumothorax (counterproductive)
- hypotension (counterproductive)
List:
steps before administering a prescribed inhaler
5 points
- six rights
- check expiration date
- shake inhaler
- determine if patient is alert enough
- use spacer device if available
Define:
diaphoretic
condition of diaphoresis
excessively sweating due to a secondary condition
Fill in the blank:
When administering a prescribed inhaler, make sure the patient [BLANK] so medication can be absorbed.
make sure the patient inhales deeply and holds breath as long as possible so medication can be absorbed.
Define:
nebulizer
device which runs oxygen or air through a liquid/mist medication
Define:
COPD
(abbreviation)
chronic obstructive pulmonary disease
Define:
chronic obstructive pulmonary disease (COPD)
broad classification of chronic lung diseases
List:
specific conditions that fall under COPD
3 points
- emphysema
- chronic bronchitis
- black lung
Describe:
most common cause of COPD
cigarette smoking
Define:
chronic bronchitis
inflammation of bronchi with production of excess mucus
Define:
emphysema
breakdown of alveoli walls (reduced surface area) which causes air trapped in lungs
form of COPD (basically low-level asthma attack all the time)
Define:
asthma
chronic pulmonary disease with episodic exacerbations
Define:
asthma attack
(what does it mean when somebody is having one?)
flare up of asthma condition resulting in bronchoconstriction and overproduction of mucus
Fill in the blank:
Bronchoconstriction and overproduction of mucus during an asthma attack can result in [BLANK].
Bronchoconstriction and overproduction of mucus during an asthma attack can result in closing of small airway passages.
(ends up severely restricting airflow)
List:
immediate treatments for COPD or asthma
5 points
- supplemental oxygen
- CPAP
- assisting with inhaler
- position of comfort
- coaching breathing
Define:
pulmonary edema
abnormal accumulation of fluid in alveoli
Explain:
why somebody with CHF might experience dyspnea
CHF is most often associated with pulmonary edema (fluid in alveoli)
(CHF is congestive heart failure; dyspnea is difficulty breathing)
Define:
CHF
(abbreviation)
congestive heart failure
Define:
congestive heart failure (CHF)
pressure build-up in pulmonary capillaries (causing swelling of heart) when fluid accumulates in alveoli (pulmonary edema)
List:
primary signs/symptoms of CHF
3 points (assessment findings)
- dyspnea
- fatigue
- edema (pulmonary or pedal)
(CHF is congestive heart failure)
List:
associated signs/symptoms of CHF
5 points (skin, HR, BP, SpO₂)
- JVD
- pale/sweaty skin
- tachycardia
- hypertension
- hypoxia
List:
treatments for CHF
2 points (what you can provide)
- supplemental oxygen
- CPAP
Define:
supportive care
treatment for respiratory disorders without specific pre-hospital protocol
generic respiratory treatment
List:
components of supportive care
3 points
- position of comfort
- assisted ventilations or supplemental oxygen (if necessary)
- patient transport
Define:
pneumonia
uni-/bi-lateral infection of alveoli caused by bacteria, viruses, or fungi
Explain:
cause of pneumonia
inhalation of certain microbes which grow in lungs and cause inflammation
List:
signs/symptoms of pneumonia
5 points
- shortness of breath
- coughing
- pleuritic chest pain
- fever/chills
- fatigue
Define:
spontaneous pneumothorax
lung collapse without injury or other obvious cause
List:
patients at highest risk for spontaneous pneumothorax
2 points
- tall and thin people
- cigarette smokers
Define:
Marfan syndrome
genetic condition that affects connective tissues
impacts hearts, eyes, blood vessels, and bones
Fill in the blank:
[BLANK] is contraindicated by pneumothorax.
(don’t give this treatment)
CPAP is contraindicated by pneumothorax.
List:
primary signs/symptoms of spontaneous pneumothorax
3 points
- pleuritic chest pain
- shortness of breath
- diminished lung sounds on side with injured lung
List:
secondary signs/symptoms of spontaneous pneumothorax
2 points (SpO₂ and HR)
- hypoxia
- tachycardia
Define:
pulmonary embolism
blockage in blood supply to lungs
Describe:
most common cause of pulmonary embolism
deep vein thrombosis (DVT)
Define:
DVT
(abbreviation)
deep vein thrombosis
List:
risk factors for pulmonary embolism
4 points
- abnormally fast blood clotting
- prolonged bed-rest or limb immobility
- torso trauma
- cigarette smoking
List:
primary signs/symptoms of pulmonary embolism
2 points
- sudden chest pain
- shortness of breath (no change in lung sounds)
List:
secondary signs/symptoms of pulmonary embolism
2 points (SpO₂, HR)
- hypoxia
- tachycardia
List:
signs/symptoms of viral respiratory infections
4 points
- sore/scratchy throat
- fever/chills
- shortness of breath
- persistent and productive cough (yellow/green sputum)
Define:
sputum
mixture of saliva and mucus coughed up from the respiratory tract
Answer:
When should the EMT most likely expect to hear wheezes in a patient complaining of shortness of breath secondary to an asthma attack?
(point of breath cycle)
when breathing out
(exhalation)
Fill in the blank:
While caring for a 3-year-old child, you should be concerned if his respiratory rate exceeds [BLANK] breaths per minute.
you should be concerned if his respiratory rate exceeds 30 breaths per minute.
Answer:
What is the benefit of using small-volume nebulizer for the treatment of respiratory problems?
(as opposed to, say, an inhaler)
allows greater exposure of the patient’s lungs to the medication
Answer:
Your patient is a 24-year-old woman with asthma who is struggling to breathe and is very agitated. She has cyanosis of her lips and nail beds, and is cool and clammy to the touch. When you attempt to assist her ventilations with a bag-valve mask device, she becomes combative and repeatedly pushes the mask away from her face.
What is the best option?
begin transport immediately and contact medical control for advice
Answer:
After administering epinephrine per medical control via an auto-injector to an unresponsive anaphylactic adult patient, your partner reassesses the lung sounds. He tells you that the patient is now wheezing loudly in all fields whereas before the injection they were diminished in the upper fields and absent in the lower.
What is your suspicion regarding the patient’s condition?
the patient’s condition is improving
Define:
epiglottitis
infection causing swelling around glottic opening
List:
signs/symptoms of epiglottitis
5 points
- throat problems (soreness/drooling/swallowing)
- muffled voice
- stridor
- fever (and sick appearance)
- respiratory distress
Define:
croup
viral infection that results in inflammation of larynx, trachea, and bronchi
usually seen in children
List:
signs/symptoms of croup
5 points
- loud seal-bark cough
- throat soreness
- dyspnea
- fever
- paleness/cyanosis
Define:
bronchiolitis
inflammation of bronchioles due to viral infection
(most commonly RSV)
List:
signs/symptoms of bronchiolitis
3 points
- runny nose
- fever
- general illness
(cold-like symptoms)
Fill in the blank:
Symptoms of bronchiolitis typically progress over a period of [BLANK] and worsen to include [BLANK].
Symptoms of bronchiolitis typically progress over a period of a few days and worsen to include respiratory distress.
Fill in the blank:
Bronchiolitis can cause significant [BLANK] and progress to [BLANK].
Bronchiolitis can cause significant respiratory distress and progress to inadequate breathing.
Define:
cystic fibrosis
genetic disease which causes thick, sticky mucus to accumulate in the lungs and digestive system
Fill in the blank:
Cystic fibrosis typically first appears in [BLANK].
(stage of life)
Cystic fibrosis typically first appears in childhood.
List:
signs/symptoms of cystic fibrosis
5 points
- coughing with large amounts of mucus (or blood)
- fatigue
- frequent pneumonia
- abdominal pain/distention
- nausea/vomiting
Choose:
Which of the following is a sign of adequate artificial ventilations in a pediatric patient?
A: The breath is delivered easily.
B: Pulse rate increases.
C: You notice cyanosis developing around the mouth.
D: Pulse rate slows down.
B
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C
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C
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B
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D
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A
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C
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D
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C
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B
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C
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C
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D
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B
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D
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C
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B
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B
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C
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B
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B
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C
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B
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D
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A
Define:
deep vein thrombosis (DVT)
(usually where?)
a blood clot that develops within a deep vein in the body
(usually in leg)
Define:
pleuritic chest pain
sharp chest pain that worsens with breathing
True or false:
CPAP can cause hypotension.
CPAP can be expected to lower a patient’s BP
True or false:
CPAP can cause hypertension.
CPAP can be expected to lower a patient’s BP
Choose:
How does emphysema contribute to airway limitation?
A. By increasing mucus secretions in the bronchioles.
B. By paralyzing the cilia that clean the airways.
C. By scarring the smaller airways.
D. By decreasing the surface area for respiration.
D
Emphysema contributes to airway limitations via a decrease in surface area for respiration via destruction of the dividing walls of the alveoli, causing the smaller alveoli to coalesce into larger ones. The secretions, cilia paralysis, and scarring are components of the small airway disease (bronchiolitis), not that of the parenchyma.
Choose:
You are treating a 9-year-old child that presents with acute onset, non-febrile respiratory distress. The patient is rapidly becoming cyanotic around his mouth and fingertips/nail beds.
Which of the following should be suspected first?
A. Foreign body aspiration
B. Croup
C. Epiglottitis
D. Pneumonia from aspiration
A
Hyperacute onset respiratory distress in children in the absence of a fever suggests foreign body aspiration. Croup and Epiglottitis would both present more slowly and likely with a fever.
Choose:
An elderly patient with shortness of breath requires transport. Assessment reveals edematous legs, diffuse rales, and extra heart sounds.
Which of the following acronyms refers to their likely underlying condition?
A. PE
B. CHF
C. CVA
D. MI
B
CHF or “Congestive Heart Failure” refers to the constellation of symptoms seen in the prompt. This can be secondary to a MI “Myocardial infarction” or PE “Pulmonary embolism.” A CVA “stroke” will not cause this condition.
Choose:
You are treating a firefighter that received thermal burns to her airway during a fire. It is critical to watch for signs and symptoms of which of the following in this patient?
A. Shock
B. Respiratory arrest
C. Bronchiolitis
D. Laryngeal edema
D
Burns to high vascularized tissue of the airway can lead to laryngeal edema and a blocked airway.
Choose:
While ventilating a patient that is apneic but not yet intubated with a BVM, it becomes increasingly harder to deliver ventilations.
Which of the following is the next best step in treatment?
A. Attempt to assess the problem while continuing to ventilate
B. Reposition the airway and watch for adequate chest rise
C. Check for a foreign body airway occlusion
D. Request ALS intercept
B
If ventilation’s are not adequate it is most appropriate to reposition the airway before looking for other causes of ventilation difficulty. The most common cause of airway obstruction is the soft tissue surrounding and within the airway.
Choose:
What is the medical term for coughing up blood?
A. Hemothorax
B. Hematuria
C. Hematemesis
D. Hemoptysis
D
Define:
hemoptysis
coughing up blood
Choose:
A patient being transported for hyperthermia resulting in loss of consciousness has an acute reduction in SpO2. On exam the patient’s lungs have diffuse rales and crackles. 100% O2 via non-rebreather results in an SpO2 of 77%.
Which of the following would be the best option to manage this patient’s airway?
A. ALS intercept for endotracheal intubation
B. Bag mask ventilation
C. The use of a high flow oxygen device
D. Chilled IV fluids
A
In hyperthermia, management follows this rationale: If the patient is unconscious, place in the recovery position, maintain the airway and assist with ventilations when necessary. The presence of hypoxemia at rest and crackles in the lung fields suggests that the dysregulation from heat stroke has resulted in fluid filling the air spaces within the lungs. This is best managed by intubation which will require an ALS intercept or rapid transport to a nearby hospital.
Choose:
A patient is involved in a motor vehicle accident and is presenting with an inability to take a breath despite gasping motions of the upper body.
Which of the following is most likely to be the root cause of this patient’s distress?
A. Compromised ventilation
B. Compromised respiration
C. Compromised airway
D. Compromised circulation
C
This patient is experiencing airway compromise, likely from a damaged trachea, larynx, or oropharynx which is resulting in an inability to ventilate. While compromise to the circulation due to bleeding may be an element of this presentation, based on the information in the prompt an airway issue is much more likely. Given that this patient seems to have use of their respiratory muscles intact ventilation is likely.
Choose:
A patient who has pleurisy is likely to have which of the following breath sounds?
A. Crackles
B. Stridor
C. Rhonchi
D. Friction rub
D
Inflammation of the pleurae (pleurisy) impairs their lubricating function and causes pain when breathing. It is caused by pneumonia and other diseases of the chest or abdomen, even as minor as a viral infection (e.g., the common cold).
Define:
aspiration
entry of foreign object (solid or liquid) past the epiglottis and into the larynx
