Chapter 9

Question 1

COPD patients rely on what drive?

Answer 1

COPD = chronic obstructive pulmonary disease

End stage COPD patients who have chronically high levels of CO2 may rely on HYPOXIC DRIVE

• • But prolonged exposure to high concentrations of oxygen in hypoxic drive patients may depress spontaneous ventilations
• • Withholding oxygen from acutely ill or injured patients is NOT recommended

Question 2

How much time does it take for injury to occur as a result of lack of oxygen to the heart and brain?

Answer 2

Heart and brain become irritable due to lack of oxygen almost immediately

Brain damage begins within 4 minutes

Permanent brain damage likely within 6 minutes

Irrecoverable injury is likely within 10 minutes

Question 3

Breathing assessment

Answer 3

look - listen - feel → don’t take more than 15 seconds for this entire process

LOOK for chest rise and fall

LISTEN for breathing / ability to speak / lung sounds

FEEL for air movement and chest rise and fall; place your ear near the victim’s mouth and nose, and your hand on the victim’s chest

Question 4

Pulse oximetry

Answer 4

SaO2 measures the % of hemoglobin (RBC) that is saturated w oxygen; acts as an indicator of respiratory efficiency

Normal SaO2 is 98% or above; below 94% indicates the need for supplemental oxygen

Question 5

sizing of Mechanical airway adjuncts

• OPA
• NPA

Answer 5

OPA: measure the corner of the mouth to the earlobe; OPA should be positioned during measurement as it will reside upon insertion

NPA: measure from the tip of the nose to the earlobe; NPA should be positioned during measurement as it will reside upon insertion

Question 6

insertion of OPA

• adults
• children

Answer 6

In adults: manually open airway; suction as needed → insert OPA upside down w distal end pointing toward roof of mouth; rotate 180 degrees while advancing OPA until flange (flat proximal portion) rests on the patient’s lips

In pediatric patients: manually open airway; suction as needed → depress tongue w a tongue depressor and insert directly (no rotation), or insert OPA sideways and rotate 90 degrees until flange rests on the lips

Question 7

OPA

• function
• indications
• contraindications

Answer 7

OROPHARYNGEAL AIRWAY
used to prevent the tongue from obstructing the airway; make sure to size and insert it correctly

Indicated in patients that are unresponsive and DO NOT POSSESS a gag reflex

Contraindicated in conscious patients or any patient w an intact gag reflex

Question 8

NPA

• function
• indications
• contraindications

Answer 8

NASOPHARYNGEAL AIRWAY

Indicated in un/conscious patients w intact gag reflex

Contraindicated in conscious patients w an intact gag reflex and capable of protecting their own airway; w severe head injury or facial trauma (esp of nose); resistance to insertion in both nostrils; patients under one year of age; actively bleeding nose

Question 9

NPA insertion

Answer 9

lubricate NPA w a water-soluble (not petroleum!) lubricant prior to insertion

> always insert w bevel towards the septum

> try larger nostril first then downsize if resistance is met

> advance gently, rotating as necessary until flange rests against the nostrils

Question 10

suction catheters
- rigid
- french
+ alternative names

Answer 10

single patient use only, thus are disposable

Rigid suction catheter: aka tonsil tip or Yankauer; best suited for suctioning the oral airway → only insert as far as you can see

French catheter: aka whistle tip; flexible catheter that comes in various sizes (based on measuring from the corner of the mouth to the earlobe) best suited for suctioning the nose, stoma, or the inside of an advanced airway device

Question 11

oxygen cylinder sizes

Answer 11

D size: about 350-liter capacity
E: 625
M: 3000
G: 5000
H: 7000; largest

Question 12

maintenance of oxygen cylinders

• when do you check them
• when do you replace them
• flow meter / pressure regulator system

Answer 12

should be tested every 3 to 5 years

amount of oxygen in a cylinder is measured in pounds per square inch (psi); full cylinder is about 2000 psi → cylinder should be taken out of service and refilled if it is below 200 psi

Flow meters are connected to pressure regulators → in combination, they reduce the pressure coming from the tank to safe levels and allow a specific flow rate (measured in liters per minute)

Question 13

simple face mask (blow by)

• lpm
• SaO2 %

Answer 13

6 to 10 lpm

40 to 60%

Question 14

when should you provide artificial ventilation to a patient

Answer 14

Consider providing artificial ventilation for any patient breathing less than 8 times per minute or more than 24 times per minute

Question 15

Rates of ventilation vary across age for APNEIC PATIENTS (without a pulse)

• how many seconds apart
• times per minute

Answer 15

Adults: one breath every 5-6 seconds → 10 to 12 times per minute

Infants / children: one breath every 3-4 seconds → 12 to 20 times per minute

Newborns: one breath every 1-1.5 seconds → 40 to 60 times per minute

Question 16

Compression to ventilation ratio is reserved for patients in cardiac arrest (thus not based on a clock)

Answer 16

30 compressions : 2 breaths → used in adult patients or any single-rescuer CPR on any patient

15 : 2 → used in two-person CPR on children and infants

3 : 1 → used in newborns
For patients in cardiac arrest with an advanced airway ventilation device in place, provide one breath every 6-8 seconds, thus 8-10 breaths per minute

Question 17

BVM volume by age of victim

Answer 17

Adult BVM: 1200 to 1600 mL
Child: 500 to 700
Infant: 150 to 240

Question 18

single rescuer vs two BVM techniques

Answer 18

Single rescuer BVM: not a preferred technique; rescuer must control the mask / mask seal / and head position with one hand and squeeze the bag w the other via “EC” clamp

Two rescuer BVM: highly preferred; one rescuer uses both hands to control the mask seal while the other uses both hands to squeeze the bag → makes it considerably easier to maintain a good seal during ventilations and ventilate slowly, thus controlling tidal volume and reduce gastric distension

Question 19

EC clamp

Answer 19

used to secure BVM to face

thumb and index make a “C” around the mask; remaining 3 fingers form an “E” and are placed along the angle of the jaw → hand controlling the mask should be placed on the same side of the patient’s jaw

Question 20

CPAP

• function
• indications
• contraindications

Answer 20

continuous positive airway pressure

used to improve ventilatory efficiency in spontaneously breathing patients in respiratory distress

Indicated in patients that are conscious in moderate to severe respiratory distress; tachypnea patients w reduced respiratory efficiency; patients w a pulse oximetry below 90%

Contraindicated in apneic patients or patients unable to follow verbal commands; w chest trauma, suspected pneumothorax, or tracheostomy; vomiting or suspected gastrointestinal bleeding; hypotension

Question 21

Signs of respiratory failure in pediatric patients

Answer 21

Bradycardia and poor muscle tone

Altered LOC

Head bobbing and grunting on exhalation

Seesaw breathing (chest and abdomen moving in opposite)

Question 22

Indication of complete or nearly complete FBAO (3)

Answer 22

FBAO = foreign-body airway obstruction

Inability to cough, speak, or breath

Clutching at the throat (in a conscious patient)

Inability to artificially ventilate the patient despite repositioning the airway and managing the tongue

Question 23

Management of FBAO for diff age groups

- conscious vs unconscious

Answer 23

In conscious adults and children: administer abdominal thrusts until the obstruction is relieved or until the patient loses consciousness

In conscious infants: administer a series of five back blows and five chest thrusts until the obstruction is relieved or until the patient loses consciousness

In unconscious patients (all ages): initiate CPR > before attempting ventilations, inspect the airway for visible foreign bodies; remove if able