Module 3 Flashcards
What are the four kinds of respiration?
PULMONARY VENTILATION
EXTERNAL RESPIRATION
INTERNAL RESPIRATION
CELLULAR RESPIRATION and METABOLISM
______________ is also commonly referred to as ventilation or breathing
RESPIRATION
Physiologically, the term respiration refers to the ___________________
GAS EXCHANGE PROCESS THAT OCCURS BETWEEN THE ALVEOLI OR CELLS AND THE CAPILLARIES
____________________ is the process of breathing air into and out of the lungs
PULMONARY VENTILATION
__________________ is the gas exchange process that occurs between the alveoli and the surrounding pulmonary capillaries
EXTERNAL RESPIRATION
_______________ can also be referred to as the alvoli/capillary gas exchange
EXTERNAL RESPIRATION
_________________ serves to oxygenate the blood and eliminate carbon dioxide in the lungs
EXTERNAL RESPIRATION
__________________ is the gas exchange process that occurs between the cells and the systemic capillaries
INTERNAL RESPIRATION
__________________ can also be referred to as cell/capillary exchange
INTERNAL RESPIRATION
_________________ is responsible for delivering oxygen to the cells and removing carbon dioxide from the cell
INTERNAL RESPIRATION
__________________ is also known as aerobic metabolism, and occurs in the cell
CELLULAR RESPIRATION AND METABOLISM
_________________ is the process that breaks down glucose in the presence of oxygen, produces high amounts of energy in the form of ATP, and releases carbon dioxide and water as a by product
CELLULAR RESPIRATION AND METABOLISM
The respiratory system is divided anatomically into the ___________ and the ______________
UPPER AIRWAY
LOWER AIRWAY
The ________________ extends from the nose and mouth to the cricoid cartilage
UPPER AIRWAY
Air normally enters the body through the ______________
NOSTRILS
When air travels through the nostrils, is flows over the damp, sticky _______________ lining of the nose
MUCOUS MEMBRANE
The _____________ is a common cause of airway obstruction in the patient with an altered mental status.
TOUNGUE
Tongue obstruction occurs when ____________________ relax.
THE MUSCLES CONTROLLING THE TONGUE (submandibular muscles)
Air entering the body through the mouth and nostrils travels into the ____________
PHARYNX
Air from the nasal passages enters through what is referred to as the _____________________
NASOPHARYNX
Air entering through the mouth travels through the __________________
OROPHARYNX
Both the oropharynx and the nasopharynx enter into the pharynx at ______________________
THE BACK OF THE THROAT
Why must the pharynx be kept clear?
Because obstructions in it can prevent air from traveling to the lower airways, or the substance may be aspirated into the lungs
What happens if something is aspirated into the lungs?
It would interfere with oxygen and carbon dioxide exchange in the alveoli
What are the two passageways that are found at the lower end of the pharynx?
TRACHEA
ESOPHAGUS
The ___________ is the passageway for air traveling into the lungs
TRACHEA
Food and water are routed to the ________________, which leads to the stomach
ESOPHAGUS
The trachea is proctected by a small, leaf shaped flap of cartilaginous tissue called the ___________________
EPIGLOTTIS
At times, the epiglottis may fail to close, and food or liquid can enter the larynx and the upper portion of the trachea causing ________________
A PATIENT TO CHOKE
If a patient is unresponsive, the ____________________ may not work during swallowing, so that foreign objects, blood, secretions, etc., can enter the trachea and cause an airway obstruction or lung infection
PROTECTIVE REFLEXES
When the muscles controlling the tongue relax in a patient with an altered mental status, the muscles controlling the ________________ also relax
EPIGLOTTIS
In the event that both the tongue and the epiglottis relax, what is the opening that is blocked?
The opening of the larynx (glottic opening)
What is the best method to use to relieve a situation in which the epiglottis and tongue relax closing the path to the trachea and airway?
Perform “head tilt, chin lift maneuver” , or a “jaw thrust maneuver” which will pull the epiglottis up away from the opening of the larynx
The ______________________ contains the vocal cords
LARYNX
The anterior portion of the the larynx is composed of large bulkky ________________
THYROID CARTIALAGE
What is thyroid cartilage normally known as?
ADAM’S APPLE
The ____________________ forms the most inferior portion of the larynx
CRICOID CARTILAGE
The _________________ is the only completely circular cartilaginous ring of the upper airway
CRICOID CARTILAGE
Pressure applied to the ________________ is often used in airway management
CRICOID RING
Pressure applied to the cricoid ring is used to help prevent ________________ and to _______________
FILLING OF THE STOMACH
PREVENT REGURGITATION
The _____________ is a common site of airway obstruction in adults, infants, and children
LARYNX
The ________________ extends from the cricoid cartilage at the lower edge of the larynx to the alveoli of the lungs
LOWER AIRWAY
The ______________ is commonly known as the windpipe
TRACHEA
The _____________ is the passageway for air entering the lungs
TRACHEA
The trachea extends fro mthe larynx to the ______________
CARINA
The ______________ is the point in which the trachea splits into the right and left mainstem bronchi
CARINA
The anterior portion of the trachea is composed of strong ______________________ that provide support and structure
C-SHAPED CARTILAGINOUS RINGS
The posterior wall of the trachea is made up of _________________ and is therefore not a rigid structure
MUSCLE
The _______________ are the two major branches of the trachea, that extend from the carina into the lungs
BRONCI
The __________________ extend from the carina into the lungs, where they continue to divide into smaller sections or branches known as __________________
BRONCHI
BRONCHIOLES
The ________________ become increasingly smaller as they continue to branch
BRONCHIOLES
The _______________ are larger airways that contain cartilage
BRONCHI
The ________________ are lined with msooth muscle and mucous membranes
BRONCHIOLES
The narrowing of the bronchioles causes an increase in __________________ inside the bronchiole, which makes it more difficult for the patient to move air into and out of the alveoli
AIRWAY RESISTANCE
An increase in __________________ causes the patient to work harder to breathe, which may lead to _______________ and failure of the respiratory muscles
AIRWAY RESISTANCE
FATIGUE
The bronchioles terminate in millions of tiny air sacs in the lungs called _________________
ALVEOLI
Each alveoli is wrapped in a web of thin-walled capillaries reffered to as the _________________
PULMONARY CAPILLARIES
The alveoli and pulmonary capilaries is the site for ____________________________
GAS EXCHANGE BETWEEN THE ALVOLI AND THE BLOOD IN THE CAPILLARIES
The _____________ are made out of elastic tissue
LUNGS
The elastic tissue of the lungs causes the lungs to react like a _____________; thus, the lungs material tendency is to recoil and collapse
RUBBER BAND
The lungs are surrounded by two layers of connective tissue called the _________________
PLEURA
What are the two layers of connective tissue called?
VISCERAL PLEURA
PARIETAL PLEURA
The ______________ is the outermost covering of the lung
VISCERAL PLEURA
The ________________ is the thicker more elastic layer of pleura that adheres to the inner portion of the chest wall
PARIETAL PLEURA
Between the two layers of pleura is the __________________
PLEURAL SPACE
The ________________ is a small space that is at negative pressure
PLEURAL SPACE
The pleural space contains a small amount of ________________ that acts as a lubricant to reduce friction when the layers of the pleura rub against each other during breathing
SEROUS FLUID
Since the lung tissue wants to recoil and collapse, it is always tugging inward toward the ______________ of the body
MIDLINE
The ________________ pleura, connected to the chest wall, retains the lung structure nad prevents them from collapsing
PARIETAL PLEURA
The ___________________ between the attached parietal pleura and visceral pleura, creates a “water-glass” effect
SEROUS FLUID
The _______________ is “if a water glass is placed open end down on a flat surface covered with water, then pulled striaght upward, a vaccuum is created between the flat surface and the glass. The water creates a seal. If the seal is broken, air is sucked inward and allows the glass to be moved off the flat surface.
WATER GLASS EFFECT
VISCERAL PLEURAL PULL
The __________________ is continuously creating a vacuum so air from outside the chest gets sucked into the pleural space through the hole in the pleura
The ___________________ is a muscle that separates the chest cavity from the abdominal cavity
DIAPHRAGM
The diaphragm is responsible for approximately ________________ percent of the effort of ventilation.
60-70 percent
The passage of air into and out of the lungs is called ________________________
VENTILATION
______________________ is ofte nreferred to as breathing
VENTILATION
__________________ is the process of breathing air in
INHALATION OR INSPIRATION
________________ is the process of breathing air out
EXHALATION OR EXPIRATION
During inhalation, the _________________ and the external _____________________ contract
DIAPHRAGM
INTERCOSTAL MUSCLES
The process of inhalation bring air into the lungs until the pressure inside the lungs is _______________________
EQUAL TO THE ATMOSPHERIC PRESSURE OUTSIDE THE BODY
Inhalation is an _____________________ because it requires energy to contract the muscles
ACTIVE PROCESS
During exhalation, the diaphragm and intercostal muscles ________________
RELAX
Because the process of inhalation involves relaxation of muscles and little energy is expended, it is considered to be _______________
PASSIVE
In some respiratory diseases affecting the lower airway, the patient has a difficult time moving air into and out of the lungs making both inhalation and exhalation ____________ processes
ACTIVE PROCESSES
Respirations are controlled by the _______________ in a variety of ways.
NERVOUS SYSTEM
What are the three respiratory rhythm centers that control impulses being sent to the respiratory muscles from the brain stem?
DORSAL RESPIRATORY GROUP (DRG)
VENTRAL RESPIRATORY GROUP (VRG)
PONTINE RESPIRATORY CENTER (PNEUMOTAXIC CENTER)
The ____________________ continuously monitor levels of oxygen, carbon dioxide, and pH in the arterial blood
CHEMORECEPTORS
The ___________________ also stimulate an increase or decrease in impulses fro the respiratory rhythm centers to control the rate and depth of ventilation
CHEMORECEPTORS
The __________________ located in the medulla are most sensitive to changes in blood pH and carbon dioxide, whereas the _________________ located in the carotid areteris and aortic arch are more sensitive to changes in arterial oxygen
CENTRAL chemoreceptors
PERIPHERAL chemoreceptors
tHE RESPIRATORY SYTEM RESPONDS PRIMARILY TO CHANGES IN THE ________________ LEVELS
carbon dioxide
If the carbon dioxide level in arterial blood increases, the chemoreceptors sense the increase and the brainstem sens impulses to the respiratory muscles to increase the __________________ and ____________ of respiration.
RATE AND DEPTH
An increase in respirations results in the increased elimination of _______________
CARBON DIOXIDE
Healthy people breath on a _______________ drive
HYPERCARBIC DRIVE (HIGH CARBON DIOXIDE DRIVE)
When the carbon dioxide level decereases in the blood, the chemoreceptors sense this and send signals to the respiratory muscles to slow down the _____________________
RESPIRATORY RATE
_______________ is much less of a stimulus for breathing in healthy people
OXYGEN
In patients with a category of conditions known as COPD, the ______________ level in arterial bloodis typically chronically elevated as a result of the disease process.
CARBON DIOXIDE
Because of the high carbon dioxide levels as a result of COPD, the chemoreceoptors become relatively ______________________ to changes in carbon dioxide
INSENSITIVE
Chemoreceptors of COPD patients tend to rely on _________ levels in the blood to regulate their breathing
OXYGEN
COPD patients breath on a ___________ drive, since they breathe to increase their oxygen and not to dreduce their carbon dioxide levels
HYPOXIC
If oxygen is provided at high concentrations to a patient with COPD over a long period of time, the oxygen levels in the arterial blood will ___________ beyond a normal level for the patient
RISE
If oxygen is provided at high concentrations to a COPD patient, the _______________ will sense this rise and may send signals to the respiratory muscles to slow down or even stop respirations
CHEMORECEPTORS
Even though respiratory failure could be a complication in the COPD patient _____________ should never be withheld from a patient if he or she needs it
OXYGEN
If respiratory failure should occur in a COPD patient, _____________________ the patient artificially, just as with any patient who suffers respiratory failure or arrest.
VENTILATE
___________________ is the process by which the blood and the cells become saturated with oxygen
OXYGENATION
Oxygenation happens as a result of __________________ and ___________________
INTERNAL RESPIRATION and EXTERNAL RESPIRATION
Internal respiration and external respiration are processes in which fresh oxygen replaces _________________
CARBON DIOXIDE
_________________ is the mechanical process of moving air into and out of the lungs
VENTILATION
________________ is the physiological process of gas exchange
RESPIRATION
______________________ is a low oxygen content in arterial blood
HYPOXEMIA
Hypoxemia typically occurs from a ___________________ mismatch.
VENTILATION-PERFUSION
A ____________________________ occurs when there is a lack of available oxygenated air in the alvoli even though perfusion to the alveoli is adequate, or when the alveoli are adequately oxygenated but perfusion to the alveoli is poor, or when there is a combination of both poor ventilation and poor perfusion in the alveolar-capillary structures.
VENTILATION-PERFUSION MISMATCH
Other possible causes of ________________ include inadequate ventilator drive, anemia, and carbon monoxide poisoning
HYPOXEMIA
________________ refers to an inadequacy in the amount of oxygen being delivered to the cells
HYPOXIA
________________ is a more general term than hypoxemia which refers only to low oxygen content in the arterial blood
HYPOXIA
____________________ can occur or result from an occluded airway, inadequate breathing, inadequate delivery of oxygen to the cells by blood, or inhalation of toxic gases
HYPOXIA
Tachypnea
Dyspnea
Pale, cool, clammy skin
Tachycardia
Elevation in blood pressure
Restlessness and agitation
Disorientation and confusion
Headache
These are signs of what level of hypoxia?
MILD TO MODERATE HYPOXIA
Tachypnea
]
Dyspnea
Cyanosis
Tachycardia that may lead to dysrthmias and eventually bradycardia
Severe confusion
Loss of coordination
Sleepy appearance
Head bobbing
Slow reaction time
Altered mental status
Seizure
These are all signs of what level of hypoxia?
SEVERE HYPOXIA
In a newborn, _________________ may be an early sign of hypoxia
BRADYCARDIA
Infants and young children normally have higher ____________________ than adults
HEART RATES
An early sign of hypoxia is an alteration in the patint’s _____________________
MENTAL STATUS
______________________ , a bluish gray color is a late sign of hypoxia and may be found in and around several areas of the body, including the lips, mouth, nose , fingernail beds, conjunctiva, and oral mucosa
CYANOSIS
___________________ occurs when adequate amounts of oxygen are no longer attached to the hemoglobin molecules
CYANOSIS
If the patient is displaying any signs of hypoxia, immediately _____________________________________>
ASSESS THE AIRWAY AND ADEQUACY OF BREATHING
If breathing status is inadequate, immediately begin __________________________
POSITIVE PRESSURE VENTILATION
The blood moving into the capillaries is ____________________
DEOXYGENATED
____________________ is found on the surface of red blood cells, is responsible for picking up the majority of oxygen in the blood and carrying it through hthe arterial system to the capillaries throughout the body
HEMOGLOBIN
A disturbance in pulmonary ventilation, oxygenation, external respiration, internal respiration, or circulation can lead to _______________________ and the conversion from aerobic to anaerobic metabolism
CELLULAR HYPOXIA
A severe alteration in perfusion can also cause a decrease in __________________ delivery to the cells
GLUCOSE
without A FUEL SOURCE, the cells will fail to produce energy and will __________________
EVENTUALLY DIE
The noses and mouths of _______________ and ______________ are smaller than those of adults making it easier to be obstructed by foreign bodies, swelling, blood, mucus, and secretions
INFANTS AND CHILDREN
______________ are obligate nose breathers
INFANTS
____________________ MEANS THAT IT IS PREFERRED TO BREATHE THROUGH THE NOSE AND NOT THROUGH THE MOUTH
obligate nose breathing
The ___________________ of an infant or a child is realtively large in proportion to the size of the mouth
TONGUE
An infant or a child is more prone to airway obstruction by _________________________
POSTERIOR DISPLACEMENT OF THE TONGUE
In infants and children less than 10 years of age, the ___________________ is typically the narrowest portion of the upper airway
CRICOID CARTILAGE
tHE CHEST WALL IN AN INFANT OR A CHILD IS _____________ NAD MORE _____________ THAN IN AN ADULT .
softer and more pliable
Infants and children rely more on the _____________ for breathing
DIAPHRAGM
When you perform artificial ventilation on an infant or child, the chest should ___________________
EXPAND AND RISE EASILY
Because the chest expands so easily on an infant or child, it is much easier for the EMT to ___________________ the lungs and cause possible lung injury
OVERINFLATE
Infants and children are smaller and have more limited _________________ than adults
OXYGEN RESERVES
Children and infants have twice the _______________ rate of adults
METABOLIC
The smaller reserve of oxygen and greater metabolic rate of infants and children will cause them to become ___________________ more rapidly than adult patients
HYPOXIC
_____________________ is the most common cause of cardiac arrest in chldren
HYPOXIA
A _________________ is necessary for adequate breathing and oxygenation
PATENT AIRWAY
The airway and respiratory tract is the conduit that allows air to move from the atmosphere and into the _________________________ for gas exchange
ALVEOLI
No matter what the patient’s condition, the ____________ must remain open at all times
AIRWAY
The degree of the ______________________ will directly affect the amount of air available for gas exchange
OBSTRUCTION
The mental status of a patient typically correlates well with the status of his or her __________________
AIRWAY
An alert, responsive patient who is talking to you in a normal voice has an ____________________
PATENT AIRWAY
A patient who has an altered mental status by continues to maintain a gag or cough reflex could still ________________________
ASPIRATE
Snoring
Crowing
Gurling
Stridor
These are all __________________
ABNORMAL UPPER AIRWAY SOUNDS
Snoring and obstruction can be corrected by performing a __________________________
HEAD TILT CHIN LIFT MANEUVER
If the patient is “gurgling” immideiatley ___________________
SUCTION THE SUBSTANCE FROM THE AIRWAY
It is necessary to open the mouth of an unresponsive or an altered metnal status patient to ______________________________
ADEQUATLEY ASSESS THE AIRWAY
Opening the mouth is done by using the ________________ technique
CROSSED FINGERS TECHNIQUE
Before a patient who is breathing inadequately can receive positive pressure ventilation, or breating assistance in which air is forced into his lungs he must have an ___________________
OPEN AIRWAY
What are the two manual airway maneuvers?
HEAD TILT, CHIN LIFT
JAW THRUST
What are the two mechanical airways?
OROPHARYNGEAL AIRWAY
NASOPHARYNGEAL AIRWAY
The _________________________ should be used for opening the airway in a patient who has no suspected spinal injury
HEAD TILT, CHIN LIFT
The ___________________ is only a temporary maneuver and must be supplemented with a mechanical airway edevice if the airway can’t be adequetly maintained
HEAD TILT, CHIN LIFT
What airway maneuver would be used on an unresponsive patient with no suspicion of spinal injury or trauma?
HEAD TILT, CHIN LIFT
What manual airway maneuver would be used on a patient with cardiac arrest not due to trauma?
HEAD TILT, CHIN LIFT
What airway maneuver would be used on an apneic patient with no signs of trauma?
HEAD TILT, CHIN LIFT
The preferred method of opening the airway in infants nad children without suspected spinal injury is the _______________________
HEAD TILT CHIN LIFT
When doing the head tilt, chin lift position on infants the head should be tilted back gently into a _____________ position
SNIFFING OR NEUTRAL POSITION
If a ________________ is suspected, the patient’s head and neck must be brought into and maintained in a neutral inline position.
SPINAL INJURY
The _________________________ is used to open the airway in such a patient in which there is a suspected spinal injury
JAW-THRUST MANEUVER
If the head tilt, chin lift maneuver is unsuccessful in opening the airway of the non spine injured patient, perform the _________________________
JAW-THRUST MANEUVER
Both the head tilt, chin lift and the jaw-thrust maneuvers must be supplemented with a __________________________ device if the airway can’t be adequately maintained
MAECHANICAL AIRWAY DEVICE
If the jaw thrust does not establish an open airway __________________ the jaw
REPOSITION
The ________________________ would be used in unresponsive patients with suspected spinal injury or trauma patients in need of a manual maneuver to open the airway
JAW THRUST MANEUVER
To position a patient with an altered mental status for airway control, place the patient in a modified ____________________________
LATERAL RECOVERY POSITION
________________________ are fixed or installed units that should be part of the required on board ambulance equiopment.
MOUNTED SUCTION DEVICES
Mounted suction devices should be powerful enough to provide an airflow of greater than _________________ at the end of the delivery tube and create a vacuum of more than _______________ mmHg on the gauge when the tubing is clamped or kinked
GREATER THAN 40 LPM
300 MMHG
A _________________________ msut produce a vacuum adequate to suction substances from the pharynx
PORTABLE SUCTION DEVICE
A portable suction device generally needs a pressure of ____________________ mmHg to provide adequate suction
80 TO 120 mmHg
_____________________ units can be electric, oxygen, air, or hand owered
PORTABLE SUCTION UNITS
_______________________ devices must have fully charged batteries to function effectively
ELECTRIC SUCTION DEVICES
____________________ devices function only as long as a source of oxygen is available
OXYGEN POWERED DEVICES
__________________ suction devices do not require any energy source other than an EMT to create the vacuum
HAND POWERED
____________________ must be disposable and capable of being connected to the suction unit’s tubing
SUCTION CATHETERS
What are the two different types of suction catheters?
HARD OR RIGID CATHETERS
SOFT CATHETERS
The ____________________ catheter is commonly referred to as a “tonsil tiop” or “tonsil sucker.”
HARD OR RIGID
The ______________________ is used to suction the mouth and oropharynx aof an unresponsive patient
HARD OR RIGID CATHETER
The _____________________ should be inserted only as far as you can see, typically not farther than the base of the tongue
CATHETER
The tip of the suction catheter may stimu8late a _______________ reflex and cause vomiting
GAG
If you are using a _________________ on a child or infant, be careful when applying suction, bercause doing so might cause soft tissue trauma and may also stimulate bradycardia
HARD CATHETER
When using a suction catheter on infants and children, never _______________________
TOUCH THE BACK OF THE AIRWAY
The _____________________ is also called a “French” catheter
SOFT CATHETER
The ___________________ is used in suctioning the nose and nasopharynx and in other siuations where the rigid catheter cannot be used.
SOFT CATHETER
_________________ is defined as the air remaining in the lungs after a maximal exhalation
RESIDUAL VOLUME
Even though the nasopharyngeal airway is lubricated, insertion is painful and may cause injury to the _________________ causing the nose to bleed and allowing blood to enter the airway, resulting in possible obstruction or aspiration.
NASAL MUCOSA
Adequate and inadequate breathing depend on what two variables ?
The RATE at which the patient is breathing and the DEPTH of each breath
_______________________ deals with both depth and rate
MINUTE VOLUME
__________________ typically correlates with how adequately the patient is breathing
MINUTE VOLUME
A decrease in either the ________________ or the respiratory rate may lead to a decrease in minute volume so severe that the patient is no longer moving an adequate amount of air per minute in and out of the lungs
TIDAL VOLUME
Typically, an increase in either _________________ or respiratory rate would increase the respiratory minute ventilation
TIDAL VOLUME
What is the best method to assess for tidal volume?
LOOK FOR ADEQUATE CHEST RISE AND LISTEN FOR AIR MOVEMENT FORM THE NOSE AND MOUTH
___________________ is the amount f air breathed in that reaches the alvoli
ALVOLAR VENTILATION
Only the air that reaches the ______________ can be used for gas exchange sicne the trachea and bronchi do not participate in gas exchange
ALVEOLI
Because of the effect of _________________ on ventilation, deceases in tidal volume can dramatically reduce the amount of air reaching the alveoli for gas exchange.
DEAD AIR SPACE
If an adult is breathing at 12 times per minute, but has a condition that depresses the respiratory system and is only breathing In 200 mL of air with each breath, what is his “Minute Volume” ?
200mL x 12 per minute
Minute Volume = 2,400 mL
What are the four steps of assessment for adequate breathing?
LOOKING
LISTENING
FEELING
AUSCULTATING
When assessing for adequate breathing, what does it mean to look (inspect)? What are the four steps?
INSPECT THE CHEST
OBSERVE THE PATIENT’S GENERAL APPEARANCE
DECIDE IF THE BREATHING PATTERN IS REGULAR OR IRREGULAR
LOOK AT THE NOSTRILS AND SEE IF THEY ARE OPEN WIDE DURING INHALATION
When assessing for adequate breathing, what does it mean to listen?
Listen to how the patient speaks to you. If he speaks with only few words at a time, or has to catch his breath, it could mean he would need ventilation
When assessing for adequate breathing, what does it mean to “feel”?
It means to feel with your ear next to the patien’ts nose and mouth, and feel for air escaping during exhalation
When assessing for adequate breathing, what does it mean to “Auscultate”?
It means to place your stethoscope at the second intercostal space, about 2 inches below the clavicle at the midclavicular line, and listening to one full inhalation and exhalation and determine if the breath sounds are present and equal bilaterally
When “Auscultating”, where are you to place your stethoscope?
About 2 inches below the clavicle at the midclavicular line, or at the fourth or fifth intercostal space on the mixaxillary line
What are the four characteristics of quality or adequate breathing?
RATE
RHYTHM
QUALITY
DEPTH
When checking for adequate breathing, what are the respiratory rates for adults, children, and infants respectively
8-24
15-30
25-30
What is “rhythm” in respect to a characteristic of adequate breathing?
It just means that the pattern is regular, and that each breath is of about the same volume
What is “quality” in respect to a characteristic of adequate breathing?
It means that the breath sounds are equal and full bilaterally, indicating a good expansion of each lung
What is “depth” (tidal volume) in respect to a characteristic of adequate breathing?
It means that the chest will rise fully with each inhalation, and that the volume of air felt and heard by placing your ear next to the patient’s mouth and nose will be full and adequate with each breath
___________________ is a condition where the patient is working harder to breathe
RESPIRATORY DISTRESS
Respiratory distress may be from the patient working harder to move _____________ into the lungs, out of the lungs or both
AIR
The key to respiratory distress is that, even though the patient is working harder to breathe, the ______________ and the ______________ are still inadequate
RESPIRATORY RATE AND TIDAL VOLUME
If at any time, either the respiratory rte, or tidal volume becomes inadequate the patient ____________________________
NEEDS TO BE VENTILATED
For the patient to have adequate breathing he must have both an adequate ______________ and an adequate __________________
TIDAL VOLUME
RESPIRATORY RATE
_________________________ occurs when the respiratory rate and or tidal volume is insufficient enough that it results in hypoxia to the cells and organs
RESPIRATORY FAILURE
_______________________ is also called apnea
RESPIRATORY ARREST
_______________ occurs when the patient completely stops breathing, and there is no movement of air
RESPIRATORY ARREST
Stroke
Myocardial infarction
Drug overdose
Toxic inhalation
Succocation
Traumatic injuries to the head, spine, chest, or abdomen
Infection to the epiglottis
Airway obstruction
These are all common causes of what?
RESPIRATORY ARREST
A patient who exhibits signs of respiratory failure or respiratory arrest requires immediate intervention with ___________________________
POSITIVE PRESSURE VENTILATION
A type of respiratory pattern that is compldetely inadequate and may be seen in witnessed cardiac arrest or in some conditions is called _________________
AGONAL RESPIRATIONS
__________________ are gasping type breaths
AGONAL RESPIRATIONS
_____________________ in the cardiac arrest patient usually appear soon after the person goes into cardiac arrest
AGONAL RESPIRATIONS
When agonal respiratiosn are found in a patient who does not yet seem to be in cardiac arrest, immediately ______________________
CHECK THE PERSON’ PULSE
If air is being forced ito the patient’s lungs, the technique is referred to as ___________________
POSITIVE PRESSRUE VENTILATION
What are the four methods of artificial ventilation?
MOUTH TO MASK
BAG VALVE MASK OPERATED BY TWO PEOPLE
FLOW RESTRICTED, OXYGEN POWERED VENTILATION DEVICE
BAG VALVE MASK OPERATED BY ONE PERSON
When performing artificial ventilation, regardless of the device being used, it is necessary to monitor the patient continuouysly to ensure that the _______________ is adequate
VENTILATION
Ventilation must not be interrupted for greter than ________________
30 seconds
Infants and children must be ventilated at a rate of ____________________
12-20 per minute
Once every 3 seconds or every 5 seconds
The ventilation rate for adults WITH A PULSE is ______________
10-12 times per minute
ONce every 6 seconds or every 5 seconds
Each ventilation should be delivered over how long?
1 second
If the adult patient has no pulse, the ventilations are performed in conjunction with chest compressions at a ratio of ____________________
30 COMPRESSIONS to 2 VENTILATIONS
If the child patient has no pulse, the ventilatonis are performed in conjunction with chest compressions at a ratio of ______________
15 COMPRESSIONS to 2 VENTILATIONS
The rate of ventilation for a newborn infant WITH a pulse is _______________________
40-60 ventilations per minute
In the newborn with no pulse, the ratio of chest compressions to ventilations is 3:1 or ___________________________
90 compression to 30 ventilations
The ventilation rate is too fast or too slow
The chest does not rise and fall with artificial ventilation
The heart does not return to normal with artificial ventilation
Color does not improve
These are all indications of what?
INADEQUATE VENTILATION
Ventilation a patient too rapidly does not allow for adequate exhalation and can also cause _________________________
GASTRIC DISTENTION
Ventilating a patient too slowly will not provide an adequate amount of _______________
OXYGEN
_________________ was once thought to reduce complications associated with positive pressure ventilation when the unresponsive patient’s airway is not protected by an advanced airway device
CRICOID PRESSURE
____________________ was intended to reduce the incidence of gastric inflation, regurgitation, and aspirations of gastric contents
CRICOID PRESSURE
According to the American heart Association, ________________f is not recommended for routine use but can be used fto facilitate insertion of an endotracheal tube in an adult
CRICOID PRESSURE
In the pediatric patient, ______________________ can be considered only if an ___________________ is available to apply pressue without comporomising the airway or effective ventilation and to guard against collapse of the trachea from excessive pressure
CRICOID PRESSURE
EXTRA EMT
Because exhaled breath contains about ________________ percent oxygen, a patient can be oxygenated with the rescuer’s exhaled breath
16
In a “mouth to mouth and mouth to nose technique” the EMT forms a seal with his mouth around the patient’s mouth or nose and uses ___________________ to ventilate
HIS EXHALED AIR
The ________________ is pinched during mouth to mouth ventilation
NOSE
What are the major disadvangaes or limitations of the mouth to mouth technique?
The inability to deliver high concentrations of oxygen
Risk posed to the EMT by contact with the patient’s body fluids
Use __________________ ventilation when the patient’s mouth cannot be opened, or when you cannot achieve a tight mouth to mouth seal
MOUTH TO NOSE
When ventilation a patient it is necessary o adjust the volume and rate of ventilation based on whether the patient has a ______________________
PULSE
If the patient has a pulse, the amount of air volume delivered to the patient should be approximately __________________, enough to make the chest rise adequately and effectively with each ventilation
10ml/kG (700-100 ml)
If the patient has an advanced airway in place, the ventilation in the patient without a pulse is reduced to ____________________
8-10 ventilations per minute
Every 6 to 8 seconds
It is extremely important to not to _______________________ the patient by providing either too fast a rate or too great a volume
OVERVENTILATE
_____________________ may cause the blood flow to the brain and heart to be reduced
OVERVENTILATON
Decreasing the ____________________ is aimed at reducing the incidence of gastric distention and the potential regurgitation and aspiration that can occur during motuh to mask or bag valve mask ventilation
VENTILATION VOLUME
________________ should be connected to the pocket mask or BVM at a liter flow of 15 lpm as early as possible when ventilating a patient
SUPPLEMENTAL OXYGEN
What are the five steps to correctly identifying proper ventilation problems
REPOSTION THE HEAD AND NECK TO ENSURE THE AIRWAY IS OPEN
CHANGE FROM A HEAD TILT, CHIN LIFT TO A JAW THRUST AND VICE VERSA
READJUST THE FACE MASK AND MAKE SURE THERE ARE NO SEAL LEAKS BETWEEN TEH FACE AND THE MASK
ADMINISTER A GREATER TIDAL VOLUME
INSERT AN OROPHARYNGEAL OR NASOPHARYNGEAL AIRWAY TO ASSIST IN MAINTAINING AN OPEN AIRWAY
________________________ is a manual resuscitator used to provide positive pressure ventilaton
BAG VALE MASK DEVICE
The _____________________ consists of a self- inflating bag, a one way non rebreathe valve, a face mask, an intake/oxygen reservoir valve, and an oxygen reservoir
BAG VALVE MASKE DEVICE
Most adult sized BVM devices have a volume of approximately ____________________
1600 mL
In the adult, deliver approximately _________________ with each ventilation
600 mL
Ensure that each ventilation delivered is enough to produce _________________ over _____________ second(s)
CHEST RISE
1 SECOND
Bag valve mask devices used for ventilation of full term newborns, infants, and children should have a minimum volume of ___________________
450-500 mL
In children 8 years or greater, use an _______________ BVM device
ADULT
Regardless of the size of the BVM, be sure to use only enogh volume to cause _______________
CHEST RISE
If you suspect a patient has a spinal injury, you must establish and maintain ____________________ as a priority
SPINAL STABILIZATION
A ____________________ is powered by oxygen and, with a proper mask seal, will deliver 100 percent oxygen to thee patient
FLOW RESTRICTED OXYGEN POWERED VENTILATION DEVICE (FROPVD)
AKA
MTV
In fa normal breathing patient the valve of the MTV is opened automatically by the negative pressure created by the ____________________
PATIENT’S INHALATION
The MTV is designed to be used only _______________________
ON ADULT PATIENTS
Accordign to the American Heart Associatoin guidelines, the FROPVD is an aid in ventilating a patient in ________________ when used in the manual mode, which requires the EMT to trigger the device to dleliver a ventilation
CARDIAC ARREST
What is the peak flow rate on a MTV?
40lpm and 100 percent oxygen
Most ________________ use oxygen as their power source, thereby delivering 100 percent oxygen during ventilation
ATV’S
The ____________ can deliver oxygen at lower inspiratory flow rates and for longer inspiratory times therefore the devices have a lesser likelihood of causing gastric distention compared to other methods of positive pressure ventilation, including mouth to mask and GBM ventilation
ATV
Some _____________ have a demand valve built in, in the event that the patient begins to breathe spontaneously
ATVS
The valve of an ATV should be able to deliver a peak inspiratory flow rate of ________________
120 lpm
The ATV should have an appropriate inspiration to exhalation ratio of ____________
1:2 seconds
Some _______________ have alarms that indicate low oxygen levels, disconnecjtion from the mask, or a low battery
ATV’S
The ________________ may also have the ability to provide positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP)
ATV
If the patient presents with either inadequate respiratory rate or tidal volume, even though he is still breathing, it is necessary to ventilate the patient and provide supplementary oxygen to ensure that he is receiving an adequate _____________________
ALVEOLAR VENTILATION VOLUME
_________________ is a form of noninvasive positive pressure ventilation used in the awake and spontaneously breathing patient who needs ventilator support
CPAP
CPAP is applied typically to patients with ____________ or ________________ with pulmonary involvement who are in moderate to severe respiratory distress or early respiratory failure who have an intact mental status and airway reflex
RESPIRATORY DISEASE
CARDIAC FAILURE
CPAP is often used to avoid the need to place an ______________________ to artificially ventilate the patient
ADVANCED AIRWAY
CPAP is delivered via a tightly fitted mask and a device that generates a continuous flow of air through the airway under positive pressure that is __________________ than normal air pressure
HIGHER
_________________ can also be used to deliver CPAP
NASAL PRONGS
The continuous delivery of air under positive pressure is intended to inflate collapsed alveoli, improve oxygenation, improve pulmonary compliance, and ____________________
REDUCE THE PATIENT’S WORK OF BREATHING
It takes a great deal of work and energy to ____________________ with each breath
REINFLATE THE ALVEOLI
By keeping the alveoli open with the __________________, less work is required and less energy is used
CPAP
The _____________________ typically averts complete respiratory failure or arrest and allows the patient to continue to breathe on his own
CPAP
___________________ increases hydrostatic pressure inside the pulmonary capillaries, forcing fluid out of the capillaries and into the adjoining aveloli displacing the air in the alvoli and inhibiting gas exchange
LEFT VENTRICULAR FAILURE
The continuous pressure created by the alvoli by CPAP prevents ___________________ into the alvoli and actually forces fluid that may already have accumulated out of the alvoli and back into the interstitial space and the capillaries
FURTHER FLUID LEAKAGE
______________________ improves the heart rate and blood pressure and reduces the sympathetic tone by improving gas exchange and oxygenation
CPAP
CPAP is delivered at a continuous airway pressure from ___________ cmH20 to ___________ cmH20
2-20
Most often, CPAP is initiated at the ____________ setting and titrated up to ________ cmH20
LOWEST
5
In most protocols, a CPAP pressure of ____________ cmH20 is never exceeded because of the increased risk of barotrauma
10
Most orders recommend using a CPAP of __________cmH20 and titrating upward based on the patient’s physiological response
5
__________________ IS USED TO SUPPORT VENTILATIONS, NOT AS A DEVICE TO PROVIDE ARTIFICAL VENTILATION
cpap
Awake, alert, and oriented enough to obey commands
Able to maintain his own airway
Able to breathe on his own and has a respiratory rate greater than 25 breaths a minute
Exhibits signs and symptoms of moderate to severe respiratory distress or early respiratory failure
These are all criteria for use of
CPAP
____________________ should be used with caution in patients with hypotension nad hypovolemia
CPAP
CPAP creates an increase in _________________ pressure that may result in decrease in cardiac output, worsening the state of hyptension or hypperfusion
INTRATHORACIC
When administering a CPAP procedure, be sure to completely _______________________ the patient, how it will feel, and its benefits
INFORM
When administering a cpap procedure, it is vital that you continuously _________________ the patient in order to lessen his anxiety and fear
COACH
When using the CPAP machine, it may take only ___________________ minutes before the patient begins to show improvement
5-10 MINUTES
When using the CPAP you must do a continuous Sp02 moniootoring and eassess the vital signs every _________ minutes
5 minutes
When using CPAP you must ensure that you have an adequate __________________ since most CPAP devices use oxygen as their source of pressure
OXYGEN SOURCE
When using the CPAP machine place the patient in a seated or ___________________________ position
SEMI-FOWLER’S POSITION
When using the CPAP machine, assemble the ________________ to the CPAP device and ensure it is properly functioning
BREATHING CIRCUIT
When using the CPAP machine, increase the CPAP pressure by increments of _____ cmH20 until the patient’s response improves
TWO
When using the CPAP, DO NOT ECEED _____CMh20 UNLESS DIRECTED BY MEDICAL DIRECTION
10
When using CPAP, do not ______________ unless directed by medical direction
DISCONTINUE
When transferring a patient on CPAP, it is important to _________________________ the receiving medical facility that the patient is on CPAP so they can prepare to transfer the patient ot theirCPAP device upon arrival without discontinuation to the patient
NOTIFY
________________ is similar to CPAP but allows for different airway pressures to be set for inspiration and expiration
BILEVEL POSITIVE AIRWAY PRESSURE
BiPAP
A ____________ is a surgical opening in the front of the neck that may be permanent or temporary
STOMA
One reason for the presence of a stoma in the patient’s neck is that a ____________________ has been performed
TRACHEOSTOMY
Often, a _________________, a curved hollow tube made of rubber, plastic or metal, is inserted into the stoma to help hold it open.
TRACHEOSTOMY TUBE
When ventilating through the tracheostomy tube, it may be necessary to seal the patient’s _____________ and __________________ to prevent air fro mescaping
MOUTH AND NOSE
________________ can cause excessive swelling that may partially or completely occlude the airway.
BLUNT INJURY
If the patient is responsive and choking but is effectively moving air when inhaling nad exhaling, instruct him to _______________
COUGH
Cough that becomes silent
Stridr heard on inhalation
Increase in labored breathing
These are all signs of ?
PARTIAL AIRWAY OBSTRUCTION WITH POOR AIR EXCHANGE
If the airway is completely occluded and there is no air movement, perform ________________ cycles of foreign body airway obstruction maneuver
THREE
In a choking patient, once the obstruction is relieved, closely asses the patient’s ___________ and ___________________
BREATHING STATUS AND PULSE
If the patient has dentures that are secure in the mouth ___________________
LEAVE THEM IN PLACE
Liquid oxygen is stored in _____________ or ____________ cylinders under a pressure of about 2,000lbs per square inch
STEEL OR ALUMINUM
What are the five sizes of oxygen cylinders used in prehospital care from least to greatest?
D cylinder- 350 liters
E culinder- 625 liters
M cylinder- 3,000 liters
G cylinder- 5,300 liters
H cylinder- 6,900 liters
The only way to truly determine the amount of oxygen in the tank is to apply the gauge and identify the _____________ remaining in the tank
PRESSURE
Because oxygen is a gas that acts as an accelerant for combustion and oxygen cyliners are under high pressure, the must be handled _____________________
VERY CAREFULLY
When using oxygen, never allow __________________ to touch the cylinder, regulator, fittings, valves, or hoses
COMBUSTIBLE MATERIALS
When using oxygen, never __________ or allow others to ______ in any area where oxygen cylinders are in use or on standby
SMOKE
When using oxygen, store the cylinders below _____________
125 *F
Gas flow from an oxygen cylinder is controlled by a _________________ that reduces the high pressure in the cylinder to a safe range
PRESSURE REGULATOR
The pressure regulator reduces the high pressure in the cylinder to a safe range from ________ to ________ psi
30-70 psi
The _________ prevents a regulator from being attached accidentally or purposefully to another type of gas.
YOKE
Oxygen cylinders in the US are generally ___________ green or ____________ gray
STEEL
ALUMINUM
What are the two types of regulators that may be attached to an oxygen cylinder?
HIGH PRESSURE REGULATOR
THERAPY REGULATOR
The ___________________ can provide 50 psi to power a flow restricted, oxygen powered ventilation device
HIGH PRESSURE REGULATOR
The ________________________ has only one gauge, which registers the cylinder contents, and a thereded outlet
HIGH PRESSURE REGULATOR
The _________________ can administer oxygen from .5lpm up to 25lpm
THERAPY REGULATOR
The therapy regulator tpically has _______ gauges.
TWO
Oxygen exits the tank in a dry ____________ form
GASEOUS
It is possible to add moisture to the oxygen by attaching an _______________________ to the regulator
OXYGEN HUMIDIFIER
The _________________is a container that is filled with sterile water
OXYGEN HUMIDIFIER
humidified OXYGEN IS RECOMMENDED IN _______________ patients
ASTHMA
______________ is actually a drug
OXYGEN
Oxygen should be used any patient in ____________ or ___________ arrest
CARDIAC OR RESPIRATORY ARREST
Oxygen should be used with any patient who is being _____________
VENTILATED
Oxygen should be used when any signs of _________________ in a patient with an adequate respiratory rate and an adequate tidal volume
HYPOXIA
Oxygen should be used with any patient who is ___________________
UNRESPONSIVE
Oxygen should be used if there is any exposure to ______________
TOXINS
If there is any doubt, it is better to err on the side of benefiting the patient ,and deliver the ________________
OXYGEN
Never withhold _____________ from a patient who you think may need it
OXYGEN
Patients with acute coronary syndrome who are exhibiting evidence of hypoxia or hypoxemia, have a complaint of dyspnea, have signs of heart failure, and have an SpO2 of less than __________ should receive supplemental oxygen
94%
_________________ is no longer a standard treatment
OXYGEN THERAPY
The oxygen levels in the arterial blood in the patient with adequate perfusion and gas exchange can be increased significantly with the use of a simple nasal cannula at _____________________
2 to 6 lpm
The preferred method for delivering oxygen in the prehospital setting when a high concentration is desirable is with a _____________________
NONREBREATHER MASK
The __________________ has an oxygen reservoir bag attached to the mask with a one-way valve between them that prevents the patien’s exhaled air form mixing the oxygen with the reservoir.
NONREBREATHER MASK
A poorly inflated nonrebreather mask reservoir may cause a decrease in the patient’s ___________________ and worsen the patient’s ventilation and oxygen status
TIDAL VOLUME
The contents of the reservoir bag is _________ percent oxygen
100
When using the nonrebreather mask, because some ambient air is inhaled from around the edges of the mask, the oxygen concentration actually delivered is usally around ______________ percent
90
When using a nonrebreather mask, the flow from the oxygen cylinder should be set at a rate that prevents ____________________
The reservoir bag form collapsing when the patient exhales
An alternative oxygen delivery device is a ________________________
NASAL CANULA
The nasal canula provides a very limited oxygen concentration from approximately ________ to _________ percent
22-44 percent
The main indication for use of a nasal canula if for a patient who is not able to tolerate a ____________________
NONREBREATHER MASK
The nasal canula is a __________ system that does not supply enough oxygen to provide the entire tidal volume during inhalation
“LOW FLOW”
As a general rule of use of the nasal canula, for every liter per minute of flow delivered, the oxygen concentration the patient inhales increases by ___________ percent
four
The liter flow for the nasal cannula should be set at no less than _________ lpm and no greater than ______ lpm
1
6
When using the nasal canula, connect the tubing to the regulator and set the liter volume flow between _____________ nad ______________ lpm
4 and 6 lpm
A ___________________ is an oxygen delivery device that has no rewervoir and can deliver up to 60 percent oxygen, depending on the patient’s tidal volume and the oxygen flow rate
SIMPLE FACE MASK
The ________________ is an oxygen delivery device that looks very similar to the nonrebreather mask but is equipped with a two way valve that allows the patient to rebreathe about 1/3 of his exhaled air
PARTIAL REBREATHER MASK
The oxygen flow rate for a simple face mask oxygen delivery device is usually set at ____________ lpm but must not be set less than _______ lpm
10
6
The flow rate for a partial rebreather mask is typically set at _________ lpm but should be no less than _____ lpm
10
6
Partial rebreather masks can provide oxygen concentrations of between ______ and ______ percent
35 and 60 percent
The ______________ is an oxygen device that is a low flow oxygen system that provides precise concentrations of oxygen through an entrainment valve connected to the face mask
VENTURI MASK
The ________________ is commonly used for a patient with a history of COPD because of its ability to deliver precise concentration of oxygen
VENTURI MASK
The ________________ is a oxygen delivery device that is used to deliver aerosolized medication, bland aersol therapy, or oxygen to a patient with a tracheostomy tube
TRECHEOSTOMY MASK
