Respiratory

Question 1

The presence of a barrel chest and clubbing of the fingers is suggestive of what respiratory condition?

Answer 1

Chronic obstructive pulmonary disease (COPD)

Question 2

Why are beta2 agonists beneficial in asthma?

Answer 2

Relaxation of bronchial smooth muscle, inhibition of chemical mediator response, and promotion of mucociliary clearance

Question 3

What should be evaluated when assessing a patient with a respiratory complaint?

Answer 3

Level of consciousness, pallor, cyanosis, vital signs, breath sounds and work of breathing to include nasal flaring, grunting, and accessory muscle use

Question 4

What type of medication is primarily used in the treatment of pneumonia?

Answer 4

Antibiotics

Question 5

What is the next course of action in the respiratory distress patient that does not respond to oxygen therapy and pharmacology?

Answer 5

Intubation and mechanical ventilation

Question 6

What are the six causes of oxygenation failure resulting in hypoxemia?

Answer 6

Hypoventilation, ventilation/perfusion mismatch, intrapulmonary shunting, cardiogenic shock, diffusion defects, and low FiO2

Question 7

What are the clinical manifestations of asthma?

Answer 7

Dyspnea, cough, wheezing, prolonged expiratory time, reduced peak flow

Question 8

Interpret the following arterial blood gas and provide a cause: pH 7.49, PaO2 98 mmHg, PaCO2 20 mmHg, HCO3- 24 mEq/L

Answer 8

Acute uncompensated respiratory alkalosis potentially from hyperventilation, CNS infection/trauma, carbon monoxide poisoning

Question 9

Male smokers in their twenties with tall stature are at greatest risk for what pulmonary emergency?

Answer 9

Primary spontaneous pneumothorax

Question 10

Corticosteroids work on what portion of the asthma cascade?

Answer 10

Inflammation and edema

Question 11

Pulmonary emboli results in hypoxemia through what mechanism?

Answer 11

Ventilation/perfusion mismatch

Question 12

Interpret the following arterial blood gas and provide a cause: pH 7.58, PaO2 92 mmHg, PaCO2 33 mmHg, HCO3- 30 mEq/L

Answer 12

Acute uncompensated metabolic alkalosis potentially from severe vomited, diarrhea, gastric suction, diuretics

Question 13

COPD patients that breathe with pursed lips are essentially mimicking what mechanical ventilator setting?

Answer 13

Positive end expiratory pressure (PEEP)

Question 14

What are the ominous signs of the need to intubate?

Answer 14

Near exhaustion, lethargy, somulence, apnea, shallow or irregular respirations; limited air movement (decreased tidal volume)

Question 15

Permanent abnormal enlargement of the air spaces distal to the terminal bronchioles and associated destructive changes of the alveolar wall is known as what respiratory illness?

Answer 15

Emphysema

Question 16

What is the most recognizable and reversible cause of hypoventilation?

Answer 16

Foreign body airway obstruction

Question 17

A pulse oximetry of 90% correlates with an approximate arterial oxygen level of?

Answer 17

PaO2 60 mmHg

Question 18

Interpret the following arterial blood gas and provide a cause: pH 7.28, PaO2 88 mmHg, PaCO2 51 mmHg, HCO3- 24 mEq/L

Answer 18

Acute uncompensated respiratory acidosis potentially from hypoventilation secondary to drug ingestion, COPD, pulmonary edema, respiratory arrest

Question 19

What are the accepted arterial blood gas values indicative of acute respiratory failure?

Answer 19

PaO2 < 60 mmHg
PaCO2 > 50 mmHg
ABG: pH < 7.3 (room air)

Question 20

What are normal arterial blood gas values?

Answer 20

pH 7.35-7.45
PaO2 80-100 mmHg
PaCO2 35-45 mmHg
HCO3- 22-26 mEq/L

Question 21

What are two potential causes of cardiogenic pulmonary edema?

Answer 21

Myocardial infarction and congestive heart failure

Question 22

Pulmonary edema is a direct result of failure of which heart chamber?

Answer 22

Left ventricle

Question 23

If the chronic bronchitis patient produces more sputum than they are able to eliminate, which adventitious lung sound will be auscultated?

Answer 23

Rhonchi

Question 24

What is the most definitive diagnostic tool in asthma?

Answer 24

Peak flow

Question 25

What medications are commonly used in the treatment of pulmonary embolus?

Answer 25

Heparin. Also LMWH (e.g. Lovenox) and warfarin. Fibrinolytic therapy may be used in critically ill patients with PE.

Question 26

Interpret the following arterial blood gas and provide a cause: pH 7.14, PaO2 89 mmHg, PaCO2 35 mmHg, HCO3- 16 mEq/L

Answer 26

Acute uncompensated metabolic acidosis potentially from diabetic ketoacidosis, renal failure, lactic acidosis

Question 27

In what instance would fluctuations in pulse oximetry, capnography, and auscultation of lung sounds be minimal with pneumothorax?

Answer 27

When the degree of lung collapse is minimal

Question 28

What are the classic early signs of asthma?

Answer 28

Dyspnea, expiratory wheezing, cough, tachycardia, and chest tightness

Question 29

What is ipratropium bromide (Atrovent) and why is it given with beta2 agonists?

Answer 29

Anticholinergic used to reverse cholinergically mediated bronchospasm, blocks vagal tone to larger airways, dries secretions, and when given with beta2 agonists, provides additive effects

Question 30

A patient presents with an elevated end tidal CO2. What should the critical care paramedic consider a cause?

Answer 30

Any condition that elevates carbon dioxide, decreased alveolar ventilation, or equipment malfunction

Question 31

What is the purpose of administration of magnesium sulfate in patients with acute bronchospasm?

Answer 31

Bronchial smooth muscle relaxation

Question 32

What mechanical ventilator settlings are frequently adjusted specifically for the treatment of adult respiratory distress syndrome (ARDS)?

Answer 32

Incrementally elevated levels of positive end expiratory pressure (PEEP), inversion of inspiratory/expiratory (I:E) ratio, limited peak inspiratory pressures (PIP), limited plateau pressures (Pplat), and reduced tidal volumes

Question 33

The classic signs and symptoms of fever, sputum production, productive cough, dyspnea, tachycardia, and pleuritic chest pain are indicative of what respiratory illness?

Answer 33

Pneumonia