Respiratory Cards Deck 1

Question 1

When is it appropriate to use the Heimlich maneuver on the choking patient ?

Answer 1

Not until there is a complete blockage of air. You do NOT want to give the Heimlich maneuver until there is a complete blockage of air. If there is not a complete blockage of air, the best treatment would be encouraging the patient to cough and transport them to the hospital.

Question 2

Dispatch has reported a 59 yr old woman with an altered level of consciousness. When you arrive on scene, the patient’s husband tells you that the woman has been vomiting for half of the day. She is pale and diaphoretic with a thready pulse. Your partner takes a blood pressure and gets a reading of 78/46. What would be the best choice of treatment for this patient?

CORRECT ANSWER is:
Oxygen at 15 LPM via NRB and immediate transport

Answer 2

This woman is in need of high flow O2 and immediate transportation to the hospital. It is wrong to get a repeat set of vitals prior to making a transport decision. Additionally, a Non Re-Breather mask is used for high flow O2, not a nasal canula.

Question 3

Pericardial tamponade, a rare condition in which the heart is impeded by fluid in the pericardium.

Answer 3

It will result in a low BP and muffled heart sounds with a very weak pulse as the heart struggles to pump.

Question 4

Anaphylactic shock

The best course of action would be to address the immediate life threat, that is the airway compromise caused by the anaphylaxis.

Definitive treatment for anaphylaxis is epinephrine injected intramuscularly at a 90 degree angle.

Answer 4

During anaphylactic shock the vessels dilate and fluid leaks from the vessels into the body’s tissues, resulting in swelling and urticaria.

Question 5

Purposes of OPA

Answer 5

The purposes of an Oropharyngeal airway include: Make it easier to suction oropharynx, keep the tongue from blocking the upper airway, and allow the passage of air to the lungs. It has no impact on the lower airway.

Question 6

Exhalation is an active part of breathing.

Answer 6

Exhalation is the passive part of breathing. During exhalation the diaphragm and intercostal muscles relax, the intrathoracic pressure increases, and air moves out of the lungs.

Question 7

You are called to a youth summer camp for a 12 year old girl having difficulty breathing. En route to the camp you are told that a group of kids were having lunch when a hive of bees was disturbed near by. The kids took off running and when they stopped the patient began having a hard time breathing. She has no known allergies. What is the best course of action?

Ask the girl if she is choking. Initiate treatment and immediate transport in a position of comfort.

Answer 7

Rationale:

Before you initiate any treatment for this patient you will want to confirm the cause of the breathing difficulty if you can. Just because there are bees present do not assume that she is going into anaphalaxis. The kids were having lunch and there is a good chance that the girl has an airway obstruction caused by food. Do not put an oxygen mask on a patient who has a possible FBAO as it may excacerbate the respiratory problems.

Question 8

Nitroglycerin is used to ?

Dilate the blood vessels.

Answer 8

Vasodilation is the desired effect of nitroglycerin, helping reduce the workload on the heart.

Question 9

Air inhaled is 16% oxygen

Air exhaled is 21% oxygen

Answer 9

Air in the atmosphere that we breath in has approximately 21% oxygen. The air that we exhale has about 16%.

Question 10

Pneumonia can cause septic shock.

Answer 10

Septic shock is often caused by pneumonia, a severe inflammation of the lungs caused by both viruses and bacteria. It is a contagious disease in which you should utilize masks for both you and the patient to help minimize the possibility of transmission. It has fairly rapid onset, and like other respiratory problems, can cause the patient to be anxious and fearful.

Question 11

Sign/Symptom

Answer 11

Symptoms are patient described and they cannot be measured or observed. A sign is something you can see, feel, hear, or measure like the bone sticking out.

Question 12

Which of the following is a sign that your patient could be perfusing poorly?

Poor Mentation

Answer 12

Poor respiratory function may be part of the cause of hypoperfusion but it is not a sign. Capillary refill needs to be more than 2 seconds. Poor mentation is a sign of hypoperfusion.

Question 13

Your are assisting a patient with ventilation.

What are the steps…… ?

Answer 13

The steps in ventilating a patient include: 1st - Explain the procedure to the patient. 2nd - Place mask over the patient’s nose and mouth. 3rd - Initially assist at a rate at which the patient is breathing. 4th - Squeeze the bag each time the patient begins to inhale. 5th - Over the next 5-10 breaths, slowly adjust the rate and volume.

Question 14

The amount of air that can be forcibly expelled from the lungs after breathing deeply is called:

Vital Capacity

Answer 14

The amount of air that can be forcibly expelled from the lungs after breathing deeply is called vital capacity. Dead space is the amount of tidal volume not reaching the alveoli during ventilation. Residual volume is the volume of air remaining in the lungs after maximum exhalation. Minute volume is the volume of air inhaled and exhaled by the lungs over a minute.

Question 15

Pertinent negatives are often used when documenting patient conditions on a PCR. Which of the following is a pertinent negative for a patient experiencing an MI?

The patient denies chest pain

Answer 15

A pertinent negative is a symptom or condition you would expect to see under certain circumstances, but is not present with a particular patient.

Question 16

Fractures of the tibia and fibula commonly include?

Damage to the Vessels

Answer 16

Fractures of the lower bones of the leg often include damage to the veins and arteries of the leg as the sharp edges of the broken bones cut through them and other tissue during the break.

Question 17

You and your partner Dave arrive on scene at a softball field where your patient is a 22 year old female softball player. She is complaining of ankle pain after sliding into 3rd base. Swelling and discoloring are apparent. What assessment should you use?

Focused Trauma

Answer 17

If you know that the chief complaint is a localized trauma injury you can use a focused trauma to evaluate the specific injury.

Question 18

In the context of pulmonary ventilation, internal respiration is best described as:

The exchange of respiratory gases between the systemic capillaries and their surrounding tissue beds

Answer 18

Internal respiration is the exchange of respiratory gases between the systemic capillaries and their surrounding tissue beds.

Question 19

Basal Skull Fracture

Answer 19

CSF drainage from the nose, raccoon eyes, and Battle’s sign are all indicators of a Basal skull fracture.

Question 20

Irregular Breathing Problems

Answer 20

An irregular respiratory pattern can be caused by: Head trauma, stroke, metabolic dysfunction, toxic environment, and a rapid respiratory rate without clinical improvement. In some cases, cushings triad can develop as the patient’s ICP increases.

Question 21

The girl is having problems breathing. The girl’s parents tell you that she has never had any problems like this before. The mother says the child has had the flu for a few days, but the girl woke up this morning complaining of difficulty breathing for the first time. As you visually inspect this 7-year girl you see her utilizing accessory muscles to breath and her nostrils are flaring. She is breathing at 20 respirations per minute and her skin is warm and dry.

Answer 21

Epiglottitis is known to strike children in this age group. Transporting with airway support via an NRB is the best treatment. Given the assessment, she does not need positive pressure ventilations at this point.

Question 22

Cells require chemicals in order to function, namely oxygen, glucose, and electrolytes.

Answer 22

Cell functions requiring chemicals include: Excretion of water, excretion of carbon dioxide, and aerobic versus anaerobic respiration.

Question 23

The left side of the heart ________________________ and ________________________.
receives pulmonary circulation, drives systemic circulation

Answer 23

The left side of the heart receives pulmonary circulation and drives systemic circulation.

Question 24

Contraindications of inserting a NPA

Answer 24

Inserting a nasopharyngeal is not recommended in patients who have sustained possible basilar fractures as the device may enter and injure the brain through a fracture.

Question 25

Gas exposure patients…….

Answer 25

Although oxygen is always important, you need to treat the underlying problem.

Irritant gases restrict the lungs ability to ventilate, therefore, the need for ventilation is priority.

Question 26

It’s 20 degrees outside and your unit has been called to an apartment complex where a man is having trouble breathing. You arrive to find the man sitting in a tripod position on a bench. He has a portable O2 tank and is receiving oxygen via a nasal cannula at 3 LPM. Your initial assessment reveals that his breathing is rapid with minimal chest rise and fall. Respiration rate is 20 breaths per minute and his pulse is 130. In a hoarse voice the man tells you he has a history of COPD and is on a new medication which he is unable to name. He denies any chest pain, but says he is getting a headache. Which of the following scenarios is most likely the cause for this man’s breathing difficulties and how would you treat him?

He is having an allergic reaction to the new COPD medication. Move him to the ambulance and administer high flow 02 via NRB

Answer 26

Given the signs and symptoms, breathing difficulty, hoarse voice, tachycardia, increased respiration rate, new medication, and headache the most likely scenario is the allergic reaction to the new medication. Answer 2 is incorrect because COPD drugs are not designed to remove surfactant from the alveoli. Also, you would not give him high flow O2 via a cannula. Answer 3 is not likely correct as live bees are not found in 20 degree temperatures. Additionally, taking a blood pressure prior to administration of the Epi pen is recommended unless you are certain there is life threatening airway compromise due to an acute allergic reaction.

Question 27

A spontaneous pneumothorax is usually caused by:

Ruptured bleb or air sac on the lung

Answer 27

Sudden onset breathing difficulties are often caused by a spontaneous pneumothorax and is more common in men than women. Unless it develops into a tension pneumothorax, there will not be any tracheal deviation or JVD.

Question 28

Unoxygenated blood travels into the lungs via the?

Pulmonary Artery

Answer 28

Blood travels into the lungs from the pulmonary artery. This is the only artery in the body that carries unoxygenated blood.

Question 29

Crackles

Are a sign of lower respiratory obstruction

Answer 29

Crackles are lung sounds that result from air moving through fluid in the lungs. This is a lower respiratory problem more likely caused by left sided CHF than right sided.

Question 30

A 46-year-old woman was hiking in the woods near her home when she accidentally stepped into a hive of hornets and was stung multiple times. She contacted 911 via her cell phone and is going to rendezvous with you at her residence. When you arrive at the home you find her lying on the front lawn. After completing your scene size up, which would be the most appropriate treatment sequence according to the NREMT Patient Assessment/Management - Medical Skill Sheet?

CORRECT ANSWER is: Determine level of consciousness - Identify life threats - Assess airway - breathing - and circulation

Answer 30

Rationale:

On the first answer, you do not know what is wrong with this woman so you cannot assist her with epi after just a general impression. On the second answer, Giving O2 sounds like a good idea, but you missed the first three steps of the primary survey AND got vitals BEFORE doing a SAMPLE. On the fourth answer the first 3 steps of the primary survey were missed, and doing a secondary assessment is incorrect. Additionally, the injection of epi would have been administered during the ABC’s if she were in anaphylaxis.

Question 31

A patient with snoring respirations benefit from a NPA.

Answer 31

The snoring is likely caused by the tongue falling back against the pharynx. The snoring may be eliminated by inserting a properly measured nasopharyngeal. If the head tilt did not help open the airway, the jaw thrust is even less likely to be effective. Snoring respirations are not usually caused by secretions in the mouth.

Question 32

Bronchi

Hollow tubes that further divide into the lower airways of the lungs and are supported by cartilage.

Answer 32

Hollow tubes that further divide into the lower airways of the lungs and are supported by muscle.
A hollow tube that passes air to the lower airway and is supported by muscle.

Question 33

While doing a patient assessment you inspect the chest and see that the patient’s diaphragm rises and the ribs move down and inward. Based on this observation what is the patient doing?

Hyperventilating
Coughing
Inhaling

Exhaling- correct answer

Answer 33

Exhalation is a passive process in which the intercostal (rib) muscles and diaphragm relax. The ribs move down and inward and the diaphragm rises. This reduces the size of the chest cavity. The opposite happens in inhalation - the ribs rise and the diaphragm contracts and moves downward. Coughing would produce an erratic movement of the chest and hyperventilation is rapid and deep breathing pattern.

Question 34

Hypercapnea

Answer 34

refers to elevated levels (hyper-) of carbon dioxide in the blood.

Question 35

The venturi mask

Answer 35

can deliver a targeted concentration of oxygen (e.g. 30%) which is most commonly used in the chronic obstructive pulmonary disease patient.

Question 36

The appropriate procedure for suctioning is to:

Answer 36

Place the tip of the suction catheter into the mouth as far as can be visualized (don’t lose sight of the end of the catheter) without suctioning. Once in place, start to suction as the Yankauer is withdrawn from the mouth.

Question 37

The process by which the air leaves the lungs is passive, which is one of the reasons why there is a pause between breaths when providing artificial ventilations.

Answer 37

Time between ventilations allows air to leave the lungs. The process is called passive because the patient does not assist or expend significant energy to expel the air.

Question 38

You respond to an office where a 50 year old male is having difficulty breathing. Upon arrival you find him sitting in a chair with cyanosis around the lips, extreme diaphoresis and looking very scared. He speaks using 1 or 2 words at a time. Based on this information what device is appropriate for administering oxygen?

Venturi mask
Non-rebreather face mask
Nasal cannula

Bag-valve mask- CORRECT MASK

Answer 38

This patient is quickly moving from acute respiratory distress to respiratory failure. Therefore, this patient should be ventilated with a bag-valve mask using an oxygen reservoir. The other three devices will deliver oxygen but based on how poorly the patient is breathing they are inappropriate and will not be effective at getting oxygen to the alveoli.