Respiratory Emergencies

Question 1

What are two potential causes of cardiogenic pulmonary edema?

Answer 1

Myocardial infarction and congestive heart failure

Question 2

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 2

Emphysema

Question 3

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

Answer 3

Chronic obstructive pulmonary disease (COPD)

Question 4

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

Answer 4

Pneumonia

Question 5

What is the most definitive diagnostic tool in asthma?

Answer 5

Peak flow

Question 6

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

Answer 6

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 7

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

Answer 7

Primary spontaneous pneumothorax

Question 8

What are normal arterial blood gas values?

Answer 8

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

Question 9

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

Answer 9

PaO2 less than 60 mmHg and PaCO2 greater than 50 mmHg and arterial pH less than 7.30 on room air

Question 10

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

Answer 10

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

Question 11

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

Answer 11

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

Question 12

What are the clinical manifestations of asthma?

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

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

Question 15

Corticosteroids work on what portion of the asthma cascade?

Answer 15

Inflammation and edema

Question 16

What is the most recognizable and reversible cause of hypoventilation?

Answer 16

Foreign body airway obstruction

Question 17

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

Answer 17

Rhonchi

Question 18

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

Answer 18

Left ventricle

Question 19

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

Answer 19

Positive end expiratory pressure (PEEP)

Question 20

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

Answer 20

Antibiotics

Question 21

What are the classic early signs of asthma?

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

When the degree of lung collapse is minimal

Question 24

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

Answer 24

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

Question 25

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

Answer 25

Bronchial smooth muscle relaxation

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

What are the ominous signs of the need to intubate?

Answer 27

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

Question 28

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

Answer 28

Intubation and mechanical ventilation

Question 29

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

Answer 29

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

Question 30

Why are beta2 agonists beneficial in asthma?

Answer 30

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

Question 31

Pulmonary emboli results in hypoxemia through what mechanism?

Answer 31

Ventilation/perfusion mismatch

Question 32

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

Answer 32

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

Question 33

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

Answer 33

PaO2 60mmHg