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Respiratory Emergencies Flashcards

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1
Q

What is respiration?

A

Exchange of oxygen and carbon dioxide.

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2
Q

What is ventilation?

A

Mechanical process of moving air in and out of lungs.

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3
Q

What part of the brain is responsible for breathing?

A

Stimulus to breath comes from the medulla. Involuntary control of breathing originates in the pons in the brainstem.

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4
Q

What motor nerves are present in inspuration?

A

Phrenic nerve - diaphragm

Intercostal nerves - external intercostal muscles

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5
Q

What is the relationship between intrapulmonary pressure and atmospheric pressure during inspiration?

A

Intrapulmonary pressure falls slightly below atmospheric pressure.

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6
Q

When does a person stop inhaling?

A

Atmospheric pressure = intrapulmonary pressure

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7
Q

Normal inspiratory reserve volume.

A

3,000 mL adult male

2,300 mL adult female.

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8
Q

Hering-Breuer reflex.

A

The nervous system mechanism that terminations inhalation and prevents overexpansion of lungs.

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9
Q

How is expiration initiated?

A

Mechanical stretch receptors in chest wall and bronchioles send signal to apneustic center via vagus nerve.

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10
Q

Inspiratory/expiratory ratio (I/E ratio)

A

1:2

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11
Q

I/E ratio in asthma.

A

1:4 or 1:5

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12
Q

Why is the I/E ratio different in a patient with a lower airway obstruction? (i.e. asthma)

A

Expiratory phase is prolonged as they have more difficulty getting our out.

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13
Q

Signs of normal breathing in adult.

A 
Rate of 12-20 breaths/min
Regular pattern
Clear and equal breath sounds
Regular and equal chest rise and fall
Adequate depth
Unlabored
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14
Q

s/s of asthma

A

wheezing on inspiration/expiration

bronchospasm

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15
Q

s/s of anaphylaxis

A 
flushed skin
hives
generalized edema
hypotensive
laryngeal edema with dyspnea
wheezing or stridor
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16
Q

s/s bronchiolitis

A 
SOB
wheezing
coughing
fever
dehydration
tachypnea
tachycardia
wheezing, crackles
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17
Q

s/s bronchitis

A

chronic cough w/ sputum production
wheezing
cyanosis
tachypnea

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18
Q

s/s heart failure

A 
Pink, frothy sputum coming from mouth
Crackles, rhonchi, wheezing
Pedal edema
Cool, diaphoretic, cyanotic skin
Tachycardia
HTN early, deteriorates to hypotension
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19
Q

s/s croup

A

fever
barking cough
stridor

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20
Q

s/s diptheria

A

difficulty breathing and swallowing
sore throat
thick, gray buildup in throat or nose
fever

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21
Q

s/s emphysema

A 
barrel chest
pursed lip breathing
DOE
cyanosis
wheezing or decreased breath sounds
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22
Q

s/s epiglottitis

A 
dyspnea
high fever
stridor
drooling
difficulty swallowing
severe sore throat
tripod or sniffing position
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23
Q

s/s pertussis

A

coughing spells
whooping sound
fever

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24
Q

s/s pneumoia

A 
dyspnea
chills, fever
cough
green, red, or rust colored sputum
localized wheezing or crackles
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25
Q

s/s pneumothroax

A

sudden pleuritic chest pain w/ dyspnea
decreased breath sounds
subcutaneous emphysema

Severe findings:
AMS
pale, diaphoretic, cyanotic
unilateral breath sounds
hyperresonance to percussion
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26
Q

s/s pulmonary embolus

A 
sudden onset sharp chest pain
dyspnea
tachycardia
tachypnea
cyanosis
hemoptysis
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27
Q

s/s tension pneumothorax

A 
severe SOB
AMS
JVD
tracheal deviation
hypotension
signs of shock
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28
Q

s/s RSV

A

cough
wheezing
fever
dehydration

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29
Q

s/s TB

A

cough
fever
fatigue
productive bloody sputum

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30
Q

What are the two types of cells found in alveoli?

A

Type I pneumocytes : almost empty allowing for better gas exchange. Lack cellular components hindering ability to reproduce.

Type II pneumocytes : can make new type I cells and produce surfactant

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31
Q

How does the body respond to mild hypocemia?

A

Increases heart rate

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32
Q

Are alveoli able to be repair themselves after being damaged by infection, cigarette smoke, or other trauma?

A

The ability to repair themselves correlates w/ type II pneumocytes. After all type II cells have been destroyed, the alveolus cannot make new cells or surfactants.

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33
Q

What happens when alveoli collapse, become fluid-filled, or puss filled?

A

They do not participate in gas exchange and create a shunt moving blood from right side of the heart bypassing alveoli and returns to the left side of the heart unoxygenated.

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34
Q

What causes right sided heart failure in patient’s with chronic lung disease and/or chronic hypoxia?

A

These patients produce a surplus of RBC making the blood viscous. The viscosity of the blood causes strain on the right side of the heart.

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35
Q

What is the medical term for right-sided heart failure secondary to chronic lung disease?

A

Cor pulmonale

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36
Q

What are the reasons for high CO2 levels?

A

Various lung disease impairing exhalation process.

The body produces too much CO2 due to disease or abnormality.

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37
Q

Define carbon dioxide retention.

A

Failure of respiratory centers in the brain to respond normally to a rise in CO2 levels in arteries.

38
Q

pH level of patient w/ hyperventilating.

A

High pH resulting in respiratory alkalosis.

39
Q

pH level of patient w/ hypoventilation.

A

Low pH resulting in respiratory acidosis.

40
Q

Causes of impaired ventilation.

A

Upper airway obstruction
Lower airway obstruction
Chest wall impairment
Neuromuscular impairment

41
Q

What conditions cause impaired ventilations in upper airway obstructions?

A

FB obstruction
Infection
Trauma

42
Q

What conditions cause impaired ventilations in lower airway obstructions?

A

Trauma
Obstructive disease
Increased mucus production
Airway edema

43
Q

What conditions cause impaired ventilation in chest wall impairment?

A

Pneumothorax
Flail chest
Pleural effusion
Restrictive disease (scoliosis, kyphosis)

44
Q

What conditions cause impaired ventilations in neuromuscular impairment?

A 
Overdose
Lou Gehrig disease (ALS)
Carbon dioxide narcosis
Injury to c-spine
Guillain-Barre syndrome
Botulism
45
Q

What conditions may interrupt a pt’s respiratory drive?

A

Acute opioid narcotic OD
Intoxication w/ ETOH, narcotic, toxins, drugs
Head injury, hypoxic drive, and asphyxia
Cardiac arrest

46
Q

s/s of pulmonary edema

A 
Dyspnea
Rapid, shallow respirations
Frothy pink sputum from nose and mouth
Orthopnea
Fatigue
Crackles
47
Q

Who are at a high risk of spontaneous pneumothorax?

A

Pt’s with emphysema and asthma. Tall, thin, athletic males.

48
Q

What are the risk factors of PE?

A 
recent surgery
pregnancy
oral contraceptives
smoking
infection
cancer
Sickle cell anemia
prolonged inactivity
49
Q

Anatomical damage caused by highly water-soluble gases. (i.e. ammonia)

A

The gas will react w/ the moist mucous membranes of upper airway causing swelling and irritation.

50
Q

Anatomical damage caused by less water-soluble gases. (i.e. phosogene, nitrogen dioxide)

A

Gases get deep into the lower airway where pulmonary edema can occur up to 24 hours later.

51
Q

Cystic fibrosis

A

Genetic disorder that affects the lungs and digestive system. Chloride is unable to move through cells without difficulty causing unusually high sodium levels and abnormally thick mucus secretions.

52
Q

Why does RSV spread rapidly in schools and child care centers?

A

The virus is spread through droplets and survive on surface including hands and clothing.

53
Q

Croup

A

Caused by inflammation and swelling of the phraynx, larynx, and trachea.

Often secondary to acute viral infection of the upper respiraoty tract.

Typically seen in 6 mo. to 3 y/o.

54
Q

Why is croup commonly found in children and rare adults?

A

Adult airways are larger and can accommodate the inflammation and mucus production w/o s/s.

55
Q

Signs of life-threatening respiratory distress in adults.

A 
AMS
Severe cyanosis
Absent or abnormal breath sounds
Audible stridor
Two-to-three word dyspnea
Coughing
Tachycardia (above 130)
Abdominal breathing
Change in respiratory rate or rhythm
Pallor and diaphoresis
Retractions and/or use of accessory muscle
Tripod positioning
56
Q

Diseases associated with wheezing.

A 
Asthma
COPD
CHF
Pulmonary edema
PNA
Bronchitis
Anaphylaxis
57
Q

Diseases associated with rhonchi.

A

COPD
PNA
Bronchitis

58
Q

Diseases associated with crackles.

A

CHF
Pulmonary edema
PNA

59
Q

Diseases associated with stridor.

A

Croup

Epiglottitis

60
Q

Diseases associated with decreased or absent breath sounds.

A 
Asthma
COPD
PNA
Hemothorax
Pneumothorax
Atelectasis
61
Q

Describe crackle breath sounds.

A

Air trying to pass through fluid in the alveoli.
Crackling or bubbling sound typically heard on inspiration.
High-pitched sounds are fine crackles
Low-pitched sounds are coarse crackles

62
Q

Described rhonchi breath sounds.

A

Secretions or mucus in the larger airway.

Lower-pitched rattling sounds.

63
Q

Describe stridor breath sounds.

A

Air tries to pass through an obstruction.
Typically partial obstruction in trachea.
High-pitched sound hear on inspiration.

64
Q

Describe wheezing breath sounds.

A

Constriction and/or inflammation in the bronchus.

High-pitched whistling sound typically heard on expiration.

65
Q

Describe pleural friction rub breath sounds.

A

Pleural layers have lost their lubrication mostly due to pleural inflammation.
Squeaking or grating sound heard on inspiration and/or expiration.

66
Q

What causes snoring respiration?

A

Partial upper airway obstruction usually in oropharynx.

67
Q

Cheyne-Stokes respirations

A

rapid and slow respirations alternating w/ periods of apnea.

68
Q

Kussmaul respirations

A

deep, rapid respirations

69
Q

Ataxic (Biot) respirations

A

rapid, irregular respirations w/ periods of apnea

70
Q

Apneustic respirations

A

impaired respirations w/ sustained inspiratory effort

71
Q

What part of exhalation is tested by ETCO2?

A

Last few milliliters of exhaled air.

72
Q

Range of normal peak flow values.

A

350-700 L/min

73
Q

How many liters is considered substantial respiratory distress when using a peak flow meter?

A

> 150 L/min

*chronic asthma pt’s may never exceed 100 L/min

74
Q

How many liters of oxygen should be used with nebulizers?

A

6 L/min

75
Q

Adulet and pediatric dose of Albuterol/

A

Adult: 2.5 mg diluted with 2.5 mL nl saline

Peds: > 20 kg: 1.25 mg/dose via handheld nebulizer or mask over 20 minutes.
<20 kg: 2.5 mg/dose via handheld nebulizer or mask over 20 minutes.

76
Q

Contraindications for MDI

A

Pt unable to help coordinate inhalation w/ depression of the trigger or too confused.
Not prescribed to pt
Did not obtain permission for medical control and/or is not permissible by local protocol
Pt already had max dose before EMS arrival
Medication expired
Contraindications specific to medication

77
Q

How do you know if your CPAP intervention is successful?

A

Respiratory rate decreases

78
Q

Tx for obstructive airway diseases

A 
Peak flow meter to establish baseline expiratory airflow
Pulse ox 
Position of comfort
Call for ALS
High flow oxygen
Assist with ventilations if needed
Use humidified oxygen if available
IV access
IV therapy if necessary
MDIs PRN
Contact medical control for further orders
79
Q

Tx for acute pulmonary edema

A 
100% oxygen
Suctions secretions if needed
Position of comfort
Assist ventilations if needed 
Consider CPAP
Establish IV access
Call ALS for possible intubation
Prompt transport
80
Q

Tx for aspiration

A

Aggressively reduce risk of aspiration by avoiding gastric distention during ventilation.
Monitor pt’s ability to protect airway
Suction

81
Q

Tx for COPD

A

Assist w/ MDI
Prompt transport
Semi-fowler position
BVM

82
Q

Tx for anaphylactic reactions

A 
Remove offending agent
Maintain airway
BVM
Prepare for ventilation PRN
Rapid transport
Early administration of Epi
83
Q

Tx for spontaneous pneumothorax

A

Begin w/ ABCs
High-flow oxygen
BVM
Position of comfort
Condition w/ determine emergent or non-emergent
Consider ALS if signs of tension pneumo develop

84
Q

Tx for pleural effusion

A

Oxygen

85
Q

Tx for pulmonary embolism

A 
Maintain airway
High-flow oxygen
BVM if needed
Initiate CPR if pulseless and apneic
Establish IV access
Bolus of isotonic crystalloid solution
Fluid hydration based on clinical sxs
Reassurance and psychological support
Call ALS PRN
86
Q

Tx for hyperventilation

A

Supplemental oxygen
Coach ventilations if anxiety-related
Psychological support

87
Q

Tx for obstruction the airway

A

Pt able to talk and breath, provide supplemental oxygen and transport carefully in a position of comfort.
Remove obstructing body for complete airway obstruction
Open airway w/ head tilt-chin lift (or jaw-thrust for suspected spinal trauma)
No improvement with opening airway, asses the upper airway for obstruction.
Supplemental oxygen and transport promptly.

88
Q

Tx for environmental/industrial exposure

A

Pt must be decontaminated first by trained responders.
Gather information about substance and cause of dyspnea.
100% supplements oxygen
Assist w/ ventilations if needed
If upper airway compromised, aggressive airway management may be required. Call ALS.

89
Q

What medications do you use to treat the three components of asthma?

A

Airway edema : corticosteroids
Increased mucus production : water and expectorants
Bronchospasm : bronchodilator

90
Q

Tx for asthma

A

Prepare to suction
Administer oxygen
Assist with MDIs
Prepare to assist ventilations w/ BVM

Advanced EMT (33 decks)

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