Respiratory protocol

Question 1

OH NO your patient is choking! What do you want to know FIRST

Answer 1

How severe is the obstruction?

Question 2

You determine your patient has a mild or moderate obstruction. Good job! now what?

Answer 2

• Don’t interfere with spontaneous breathing or coughing
• Position of comfort
• Oxygen
• Suction if needed

Precaution *Consider recovery position in the event of emesis

Question 3

How do you determine is a patient has a complete or incomplete obstruction?

Answer 3

Complete
- Patient is mute

Incomplete
- Patient is speaking, coughing, or breathing in any fashion

Question 4

What is the order of operations for a severe or complete obstruction without successful ventilations and nothing you do is successful

Include paramedic steps as well

Answer 4

1. Open airway with head tilt chin lift or jaw thrust
2. Attempt ventilations with BVM
3. Able to ventilate NO
4. Paramedic does laryngoscope looking for obstruction (Paramedic is attempting to remove it or push it into the bainstream bronchus
5. Able to ventilate? NO
6. Perform abdominal thrusts then attempt to ventilate.

Did it work? HAHA NO good try
7. Cricothyrotomy

Question 5

Once you clear an obstruction how do you postiion the patient?
What do you need to monitor?
What preperations do you need to do to prevent further injury/damage?

Answer 5

• position of comfort
  -O2 via NRB @ 15lpm
  -Monitor ABCs, and vitals especially SpO2
  -Suction as needed and prepare for vomitting, which is common

Question 6

OH NO your patient is unconsious after youve determined cause is a severe obstruction! What do you do first and what part of the airway obstruction protocol will you follow?

Answer 6

First begin chest compressions and each time the airway is opened look for obstruction. If found remove it!

Then follow severe or complete obstruction protocol

Question 7

Pending incident….. Incident assigned…
You are being called to an adult in respiratory distress. AHHH dont panic!
What are your differentials

( theres 10 potential differentials on this card)

Answer 7

• Is the airway patent
• Anaphylaxis?
• Asthma or COPD?
• CHF/pulmonary edema?
• Pneumothorax
• Pulmonary embolism
• pneumonia
• sepsis
• metabolic acidosis (DKA)
• Anxiety

Question 8

Do the number in the order 40-30-20 mean anything to you?

Hint- Answer should be Yes.

Hint - gasp….. a child!

Answer 8

Ventilation rate in respiratory failure for a child
Neonatal - 40
Infants - 30
Children - 20

Question 9

For pediatric respiratory distress what is step one per protocol

Answer 9

Monitor SpO2 and capnography

Question 10

What are the characteristics of stridor

(Under pediatric respiratory distress protocol)

Answer 10

• High pitched, harsh sound most often hears on inspiration
• occurs with upper airway restriction
• significant restriction may result in biphasic stridor (hears on inspiration and expiration)