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prehospital care theory > week 7 - breathing > Flashcards

week 7 - breathing Flashcards

1
Q

oxygenation

A

need for more oxygen

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2
Q

ventilation

A

helping (assisting) them to breathe

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2
Q

3 lobes of the right lung

A
  1. upper
  2. middle
  3. lower
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3
Q

2 lobes of the left lung

A
  1. upper
  2. lower
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4
Q

5 chest osculation techniques

A
  1. quiet environment
  2. remove excess clothing
  3. apply stethoscope to landmarks
  4. have the patient inhale and exhale deeply
  5. listen to 1 full breath
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5
Q

if you hear adventitious sounds during chest osculation what are the 3 things to ask yourself

A
  1. are they during the inspiratory or expiratory or both
  2. where on the chest wall are they
  3. do they clear with deep breathing or cough
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6
Q

hypoxia

A

a lack of oxygen to the body cells and tissues

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7
Q

anoxia

A

absence of oxygen

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8
Q

example of Fio2

A

the gas mixture at room air has a fraction of inspired O2 at 21% meaning that the fraction of O2 at room air is 21%

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8
Q

Fio2

A

the fraction of inspired oxygen is the concentration of oxygen in the gas mixture (% of oxygen in the space being measured)

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9
Q

dyspnea

A

any difficulty in respiratory rate, regularity or effort

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10
Q

bradypnea

A

is a respiratory rate this is lower than normal for age

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11
Q

tidal volume

A

normal volume of air displaced between normal inhalation and exhalation

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11
Q

tachypnea

A

is a respiratory rate that is greater than normal for age

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12
Q

apnea

A

stopping of breathing

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13
Q

effects of hypoxia

A

has effects on every body system and every cell but first most rapid effects are seen in the brain

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14
Q

difference between a failed respiratory system and a failed circulatory system

A

failed respiratory system = O2 can’t get in
failed circulatory system = O2 can’t be distributed

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15
Q

5 neurological effects of hypoxia

A
  1. decreased LOC
  2. confusion
  3. disorientation
  4. agitation
  5. uncoordinated movements
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16
Q

when does hypoxia occur

A

when the bodies requirements for O2 aren’t met

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17
Q

inspiratory reserve volume

A

maximal amount of air that can be drawn into the lungs after normal inspiration

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18
Q

residual volume

A

the volume of air remaining in the lungs after the most forcible expiration

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18
Q

expiratory reserve volume

A

the additional amount of air that can be expired after normal breath

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19
Q

5 physical signs of respiratory distress

A
  1. accessory muscle use
  2. cyanosis (fingertips = peripheral, central = lips)
  3. pallor
  4. diaphoresis
  5. tripod position
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20
Q

where does cyanosis show first

A

in the fingertips, if seen near the lips that indicated it is way more severe

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20
Q

general impression

A

the hands off, from a distance assessment of how distressed a patient is

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20
Q

order of respiratory assessment

A
  1. general impression
  2. physical exam
  3. vital signs
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21
Q

4 things to look for when giving a general impression

A
  1. position
  2. LOC
  3. fatigue
  4. appearance of difficulty
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22
Q

6 things to assess when performing a physical exam

A
  1. head
  2. neck
  3. chest
  4. abdomen
  5. extremities
  6. speech
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23
Q

what to look for when assessing the extremities

A
  1. cyanosis
  2. radial pulse
  3. muscle tone

** cyanosis = hypoxia present for awhile
** radial pulse = quicker pulse means quicker respiratory rate

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23
Q

what to look for when assessing the head

A
  1. cyanosis
  2. fatigue
  3. airway sounds
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24
Q

what to look for when assessing the neck

A
  1. accessory muscle use
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25
Q

what to look for when assessing the abdomen

A
  1. accessory muscle use in the intercostal muscles
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25
Q

what to look for when assessing the chest

A
  1. lung sounds
  2. accessory muscle use
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26
Q

crackling adventitious sounds

A
  1. bubbling or crackle sounds are like when you have a straw in milk and are blowing bubbles
  2. indicates fluid in the lungs
  3. best heard on inspiration
  4. pathology = CHF, pneumonia, bronchitis, fibrosis
26
Q

what to look for when assessing the speech

A

how well a person can speak is a useful indicator of how much respiratory distress they are in
- the sound of their voice
- use yes or no (close-ended questions) for someone who can’t breathe well

27
Q

consolidation adventitious sounds

A
  1. low pitch, snoring quality to the absence of breath sounds
  2. best heard on expiration
  3. trachea and mainstream bronchi
  4. pathology = pneumonia, bronchitis, aspiration
28
Q

aspiration

A

if the patient’s airway is not clear they will start breathing in whatever is blocking the airway for example vomit, blood etc

28
Q

wheezing adventitious sounds

A
  1. high pitched sound
  2. air is being forced through a small space
  3. best heard on expiration but might be present on inspiration
  4. all lung fields
  5. pathology = asthma, COPD, bronchitis
29
Q

pleural rub adventitious sounds

A
  1. rubbing or grating
  2. inflammation of the pleural surfaces (lining of the lungs)
  3. best heard during inspiration and expiration
  4. peripheral lung fields
30
Q

3 things to asses respiratory rates for

A
  1. number of breaths per minute
  2. rhythm
  3. volume and depth
31
Q

2 types of rhythm

A
  1. irregular
  2. regular
32
Q

4 types of volumes

A
  1. shallow
  2. deep
  3. gasping
  4. “agonal”
33
Q

normal respiratory rates

A

adults = 12-20 breaths per min
children = 15-30 breaths per min
infants = 25-30 breaths per min

34
Q

pulse oximetry

A

measures the percentage of hemoglobin bound to a gas (usually O2)

35
Q

normal pulse oximetry range

A

92-96 % (based on reading)

**anything below 92% = hypoxic
** values in 70 & 80% = critical

36
Q

6 caution notes when measuring pulse oximetry

A
  1. ambient light
  2. hypothermia
  3. carbon monoxide
  4. poor perfusion
  5. manicures
  6. incorrectly position or placed
37
Q

levels of patient distress

A
  1. mild
  2. moderate
  3. severe
  4. respiratory failure
38
Q

oxygen

A

stored in pressurized aluminum cylinders

38
Q

2 sizes of oxygen tanks by letter

A
  1. D tank
  2. M tank
39
Q

supplemental oxygen

A

increases the alveolar content of inspired oxygen and decreases the work of breathing

40
Q

M tank

A
  • bigger
  • in ambulance
  • is used when a patient has been put into the ambulance and you are moving elsewhere
41
Q

D tank

A
  • smaller
  • used in the field to take to the patient
  • in bags on the ambulance
42
Q

cylinder size for D oxygen tank

A

0.16

43
Q

cylinder size for M oxygen tank

A

1.56

44
Q

what is the safe residual pressure of a oxygen tank

A

200 psi

45
Q

how to calculate a tank life (in minutes)

A

tank pressure (psi) - are residual pressure x cylinder constant (divided by) flow rate (L/min) = duration of flow in minutes

46
Q

TRUE or FALSE
it is a routine procedure at the end of shift to check oxygen

A

FALSE - it is routine procedure at the START of the shift to check the oxygen

47
Q

what is the tank pressure in psi

A
  • look at the gage
  • full tank = 2000 psi
  • value on tank indicated pressure
48
Q

what is the safe residual pressure

A
  • never under 200
  • change tank once it reaches just over 200 or else it won’t run smoothly
49
Q

what are the cylinder constants

A

D = 0.16
M = 1.56
** will be either constant depending on what tank is being used at the time of calculation

50
Q

what is the flow rate (L/min)

A

how much oxygen you are giving the patient

51
Q

what must be present in order to have oxygen delivery

A

spontaneous breathing

52
Q

spontaneous breathing

A

the movement of gas in and out of the lungs that is produced in response to an individual’s respiratory muscles = natural breathing

53
Q

5 steps to oxygen administration

A
  1. turn on the oxygen source
  2. select oxygen delivery device
  3. connect the O2 delivery device to the regulator and select the appropriate flow rate
  4. apply oxygen delivery deice to patient
  5. reassess patient
54
Q

6 ways of oxygen delivery for spontaneously breathing patients

A
  1. nasal cannula
  2. simple face mask
  3. non rebreather mask
  4. filtered mask
  5. controlled concentration mask
  6. pocket mask
55
Q

specifications of a nasal cannula

A

1-6 LPM
24-44 % Fio2

VERY SLOW

56
Q

specifications of simple face mask

A

6-10 LPM
35-60% Fio2

57
Q

specifications of non rebreather mask

A

10-15 LPM
> 95% Fio2

58
Q

filtered mask

A
  • the patient is breathing out
  • air is being filtered before coming out to help eliminate germs/particles that the patient is breathing out so some is filtered
59
Q

apneic or ineffective breathing

A

not breathing or ineffective breathing

60
Q

what is used to help a patient that has apneic breathing

A

BVM

61
Q

BVM

A

bag valve mask

62
Q

specifications of BVM

A
  1. 15-25 LPM
  2. 90-100% Fio2 (closer to 100% SPO2)
  3. 2000mL capacity
  4. when you see the patients chest start rising = stop squeezing
63
Q

decreased LOC + respiratory distress =

A

positive pressure ventilations

64
Q

establishing an airway in a less responsive patient - 4 techniques in order

A
  1. sniffing position
  2. E2SN (if practical)
  3. airway adjunct (as needed)
  4. suction
64
Q

establishing an airway in an unresponsive/VSA patient - 4 techniques in order

A
  1. head tilt chin lift
  2. sniffing position
  3. E2SN (if practical)
  4. oral airway
65
Q

considerations for ventilating a patient

A
  1. tidal volume (vT)
  2. respiratory rate
  3. resistance
  4. compliance
  5. gastric insufflation (pushing air into stomach, expands stomach, and causes patient to vomit)
65
Q

2 types of mask placements

A
  1. one handed
  2. two handed
66
Q

technique for ventilating the patient

A
  1. deliver slow - 1 to 2 seconds for each ventilation
  2. allow for exhalation
  3. monitor chest rise
  4. ventilate gently
67
Q

mnemonic for good BVM seal

A

JAWS

68
Q

what does JAWS stand for

A

J = jaw thrust
A = airways (OPA/NPA)
W = work together
S = slow and small squeezes

69
Q

6 steps to ventilation

A
  1. position patient
  2. establish airway
  3. connect BVM to O2
  4. apply BVM
  5. ventilate patient
  6. assess
70
Q

predictors of a difficult airway

A

O = obesity
B = beards
E = edentulous (lacking teeth)
S = sleep apnea
E = elderly

prehospital care theory (5 decks)

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