Studied by 39 people
Used study guide and review sheet to make study cards - should still look at lesson plan, notes, textbook, and adaptive tests
T/F: a BiPAP allows you to set different airway pressures for inspiration and expiration.
true
what is the formula to calculate how long an oxygen cylinder will last?
T/F: when using a BVM, select the appropriate size and use only enough volume to cause the chest to rise.
true
disadvantages of mouth-to-mask ventilations
The mask is perceived by some EMT s as having an increased risk of infection.
The EMT providing ventilation may fatigue.
Doesn’t allow for the highest possible concentration of oxygen to be delivered.
advantages of mouth-to-mask ventilations
A single EMT can maintain a good seal.
Eliminates direct contact with the patient.
One-way valve.
Provides adequate tidal volume.
Supplemental oxygen can be administered.
how much oxygen does mouth-to-mouth/mouth-to-nose deliver?
16%
what is Paradoxical chest wall movement?
chest wall segment moves in during inspiration and out during expiration, which is the reverse of normal
If breathing is inadequate, the brain begins to die within
4-6 minutes
T/F: Breathing can be adequate, but if the patient is working harder to breathe, he is in respiratory distress.
true
how should you insert a NPA?
bevel toward the septum or base of tonsil
T/F: Use an infant or child mask with your bag-mask device to make a seal over the stoma.
true
contraindications for CPAP
Patient is in respiratory arrest or has agonal respirations.
Patient is hypoventilating.
Patient cannot speak.
Patient is unresponsive or otherwise unable to follow verbal commands.
Patient cannot protect his or her own airway.
Patient has hypotension.
Signs and symptoms of pneumothorax or chest trauma
Patient who has a tracheostomy
Active gastrointestinal bleeding or vomiting
Patient has experienced facial trauma.
Patient is in cardiogenic shock.
Patient cannot sit upright.
CPAP system mask and strap cannot properly fit.
Patient cannot tolerate the mask.
Always reassess the patient for signs of deterioration and/or respiratory failure.
patient is under the age of 12
what is minute volume vs tidal volume?
minute: the amount of gas inhaled/exhaled in one minute (product of respiratory rate + tidal volume)
tidal: the amount of gas inhaled/exhaled in one breath
contraindication for OPA
the patient has gag/cough reflex
what does it mean when a patient’s skin is diaphoretic?
the patient is excessively sweating
common causes of respiratory arrest
stroke
myocardial infarction (heart attack)
drug overdose (especially opiates and other CNS depressants)
toxic inhalation
electrocution and lightning strike
suffocation
traumatic injuries to head, spine, chest, or abdomen
infection to the epiglottis
airway obstruction by a foreign body
what two things = minute volume?
tidal volume x respiration rate
4 things you should look for to see if patient is adequately breathing
rate
rhythm
quality
depth (tidal volume)
soft catheter AKA:
french catheter or whistle-tip or nonrigid plastic
rigid catheter AKA:
hard catheter or Yankauer “tonsil tip” or “tonsil sucker”
Airway anatomy in children vs adults
child:
chest wall more pliable
rely more on diaphragm
more likely to overinflate lungs when giving ventilations
nose and mouth are smaller
epiglottis is U-shaped and protrudes into the pharynx
cricoid cartilage is less rigid and less developed
trachea is narrower, softer, and more flexible
larger tongue takes up more space in the pharynx
what is edema?
swelling
while you are transporting a patient with altered mental status, he suddenly vomits and partially digested food along with large blood clots. the vomitus is too big for the rigid suction catheter. the EMT should immediately place the patient on his side and:
perform a finger sweep
when a person’s diaphragm contracts and the intercostal muscles pull the ribs upward, what will occur relative to the exchange of air and/or gases?
air will flow into the lungs
respiratory distress vs respiratory failure vs respiratory arrest
distress: abnormal (increased/decreased) respiratory rate/effort
includes: increased work of breathing, inadequate respiratory effort (e.g hypoventilation or bradypnea), and irregular breathing.
respiratory distress —> (leads to) —> respiratory failure
failure: there is an inadequate blood oxygenation/ventilation/both to meet the metabolic demands of the body tissues
job of the lungs is to ventilate and oxygenate. when it doesn’t do any of that, it is failing
arrest: absence of breathing
T/F: a mask with an oxygen inlet provides oxygen during mouth-to-mask ventilation
true
should you use caution with patients with potentially low BP when using a CPAP? Why?
yes because CPAP causes a drop in cardiac output (mount of blood pumped by the heart)
T/F: you should take a helmet off a motorcycle driver after an accident to see the condition of his face/head
false - only take the helmet off if you need to do something for his airway
purpose of mucous membranes in notaris (in the nose)
to warm, moisten, and filter air
what is external respiration?
gas exchange process that occurs between the alveoli and the surrounding pulmonary capillaries
Referred to as alveoli/capillary gas exchange
serves to oxygenate the blood and eliminate carbon dioxide from the lungs
what is internal respiration
gas exchange process that occurs between the cells and systemic capillaries
AKA cell/capillary gas exchange
responsible for delivering oxygen to the cells and removing carbon dioxide from the cell
disadvantage of using a BVM
can be hard to maintain a tight seal - for best results, it requires two people
what is the epiglottis?
small, leaf shaped flap of cartilaginous tissue that protects the trachea
valve that closes over the opening to the larynx while food and drink are being swallowed
what is ventilation?
passage of air in/out of the lungs
referred to as breathing, pulmonary ventilation
mechanical process, involves movement of air
creates pressure changes in the lungs to draw air in/out (inhalation, exhalation)
what is respiration?
gas exchange in the alveoli (external respiration) and in the cells (internal respiration)
physiologic
the exchange of oxygen and carbon dioxide
when using a BVM, check for:
bilateral chest rise and fall
what is the trachea?
passageway for air entering the lungs
AKA the windpipe
extends for the larynx to the carina
what is the carina?
the point at which the trachea splits into right and left mainstem bronchi
what is oxygenation?
the process by which the blood and cells become saturated with oxygen
process of leading oxygen molecules onto hemoglobin in the bloodstream
required for internal respiration
does not gaurantee that internal respiration is taking place
what is a Bag-Valve Mask (BVM)?
a manual device used to provide positive pressure ventilation
what does a BVM consist of?
self-inflating bag
one-way nonrebreather valve
face mask
intake/oxygen reservoir valve
oxygen reservoir
pop off valve
standard respiration rate for adult
12-20 breaths/min (can fall within 8-24)
standard respiration rate for adolescent
12-20 breaths/min
standard respiration rate for for school aged children
15-30
standard respiration rate for preschooler
20-30 breaths/min
standard respiration rate for infant
25-40 breaths/min
standard respiration rate for newborn
30-60 breaths/min
the most effective way to use a BVM is by:
connecting it to high flow concentrated oxygen
abnormal upper airway sounds
snoring
crowing
gurgling
stridor
snoring description
upper airway partially obstructed by the tongue or by relaxed tissues in the pharynx
obstruction can be corrected by performing a head-tilt, chin-lift maneuver
in a patient with suspected spinal injury, a jaw-thrust maneuver should be used
crowing description
like a crow cawing that occurs when the muscles around the larynx spasm and narrow the opening into the trachea
air rushing through the restricted passage causes the sound
gurgling description
usually indicates the presence of blood, vomits, secretions, or other liquid in the airway
immediately suction the substance from the airway
stridor description
high-pitched sound heard during inspiration
characteristic of a significant upper airway obstruction from swelling in the larynx
may also be heard if a mechanical obstruction by food or other objects is present
what is cellular respiration and aerobic metabolism?
process that breaks down glucose in the presence of oxygen
produces high amounts of energy in the form of ATP
releases carbon dioxide and water as a by-product
brain needs oxygen and glucose
what two things does the brain need?
oxygen and glucose
when alone, the preferred method for ventilations is to use
a pocket mask
what is a NPA?
Nasopharyngeal Airway
what is a NPA used for?
useful in patient with clenched teeth, some facial injuries and those unable to tolerate an OPA
what is a contraindication for NPA?
it shouldn’t be used in a patient with suspected fracture of the base of the skull or severe facial trauma
what is minute volume (minute ventilation)?
the amount of air moved in/out of lungs in one minute
what is a FROPVD?
Flow Restricted, Oxygen-Powered Ventilation Device
manually triggered ventilation device
used by 1 EMT, using 2-handed technique to seal mask
what % of oxygen does FROPVD deliver?
100%
T/F: FROPVD is only used for adult patients
true
what is the most common airway obstruction?
the tongue - when muscles controlling the tongue relax, it causes the tongue to fall back and block the airway
normal pulse oximeter reading
95%-100%
how much oxygen does a BVM without an oxygen source deliver?
21%
how much oxygen can a BVM deliver when connected to an oxygen source and reservoir?
close to 100% oxygen
why can snoring and obstructs can be corrected by performing a head-tilt, chin-lift maneuver?
because it lifts the base of the tongue from the back of the pharynx (throat)
what does fluid in the alveoli negatively effect?
gas exchange
what should you do if you don’t see chest rise and fall and use an adjunct (OPA/NPA)?
readjust the head and try ventilating again
patient falls 20 feet onto the ground. how should you open the airway?
jaw thrust maneuver
how should jaw thrust maneuver be performed?
the jaw is displaced forward by an EMT’s fingers
this causes patient’s tongue to be pulled forward, away from the back of the airway
when should you use the head tilt, chin lift maneuver?
to open the airway in a patient with no suspected spinal injury
how should the head-tilt, chin-lift maneuver be performed?
place 1 hand on patients forehead and apply firm, backward pressure with the palm of the hand to tilt the head back
place the tips of fingers of other hand underneath the bony part of the lower jaw
with head tilted backward, lift the jaw upward (do not compress the soft tissues underneath the chin; they might obstruct the airway
lift the chin and jaw so that the teeth are brought nearly together (If necessary, you can use your thumb to depress or retract the lower lip; this keeps the patient’s mouth slightly open.)
If the patient has loose dentures, hold them in position, making obstruction by the lips less likely. A seal is easier to form when the dentures are in place. If the dentures cannot be managed, remove them.
T/F: you should place the tips of the fingers of the hand underneath the soft tissues underneath the chin during the head tilt, chin lift maneuver
false - you should place the tips of the fingers of the hand underneath the bony part of the lower jaw
do not compress soft tissues underneath the chin; they might obstruct the airway
T/F: you can use your thumb to depress or retract the lower lip when doing the head-tilt, chin-lift maneuver if necessary
true - it keeps the mouth slightly open
if the patient has loose dentures and you need to perform a head-tilt, chin-lift maneuver, what should you do?
hold them in position
makes obstruction by the lips less likely
a seal is easier to form when the dentures are in place
if dentures cannot be managed, remove them
what is a quick way to check a patient for proper circulation?
check if they are cyanotic
what is cyanosis?
bluish gray color - late sign of hypoxia
may be found in and around several areas of the body
lips
mouth
nose
fingernail beds
conjunctive (eye)
oral membranes (mouth/gums)
T/F: you should place an OPA in patient in cardiac arrest before transport
true
if the patient is coughing and showing universal sign that they are choking, what should you encourage the patient to do?
continue coughing to unblock the airway
what does it mean when a person is struggling to breath and is diaphoretic?
they aren’t receiving enough oxygen
what does it mean when a patient is diaphoretic?
they are profusely sweating
what is the best technique for using a BVM?
2-person to obtain an adequate seal on patient
patient is hit in the throat. you will hear ______ sounds due to the significant upper airway obstruction from swelling in the larynx (vocal cords)
stridor
when an elderly patient is breathing irregularly but is unresponsive, what is it a sign of?
sign of stroke
a patient is not breathing but has a pulse after falling out of a car window. what kind of injury do they have?
spinal injury
if you hear gurgling sounds, what should you use to suction their airway?
rigid tip suction catheter
what is a rigid tip suction catheter?
used for suctioning the mouth and oropharynx
used in unresponsive patients
insert only as far as you can see into the mouth
avoid touching the back of the oropharynx
what is a soft (french) tip catheter?
can be used to suction the nose or nasopharynx
should not be inserted beyond the base of the tongue
avoid inserting too far
T/F: the soft suction catheter should not be inserted beyond the base of the tongue
true
T/F: a rigid tip suction catheter should be inserted, touching the back if the oropharynx
false - avoid touching the back of the oropharynx and only insert as far as you can see into the mouth
if a patient hits their chest and bends the steering wheel in a car accident, what type of injury do they have?
a chest injury
what is a flail segment/flail chest?
type of motion seen when two or more adjacent ribs are fractured in two or more places
interferes with effectiveness of chest wall movement
alters negative pressure in chest
causes alveoli to collapse
thus reduces adequacy of breathing and oxygenation
what is PPV?
Positive Pressure Ventilation
the process of forcing air into the lungs of a patient
what are disadvantages of PPV?
airway walls are pushed outward, creating a larger space
requires higher volumes to fill larger space and ventilate patient effectively
can overcome esophageal opening pressure
allows air to enter the esophagus and fills the stomach with air during ventilation (gastric distention and possibility of regurgitation)
thorax becomes positive during inhalation phase as air is forced into lungs
with loss of negative air pressure generated during normal ventilation, vacuum effect is diminished and venous return decreases
decreases preload
reduces stroke volume, cardiac output, blood pressure, and perfusion
disadvantages of FROPVD or Manually Triggered Ventilation (MTV) device
designed only for adult patient use
because it delivers oxygen at high pressure and high flow rate (can’t be used on infants/children)
EMT is unable to feel the compliance of air being delivered during ventilation
T/F: FROPVD and MTV are the same thing
true - same thing, referred to as different names
what is compliance when using a BVM?
how easy/difficult it is to squeeze the BVM
what is the most common cause of cardiac arrest
hypoxia
Note 
Flashcard (85)