Chapter 19 - Resp. Emergencies

Normal RR for adults/adolecents

12-20

Normal RR for school-age children

18-30

Normal RR for infants (0-6 months)

30-60

Seesaw breathing

As a child breathes in, diaphragm descends, causing abdomen to lift and chest to sink

Signs of inadequate breathing in children

Nasal flaring, Grunting, seesaw breathing, retractions

Rate for artificial ventilations in adults

10-12 breaths per minute

Rate of artificial ventilations for infants/children

12-20 breaths per minute

Fundamental principals of care for patients with difficulty breathing

Assessment, Oxygen, Positioning, Prescribed inhalers, CPAP

Continuous positive airway pressure CPAP is form of…

noninvasive positive pressure ventilation (NPPV)

Max. airflow from CPAP

70 lpm

Amount of O² delivered through CPAP depends on…

How much O² is used in the generation of flow

Positive end expiratory pressure (PEEP)

Pressure within the respiratory system at the end of an exhalation (most helpful when treating respiratory distress)

CPAP systems are designed to deliver ___ of water PEEP

7-15cm

Indications for use of CPAP

Pulmonary edema, drowining, asthma, COPD, and Respiratory failure

Anatomic-physiologic contraindications for CPAP

Poor mental status in which patient cannot protect their airway / follow directions, lack of normal and spontaneous RR, inability to sit up, hypotension, inability to get and maintain a good mask seal, hx of pulmonary fibrosis

Pathologic contraindications for CPAP

N/V, Chest trauma, possible pneumothorax, shock, upper gastrointestinal bleeding, recent gastric surgery, any condition that would prevent a good mask seal

Systolic BP must be __mmHg for use of CPAP

>90

Common diagnostic indication of acute pulmonary edema

prior hx of CHF

Common S/S of pneumonia

Productive cough, fever, chest pain (sharp and pleuritic), severe chills, SOB, headache, pale/clammy skin, fatigue, crackles in chest, and occasionally confusion

Spontaneous pneumothorax

When a lung collapses without injury or any other obvious cause

Bleb

Term that may be used to describe a small section of the lung that is weak

Pulmonary embolism

When something such as a blood clot, air, or fat gets stuck in an artery in the lung

DVT

A blood clot that starts in a vein, often in leg or pelvis. Common causes are extended periods of sitting/laying down, active cancer, or immobilized limb in a cast.

S/S of PE

Acute angina (sharp, pleuritic pain), SOB, Anxiety, cough (occasionally productive with bloody sputum), tachycardia, tachypnea, lightheaded/dizzy, pain/swelling in one or both legs, may be hypotensive or in cardiac arrest

Epiglottitis

When an infection inflames the area around and above the epiglottis

S/S of epiglottitis

unvaccinated (Haemophilus influenzae type B) children, Recent cold, sore throat, painful/difficulty swallowing, sick appearance, muffled voice, fever, drooling, and stridor

Croup

inflammation of the larynx, trachea, and bronchi that is the result of a group of viral illnesses

S/S of croup

loud, barking cough and hoarse voice, breathing difficulty that is resolved when sitting up right. Can be severe and cause inadequate breathing.

Bronchiolitis

Condition in which small airways become inflamed because of viral infections. Common cause is RSV

Cystic Fibrosis

Genetic disease that appears in childhood. Causes thick, sticky mucus that accumulates in the lungs and digestive system.

S/S of Cystic Fibrosis

Productive cough with large amounts of mucus from the lungs, fatigue, frequent occurrences of pneumonia, abdominal pain/distention, coughing up blood, nausea, weight loss

Viral Respiratory Infection PPE

Eye protection, Gloves, and protective surgical masks

Types of SVN bronchodilator medications

Albuterol, Ipratropium bromide, DuoNeb (both albuterol and ipratropium bromide)

Contraction of diaphragm relates to:

Intake of breath

Which of the following best describes the process of expiration in normal​ breathing?

Passive

Which of the following structures separates the thoracic and abdominal​ cavities?

Diaphragm

A patient with a blockage of the passage between the trachea and the lungs would be​ experiencing:

Bronchoconstriction

Where does the exchange of oxygen and carbon dioxide take​ place?

Alveoli

Which of the following would be considered an active phase of breathing under normal​ circumstances?

Inhalation

A​ 65-year-old female complains of respiratory distress. You wish to obtain a​ "room air" pulse oximetry​ reading, but realize the pulse oximeter is in the ambulance. You​ should:

Immediately administer supplemental oxygen

A​ 25-year-old male is complaining of difficulty breathing after a submersion​ (near-drowning) injury. He says that the breathing difficulty​ "came on all of a​ sudden." Rales are noted when listening to his chest. His vital signs are P​ 120, R​ 36, BP​ 130/88. You should​ next:

Administer CPAP.

Why should the EMT explain the CPAP device to the​ patient?

The device might cause the patient to feel smothered and anxious

Why are nausea and vomiting a contraindication to​ CPAP?

CPAP may increase risk of aspiration

Following the administration of a​ bronchodilator, what would the EMT expect to hear during auscultation if the medication had its desired​ effect?

Diminishment in wheezing

The patient is complaining of respiratory distress. Which of the following statements is correct regarding management of this​ patient?

Do not delay administration of oxygen for a patient in respiratory distress

A​ 65-year-old conscious female is in severe pulmonary edema. It’s been determined that there is an appropriate need for CPAP. The next step should be:

Explain device to the patient

When administering CPAP, start with a low level of PEEP, such as:

5-7 cm H²O PEEP

Which of the following side effects of CPAP would likely be of most concern to the​ EMT?

Hypotension

A patient is complaining of respiratory distress. She also tells you that her feet and ankles are unusually swollen. This swelling​ is:

An associated symptom

If a patient is breathing adequately but with​ difficulty, you should​ first:

provide supplemental oxygen

A condition in which a lung collapses without any chest trauma is called:

Spontaneous pneumothorax

Your​ 44-year-old patient has a decreased level of​ consciousness, respiratory​ distress, and shallow breathing. You should​ immediately:

Assist ventilations

A​ 71-year-old female presents with respiratory distress. She has diminished lung sounds and​ slow, shallow respirations. You note that she is cyanotic and confused. The patient is presenting​ with:

Inadequate breathing

A​ 29-year-old female complains of a sore throat and runny nose for 3 days. Today she notes she is having difficulty breathing due to frequent and severe coughing spells. She is alert and​ oriented, and her vital signs are P​ 84, R​ 20, BP​ 122/80. Given her​ symptoms, one should suspect:

Viral respiratory infection

A​ 2-year-old male is having severe respiratory distress caused by a partial obstruction of his upper airway by a foreign object. Which of the following sounds would most likely be associated with this​ condition?

Stridor

Which of the following medications is used in some​ fast-acting emergency​ inhalers?

Ipratropium

You are caring for an asthma patient with dyspnea. Which of the following would most likely benefit this​ patient?

A bronchodilator medication

A permanent disease process that is characterized by destruction of the alveolar​ walls, greatly reducing the surface area for respiratory​ exchange, is a type of COPD​ called:

Emphysema

Which of the following would be considered an appropriate reason to use a spacer in assisting a patient with a rescue​ inhaler?

Spacers make exact timing less important

Patients with COPD often get progressively worse and call an ambulance because​ of:

Recent Upper respiratory infection

What is the best way to determine whether artificial ventilations are​ adequate?

The​ patient's chest will rise and fall with each ventilation.

You respond to the regional airport to remove an elderly patient from a plane that just landed after a long flight. A respiratory condition that may be caused by a deep vein thrombosis after sitting for a long time is​ called:

Pulmonary Embolism

If the patient has difficulty breathing that is leading to​ hypoxia, it is likely that the​ patient's color will​ be:

Cyanotic

Which of the following signs of respiratory distress is more common in pediatric patients than in patients in other age​ groups?

Seesaw breathing

In an​ adult, a lack of oxygen will cause the pulse to​ increase:

Most of the time

En route to the​ hospital, it is important to perform an ongoing assessment of the patient with breathing difficulty. While reevaluating your​ patient, remember​ that:

Decreased wheezing may not indicate improvement

Which of the following sounds is created by the presence of fluid in the alveoli or by the opening of closed​ alveoli?

Crackles

Which of the following would be a sign that a pediatric patient was in respiratory​ distress?

Retracted muscles of breathing

Which of the following statements about differences between adults and children is​ true?

The trachea is smaller, softer, and more flexible in infants and children.

In which of the following diseases are there episodic​ flares, but the patient can lead a normal life between​ flares?

Asthma

A​ 3-year-old male complains of breathing difficulty. You assess stridor and flared nostrils. What would you expect the​ patient's breathing effort to​ be?

Labored

Which of the following is true regarding adult and pediatric​ patients?

Children depend more heavily on the diaphragm for respiration

A​ 45-year-old male has dyspnea associated with a suspected pulmonary embolism. Which of the following would be the most important​ treatment?

High-concentration oxygen

A respiratory condition that was formerly prominent in children but is now more often found in adults​ is:

Epiglottitis