Emt 13th edition chapter 11

What is the most immediate action for a heart failure patient feeling smothered?

Position him so that he is sitting up.

What should you do for a heart failure patient with BP 170/90, pulse 110, respirations 22, SpO₂ 75%?

Begin treatment with continuous positive airway pressure (CPAP).

What is a sign of inadequate ventilation?

Shallow chest rise during inhalation.

When is CPAP therapy contraindicated?

Agonal respirations.

What must you ensure before applying CPAP?

The patient can follow verbal commands.

What causes a ventilation/perfusion mismatch in heart failure patients?

Oxygen is unable to diffuse into and out of the alveoli.

What can cause an inaccurate pulse oximetry reading?

Severe anemia.

What does an end-tidal carbon dioxide reading of 70 mm Hg indicate?

The patient is breathing too slowly.

What should you do if a patient on CPAP becomes cyanotic and has an SpO₂ of 72%?

Begin ventilation with a bag-mask device.

What is the primary origin of respiratory distress and hypoxemia?

Failure of ventilation.

What is the airway?

The passageway that allows air to move from the mouth/nose to the lungs.

What is ventilation?

The movement of air in and out of the lungs.

What is oxygenation?

The process of oxygen getting into the blood.

What is respiration?

The exchange of oxygen and carbon dioxide.

What is external respiration?

Gas exchange between the alveoli and pulmonary capillaries.

What is internal respiration?

Gas exchange between the blood and body cells.

What is cellular respiration?

The cells using oxygen to make energy.

What is perfusion?

Blood flow through the body's tissues and organs.

What is hypoxia?

Not enough oxygen in the body's tissues.

What is hypoxemia?

Low oxygen level in the blood.

What is apnea?

No breathing.

What is dyspnea?

Difficulty breathing or shortness of breath.

What is tidal volume?

The amount of air moved in or out with each breath.

What is minute volume?

The amount of air moved in and out of the lungs in one minute.

What is dead air space?

Air that does not reach the alveoli for gas exchange.

What is adequate breathing?

Good rate, good depth, equal chest rise, and normal mental status/skin signs.

What is inadequate breathing?

Poor rate, shallow depth, poor chest rise, abnormal skin signs, or altered mental status.

What are signs of adequate breathing?

Normal rate, good chest rise, clear/equal breath sounds, normal skin, alert mental status.

What are signs of inadequate breathing?

Slow/fast respirations, shallow breathing, cyanosis, altered mental status, accessory muscle use, poor chest rise.

What is the normal adult respiratory rate?

12–20 breaths/min.

What does an adult respiratory rate less than 8 or greater than 24 indicate?

Usually indicates inadequate breathing and needs intervention.

What are agonal respirations?

Occasional gasping breaths that are not adequate.

What should you do if a patient has agonal respirations?

Treat as inadequate breathing and ventilate with a BVM.

What causes snoring respirations?

Usually caused by the tongue blocking the airway.

What do gurgling respirations indicate?

Usually means fluid, vomit, or secretions in the airway.

What is stridor?

High-pitched upper airway sound, often from obstruction or swelling.

What is wheezing?

High-pitched lower airway sound, often from bronchoconstriction.

What are crackles?

Wet lung sounds often caused by fluid in the alveoli.

What are rhonchi?

Coarse sounds often caused by mucus in larger airways.

What is the tripod position?

Sitting forward with hands on knees to help breathing.

What is accessory muscle use?

A sign of increased work of breathing.

What is nasal flaring?

A sign of respiratory distress, especially in children.

What are retractions?

Skin pulling in around ribs/neck during breathing; sign of distress.

What is cyanosis?

Blue/gray skin color caused by poor oxygenation.

What does pulse oximetry measure?

The percentage of hemoglobin saturated with oxygen.

What is the normal SpO₂ range?

Usually 95–100%.

What does an SpO₂ less than 94% indicate?

Can indicate hypoxemia depending on patient condition.

How can severe anemia affect pulse oximetry readings?

Can cause misleading pulse oximetry because there is not enough hemoglobin.

How does carbon monoxide poisoning affect pulse oximetry readings?

Pulse ox may read falsely normal because it cannot tell CO from oxygen.

How can poor perfusion affect pulse oximetry readings?

Can cause inaccurate readings due to weak peripheral blood flow.

How can cold extremities affect pulse oximetry readings?

Can cause inaccurate readings.

What is end-tidal CO₂?

Measurement of carbon dioxide at the end of exhalation.

What is the normal ETCO₂ range?

About 35–45 mm Hg.

What does a high ETCO₂ usually mean?

Hypoventilation or breathing too slowly/shallowly.

What does a low ETCO₂ usually indicate?

Hyperventilation, poor perfusion, or low CO₂ production.

What does an ETCO₂ of 70 mm Hg indicate?

The patient is breathing too slowly or not ventilating enough.

What is the first step in airway management?

Open and maintain the airway.

What is the head tilt-chin lift maneuver used for?

Airway maneuver for patients with no suspected spinal injury.

What is the jaw-thrust maneuver used for?

Airway maneuver for patients with suspected spinal injury.

What is the recovery position?

Position used for an unconscious breathing patient without suspected spinal injury to help keep airway clear.

When should you suction?

When fluids, blood, vomit, or secretions are blocking the airway.

What is the maximum suction time for an adult?

No more than 15 seconds at a time.

What is the maximum suction time for a child?

No more than 10 seconds at a time.

What is the maximum suction time for an infant?

No more than 5 seconds at a time.

What is an OPA?

Oropharyngeal airway.

What is an NPA?

Nasopharyngeal airway.

What is the indication for an OPA?

Unconscious patient without a gag reflex.

What is the contraindication for an OPA?

Conscious or semiconscious patient with a gag reflex.

How do you measure an OPA?

From the corner of the mouth to the angle of the jaw.

How is an adult OPA inserted?

Insert upside down and rotate 180 degrees, or insert with tongue depressor.

What is the indication for an NPA?

Patient who needs airway support but still has a gag reflex.

What is the contraindication for an NPA?

Suspected basilar skull fracture or severe facial trauma.

How do you measure an NPA?

From the tip of the nose to the earlobe.

How is an NPA inserted?

Lubricate and insert gently into the larger nostril.

What is a nasal cannula?

Low-flow oxygen device for patients breathing adequately.

What is the flow rate for a nasal cannula?

1–6 L/min.

What is the oxygen concentration of a nasal cannula?

About 24–44%.

What is a nonrebreather mask?

High-concentration oxygen device for patients breathing adequately.

What is the flow rate for a nonrebreather mask?

10–15 L/min.

What is the oxygen concentration of a nonrebreather mask?

Up to about 90%.

What should you do before applying a nonrebreather mask?

Inflate the reservoir bag.

What is a simple face mask?

Moderate oxygen device that requires at least 6 L/min.

What is a Venturi mask?

Delivers a precise oxygen concentration.

What is a BVM?

Bag-valve-mask device used to provide positive-pressure ventilation.

When should you use a BVM?

Inadequate breathing, apnea, agonal respirations, or worsening mental status with poor respirations.

What is the adult BVM ventilation rate with a pulse?

1 breath every 5–6 seconds.

What is the child/infant BVM ventilation rate with a pulse?

1 breath every 3–5 seconds.

What is the ventilation rate during CPR with an advanced airway?

1 breath every 6 seconds.

What is proper BVM ventilation?

Give slow gentle breaths just enough to see chest rise.