Medic CH 16 Free Essay Example from StudyTiger

Which of the following statements regarding epiglottitis is correct

Epiglottitis has become relatively rare in children due to vaccinations against haemophilus influenza type b bacterium

Frothy sputum that has a pink tinge to it is MOST suggestive of

CHF

Patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she

was previously intubated for his or her condition

Patient with respiratory distress who is willing to lie flat

may be acutely deteriorating

Apneustic breathing is characterized by

short, brisk inhalations with a long pause before exhalation

When replacing a dislodged tracheostomy tube, it is MOST important that you

Take appropriate standard precautions

When administering oxygen via a nonrebreathing mask, you must ensure that the

patient has adequate tidal volume

King LT airway can be used to

Maintain a patent airway in spontaneously breathing patients

Young woman experiences massive facial trauma after being ejected from her car when it struck a tree. She is semiconscious, has blood draining from her mouth, and has poor respiratory effort. The MOST appropriate initial airway management for this patient involves

alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2 minutes until you can definitively secure her airway

Person who experience sharp chest pain following an increasing dyspnea after her or she coughs most likely has

a pneumothorax

Patient with quiet tachypnea is MOST likely experiencing

shock

Bourdon gauge oxygen flowmeter

Reduces the high pressure in the oxygen cylinder to a safe pressure

Would NOT be appropriate to place a patient in the recovery position if he or she

Is breathing shallowly

Which of the following statements regarding orotracheal intubation is correct

Orotracheal intubation is the most common method of performing ET intubation

Asymmetric chest wall movement is characterized by

one side of the chest moving less than the other

Capnography is a reliable method for confirming proper ET tube placement because

carbon dioxide is not present in the esophagus

Would be appropriate to insert a nasopharyngeal airway in patients who

have an altered mental status with an intact gag reflex

Hepatomegaly and jugular venous distention are MOST suggestive of

Right heart failure

Patent airway

Does not equate to adequate ventilation

During sleep, the metabolic rate is____ and the number of respirations ____

low, decreases.

Adult patient with an abnormal respiratory rate should

Be evaluated for other signs of inadequate ventilation

Testing of the skin under the jaw often occurs when airway devices are inadvertently inserted into the

pyriform fossae

Which of the following situations would ET intubation of pediatric patient be LEAST necessary?

Administration of certain resuscitative medications

Which of the following patients is LEAST likely in need of positive pressure ventilation?

Conscious 36 year old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin

Used properly, and under the correct circumstances, sedation during airway management

Effectively increases patient compliance, thus making definitive airway management safer to perform

_____ breath sounds are the MOST commonly heard breath sounds and have a much more obvious inspiratory component

vesicular

Pulse oximetry reading would be LEAST accurate in a patient

with poor peripheral perfusion

When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of Mallampati Class

III

By-product of cellular respiration

Carbon dioxide

Pickwickian syndrome is a condition in which respiratory compromise results from

Extreme obesity

After inserting the needle into the cricothyroid membrane, you should next

insert the needle about 1 cm farther and then aspirate with the syringe

Which of the following represents the correct dequence for managing a patient's airway

Open, clear, assess, intervene

Respond to a residence for a possible overdose. The patient, a young man, is unresponsive with slow, snoring respirations. There are obvious needle track marks on his arms. Your first action should be to

Manually open his airway

Digital intubation can be performed on trauma patients because

The head does not have to be placed in a sniffing position

Murphy's eye, an opening on the distal side of an ET tube, allows ventilation to occur

Even if the tip of the tube is occluded by blood or mucus

Main disadvantage of the LMA is that it

Does not provide protection against aspiration

Some cases, atropine sulfate, in a dose of ____, may be given to children to prevent vagal-induced bradycardia during ET intubation

0.02 mg/kg

Which of the following statements regarding pediatric ET intubation in the prehospital setting is correct

Bag mask ventilation can be as effective as intubation for EMS systems that have short transport times

Barrel chest appearance classically seen in emphysemic patients is secondary to

Air trapping in the lungs

Involuntary control of breathing originates in the

Pons and medulla

CPAP is NOT appropriate for patients with

Slow, shallow respiratory effort

ET tube that is too large for a patient

can be difficult to insert and may cause trauma

Retractions of the sternum or ribs during inhalation

Are especially common in infants and small children

Either side of the glottis, tissue forms a pocket called the

Piriform fossae

Reactive airway disease is characterized by

Bronchospasm, edema, and mucus production

Hallmarks of a pulmonary embolism is

Cyanosis that does not resolve with oxygen therapy

BURP maneuver usually involves applying backward, upward and rightward pressure to the

Lower third of the thyroid cartilage

Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading

Carboxyhemoglobin

While transporting an intubated 8 year old boy, he suddenly jerks his head and becomes cyanotic shortly thereafter. His oxygen saturation and capnometry readings are both falling, and he is becoming bradycardic. You attempt to auscultate breath sounds, but are unable to hear because of the drone of the engine. What has MOST likely happened

Inadvertent extubation

Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because

It must be performed on spontaneously breathing patients

Paradoxical respiratory movement is characterized by

the epigastrium and thorax moving in opposite directions

Hyperventilating patient

May be acidotic and is trying to decease his or her pH level

Cricothyroid membrane

Is relatively avascular and is covered by skin and minimal subcutaneous tissue

Digital clubbing is MOST indicative of

chronic hypoxia

Wheezing is resolved with medication that

Relax the smooth muscle of the bronchioles

Mainstem bronchus ends at the level of the

bronchioles

Intrapulmonary shunting occurs when

Nonfuctional alveoli inhibit pulmonary gas exchange

Patients with pneumonia often experience a coughing fit when they roll from one side to the other because

Pneumonia often occurs in the lung bases, typically on only one side

COPD is characterized by

Changes in pulmonary structure and function that are progressive and irreversible

When intubating a 3 year old child, you would MOST likely use a

Size 2 straight blade

When a patient is given a paralytic without sedation

He or she is fully aware and can hear and feel

Compared with an open cricothyotomy, needle cricothyrotomy

allows for subsequent attemts to intubate the patient

Most complications caused by intubation induced hypoxia

are subtle and occur gradually

Fraction of inspired oxygen (FIO2) increases with

supplemental oxygen

Anterior portion of the palate is formed by the

Maxilla and palatine bones

Indications for CPAP include

acute pulmonary edema

Suspect that an unconscious patient has experienced a spinal injury, you should open his or her airway by

placing your fingers behind the angle of the jaw and lifting the jaw forward

Paralytic medications exert their effect by

Functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine

What is the alveolar minute volume of a patient with a respiratory rate of 12 breaths/min, a tidal volume of 450 mL, and a deal space volume of 135 mL

3,780 mL

Using the DOPE mnemonic, which of the following interventions would you MOST likely have to perform if you suspect "O" as the cause of acute deterioration in the intubated child?

Tracheobronchial suctioning

Pressure relief valve on an automatic transport ventilator may lead to unregonized hypoventilation in patients with all the following conditions EXCEPT

prolonged apnea

Which of the following medications has been shown to blunt the increase in intracranial pressure associated with suctioning and laryngeal stimulation?

lidocaine

Unresponsive patient does not have a gag reflex, an oropharyngeal airway

should be inserted whether the patient is breathing or not

Length based resuscitation tape measure can be used to determine the most appropriate size of bag mask device for pediatric patients who weigh up to

34 kg

During forceful inhalation, the vocal cords

Open widely to provide minimum resistance to air flow

What size ET tube would be MOST appropriate to use for a 4 year old child?

5.0mm

Average peak expiratory flow rate in a healthy adult is approximately

550ml

Contrast to needle cricothyrotomy, an open cricothyrotomy

enables the paramedic to provide greater tidal volume

Approximately how far should you insert a 5.0 mm ET tube in a 4 year old child?

15 cm

Using a bulb style esophageal detector device to assist you in confirmed proper ET tube placement, you should expect the bulb to

Refill briskly in the tube is in the trachea

Transporting an intubated patient and note that the digital capnometry reading has quickly fallen below 30 mm Hg. You should

Slow your ventilation rate to see if the ETC02 reading decreases.

Transillumination-guided intubation can be difficult or impossible to perform

in a brightly lit environment

Once you have confirmed that the lighted stylet ET tube combination has entered the trachea, you should

hold the stylet in place and advice the tube about 2-4 cm into the trachea

When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear

crackles in the bases of the lungs at the end of inspiration

Sudden increase in end tidal C02 may be the earliest indicator of

Return of spontaneous circulation

Hypoxic drive is a phenomenon in which

bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance

Diaphragm of the stehoscope is designed to auscultate

high pitched sounds

When administering a nebulized bronchodilator, the oxygen flow rate should be set to at least ____ liters per minute

King LT-D airway features a

curved tube with ventilation ports located between two inflatable cuffs

Factors would increase a person's respiratory rate, EXCEPT

Narcotic analgesic use

Hering-Breur reflex is a protective mechanism that

Terminates inhalation and prevents lung overexpansion

Which of the following is NOT an appropriate method for confirmed proper ET tube placement in a 15 kg child

Esophageal bulb or syringe

Rigorous tube confirmation protocol must be following after performing digital intubation because

the procedure of digital intubation is truly a blind technique

_____ is the lowest portion of the pharynx and opens into the larynx anteriorly and the esophagus posteriorly

laryngopharynx

Before performing orotracheal intubation, it is MOST important for the paramedic to

wear gloves and facial protection

MOST likely observe grossly low respiratory rate and volume in a patient who overdosed on

Heroin

Patient with orthopnea

seeks a sitting position when short of breath

50-year old woman presents with acute respiratory distress while eating. Upon your arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals that her skin is pink and moist. In addition to transporting her to the hospital, you should

Encourage her to cough and closely monitor her condition

21-year old man experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. He is noticeably dyspneic, has an oxygen saturation of 93% on room air, and has diminished breath sounds to the upper right lobe. The MOST appropriate treatment for this patient involves

Administering high-flow supplemental oxygen and transporting at once

Transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should

Begin assisting his ventilations with a bag-mask and 100% oxygen

Children more prone to croup when they acquire a viral infection that adults infected with the same virus?

A child's airway is narrower than an adult's and even minor swelling can result in obstruction

Polycythemia is a condition in which

Excess red blood cells are produced in response to chronic hypoxia

Patient's hemoglobin level is only 10g/dL, ___% would have to be desaturated before he or she would appear cyanotic

Respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically searching. You should

Recognize that he is experiencing end stage COPD, begin assisting ventilations, and contact medical control as needed

Increase in the number of EMS calls for patients with chronic respiratory problems most commonly occurs

During sudden weather changes

36 year old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should

Assist his ventilations and establish vascular access

Pneumonitis is especially common in older patients with

chronic food aspiration

Presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates

Thick secretions in the large airways

What function do the nasal turbinates serve?

Warming and humidifying inhaled air

Patient's initial presentation makes you suspicious about a particular respiratory condition, you must

Confirm your suspicions with a thorough assessment

____ cartilage forms a complete ring and maintains the trachea in an open position

Cricoid

Uncontrollable coughing and hemptysis in a cigarette smoker are clinical findings MOST consistent with

Lung cancer

Otherwise healthy adult whose normal hemoglobing level is 12 to 14 g/dL typically will begin to exhibit cyanosis when

about 5 g/dL of hemoglobin is desaturated

Hypoventilating patients

Become hypercapneic and acidotic

MOST clinically significant finding when questioning a patient with a chronic respiratory disease is

Prior intubation for the same problem

Transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should

Remove the CPAP unit, assist his ventilations with a bag mask device and prepare to intubate him

76 year old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prlonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to

place her in a position that facilitates breathing

Emphysema is caused by

Chronic destruction of the alveolar walls

Morbidly obese man called 9-1-1 because of difficulty breathing. When you arrive, you find the 39 year old patient lying supine in his bed. He is in marked respiratory distress and is only able to speak in two-word sentences. He has a history of hypertension, but denies any respiratory conditions. What should you do FIRST?

Sit him up or place him on his side

Inspiratory and expiratory _____ sounds are both loud, but the inspiratory sounds are shorter than the expiratory sounds

bronchial

When regard to intubation difficulty, neck mobility problems are MOST commonly associated with

Elderly patients

Endotracheal intubation is MOST accurately defined as

passing an ET tube through the glottis opening and sealing off the trachea

Contrast to the nasogastric tube, the orogastric tube

is safer to use in patients with severe facial trauma

Artificial airway adjust

does not obviate the need for proper head positioning

Nondepolarizing neuromuscular blocking agents include all of the following EXCEPT

succinylcholine chloride

Proper insertion of the LMA involves

Inserting the LMA along the roof of the mouth and using your fingers to push the airway against the hard palate

Patients with a partial laryngectomy

are called partial neck breathers because they breathe through both a stoma and the nose and mouth

Trachea and mainstem bronchi

are lined with beta-2 receptors that result in bronchodilation when stimulated

Surfactant is

A phospholipid compound that decreases surface tension on the alveolar walls

After tracheobronchial suctioning is complete, you should

Reattach the bag-mask device, continue ventilations, and reassess the patient

MOST obvious risk associated with extubation is

Overestimating the patient's ability to protect his or her own airway

66 year old woman is found to be unresponsive and apneic. Her carotid pulse is weak and rapid. When ventilating this patient, you should deliver

Each breath over 1 second at a rate of 10 to 12 breaths/min

Intubated 33 year old man is becoming agitated and beings moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should

administer a sedative medication

Complications associated with orotracheal intubation, EXCEPT

necrosis of the nasal mucosa

Which of the following medications is safest to use in patients with borderline hypotension or hypovolemia?

Etomidate

Disadvantage of ET intubation is that it

Bypassess the upper airway's physiologic functions of warming, filtering and humidifying

Intubation of a child is unsuccessful after two attempts, your MOST appropriate action is to

discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately

____ are formed by the cranial bones and prevent contaminants from entering the respiratory tract

sinuses

Should be MOST suspicious of tube misplacement following an open cricothyrotomy if

a crackling sensation is noted when palpating the neck

When performing an open circothyrotomy, you should FIRST

palpate the V notch of the thyroid cartilage and stabilize the larynx

Contrast to a curved laryngoscope blade, a straight laryngoscope blade is designed to

extend beneath the epiglottis and lift it up

Fentanyl (Sublimaze) is a

narcotic analgesic

ET tube has been positioned properly in the trachea

the bag-mask device should be easy to compress and you should see corresponding chest expansion

Anatomically, the _____ is directly anterior to the glottis opening

vallecular space

Diazepam and midazolam provide all of the following therapeutic effects, EXCEPT

analgesia

Placing a suction catheter past the base of the tongue

may cause the patient to gag or vomit

After inserting the combitube to the proper depth, you should next

Inflate the pharyngeal cuff with 100 mL of air

Oxygen that is entirely devoid of moisture

Will dry the patient's mucous membranes quickly

Digital intubation is absolutely contraindicated if the patients

is unconscious but breathing

After properly positioning the patient's head for intubation, you should open his or her mouth and insert the blade

into the right side of the mouth and sweep the tongue to the left

Which of the following is NOT a contraindication for nasotracheal intubation

Spinal injury

Which of the following interventions is NOT appropriate when treating an unresponsive patient whose airway is obstructed by a dental appliance

Abdominal thrusts

When administering CPAP therapy to a patient, it is important to remember that

the increased intrathoracic pressure caused by CPAP can result in hypotension

Unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have ____ respirations

Bradypneic

Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD

Fever and localized crackles

Most obvious external landmark of the larynx is the

Thyroid cartilage

Hepatojugular reflex occurs when

Mild pressure placed on the patient's liver further engorges the jugular veins

Colormetric ETC02 detector turns purple during exhalation phase through an ET tube, approximately how much carbon dioxide is being exhaled

Less than 0.5%

____ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea

Biot

Bedridden patients with excessive pulmonary secretions are MOST prone to developing

Pneumonia

Difficulty with exhalation is MOST characteristic of

Obstructive lung disease

Which of the following statements regarding anatomic dead space is correct

Anatomic dead space is about 1 mL per pound of body weight

Known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow and his pulse is slow and weak. You should

Assist ventilations with a bag mask device, administer naloxone, and reassess his ventilatory status

Unlike bronchodilator therapy, corticosteroid therapy

Takes a few hours to reduce bronchial edema

____ cells are found in the lining of the airways and produce a blanket of mucus that covers the entire lining of the conducting airways

Goblet

Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT

a decreased expiratory phase

Which of the following statements regarding anemia is correct

Anemia results in a decreased ability of the blood to carry oxygen

King airway should NOT be used in patients

With known esophageal disease

When correctly placed, the distal tip of the Cobra perilaryngeal airway (CobraPLA)

Is proximal to the esophagus and seals the hypopharynx

Capnographic waveform, point ___ is the maximal ETC02 and is the best reflection of the alveolar C02 level

Which of the following medications does NOT possess hypnotic properties

Alfentanil

Average depth of ET tube insertion for adult patients is

21 to 25 cm

MOST effective way to minimize the risk of hypoxia while intubating a child is to

Limit your intubation attempt to 20 seconds

Must insert the ET tube in the patient's left nostril, you should

Rotate the tube 180 degrees as its tip enters the nasopharynx

Orotracheal intubation should be performed with the patient's head

in the sniffing position

Normal alveolar volume in a healthy adult is

350 mL

When using a straight blade, a major mistake of new paramedics is to

Try to pass the ET tube down the barrel of the blood

Intrapulmonary shunting is defined as

The return of unoxygenated blood to the left side of the heart

Several attempts to orotracheally intubate an unresponsive, apneic young man have failed. You resume bag mask ventilations and begin transport to a hospital located 25 miles away. En route, you begin having difficulty maintaining an adequate mask to face seal with the bag mask device. Assuming that you have the proper equipment, which of the following techniques to secure a patent airway would be MOST appropriate?

Transillumination intubation

When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should

Perform the test three times and take the best rate of the three readings

When determining the correct sized nasogastric tube for a patient, you should measure the tube

From the nose to the ear and the xiphoid process

Contrast to negative pressure ventilation, positive pressure ventilation

May impair blood return to the heart

____ are pyramid like structures that form the posterior attachment of the vocal cords

Arytenoid cartilages

Order for a tracheostomy tube to be compatible with a mechanical ventilator or bag mask device

It must be equipped with a 15/22 mm proximal adaptor

Negative pressure ventilation occurs when

Air is drawn into the lungs when intrathoracic pressure decreases

Cor pulmonale is defined as

Right heart failure secondary to chronic lung disease

Patient with status asthmaticus commonly presents with

physical exhaustion and inaudible breath sounds

Patient who is coughing up purulent sputum is MOST likely experiencing

An infection

CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases by

improving patency of the lower airway through the use of positive and expiratory pressure

Classic presentation of chronic bronchitis is

excessive mucus production and a chronic or recurrent productive cough

Patient who is coughing up thick pulmonary secretions should NOT take

An antitussive

Amount of pulmonary surfactant is decreased

Alveolar surface tension increases

Intubation of a patient with severe asthma

Is often the last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces

Patient who is experiencing an allergic reaction states that his tongue "feels thick" and speaks at a low volume. You should immediately evaluate for

Angioedema

Nasal cannula is of MOST benefit to patients

With mild hypoxemia and claustrophobia

Undersedation of a patient during airway management would likely result in all of the following, EXCEPT

Respiratory depression

After obtaining a peak expiratory flow reading of 200 mL, you administered one bronchodilator treatment to a 21 year old woman with an acute episode of expiratory wheezing. The next peak flow reading is 400 mL. You should

Recognize that the patient's condition has improved

Needle cricothyrotomy is contraindicated in patients with

Obstruction above the catheter insertion site

Complications of aspiration include all of the following, EXCEPT

Excess surfactant production

Which of the following findings is MOST clinically significant in a 30 year old woman with difficulty breathing and a history of asthma

Prior ICU admission for her asthma

Because the high pressure ventilator used with needle cricothrotomy would cause an increase in intrathoracic pressure, ____ and ____ may result

Barotrauma, pneumothorax

Which of the following patients may benefit from CPAP?

Alert patient with respiratory distress following submersion in water

Open cricothyrotomy is generally contraindicated in all of the following situations, EXCEPT

any patient who is younger than 16 years of age

Spacer device in conjunction with a metered dose inhaler

Collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment

Conditions will cause an increase in the circulating levels of carbon dioxide in the blood, EXCEPT

Acute hyperventilation

Which of the following patients has the lowest minute volume

Tidal volume of 350 mL; respiratory rate of 12 breaths/min

Elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a "water pill" and vasotec for high blood pressure. You should

Suspect acute right heart failure and administer oxygen

Respiratory alkalosis is the result of

Excess carbon dioxide elimination

Mouth opening width of less than ____ cm indicates a potentially difficult airway

Contrast to decreased P02 levels, increased PC02 levels typically manifest as

sedation or sleepiness

Assessing a young woman who was struck in the head with a baseball bat. The patient is semiconscious and has slow, irregular respirations. Further assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood in her mouth, but clenches her teeth and becomes combative when you attempt to suction her oropharynx. The MOST appropriate airway management for this patient involves

sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea

Patient with orthopnea

has dyspnea while lying flat

Patient with obvious respiratory failure require immediate

Ventilation support

Primary treatment of bronchospasm is

bronchodilator therapy

What type of medication dries secretions in the airway and prevents the cilia from removing them effectively

Antihistamine

36 year old man experienced significant burns to his face, head, and chest following an incident with a barbeque pit. Your assessment of his airway reveals severe swelling. After administering medications to sedate and paralyze the patient, you are unable to intubate him. Furthermore, bag mask ventilations are producing minimal chest rise. The quickest way to secure a patent airway in this patient is to

perform a needle cricothyrotomy

Phenylephrine hydrochloride ( Neo-Synephrine) during nasotracheal intubation will

reduce the likelihood and severity of nasal bleeding

After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then

inflate the distal cuff with 5 to 10 mL of air

Dispatched to a residence for a 59 year old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. The patient is MOST likely experiencing

pneumonia

Which of the following statements regarding translaryngeal catheter ventilation is correct?

Ventilation is achieved by the use of a high pressure jet ventilator

Which of the following medications is a parasympathetic bronchodilator

ipratropium

Which of the following conditions would LEAST likely present with an acute onset of respiratory distress?

Pneumonia

Process of moving air into and out of the lungs is called

Ventilation

When a patient's respirations are too rapid and too shallow

Inhaled air may only reach the anatomic dead space before being exhaled

MOST significant complication associated with the use of multilumen airways is

Unrecognized displacement of the tube into the esophagus

Contrast to the right lung, the left lung

Has two lobes

Supplemental oxygen given to a patient with an acute myocardial infarction

Enhances the body's compensatory mechanisms during the cardiac event

Digital intubation should be performed only on a patient who has a bite block inserted in his or her mouth and who is ____ and ____

unconscious, apneic

After opening an unresponsive patient's airway, you determine that his respirations are rapid, irregular, and shallow. You should

Begin positive pressure ventilations

Removal of a dental appliance after intubating a patient is

Dangerous and may cause dislodgement of the tube

40 year old man named Jose fell 20 ft from a tree while trimming branches. Your assessment reveals that he is unresponsive. you cannot open his airway effectively with the jaw thrust maneuver. You should

Carefully open his airway with the head tilt chin lift maneuver

Automated transport ventilator is NOT appropriate for patients who are

Breathing spontaneously

Stretch receptors in the lungs are responsible for the ___ reflex, which causes you to cough if you take too deep a breath

Hering-Breuer

Patients with COPD typically experience an acute exacerbation of their condition because of

Environmental changes such as weather or the inhalation of trigger substances

Drugs such as vecuronium bromide (Norcuron) and pancuronium bromide (Pavulon) are MOST appropriate to administer when

Extended periods of paralysis are needed

Major advantage of ET intubation is that it

Protects the airway from aspiration

Oxygen that is dissolved in the blood plasma

Makes up the partial pressure of oxygen

Which of the following conditions would MOST likely cause laryngeal spasm and edema

Inhalation injury

Physiologic effects of CPAP include

Opening of collapsed alveoli

Biot respirations are characterized by

An irregular pattern of breathing with intermittent periods of apnea

When checking the cuff of the LMA prior to insertion, you should

Inflate the cuff with 50% more air than is required

Venturi Mask is MOST useful in the prehospital setting when

A COPD patient requires a long range transport

During tracheobronchial suctioning, it is MOST important to

Monitor the patient's cardiac rhythm and oxygen saturation

After confirming that an intubated patient remains responsive enough to maintain his or her own airway, you should first

have the patient sit up or lean slightly forward

Size 3 or 4 LMA

will accomodate the passage of a 6.0 mm ET tube

MOST significant complication associated with digital intubation is

Hypoxia

Foreign body airway obstruction should be suspected in a child who presents with

Acute respiratory distress without fever

Paramedic should be especially dilligent when confirming tube placement following blind nasotracheal intubation because

he or she did not visualize the tube passing between the vocal cords

Signs of clinical improvement during CPAP therapy include

increased ease of speaking

Patient with respiratory splinting

Is breathing shallowly to alleviate chest pain

Oropharynx is

Forms the posterior portion of the oral cavity

Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the

pH of the CSF decreases

Which of the following is NOT a step that is performed during nasotracheal intubation?

Ensuring that the patient's head is hyperflexed

Hypoventilation causes a(n) ____ and leads to ____

Decreased minute volume, hypercarbia

Surgical opening into the trachea is called a

tracheostomy

66 year old man with chronic bronchitis presents with severe respiratory distress. The patient's wife tells you that he takes medications for high blood pressure and bronchitis, is on home oxygen therapy, and has recently been taking an over the counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of the patient's respiratory distress?

Recent antitussive use

Intubating a 60 year old man in cardiac arrest and have visualized the ET tube passing between the vocal cords. AFter removing the laryngoscope blade from the patient's mouth, manually stabilizing the tube, and removing the stylet, you should

inflate the distal cuff with 5 to 10 mL of air

When performing an open cricothyrotomy, you will MOST likely avoid damage to the jugular veins if

The cricothyroid membrane is incised vertically

Chest compressions and repositioning of the airway are unsucessful in removing a severe airway obstruction in an unconscious patient, you should

Perform laryngoscopy and use Magill forceps

Procedure in which the vocal cords are visualized for placement of an ET tube is called direct

Laryngoscopy

When performing nasotracheal intubation, you should use an ET tube that is

1 to 1.5 mm smaller than you would use for orotracheal intubation

Whistle tip suction catheter is MOST often used to

Remove secretions from an ET tube

Which of the following statements regarding field extubation is correct

It is generally better to sedate the patient rather than extubate

Airway obstruction secondary to a severe allergic reaction

Requires specific and aggressive treatment

8 year old child in cardiac arrest has been intubated. When ventilating the child, the paramedic should

Deliver 8 to 10 breaths per minute

During ventilation with the LMA, the paramedic should

Observe the patient for signs of inadequate ventilation

Exchange of oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries is called

External respiration

With regard to pulse oximetry, the more hypoxic a patient becomes

The faster he or she will desaturate

Neuromuscular blocking agents

Convert a breathing patient with a marginal airway into an apneic patient with no airway

You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see

two white fibrous bands that lie vertically within the glottic opening

According to the most current guidelines for emergency cardiac care, the MOST reliable method for monitoring correct ET tube placement is

Waveform capnography

Which of the following conditions would you be LEAST likely to encounter pulse paradoxus

Moderate asthma attack

Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia

Kussmaul respirations

Patients with decompensated asthma or COPD who require positive-pressure ventilation

May develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly

Increasing peak expiratory flow reading in a patient with respiratory distress suggests that the patient is

responding to bronchodilator therapy

Patient's hemoglobin level is 8 g/dL due to a hemorrhage and all of the hemoglobin molecules are attached to oxygen, the patient's oxygen saturation would MOST likely read

above 95%

Typically, ETCO2 is approximately

2 to 5 mm Hg lower than the arterial PaCO2

Function of the lower airway is to

Exchange oxygen and carbon dioxide

Hyperpnea and tachypnea

cause an increase in minute ventilation

External jugular veins run ______ and are located ____ to the cricothyroid membrane

Vertically, lateral

______ is an anatomic space located between the base of the tongue and the epiglottis

Vallecula

Albueterol (Proventil, Ventolin) - RESPIRATORY DRUG

Adult Dose: Adult 2.5mg in 2-3 mL NS via nebulizer Class: sympathomimetic dilator MOA: Beta-2 agonist that causes bronchodilation. Relaxes the smooth muscles of the bronchial tree. Indications: bronchospasms, asthma, COPD, emphysema chronic bronchitis,allergic reaction involving the airway. (Wheezing) Contraindications: hypersensitivity (allergic), precaution : heart rate greater than 150 HR>150 Side effects: tachycardia, palpitations, lightheadedness, tremors, mucous production. Pediatric Dose: <20 kg: 1.25 mg/dose via hand nebulizer over20 minutes. >20 kg 2.5 mg/dose via hand nebulizer over 20 minutes.

Benzocaine spray (Hurricane) - RESPIRATORY DRUG

Adult Dose: 0.5-1.0 second spray, repeat as needed. Repeat as needed. Class: topical anesthetic MOA: suppresses the pharyngeal and tracheal gag reflex Indications: intact gag reflex Contraindications: allergy, suppressed gag reflex Adverse reaction: methemoglobinemia (causes an inability of oxygen to bind to hemoglobin and prevents oxygen that is already bound to hemoglobin to be released at the cellular level, can cause cellular hypoxia) Pediatric Dose: 0.25-0.5 second spray. Repeat as needed.

Bumetanide (Bumex) - RESPIRATORY DRUG

Adult Dose: 0.5-1.0mg IV over 1-2 minutes. IM 2-2.5 times stronger than Lasix. Class: Loop diuretic MOA: a potent loop diuretic with a rapid onset and short duration. Blocks the reabsorption of sodium and chloride at the Loop of Henle. Indications: CHF, pulmonary edema. Won't be used for hypertensive crisis. Contraindications: allergic, hypovelemic, hypotension, suspect electrolyte imbalance. Side effects: orthostatic hypotension Pediatric Dose: Safety and effectiveness in pediatric patients is not established.

Dexamethasone (Decadron) - RESPIRATORY DRUG

Adult Dose: 1mg/kg slow IV (typical dose 10-100mg). Class: corticosteroid, Antiimflammatory MOA: suppresses acute and chronic inflammation Indications: anaphylaxis, asthma, croup, spinal cord injury Contraindications: allergy, suspected sepsis Pediatric Dose: 0.25 -1.0 mg/kg (IV/IM/IO)

Diazepam (Valium) - SEDATIVE

Adult Dose: seizure activity, anxiety, agitation, cocaine induced SVT's, acute alcohol withdrawal: 5-10mg slow IV/IM every 10-15 minutes as needed (PRN) Premedication for RSI, Cardioversion: 5-15mg slow IV Class: benzodiazepine sedative/ hypnotic, anticonvulsant MOA: Long acting sedative / hypnotic, controls seizure threshold Indications: Extreme anxiety, agitation, acute alcohol withdrawal, seizure activity, sedation for medical procedures (RSI, Cardioversion), cocaine induced SVT Contraindications: allergic, acute narrow angle glaucoma, respiratory depression, hypotension Side effects: respiratory depression, hypotension a Pediatric Dose: Not recommended in prehospital setting.

Diphenhydramine (Benadryl) - RESPIRATORY DRUG

Dose: 25-50 mg IV, IM Class: Antihistamine, Anticholinergic MOA: Blocks cellular histamine receptors Indications: Allergic reactions, acute days tonic reactions Contraindications: hypersensitivity

Epinephrine (adrenaline) - RESPIRATORY DRUG ETC.

Class: Sympathomimetic MOA: Alpha-1 vasoconstriction, Beta-1 Inotropic, Chronotropic and Dromotropic effects, Beta-2 bronchial smooth muscle relaxation. Indications: Initial drugs used in cardiac arrest (asystole, PEA, V-fib, V-tach) an alternative to Dopamine, allergic reaction (anaphylaxis), and severe asthma. Contraindications: hypertension, hypothermic, hypovelemic shock. Adult Dose: cardiac arrest - 1.0mg (1:10,000 solution) IV/IO every 3-5 minutes, follow each dose with 20mL flush and elevate extremity. Alternative to Dopamine - add 1.0mg of Epi 1:1,000 solution into 500mL NS bag (yields 2mcg/mL), administer and infusion rate of 1-10mcg/min, titrate to effect. Mild allergic reaction and severe asthma - 0.3-0.5mg (0.3-0.5mL 1:1,000 solution) SC/IM Anaphylaxis- 0.1mg (1mL of 1:10,000 solution) IV *supplied 1mg in 10mL of solution.

Epi Racemic (Micronefrin) - RESPIRATORY DRUG

Adult Dose: mix 0.5 mg of Epi 1:1000 in 5 mL of NS by nebulizer. One time dose only. Class: sympathomimetic MOA: stimulates beta-2 receptors in the lungs causing bronchodilation, reduces airway resistance, reduces laryngeal edema. Indications: asthma, Croup (laryngotrachealbronchitis), laryngeal edema Contraindications: hypertension, cardiovascular disease, epiglotitis, allergy Side effects: tachycardia, nausea, vomiting, anxious, palpitations

Furosemide (Lasix) - RESPIRATORY DRUG ETC.

Adult Dose: 0.5 - 1.0 mg/kg over 1-2 minutes. Typical dose is 40-120 mg for test purposes street dosage typically 30-40 mg *lung sounds rales/crackles *orange vial or syringe Class: Loop Diuretic MOA: inhibits the absorption of sodium (Na+) or chloride at the loop of Henle causing increased urine output. Indications: CHF, pulmonary edema, hypertensive crisis, *They have to have had a diagnosis of CHF Contraindications: allergic, hypovelemia, hypotension, suspect electrolyte imbalance, fever Side effects: orthostatic hypotension (vital signs change with a change in body position.

Ipratropium (Atrovent) - RESPIRATORY DRUG

ADULT/PED Dose Same: 500 mcg in 2-3 mL NS via nebulizer, 0.5 mg in 2.3 mL NS via nebulizer, 1 time dose (usually given in conjunction with Albueterol.) Class: Anticholinergic bronchodilator MOA: Dries secretions and causes bronchodilation Indications: bronchospasms, asthma, COPD, emphysema chronic bronchitis, allergic reaction involving the airway. (Wheezing) Contraindications: hypersensitivity (allergic), peanuts

Isoetherine (Bronchosol) - RESPIRATORY DRUG

Dosage: 2.5-5.0mg in 3mL of NS by nebulizer. Class: sympathomimetic MOA: beta-2 agonist, relaxes bronchioles Indications: asthma, bronchospasms especially in COPD Contraindications: allergy, cardiovascular disease. *use caution in patients with diabetes Side effects: tachycardia, palpitations, nausea, vomiting

Levalbueterol (Xoponex) - RESPIRATORY DRUG

Adult Dose: 1.25-2.5mg in 3mL NS by nebulizer up to 3 doses. Class: Sympathomimetic bronchodilators MOA: stimulates beta-2 receptors resulting in smooth muscle relaxation of the bronchial tree and peripheral vasculature. Indications: Acute bronchospasms in patients with COPD and asthma. Contraindications: allergy, Tachycardia 160>

Magnesium Sulfate - RESPIRATORY DRUG ETC.

Adult Dose: syringe (Eclampsia 1-4g IV over 3 minutes); cardiac (refractory to Amiodarone) 1-2g IV,IO; Torsades 1-2g IV,IO; infusion (respiratory) 1-2g in 100mL NS 5-10 minutes 10 gtts/mL set Pink top, supplied 1g/ 2mL Class: Electrolyte, Anti Inflammatory MOA: anti Inflammatory, relaxes muscles Indications: Asthma, Emphysema, COPD, Chronic Bronchitis, Eclampsia (seizures of pregnancy), Torsades De Pointes (issue in v-tach), Hypomagnasemia, cardiac arrest (v-fib, v-tach) refractory to amiodarone Contraindication: allergy, heart block Side effects: hypotensive, CNS depression

Metaproterenal (Alupent) - RESPIRATORY DRUG

Adult Dose: 0.2-0.3mL of a 5% solution in 2.5mL of NS Class: beta-2 agonist, bronchodilator MOA: relax smooth muscles of bronchial tree Indications: asthma, bronchospasms, chronic bronchitis, COPD Contraindications: allergy, tachycardia Side effects: tachycardia, palpitations, nausea, vomiting.

Methylprednisone (Solu-medrol)

Dose: Adult 1-2 mg/kg given IV/IM/IO. Typical dosage is 125 mg given IV/IM/IO. *has to be mixed prior to use Class: Corticosteroid, anti inflammatory, smooth muscle relaxer, Synthetic MOA: Antiimflammatory Indications: asthma, COPD, emphysema,chronic bronchitis, allergic reaction involving the airway. Acute spinal cord injury to help reduce swelling Contraindications: Allergic Side effects: negligible

Morphine Sulfate (MSO4)

Adult Dose: acute MI (STEMI) , CHF, pulmonary edema: 2-4mg slow IV every 5-15 minutes to max 10 mg Moderate/ severe pain: 2-10mg slow IV Class: Opiod analgesic (schedule II narcotic) MOA: alleviates pain through CNS action, increases peripheral vasodilation and decreases preload. Indications: severe CHF, pulmonary edema, chest pain associated with an acute MI, moderate to severe pain. Contraindications: allergic, significant head injury, depressed respiratory drive, hypotension, undiagnosed abdominal pain, decreased Loc Side effects: sedation, CNS depression, respiratory depression, hypotension, nausea and vomiting.

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