Rgemt Brady Ch. 19 - Respiratory Emergencies Rgb

Front 1

Define "inspiration."

Back 1

An active process in which the intercostal muscles and the diaphragm contract, expanding the size of the chest cavity and causing air to flow into the lungs.

Front 2

Define "inhalation."

Back 2

Another term for inspiration. An active process in which the intercostal muscles and the diaphragm contract, expanding the size of the chest cavity and causing air to flow into the lungs.

Front 3

Define "expiration."

Back 3

A passive process in which the intercostal muscles and the diaphragm relax, causing the chest cavity do decrease in size and forcing air from the lungs.

Front 4

Define "exhalation."

Back 4

Another term for "expiration." A passive process in which the intercostal muscles and the diaphragm relax, causing the chest cavity do decrease in size and forcing air from the lungs.

Front 5

What is the normal respiration rate for an adult?

Back 5

12-20 breaths per minute

Front 6

What is the normal respiration rate for an child?

Back 6

15-30 breaths per minute

Front 7

What is the normal respiration rate for an infant?

Back 7

25-50 breaths per minute

Front 8

What three components make up the "quality" of somebody's breathing?

Back 8

Breath sounds, chest expansion, effort of breathing

Front 9

What three elements paint a picture of a patient's breathing?

Back 9

Rate, rhythm, quality.

Front 10

Define "inadequate breathing."

Back 10

Breathing that is not sufficient to support life.

Front 11

If the patient is breathing inadequately, what might you see pertaining to their rate of breathing?

Back 11

Breathing either too fast and too shallowly, or too slowly. Agonal respirations are sporadic, irregular breaths that are usually seen right before respiratory arrest and death.

Front 12

Is rhythm an absolute indicator of adequate breathing?

Back 12

No.

Front 13

What kinds of breath sounds signify inadequate breathing?

Back 13

Dimished or absent. Also keep your ears open for snoring or gurgling, which indicate airway problems.

Front 14

What are the major differences between a child's airway and an adult's airway?

Back 14

1) Child's airway is smaller and more easily obstructed

2) Child's tongue is proportionally larger and more likely to obstruct the airway

3) Child's trachea is smaller, softer, and more flexible, and cricoid cartilage is less rigid, meaning that trauma to this region is more likely to cause obstruction.

4) A child's diaphragm is more developed (compared to their underdeveloped intercostal muscles), so children are more prone to seesaw breathing when breathing is inadequate, meaning that the chest and abdomen move in opposite directions.

5) Children are more prone to nasal flaring, grunting, and retractions

Front 15

What is your number one priority on a call if a patient's breathing is inadequate?

Back 15

Treating the inadequate breathing.

Front 16

In order of preference, what are four methods of providing assisted ventilations?

Back 16

1) Pocket face mask with supplemental oxygen

2) Two-rescuer bag-valve-max with supplemental oxygen

3) Flow restricted oxygen powered ventilation device

4) One rescuer bag-valve-mask with supplemental oxygen

Front 17

If you are uncertain about whether a patient's breathing is inadequate and requires artificial ventilation, what do you do?

Back 17

Provide artificial ventilation!

Front 18

What interventions should an EMT take for a patient that's breathing adequately, but requires supplemental oxygen due to a traumatic or medical condition?

Back 18

Administer oxygen by a non-rebreather mask or a nasal cannula.

Front 19

What interventions should an EMT take for a patient that's breathing inadequately?

Back 19

Provide assisted ventilations with a pocket-face mask, bag-valve-mask, or FROPVD.

Front 20

What interventions should an EMT take for a patient that's not breathing at all?

Back 20

Provide artificial ventilations with a pocket face mask, bag valve mask, or FROPVD at 12/minute for an adult or 20/minute for a child.

Front 21

When providing artificial ventilation, what should you keep a close eye on?

Back 21

1) Make sure the chest is rising (sign of adequate ventilation)

2) Make sure you're delivering ventilations at the proper rate -- 12/minute for adults, 20/minute for children (sign of adequate ventilation)

3) Monitor the patient's pulse carefully. A pulse that remains the same or increases may indicate inadequate ventilation. If pulse disappears, patient requires CPR.

Front 22

What major difference exists between the reaction of a child's pulse and an adult's pulse as hypoxia sets in?

Back 22

In an adult, the pulse increases. In a child, there's a slight increase in pulse early on, but soon the pulse will drop significantly. If a child or infant's pulse is LOW, you're in trouble!

Front 23

What do you do if you observe a pulse below the expected rate when you're dealing with a child or an infant?

Back 23

Evaluate your ventilations or oxygen therapy thoroughly. Check the airway, check your equipment, check that your rate is correct (20/min), check that the child's chest is rising with each breath.

Front 24

What do you do when you're artificially ventilating and there's no chest rise?

Back 24

1) Increase force of ventilations

2) Confirm open airway via head-tilt/chin-lift or jaw-thrust maneuver

3) Insert airway adjunct if necessary

4) Suction as necessary

5) Use abdominal thrusts or finger sweeps in the case of large obstructions

6) Verify that oxygen equipment is connected correctly, secure, and free of kinks in any hosing

Front 25

If a child or infant has:

1) Wheezing, stridor, or grunting
2) Increased breathing effort
3) Flared nostrils/retractions
4) Rapid breathing
5) Cyanosis

... what do you do?

Back 25

Refrain from placing anything in patient's mouth, administer oxygen, and transport as quickly as possible.

Front 26

A patient's description of his difficulty breathing is a _____ perception.

Back 26

Subjective.

Front 27

Is a patient's description of their breathing difficulty a solid piece of information you can base your treatment on?

Back 27

No. Your assessment of the patient based on their chief complaint is the basis for your treatment of the patient.

Front 28

List off some signs that an adult is having breathing difficulty.

Back 28

Increased pulse rate

Changes in breathing rate (above or below normal levels)

Changes in breathing rhythm

Pale, cyanotic, or flushed skin

Noisy breathing

Inability to speak full sentences

Use of accessory muscles

Retractions

Altered mental status

Coughing

Flared nostrils

Tripoding

Unusual anatomy (barrel chest)

Oxygen saturation (or SpO2) reading of less than 95%.

Front 29

What is stridor, and what does it indicate?

Back 29

Stridor is a harsh, high-pitched sound during breathing. It usually indicates an upper airway obstruction.

Front 30

If a patient is having difficulty breathing and you have a pulse oximiter readily available, what should you do?

Back 30

Take a pulse oximetry reading right away to obtain a baseline. Document subsequent readings to see if patient's saturation levels are increasing. However, NEVER delay oxygen delivery for any reason, so ONLY take a reading if it's feasible and the device is readily available.

Front 31

When a patient is suffering from breathing difficulty, what are the four steps to follow?

Back 31

1) Assessment

2) Oxygen therapy

3) Positioning -- sit the patient up if their breathing is adequately, otherwise get them supine if they require assisted ventilations

4) Inhaler - If patient has a prescribed inhaler, you could consult medical direction for instructions on helping the patient take their medication

Front 32

What are the most important sounds that you can hear through your stethescope?

Back 32

The sounds of air moving in and out.

Front 33

What do absent lung sounds indicate?

Back 33

A serious condition such as inadequate breathing, respiratory arrest, or a collapsed lung

Front 34

What abnormal lung sounds might an EMT hear, and what do they indicate?

Back 34

1) Wheezes -- high-pitched sounds, almost musical in nature. Indicates narrowed airways, common with asthma, COPD, emphysema, bronchitis. Most commonly heard during expiration.

2) Crackles -- a fine crackling/bubbling sound caused by fluid in alveoli or by the opening of closed alveoli

3) Rhonchi -- lower pitched sounds that resemble snoring or rattling. Caused by secretions in larger airways, may indicate pneumonia, bronchitis, or fluids inhaled into lungs.

Stridor -- a high-pitched sound heard upon inspiration. Indicates partial obstruction of trachea or larynx

Front 35

Where might you listen for lung sounds?

Back 35

Just below the clavicles on the mid-clavicular line.

At the bases of the lungs and just lateral to the mid-clavicular line (under the nipples)

These same positions, but on the back of the body.

On the mid-axillary line a bit below the armpit.

Front 36

Is it necessary to diagnose a patient's respiratory condition in order to provide effective treatment as an EMT?

Back 36

No. The care for all respiratory conditions is virtually the same.

Front 37

What is COPD?

Back 37

Chronic obstructive pulmonary disease. This group of diseases includes chronic bronchitis, black lung, and many undetermined respiratory illnesses that cause emphysema-like conditions.

Essentially, it's a disorder that prevents proper CO2/O2 exchange in the lungs, and necessitates constant oxygen therapy.

Front 38

What is emphysema?

Back 38

Emphysema is a disease in which the walls of the lungs' alveoli break down, reducing the surface area for respiratory gas exchange. The lungs lose elasticity, and these factors allow stale air to sit in the lungs.

Front 39

What is chronic bronchitis?

Back 39

Chronic bronchitis is a condition in which the bronchiole lining is inflamed, excess mucus is formed, the cilia that usually sweep away the mucus are damaged, and this combination of inflammation and mucus build up hamper respiratory gas exchange.

Front 40

Why do most patients with COPD call for an ambulance?

Back 40

Usually an upper respiratory infection has caused an acute worsening of their chronic disease.

Front 41

Define "hypoxic drive."

Back 41

Hypoxic drive is a rare phenomenon. Basically it occurs in COPD patients, and the brain stops using high levels of CO2 as a trigger to breathe. It instead gets used to low oxygen levels and high CO2 levels that are always present, and uses extra-low oxygen levels as a trigger to breathe. In these cases, oxygen therapy can actually cause the patient to go into respiratory arrest, but that is very rare.

Front 42

What can cause an asthma attack?

Back 42

Allergic reactions, pollutants, infection, strenuous exercise, or emotional stress.

Front 43

What happens during an asthma attack?

Back 43

Bronchioles constrict and an overproduction of mucus begins. The combined effect causes bronchial passages to narrow to a point where adequate breathing is difficult or impossible

Front 44

Define "bronchoconstriction."

Back 44

Constriction, or blockage, of the bronchi that lead from the trachea to the lungs.

Front 45

Who must you consult before helping a patient use their inhaler, and what questions must you ask the patient?

Back 45

You must consult medical direction.

Ask the patient if, and when, they recently used the inhaler.

Front 46

In what form does the medicine in an inhaler come?

Back 46

The medicine is a fine powder.

Front 47

Why are inhalers difficult to use?

Back 47

Because timing is essential. If you're not inhaling at the correct moment, the medicine will come to rest in your mouth, where it's ineffective. You must inhale the powder so it enters your airway.

Front 48

What device can make inhaler use easier?

Back 48

A spacer.

Front 49

When assisting a patient with using their inhaler, what steps will you take?

Back 49

1) Consult medical direction

2) Ensure that you have the right patient, the right medication, the right dose, and the right route. Get the inhaler to room temperature and shake it.

3) Make sure that the patient is alert enough to use the inhaler properly. Use spacer if available.

4) Have patient put lips around the opening, press inhaler while he inhales deeply.

5) Make sure that the patient holds his breath as long as possible so that the medication can be absorbed.

Front 50

Should you assist the following patient with using an inhaler?

Patient is a 14-year-old with difficulty breathing. History of asthma. Pulse 104, strong, regular. Respirations are 28 with audible wheezing. BP is 130/84, and skin is warm and dry. Parents are present, inhaler is prescribed.

Back 50

Yes -- the patient is breathing adequately enough for the inhaler to do some good, plus it's his inhaler and prescribed to him.

Front 51

Should you assist the following patient with using an inhaler?

67-year old, difficulty breathing. Has a history of breathing problems, but can't think of the name of the condition. Pulse 122 and strong and regular, respirations 28 with audible wheezes, BP 104/64, skin cool and dry. The daughter presents an inhaler that's not prescribed.

Back 51

No. The patient's condition may not be asthma, and the inhaler may do more harm than good.

Front 52

Should you assist the following patient with using an inhaler?

Patient is 24, was just exercising, developed difficulty breathing. Pulse 142, respirations 42 and shallow, BP 96/56, skin cool and moist. Has an inhaler on her person that's prescribed to her.

Back 52

No. Respirations are too shallow for the medication to do any good. Patient needs oxygen therapy and priority transport.

Front 53

What are common generic names for prescribed medications delivered by inhaler?

Back 53

Albuterol, isoetharine, metaproterenol

Front 54

What are common trade names for prescribed medications delivered by inhaler?

Back 54

Proventil, Ventolin, Bronkosol, Bronkometer, Alupent, Metaprel

Front 55

What are indications for use of a prescribed inhaler?

Back 55

1) Patient exhibits signs and symptoms of respiratory emergency

2) Patient has physician-prescribed inhaler

3) Medical direction gives specific authorization to use.

Front 56

What are some contraindications against the use of a prescribed inhaler?

Back 56

1) Patient is unable to use the device

2) Inhaler is not prescribed for the patient

3) No permission has been given by medical direction

4) Patient has already taken maximum prescribed dose prior to EMT's arrival

Front 57

What is a small-volume nebulizer?

Back 57

A small-volume nebulizer is a device that can create a continuous flow of aeorosolized medication that the patient can easily and effectively inhale. It uses the same medications as an inhaler.