Emsp Review For Registry From Emt Achieve

Front 1

1. Flow restricted oxygen powered ventilation devices require a constant supply of pressurized oxygen to work correctly. In conjunction with a full oxygen cylinder, what other piece of oxygen equipment is necessary?

Back 1

An oxygen tank regulator with a high pressure port

Front 2

In order to properly use a flow restricted oxygen powered ventilatory device (FROPVD), the driving pressure from the oxygen tank must be great enough to drive the oxygen into the lungs. This requires a tank therapy regulator with a high pressure port (the threaded port on the body of the regulator). The driving pressure from the oxygen source at the regulator outlet nipple is usually around 2 psi, which is insufficient to adequately ventilate the non-breathing patient.

Back 2

The manually controlled, pneumatically powered ventilator (also called the demand valve device, the manually triggered ventilator, or the flow-restricted, oxygen-powered ventilation device) is operated by depressing a pressure-release button. When the button or valve is opened, oxygen flows to the mask. The device will deliver 100 percent oxygen from the tank at up to 40 l/min flow. These devices are sturdy, compact, and easy to handle.

Many demand valve devices are equipped with an inspiratory release valve. The negative pressure generated by the patient on inspiration will trigger the valve. This allows use in a spontaneously breathing patient. The demand valve will supply more oxygen as inspiratory pressure increases. When inhalation stops, the demand valve shuts off the oxygen flow.

These devices have been documented to deliver pressures that can cause gastric insufflation or pneumothorax when used incorrectly. This concern led to the recommendation that the flow rate should be limited to 40 l/min and a pop-off valve should be activated if pressures exceed 50 mL H2O. Pressure is restricted to about 30 cm of water in most devices. The current devices do not create the excessive pressures documented with the older styles. This results in a decreased risk of gastric distention.

The device can deliver oxygen to the mask or endotracheal tube. It is the operator s responsibility to ensure that the mask is appropriately sealed and that the patient actually receives the oxygen flow. This device also uses a lot of oxygen, so small portable oxygen cylinders can be rapidly depleted by use of a demand valve

Front 3

2. You are managing a 24-year-old asthmatic patient with significant respiratory distress. Bilateral expiratory wheezing is heard. You have already administered 2 albuterol nebulized treatments with no relief of respiratory distress. What drug should be administered for prompt relief of asthma-related respiratory distress?

Back 3

0.3 mg 1:1,000 epinephrine subcutaneously

Front 4

If inhaled bronchodilators are unsuccessful, administration of 0.1-0.3 mg of 1:1,000 epinephrine can be administered subcutaneously for mild bronchoconstriction (some protocol prefer the medication to be given intramuscular rather than subcutaneously). More severe bronchoconstriction may require 0.1-0.3 mg of 1:10,000 epinephrine intravenously. In addition, 1-2 g of magnesium sulfate in 50-100 mL of D5W can be administered intravenously as an infusion for resistant bronchoconstriction. Since succinylcholine is a paralytic, it would not improve the patient's ability to breath.

Back 4

Treatment of asthma is designed to correct hypoxia, reverse any bronchospasm, and treat the inflammatory changes associated with the disease. Administer oxygen at a high flow rate and a high concentration (100 percent). Establish intravenous access and place the patient on an ECG monitor. Direct initial treatment at reversing any bronchospasm present. The most commonly used drugs are the inhaled beta-agonist preparations such as albuterol (Ventolin, Proventil) in conjunction with ipratropium bromide (Atrovent). These can be easily administered with a small volume, oxygen-powered nebulizer. Monitor the patient s response to these medications by noting improvement in PEFR and pulse oximetry readings. Many asthmatic patients will wait before summoning EMS. The longer the time interval from the onset of the asthma attack until treatment, the less likely it will be that bronchodilator medications will work. Often, after a prolonged asthma attack, the patient may become fatigued. A fatigued patient can quickly develop respiratory failure and subsequently require intubation and mechanical ventilation. Always be prepared to provide airway and respiratory support for the asthmatic.

Front 5

3. You are managing a 24-year-old asthmatic patient with significant respiratory distress. Bilateral expiratory wheezing is heard. You have already administered 2 albuterol nebulized treatments with no relief of respiratory distress. Since you are unable to relieve the respiratory distress by pharmacological therapy and the patient's mental status is starting to deteriorate, you choose to intubate the patient. What would you suspect will occur with intubation and PPV if your diagnosis of status asthmaticus is correct?

Back 5

Difficulty in ventilating after intubation.

Front 6

There would be increased difficulty in ventilating due to bronchoconstriction and air-trapping within the lungs. Intubation has no effect on bronchoconstriction, and laryngeal edema is not associated with asthma.

Back 6

Status asthmaticus is a severe, prolonged asthma attack that cannot be broken by repeated doses of bronchodilators. It is a serious medical emergency that requires prompt recognition, treatment, and transport. The patient suffering status asthmaticus frequently will have a greatly distended chest from continued air trapping. Breath sounds, and often wheezing, may be absent. The patient is usually exhausted, severely acidotic, and dehydrated. The management of status asthmaticus is basically the same as for asthma. Recognize that respiratory arrest is imminent and be prepared for endotracheal intubation. Transport immediately and continue aggressive treatment en route.

Front 7

4. You are treating a patient in respiratory distress with a history of COPD. The patient's condition creates which of the following concerns?

Chronic carbon dioxide retention

Chronic oxygen retention

Chronic oxygen deprivation

Back 7

Chronic carbon dioxide retention

Front 8

COPD creates a state of respiratory acidosis through chronic carbon dioxide retention. This patient does not suffer from oxygen retention although the air in the alveoli has less than optimal levels of oxygen due to diminished tidal volumes and reduced expiratory air flow.

Back 8

Metabolic disorders can cause alterations in the normal homeostasis of the body, with the result being seizure activity. Inadequacies in the cardiovascular or respiratory system can cause inadequate blood flow (hypoperfusion) and inadequate oxygenation (hypoxia) to the brain, along with inadequate removal of cellular byproducts, especially carbon dioxide (hypercapnia). Hypercapnia is caused almost exclusively by hypoventilation or hypoperfusion. The increase in CO2 levels fosters the edema, or swelling, that commonly accompanies head injuries. Hypoperfusion and hypercapnia, regardless of the cause, can lead to a number of serious consequences, ranging from seizures to strokes and even to death.

Front 9

5. You are transporting a 48-year-old male patient between medical facilities. During the history, you learn that the patient was
involved in a fall at work and suffered a hip fracture and a head injury. The patient is now presenting with labored breathing at 30/min that has progressively worsened over the last 24 hours, a heart rate of 104, and a blood pressure of 98/70. On auscultation, you hear diffuse rales. The patient denies any complaints of pain other than those related to his recent fall. What is the most likely cause of the patient's respiratory distress?

Back 9

Adult respiratory distress syndrome

Front 10

ARDS is a disorder of lung diffusion that results from increased fluid in the interstitial space. Each of the underlying conditions cited previously results in the inability to maintain a proper fluid balance in the interstitial space. Severe hypotension, significant hypoxemia as the result of cardiac arrest, drowning, seizure activity or hypoventilation, high altitude exposure, environmental toxins, and endotoxins released in septic shock all can cause disruption of the alveolar-capillary membrane. Increases in pulmonary capillary permeability, destruction of the capillary lining, and increases in osmotic forces act to draw fluid into the interstitial space and contribute to interstitial edema. This increases the thickness of the respiratory membrane and limits diffusion of oxygen. In advanced cases, fluid also accumulates in the alveoli, causing loss of surfactant, collapse of the alveolar sacs, and impaired gas exchange. This results in a significant amount of pulmonary shunting with unoxygenated blood returning to the circulation. The result is significant hypoxia.

Back 10

ARDS is a disorder of lung diffusion that results from increased fluid in the interstitial space. Each of the underlying conditions cited previously results in the inability to maintain a proper fluid balance in the interstitial space. Severe hypotension, significant hypoxemia as the result of cardiac arrest, drowning, seizure activity or hypoventilation, high altitude exposure, environmental toxins, and endotoxins released in septic shock all can cause disruption of the alveolar-capillary membrane. Increases in pulmonary capillary permeability, destruction of the capillary lining, and increases in osmotic forces act to draw fluid into the interstitial space and contribute to interstitial edema. This increases the thickness of the respiratory membrane and limits diffusion of oxygen. In advanced cases, fluid also accumulates in the alveoli, causing loss of surfactant, collapse of the alveolar sacs, and impaired gas exchange. This results in a significant amount of pulmonary shunting with unoxygenated blood returning to the circulation. The result is significant hypoxia.

Front 11

6. The patient continues to deteriorate while receiving high flow oxygen therapy with a nonrebreather. His level of consciousness is dropping and the airway is starting to produce sonorous sounds. You elect to provide airway maintenence and support the patient s ventilations. Which of the following airway devices will best support the failing airway?

Back 11

Intubation

Front 12

Intubation and mechanical ventilation are needed during the stabilization of severe cases of ARDS. The use of artificial airways is obviously indicated, but an OPA and NPA does not provide the same degree of airway security as endotracheal intubation does. A venturi mask is not an airway adjunct, rather it is a oxygenation adjunct

Back 12

Specific management of the patient’s underlying medical condition is the hallmark of treatment for this disorder. Treatment of gram-negative sepsis with appropriate antibiotics, removal of the patient from any inciting toxin, or rapid descent to a lower altitude in patients with HAPE are the most important therapies for this condition. The patient will usually tolerate an upright position with the legs dangling off the cart.

Since the hypoxia seen in ARDS is the result of diffusion defects, oxygen supplementation is essential for all patients with this condition. Establish intravenous access, but provide fluids only if hypovolemia exists. Establish cardiac monitoring. Suctioning of lung secretions is often required to maintain airway patency.

Use positive pressure ventilation to support any ARDS patient who demonstrates signs of respiratory failure. Use bag-valve-mask ventilation for initial respiratory support but note that these patients generally require endotracheal intubation and support using a mechanical ventilator for early management. Positive end-expiratory pressure (PEEP) is often required to maintain patency of the alveoli and adequate oxygenation.

Front 13

7. In addition to ensuring adequate oxygenation, which of the following treatments would be most appropriate for this patient?

Back 13

Monitored fluid resuscitation

Front 14

Because ARDS is non-cardiogenic, fluid replacement is necessary, especially as the patient becomes hypotensive. This patient has a fluid distribution problem similar to anaphylaxis. Diuretic therapy may be contraindicated in this patient as it can further reduce intravascular volume. The problem with ARDS is pulmonary capillary permeability, not left ventricular dysfunction that results in pulmonary hypertension. Corticosteroids are not useful unless the patient has resultant lung damage. Nebulized bronchotherapy should only be used if the patient presents with wheezing.

Back 14

Specific management of the patient’s underlying medical condition is the hallmark of treatment for this disorder. Treatment of gram-negative sepsis with appropriate antibiotics, removal of the patient from any inciting toxin, or rapid descent to a lower altitude in patients with HAPE are the most important therapies for this condition. The patient will usually tolerate an upright position with the legs dangling off the cart.

Since the hypoxia seen in ARDS is the result of diffusion defects, oxygen supplementation is essential for all patients with this condition. Establish intravenous access, but provide fluids only if hypovolemia exists. Establish cardiac monitoring. Suctioning of lung secretions is often required to maintain airway patency.

Use positive pressure ventilation to support any ARDS patient who demonstrates signs of respiratory failure. Use bag-valve-mask ventilation for initial respiratory support but note that these patients generally require endotracheal intubation and support using a mechanical ventilator for early management. Positive end-expiratory pressure (PEEP) is often required to maintain patency of the alveoli and adequate oxygenation

Front 15

What concentration of nitrogen is found in the atmosphere?

Back 15

0.79

Front 16

Nitrogen comprises 79% of the atmospheric gas. Oxygen comprises approximately 21%. Carbon dioxide is roughly 3%

Back 16

Nitrogen comprises 79% of the atmospheric gas. Oxygen comprises approximately 21%. Carbon dioxide is roughly 3%

Front 17

What is the correct technique used for percussion to help identify a hemothorax?

Back 17

Place your middle finger of one hand over the lung field and sharply strike that finger with the index or middle finger of the opposite hand.

Front 18

Tapping the distal knuckle of your middle finger with the index or middle finger from the opposite hand will produce a hyporesonant (dull) sound if a hemothorax is present. The hyporesonant sound is from the chest cavity being filled with blood. A hyperresonat sound is created when the chest wall is filled with air

Back 18

Tapping the distal knuckle of your middle finger with the index or middle finger from the opposite hand will produce a hyporesonant (dull) sound if a hemothorax is present. The hyporesonant sound is from the chest cavity being filled with blood. A hyperresonat sound is created when the chest wall is filled with air

Front 19

10. What technique is used immediately prior to intubation to allow the paramedic to more easily visualize the vocal cords?

Back 19

Cricoid pressure

Front 20

There is a difference between cricoid pressure and Sellick�s maneuver. Cricoid pressure is used to bring vocal cords into better view. Sellick�s maneuver by definition is pressure delivered to the cricoid ring sufficient to compress the esophagus. Hyoid pressure would actually obscure the vocal cords. And finally, there is no such thing as a Cushing's maneuver

Back 20

There is a difference between cricoid pressure and Sellick�s maneuver. Cricoid pressure is used to bring vocal cords into better view. Sellick�s maneuver by definition is pressure delivered to the cricoid ring sufficient to compress the esophagus. Hyoid pressure would actually obscure the vocal cords. And finally, there is no such thing as a Cushing's maneuver.