-
What is a test that measures the amount of expired air in patients with known respiratory problems?
PEFR peak expiratory flow rate
-
What is polycythemia?
Increased red blood cell production secondary to chronic hypoxia
-
What does PEEP do?
Creates pressure to keep the alveoli open
-
The term "pink puffer" refers to someone with what disease?
Emphysema
-
38-year old female, just returned from China c/o sudden onset chest pain and dyspnea. O2 sats are 88% and lung sounds are clear. ECG shows no changes and her O2 sats don't improve with oxygen. What do you suspect?
Pulmonary embolism
-
The term "blue bloater" refers to someone with what disease?
Chronic bronchitis
-
Pulmonary edema would lead to a problem with which part of the Fick principle?
Diffusion; the crossing of oxygen from the alveoli to the capillary beds
-
35 y/o woman with sudden onset chest pain and dyspnea; hypotensive, no cardiac problems, clear lung sounds, and no edema in her extremities. What would be definitive treatment for this patient?
Heparin (a thrombolytic)
-
What is the expected body morphology in a patient with emphysema?
Thick barrel chest, thin appearance otherwise
-
YOu have just intubated a patient with suspected exascerbated asthma; but immediately after the patient is easy to ventilate. What should you suspect?
The patient was actually probably suffering from an upper airway obstruction and not asthma
-
What is the most common site for thrombus formation leading to PE?
the legs
-
What is consolidation?
a condition in which an area of the lungs fills with fluid and cellular debris; seen in pneumonia
-
What lung sounds should you expect to hear with a PE?
clear
-
Define pulmonary embolism.
The blockage of a pulmonary artery by a blood clot
-
What is a differentiating sign between pneumonia and COPD?
the presence of fever
-
Respiratory alkalosis associated with hyperventilation syndrome is due to what cause?
An excessive loss of CO2
-
34 y/o male, cannot catch his breath. Tachypneic, clear lung sounds; patient c/o numbness and tingling in his lips and fingers. Pt. has no medical history. What do you suspect?
Hyperventilation syndrome
-
Define status asthmaticus.
A prolonged asthma attack that does not respond to bronchodilators
-
What is the first-line treatment for asthma in the US?
Albuterol
-
What kind of body morphology is at higher risk for developing a spontaneous pneumothorax?
A patient who is thin and tall and has a narrow chest
-
Chronic bronchitis is most commonly associated with exposure to...
cigarette smoke
-
The most common cause of children's pneumonia is what?
Influenza A
-
What is the major side effect of administering bronchodilators to a patient with exascerbated asthma?
Increased myocardial oxygen demand
-
Define ARDS.
Acute respiratory distress syndrome; it exists when the capillaries in the lung have increased permeability leading to rales and stiff alveoli
-
Days after a seizure and a period of unconsciousness, a patient develops pneumonia. What type of pneumonia are they at high risk for?
Aspiration pneumonia (chemical pneumonia)
-
What is the first line treatment for a patient with hyperventilation syndrome?
Calming and reassuring them
-
Define ventilation.
The process of air moving in and out of the lungs
-
All disorders that result in ARDS cause what?
pulmonary edema
-
In a normally healthy person, what is the primary drive to breath based on?
Levels of CO2
-
What condition can pulmonary hypertension lead to?
Right sided heart failure
-
What is a bleb?
A weakened area of the lung
-
74 y/o female, high fever and productive cough, shaking chills for the past 3 hours. What do you suspect?
Pneumonia
-
Which lung sounds are most commonly associated with asthma?
Wheezing
-
Which part of the Fick principle would a FBAO interfere with?
Ventilation (getting air into the lungs)
-
What is cor pulmonale?
Right sided heart failure and hypertrophy resulting from increased pressures in the pulmonary arteries
-
Should you withhold oxygen from a patient with COPD if their sats are at 85% but you are afraid to knock out their respiratory drive?
Never- provide high flow oxygen and prepare to ventilate if necessary
-
What kind of pneumonia do vaccinations protect against and at what efficacy?
80% to 90% against bacterial pneumonia
-
Define carpopedal spasm.
Tingling in the hands that may progress to spasm and tetany associated with hyperventilation syndrome
-
What kind of breathing pattern is associated with hyperventilation syndrome?
Rapid and deep
-
Describe emphysema.
Englargement and loss of elasticity of the alveoli
-
Define a spontaneous pneumothorax.
Air entering the pleural space not resultant of trauma
-
What would bradycardia with a pulmonary cause imply?
Severe hypoxemia and imminent respiratory arrest
-
What is the difference between BiPAP and CPAP?
BiPAP reduces the pressure applied when the patient exhales; CPAP is continuous
-
Define chronic bronchitis.
Inflammatory changes and excessive mucus production in the bronchial tree
-
What does clubbing of the fingers indicate?
Chronic hypoxemia
-
When do patients with emphysema have increased airway resistance?
on expiration
-
When do patients with chronic bronchitis have increased airway resistance?
on both inspiration and expiration
-
Asthma exascerbation can be commonly triggered by what kind of infection?
any viral respiratory infection
-
Define asthma.
A reactive airway disease that is stimulated by both intrinsic and extrinsic factors; involves inflammation, bronchoconstriction, and increased mucus production
-
Define pulmonary hypertension.
An increase in the pressure of the pulmonary artery due to vasoconstriction of the pulmonary capillaries
-
What three diseases does the term "obstructive airway disease" refer to?
Chronic bronchitis, asthma, and emphysema
-
What is a productive cough with thick green sputum indicate?
Pneumonia
-
A PEFR that varies by 20-30% from previous readings indicates what level of exascerbation was present?
moderate
-
A PEFR that varies by more than 30% from previous readings indicates what level of exascerbation was present?
severe
-
What part of Fick's principle would CNS depression lead to a problem with?
Ventilation; moving air into and out of the lungs
-
Excessive positive intrathoracic pressure during an asthma attack may lead to what sign?
Pulsus paradoxus
-
After placing an ET tube, there are no lung sounds and positive epigastric sounds. The tube is most likely in the...
esophagus
-
What is the most adequate indicator that adequate tidal volumes are being delivered during artificial ventilation?
adequate chest rise
-
What is normal PCO2?
35-40 mmHg
-
Physiologic dead space is increased in patients with...
respiratory diseases like emphysema
-
If an ET tube has been properly placed, an esophageal detector device will...
reinflate easily
-
What concentration of oxygen can be delivered using a simple face mask at 10lpm?
40-60%
-
What is the most important factor in determine the extent to which oxygen combines with hemoglobin?
the partial pressure of oxygen in the blood plasma
-
The ET tube size used for a cric is usually?
6.0 to 7.0
-
Which is the gas most prevalent in the atmosphere?
nitrogen
-
The safe residual (i.e. when an oxygen cylinder is considered empty) is?
200 psi
-
What is the primary cause of airway obstruction in unconscious patients?
the tongue
-
A BVM with a reservoir and an oxygen source of 15lpm delivers what oxygen concentration?
100%
-
Depolarizing agents have what kind of onset and duration as compared to polarizing agents?
Quicker onset and shorter duration
-
Blood in the pulmonary veins is...
high in oxygen
-
How do you apply cricoid pressure?
place firm pressure against the cricoid cartilage
-
Define compliance.
the ease with which the lungs expand during inspiration
-
What is the minimum flow rate of oxygen to be delivered when giving mouth-to-mask ventilations with supplemental oxygen?
10-12 lpm
-
What is the anatomic difference in a child's airway as compared to that of an adult?
the epiglottis is omega shaped in a child
-
What does pulmonary surfactant do?
lowers the surface tension, preventing alveolar collapse
-
What is the correct location for a needle cric?
the cricothyroid membrane
-
What is the maximum acceptable flow rate for a nasal cannula?
6 lpm
-
Define diffusion.
The movement of a gas from a higher pressure to a lower pressure across a semipermeable membrane
-
Define internal respiration.
The transfer of oxygen and carbon dioxide between the capillary red blood cells and the tissue cells
-
What is one example of a depolarizing neuromuscular blocker?
succinylcholine
-
What is the purpose of an oral airway (OPA)?
Keep the tongue from obstructing the glottis during ventilation
-
What is the minimum oxygen flow rate for any face mask?
6 lpm
-
A patient with chronic bronchitis is likely to rely on what mechanism to stimulate their respiratory drive?
hypoxia
-
What is an intubation technique that may be performed without the use of specialized equipment?
digital intubation
-
Define Biot's respirations.
characterized by irregular pattern, rate, and volume with intermittent periods of apnea
-
What does pulse oximetry measure?
the amount of hemoglobin saturated with oxygen
-
What is a whistle-tip suction catheter?
flexible and designed to suction smaller portions of the airway or through an ET tube
-
After the administration of sux, a patient is usually relaxed enough for intubation after how many seconds?
10
-
What does the acronym BURP stand for and why is it used?
backwards upwards rightwards pressure and it maneuvers the larynx to help visualize the vocal cords during intubation
-
Define central neurogenic hyperventilation.
deep, rapid, regular respirations
-
In ideal circumstances, the suctioning of an adult patient should not exceed...
15 seconds
-
Define tidal volume.
The amount of air inhaled or exhaled during a normal breath
-
Treatment for a myocardial contusion following significant blunt-force trauma may include...
high flow oxygen
-
Define tension pneumothorax.
air trapped in the pleural space under pressure
-
The release of a patient from a position of traumatic asphyxia may cause...
hypovolemia and shock
-
What is a common sign/symptom associated with hemothorax?
shock
-
Define flail segment.
Three or more adjacent ribs fractured in two or more places
-
What is the definitive treatment for a cardiac tamponade?
pericardiocentesis
-
What is good treatment for a patient with a pulmonary contusion?
Intubation with positive pressure ventilation
-
Define pulmonary contusion.
alveolar and lung capillary damage resulting in interstitial and intraalveolar bleeding and swelling
-
What do we cover an open pneumothorax with?
An occlusive dressing taped on three sides
-
Define paradoxical movement.
the injured portion of the chest (or flail segment) is moving in an opposite direction from the rest of the thorax during respiration
-
What is the correct placement for a needle thoracostomy in a patient with a tension pneumothorax?
2nd intercostal space, over the third rib, midclavicular line
-
A simple pneumothorax most often occurs as a result of what injury?
a rib fracture that penetrates the chest wall
-
A rare complication associated with fractures of the clavicle or ribs 1 or 2 may be injury to what vein?
subclavian
-
What is Beck's triad and what condition does it indicate?
muffled heart sounds, JVD, and hypotension; pericardial tamponade
-
How much blood can be contained in one hemithorax?
2-3L
-
What is a sign that is typically associated with myocardial contusion?
new cardiac murmur
-
What CO2 finding would indicate the need for intubation and positive pressure ventilation in a patient with a flail chest?
55mmHg
-
What diseases is the use of albuterol usually indicated in?
asthma, emphysema, chronic bronchitis
-
What is the adult dose for albuterol?
2.5-5mg in 3cc via nebulizer; max 10mg
-
What is the pediatric dose for albuterol?
1.25-2.5mg in 3cc via nebulizer; max 5 mg
-
How does albuterol work?
beta 2 selective agonist; bronchodilator
-
What diseases is aminophylline usually indicated for?
asthma, emphysema, chronic bronchitis, anaphylaxis
-
How does aminophylline work?
xanthine bronchodilator
-
What respiratory disease is atropine usually indicated in?
bronchial asthma
-
How does atropine work?
Anticholinergic
-
What is the adult dose for atropine?
2.0mg IVP PRN
-
What is the pediatric dose for atropine?
0.5mg/kg PRN
-
What disease is the use of corticosteroids usually indicated in?
Reactive airway diseases; exascerbated asthma
-
What is the mechanism of action of corticosteroids in asthma?
anti-inflammatory
-
What is the adult dose for dexamethasone?
4-10mg
-
What is the pediatric dose for dexamethasone?
0.6mg/kg
-
What is the adult dose for methylprednisoline?
125-250mg
-
What is the pediatric dose for methylprednisoline?
2mg/kg
-
What is the adult dose for prednisone?
1mg/kg max 60mg
-
What respiratory diseases indicate the use of diphenhydramine?
allergic reaction and anaphylaxis
-
By what two mechanisms does diphenhydramine work?
Anticholinergic and antihistamine
-
What is the adult dose of diphenhydramine?
20-50mg SIVP
-
What is the pediatric dose of diphenydramine?
1mg/kg SIVP max 50mg
-
What respiratory diseases indicate the use of epinephrine?
anaphylaxis, severe bronchospasm due to asthma, allergic reaction
-
What is the adult dose of epinephrine?
0.3mg PRN
-
What is the pediatric dose of epinephrine?
0.01mg/kg max 0.3mg PRN
-
What is Flolan used for?
management of primary pulmonary hypertension
-
What mechanism does Flolan work by?
Directly dilates the pulmonary and systemic arterial vasculature
-
What is the indication for Furosemide?
CHF with severe pulmonary edema
-
What class/action is Furosemide?
loop diuretic
-
What is the adult dose for Furosemide?
2X the patient's PO; 20-40mg; or 0.5-1.0mg/kg
-
What is the pediatric dose for Furosemide?
1mg/kg SIVP
-
What respiratory disease is glucagon indicated in?
anaphylaxis refractory to epinephrine
-
What is the adult dose for glucagon?
1-2mg q 5-10 PRN
-
What is the pediatric dose for glucagon?
0.1mg/kg up to 1mg
-
What is the indication for giving hydroxycobalamine?
Antidote for cyanide poisoning
-
What is the adult dose for hydroxycobalamine?
5g over 30 min IV
-
What is the pediatric dose for hydroxycobalamine?
(<70kg) 70 mg/kg IV
-
What is the indication for Xylocaine?
nasal intubation
-
How does Xylocaine work?
local anesthetic; sodium channel blocker
-
What respiratory disease is an indication for magnesium sulfate?
Acute asthma refractory to other treatment
-
What is the action of magnesium?
smooth muscle relaxant
-
What is the adult dose for magnesium?
1-2g SIVP
-
What is the pediatric dose for magnesium?
25-50mg/kg IVP max 2g
-
What is the respiratory indication for morphine?
CHF with severe pulmonary edema
-
What is the adult dose for morphine?
2-10mg SIVP
-
What is the pediatric dose for morphine?
0.1mg/kg SIVP max 15mg
-
What is the respiratory indication for naloxone?
suspected narcotic overdose to increase respiratory effort
-
What is the adult dose for naloxone?
0.4-2.0mg
-
What is the pediatric dose for naloxone?
- 0.1mg/kg <5 years or <20 kg
- 2mg >5 years or >20kg
- neonates 0.1mg/kg
-
What is the respiratory indication for nitroglycerin?
CHF with pulmonary edema
-
What is the adult dose for nitro?
0.4mg X3 q 3-5
-
What is considered low flow oxygen?
1-4 lpm
-
What is considered moderate flow oxygen?
6-8 lpm
-
What is considered high flow oxygen?
10-15 lpm
-
What is the indication for phenylephrine?
nasal intubation
-
How does phenylephrine work?
pure alpha adrenergic agent; vasoconstriction
-
What is the "dose" for phenylephrine?
2 squirts in the selected nostril prior to intubation
-
What is the indication for promethazine?
prevention of nausea/vomiting; prevents aspiration
-
What is the adult dose for promethazine?
12.5-25mg
-
What is the pediatric dose for promethazine?
>2 years 0.25-0.5mg/kg
-
What is the indication for propofol?
maintenance of sedation in the intubated mechanically ventilated patient
-
What is the indication for terbutaline?
asthma
-
What is the most common cause of laryngospasm?
extubation
-
Define mucosal necrosis.
Perfusion of endothelium in larynx is impaired and causes permanent damage; caused by overinflation of cuffs on tubes
-
How far do you insert the King airway?
To the teeth guard
-
What is one big advantage of the King airway over others?
The sizes can get down to a much smaller patient size
-
How can you determine if your placement is correct with a King airway?
Bag compliance
-
Define atelectasis.
the formation of fewer but larger alveoli due to destruction and collapse of alveolar walls
-
What is the length and gauge of a needle used in a chest dart?
2-3" long, 12-14 gauge
-
How can pulsus paradoxus occur with a tension pneumothorax?
The pressure from the tension pneumothorax can actually cause a cardiac tamponade
-
What is the principle behind V:Q mismatch?
you need 5 liters of blood for every 4g of O2 (0.8 is the goal)
-
V:Q mismatch can occur two ways. Name them.
Too much blood and not enough O2 or Too much O2 and not enough blood
-
What is the physiology behind why pulmonary edema increases difficulty in oxygen transfer?
alveoli are normally about 3 cell widths away from the capillary beds; edema pushes the alveoli further away from the vessels
-
What kind of edema is created with smoke inhalation and hypothermia?
Flash edema; needs CPAP but not fluid dump
-
What is non-cardiogenic pulmonary edema?
High permeability of the capillaries; something happened at the alveolar level to cause leakage or widened interstitial space and impede gas exchange
-
What are some causes of non-cardiogenic pulmonary edema?
- Toxic inhalation
- Near drowning
- Liver disease
- Some lymphomas
- Nutritional deficiencies
- HAPE
- ARDS
- Hypothermia
-
What are the six categories of pulmonary edema?
- Secondary to altered capillary permeability (respiratory alkalosis)
- Secondary to increased pulmonary capillary pressure (PE, stenosis, volume overload)
- Secondary to decreased osmotic pressure found with hypoalbuminemia (albumin low in blood serum)
- Secondary to lymphatic inefficiency (no fluid reabsorption)
- Secondary to large negative pleural pressure w/ increased end expiratory volume (forced inhale can cause too much pressure)
- Secondary to unknown mechanisms
-
What does PROP stand for?
- Position of comfort
- Reassure patient
- Oxygen
- Positive pressure
-
For adult patients with a perfusing rhythm, but who are in respiratory arrest, you should give ________ breaths per minute.
10 - 12
-
A portable suction device generally creates a suction force of:
- 80 to - 120 mm Hg
-
A wall-mounted suction unit generally creates a suction force of:
at least negative 300 mm Hg
-
What rate should ventilations be provided at in an intubated patient in cardiac arrest?
8 - 10 bpm without pausing for chest compressions
-
Define paroxysmal nocturnal dyspnea.
characterized by sudden attacks of dyspnea, profuse diaphoresis, tachycardia, and wheezing that awakens a person from sleep; often associated with left ventricular failure and pulmonary edema
-
Define respiration.
the exchange of oxygen and carbon dioxide between an organism and the environment
-
Define external respiration.
the transfer of oxygen and carbon dioxide between the inspired air and pulmonary capillaries
-
Define pulmonary ventilation.
the movement of air into and out of the lungs, bringing oxygen into the lungs and removing carbon dioxide
-
Is expiration an active or a passive motion?
Passive; relaxation of the diaphragm and intercostals allows the elastic recoil properties of the lungs to decrease the size of the thoracic cavity
-
In a healthy person, the energy needed for normal quiet breathing is about what percentage?
3% of total body expenditure
-
In a person with pulmonary diseases, the energy needed for normal quiet breathing is about what percentage?
33% of total body expenditure
-
Define anatomical dead space.
the upper respiratory tract and the lower nonrespiratory bronchioles; space where gas exchange cannot occur
-
Define physiological dead space.
the anatomical dead space plus the volume of any nonfunctional alveoli
-
What is tidal volume?
the volume of gas inhaled or exhaled during a normal breath; normally 500 to 600cc
-
What is the typical volume of air held in the anatomical dead space?
150 cc
-
What is inspiratory reserve volume?
amount of gas that can be forcefully inhaled after inspiration of the normal tidal volume
-
What is expiratory reserve volume?
the amount of gas that can be forcefully exhaled after inspiration of the normal tidal volume
-
What is residual volume?
the volume of gas that remains in the respiratory system after forced expiration; normally 1000 to 1200cc
-
What is inspiratory capacity?
tidal volume plus inspiratory reserve volume; usually about 3500cc
-
What is functional residual capacity?
expiratory reserve volume plus the residual volume; usually about 2300cc
-
What is vital capacity?
- volume of gas that can move on deepest inspiration and expiration
- the sum of inspiratory reserve volume, expiratory reserve volume, and tidal volume; usually about 4600cc
-
What is total lung capacity?
the sum of the vital capacity and the residual volume; usually about 5800cc
-
What is minute volume?
- the amount of gas inhaled or exhaled in 1 minute
- multiply the tidal volume by the respiratory rate
-
What is minute alveolar ventilation?
- the amount of inspired gas available for gas exchange during 1 minute
- tidal volume minus dead space times respiratory rate
-
How long does it take for brain damage to occur after interruption of breathing and circulation?
4-6 minutes
-
What happens after 10 minutes of circulatory arrest?
some parts of the brain have been irreversibly damaged to the point of death
-
What is the maximum oxygen concentration obtainable with a nasal cannula?
30-35%
-
What is the maximum oxygen concentration obtainable with a simple face mask?
35-60%
-
What is the difference between a partial rebreather mask and a nonrebreather mask?
the partial has vent ports with one way disks that allow a portion of the patient's exhaled gas to enter the reservoir bag and be reused
-
What is the maximum oxygen concentration obtainable with a partial rebreather mask?
35-60%
-
What is the maximum oxygen concentration obtainable with a nonrebreather mask?
above 95%
-
When might mouth-to-nose ventilations be appropriate?
patients who have injuries to the mouth and lower jaw or have missing teeth or dentures
-
What is the ventilation rate for children and infants during mouth to mouth and nose breathing?
12-20 bpm
-
How far should the suction catheter be entered into the trachea when suctioning a patient's stoma?
no more than 3-5 inches
-
What is the difference in patient positioning when ventilating a stoma?
head should be kept in in-line position and the shoulders should be slightly elevated; the patients nostrils and mouth may need to be sealed to prevent air escape
-
When using a mouth to mask device, what oxygen liter flow should be attached?
10-12 lpm
-
What is the liter flow for most automatic transport ventilators?
40 lpm
-
Most ATVs are not to be used in children under ____ years of age.
5
-
ATVs should have a default rate of ___ bpm for adults and ___ bpm for pediatrics.
10 and 20
-
What formula should you use to determine the depth of ET tube insertion in a child over the age of 2?
depth = ET tube internal diameter X 3
-
Colormetric devices can be affected by what two factors?
vomitus and carbonated beverages
-
During CPR, why should an alternate method to colormetric devices be used to confirm ET tube placement?
because cardiac output is very low and not much gas exchange is happening to produce a color change
-
How does the LMA affect aspiration possibilities?
it does not offer full protection but aspiration is uncommon with it; blocks the esophagus fairly effectively
-
When performing RSI, what drug may be given prior to a neuromuscular blocker to blunt an increase in ICP?
lidocaine
-
What are the Mallampati signs of difficult intubation?
Class I-IV; indicates how difficult an intubation may be
-
What is the Class I Mallampati sign?
soft palate, uvula, fauces, pillars all visible; no difficulty
-
What is the Class II Mallampati sign?
soft palate, uvula, fauces visible; no difficulty
-
What is the Class III Mallampati sign?
soft palate, only base of uvula visible; moderate difficulty
-
What is the Class IV Mallampati sign?
hard palate only visible; severe difficulty
-
Rib fractures most commonly occur in which ribs and why?
3-8, where the ribs are least protected by musculature
-
What is the complication of a tension pneumothorax that can cause a decrease in cardiac output?
compression of the vena cava resulting in reduced venous return to the heart
-
If a tension pneumothorax develops from an open pneumothorax, the paramedic can attempt to burp the occlusive dressing. If this still does not relieve symptoms, what should be the next step?
Gently spread the wound to allow air to escape
-
Define traumatic asphyxia.
a severe crushing injury to the chest and abdomen resulting from an increase in intrathoracic pressure
-
What are the SXS of traumatic asphyxia?
- reddish purple discoloration of the face and neck
- skin below the area remains pink
- JVD
- swelling or hemorrhage of the conjunctiva (possible petechiae)
-
What is a common cause of myocardial contusion?
blunt chest trauma; often MVAs; often seen with sternal and multiple rib fractures
-
What are the SXS of a myocardial contusion?
- chest pain similar to MI
- ECG abnormalities
- new cardiac murmur
- pericardial friction rub
- persistent tachycardia
- palpitations
-
Define pulsus paradoxus.
systolic BP that drops more than 10-15 points during inspiration compared with expiration; can be seen with cardiac tamponade
-
What is electrical alternans?
change in the amplitude of a patient's ECG waveforms that decrease with every other cardiac cycle; can be seen with cardiac tamponade
-
What is myocardial rupture?
- the blood-filled chambers of the ventricles are compressed with enough force to rupture the chamber wall, septum, or valve
- nearly always instantly fatal, but death may be delayed for 2 to 3 weeks after injury
- signs and symptoms of congestive heart failure and cardiac tamponade are present
-
What are the common mechanisms of injury that produce traumatic aortic rupture?
- high speed MVAs
- falls from great heights
- crushing injuries
-
What is the typical site of damage to the aorta in a traumatic aortic rupture?
distal arch; just beyond the take off to the left subclavian and proximal to ligamentum arteriosum
-
What are some SXS of aortic rupture?
- BP may be normal or elevated with a significant difference between the two arms
- Upper extremity hypertension may be present combined with absent or weak femoral pulses
- May have paraplegia without spinal injury (decreased blood flow to spine)
-
If a tension pneumothorax does not improve after needle decompression OR the lack of a continuous flow of air after a dart should make you suspect what injury?
tracheobronchial injury
-
Diaphragmatic rupture is most often seen on which side of the body?
the left
-
What are the SXS of a diaphragmatic rupture?
- abdominal pain
- SOB
- decreased breath sounds
- abdomen may appear hollow or empty
- bowel sounds heard in chest
-
Some protocols may advise that a _______ _____ be placed to empty the stomach and reduce abdominal pressure.
nasogastric tube
-
Why is it important to ask patients whether they have been intubated before because of breathing difficulty?
history of previous intubation indicates severe pulmonay disease and may suggest that they may need to be intubated again
-
A slowing respiratory rate in a patient who is not improving suggests what?
exhaustion and impending respiratory insufficiency
-
Yellow or pale gray sputum may be realted to what kind of causes?
allergic or inflammatory causes
-
Pink frothy sputum is associated with...
late stages of pulmonary edema
-
What causes peripheral cyanosis?
a large amount of the hemoglobin in the blood is not carrying oxygen
-
What is bronchiectasis?
an abnormal dilation of the bronchi; caused by a pus-producing infection of the bronchial wall
-
What does inspiratory wheezing indicate?
- large and midsize muscular airways are obstructed
- may also suggest that the large airways are filled with secretions
-
What are some SXS of pneumonia?
- chest pain
- cough
- fever
- dyspnea
- hemoptysis (occasionally)
- acute shaking chills
- tachypnea
- tachycardia
- sputum production
- flank pain
-
How do we manage a patient with pneumonia?
- airway support with oxygen
- IV fluids to support BP and to thin secretions and mucus
- ECG
- transport
-
What is the most common cause of lung cancer?
cigarette smoking
-
What are some SXS of lung cancer?
- coughing
- sputum production
- lower airway obstruction (wheezing)
- respiratory illness (i.e. bronchitis)
-
What are some diseases that may present similar SXS as anaphylaxis?
- severe asthma with respiratory failure
- upper airway obstruction
- toxic or septic shock
- pulmonary edema (with or without MI)
- drug overdose
- hypovolemic shock
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What are some cardiovascular effects seen with severe allergic reactions?
- mild hypotension
- profound shock
- dysrhythmias are common
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What is angiodema?
a localized edematous reaction of the deep dermis or subcutaneous or submucosal tissues; appears in the form of giant wheals
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What drugs may be used in anaphylactic reactions?
- epinephrine
- beta-agonists
- glucagon
- corticosteroids
- possibly vasopressors
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What drugs a patient might be on may product a paradoxical response to epinephrine?
beta blockers; may increase the incidence and severity of anaphylaxis; in these cases, glucagon may be indicated
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Cardiac arrest from anaphylaxis requires what aggressive treatment?
volume replacement 2-4L to support circulation
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What are the "great vessels" located either partially or fully within the thoracic cavity?
- aorta
- pulmonary arteries
- pulmonary veins
- vena cava
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Where do the intercostal nerve, artery, and vein lie?
along the bottom of the rib
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Where does the phrenic nerve (that helps control the diaphragm) originate in the spinal column?
C3 C4 C5
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What is the anatomical difference in a child's airway vs. an adult?
in a child the epiglottis is omega shaped
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What is a normal PO2?
80 mmHg
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What is the most challenging thing about providing ventilations through a BVM?
obtaining and maintaining adequate seal
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When suctioning, when should the suction force be applied?
on extrication of the catheter
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What is the approximate depth of insertion in cm for an ET tube in a 10-year-old child?
17 cm
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Before a second attempt at intubation is made, how long must the patient be ventilated for?
15-30 seconds
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What is the volume that a pediatric BVM should hold?
450cc
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