1. What is a test that measures the amount of expired air in patients with known respiratory problems?
    PEFR peak expiratory flow rate
  2. What is polycythemia?
    Increased red blood cell production secondary to chronic hypoxia
  3. What does PEEP do?
    Creates pressure to keep the alveoli open
  4. The term "pink puffer" refers to someone with what disease?
  5. 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
  6. The term "blue bloater" refers to someone with what disease?
    Chronic bronchitis
  7. 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
  8. 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)
  9. What is the expected body morphology in a patient with emphysema?
    Thick barrel chest, thin appearance otherwise
  10. 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
  11. What is the most common site for thrombus formation leading to PE?
    the legs
  12. What is consolidation?
    a condition in which an area of the lungs fills with fluid and cellular debris; seen in pneumonia
  13. What lung sounds should you expect to hear with a PE?
  14. Define pulmonary embolism.
    The blockage of a pulmonary artery by a blood clot
  15. What is a differentiating sign between pneumonia and COPD?
    the presence of fever
  16. Respiratory alkalosis associated with hyperventilation syndrome is due to what cause?
    An excessive loss of CO2
  17. 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
  18. Define status asthmaticus.
    A prolonged asthma attack that does not respond to bronchodilators
  19. What is the first-line treatment for asthma in the US?
  20. 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
  21. Chronic bronchitis is most commonly associated with exposure to...
    cigarette smoke
  22. The most common cause of children's pneumonia is what?
    Influenza A
  23. What is the major side effect of administering bronchodilators to a patient with exascerbated asthma?
    Increased myocardial oxygen demand
  24. Define ARDS.
    Acute respiratory distress syndrome; it exists when the capillaries in the lung have increased permeability leading to rales and stiff alveoli
  25. 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)
  26. What is the first line treatment for a patient with hyperventilation syndrome?
    Calming and reassuring them
  27. Define ventilation.
    The process of air moving in and out of the lungs
  28. All disorders that result in ARDS cause what?
    pulmonary edema
  29. In a normally healthy person, what is the primary drive to breath based on?
    Levels of CO2
  30. What condition can pulmonary hypertension lead to?
    Right sided heart failure
  31. What is a bleb?
    A weakened area of the lung
  32. 74 y/o female, high fever and productive cough, shaking chills for the past 3 hours. What do you suspect?
  33. Which lung sounds are most commonly associated with asthma?
  34. Which part of the Fick principle would a FBAO interfere with?
    Ventilation (getting air into the lungs)
  35. What is cor pulmonale?
    Right sided heart failure and hypertrophy resulting from increased pressures in the pulmonary arteries
  36. 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
  37. What kind of pneumonia do vaccinations protect against and at what efficacy?
    80% to 90% against bacterial pneumonia
  38. Define carpopedal spasm.
    Tingling in the hands that may progress to spasm and tetany associated with hyperventilation syndrome
  39. What kind of breathing pattern is associated with hyperventilation syndrome?
    Rapid and deep
  40. Describe emphysema.
    Englargement and loss of elasticity of the alveoli
  41. Define a spontaneous pneumothorax.
    Air entering the pleural space not resultant of trauma
  42. What would bradycardia with a pulmonary cause imply?
    Severe hypoxemia and imminent respiratory arrest
  43. What is the difference between BiPAP and CPAP?
    BiPAP reduces the pressure applied when the patient exhales; CPAP is continuous
  44. Define chronic bronchitis.
    Inflammatory changes and excessive mucus production in the bronchial tree
  45. What does clubbing of the fingers indicate?
    Chronic hypoxemia
  46. When do patients with emphysema have increased airway resistance?
    on expiration
  47. When do patients with chronic bronchitis have increased airway resistance?
    on both inspiration and expiration
  48. Asthma exascerbation can be commonly triggered by what kind of infection?
    any viral respiratory infection
  49. Define asthma.
    A reactive airway disease that is stimulated by both intrinsic and extrinsic factors; involves inflammation, bronchoconstriction, and increased mucus production
  50. Define pulmonary hypertension.
    An increase in the pressure of the pulmonary artery due to vasoconstriction of the pulmonary capillaries
  51. What three diseases does the term "obstructive airway disease" refer to?
    Chronic bronchitis, asthma, and emphysema
  52. What is a productive cough with thick green sputum indicate?
  53. A PEFR that varies by 20-30% from previous readings indicates what level of exascerbation was present?
  54. A PEFR that varies by more than 30% from previous readings indicates what level of exascerbation was present?
  55. What part of Fick's principle would CNS depression lead to a problem with?
    Ventilation; moving air into and out of the lungs
  56. Excessive positive intrathoracic pressure during an asthma attack may lead to what sign?
    Pulsus paradoxus
  57. After placing an ET tube, there are no lung sounds and positive epigastric sounds. The tube is most likely in the...
  58. What is the most adequate indicator that adequate tidal volumes are being delivered during artificial ventilation?
    adequate chest rise
  59. What is normal PCO2?
    35-40 mmHg
  60. Physiologic dead space is increased in patients with...
    respiratory diseases like emphysema
  61. If an ET tube has been properly placed, an esophageal detector device will...
    reinflate easily
  62. What concentration of oxygen can be delivered using a simple face mask at 10lpm?
  63. 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
  64. The ET tube size used for a cric is usually?
    6.0 to 7.0
  65. Which is the gas most prevalent in the atmosphere?
  66. The safe residual (i.e. when an oxygen cylinder is considered empty) is?
    200 psi
  67. What is the primary cause of airway obstruction in unconscious patients?
    the tongue
  68. A BVM with a reservoir and an oxygen source of 15lpm delivers what oxygen concentration?
  69. Depolarizing agents have what kind of onset and duration as compared to polarizing agents?
    Quicker onset and shorter duration
  70. Blood in the pulmonary veins is...
    high in oxygen
  71. How do you apply cricoid pressure?
    place firm pressure against the cricoid cartilage
  72. Define compliance.
    the ease with which the lungs expand during inspiration
  73. What is the minimum flow rate of oxygen to be delivered when giving mouth-to-mask ventilations with supplemental oxygen?
    10-12 lpm
  74. 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
  75. What does pulmonary surfactant do?
    lowers the surface tension, preventing alveolar collapse
  76. What is the correct location for a needle cric?
    the cricothyroid membrane
  77. What is the maximum acceptable flow rate for a nasal cannula?
    6 lpm
  78. Define diffusion.
    The movement of a gas from a higher pressure to a lower pressure across a semipermeable membrane
  79. Define internal respiration.
    The transfer of oxygen and carbon dioxide between the capillary red blood cells and the tissue cells
  80. What is one example of a depolarizing neuromuscular blocker?
  81. What is the purpose of an oral airway (OPA)?
    Keep the tongue from obstructing the glottis during ventilation
  82. What is the minimum oxygen flow rate for any face mask?
    6 lpm
  83. A patient with chronic bronchitis is likely to rely on what mechanism to stimulate their respiratory drive?
  84. What is an intubation technique that may be performed without the use of specialized equipment?
    digital intubation
  85. Define Biot's respirations.
    characterized by irregular pattern, rate, and volume with intermittent periods of apnea
  86. What does pulse oximetry measure?
    the amount of hemoglobin saturated with oxygen
  87. What is a whistle-tip suction catheter?
    flexible and designed to suction smaller portions of the airway or through an ET tube
  88. After the administration of sux, a patient is usually relaxed enough for intubation after how many seconds?
  89. 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
  90. Define central neurogenic hyperventilation.
    deep, rapid, regular respirations
  91. In ideal circumstances, the suctioning of an adult patient should not exceed...
    15 seconds
  92. Define tidal volume.
    The amount of air inhaled or exhaled during a normal breath
  93. Treatment for a myocardial contusion following significant blunt-force trauma may include...
    high flow oxygen
  94. Define tension pneumothorax.
    air trapped in the pleural space under pressure
  95. The release of a patient from a position of traumatic asphyxia may cause...
    hypovolemia and shock
  96. What is a common sign/symptom associated with hemothorax?
  97. Define flail segment.
    Three or more adjacent ribs fractured in two or more places
  98. What is the definitive treatment for a cardiac tamponade?
  99. What is good treatment for a patient with a pulmonary contusion?
    Intubation with positive pressure ventilation
  100. Define pulmonary contusion.
    alveolar and lung capillary damage resulting in interstitial and intraalveolar bleeding and swelling
  101. What do we cover an open pneumothorax with?
    An occlusive dressing taped on three sides
  102. 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
  103. 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
  104. A simple pneumothorax most often occurs as a result of what injury?
    a rib fracture that penetrates the chest wall
  105. A rare complication associated with fractures of the clavicle or ribs 1 or 2 may be injury to what vein?
  106. What is Beck's triad and what condition does it indicate?
    muffled heart sounds, JVD, and hypotension; pericardial tamponade
  107. How much blood can be contained in one hemithorax?
  108. What is a sign that is typically associated with myocardial contusion?
    new cardiac murmur
  109. What CO2 finding would indicate the need for intubation and positive pressure ventilation in a patient with a flail chest?
  110. What diseases is the use of albuterol usually indicated in?
    asthma, emphysema, chronic bronchitis
  111. What is the adult dose for albuterol?
    2.5-5mg in 3cc via nebulizer; max 10mg
  112. What is the pediatric dose for albuterol?
    1.25-2.5mg in 3cc via nebulizer; max 5 mg
  113. How does albuterol work?
    beta 2 selective agonist; bronchodilator
  114. What diseases is aminophylline usually indicated for?
    asthma, emphysema, chronic bronchitis, anaphylaxis
  115. How does aminophylline work?
    xanthine bronchodilator
  116. What respiratory disease is atropine usually indicated in?
    bronchial asthma
  117. How does atropine work?
  118. What is the adult dose for atropine?
    2.0mg IVP PRN
  119. What is the pediatric dose for atropine?
    0.5mg/kg PRN
  120. What disease is the use of corticosteroids usually indicated in?
    Reactive airway diseases; exascerbated asthma
  121. What is the mechanism of action of corticosteroids in asthma?
  122. What is the adult dose for dexamethasone?
  123. What is the pediatric dose for dexamethasone?
  124. What is the adult dose for methylprednisoline?
  125. What is the pediatric dose for methylprednisoline?
  126. What is the adult dose for prednisone?
    1mg/kg max 60mg
  127. What respiratory diseases indicate the use of diphenhydramine?
    allergic reaction and anaphylaxis
  128. By what two mechanisms does diphenhydramine work?
    Anticholinergic and antihistamine
  129. What is the adult dose of diphenhydramine?
    20-50mg SIVP
  130. What is the pediatric dose of diphenydramine?
    1mg/kg SIVP max 50mg
  131. What respiratory diseases indicate the use of epinephrine?
    anaphylaxis, severe bronchospasm due to asthma, allergic reaction
  132. What is the adult dose of epinephrine?
    0.3mg PRN
  133. What is the pediatric dose of epinephrine?
    0.01mg/kg max 0.3mg PRN
  134. What is Flolan used for?
    management of primary pulmonary hypertension
  135. What mechanism does Flolan work by?
    Directly dilates the pulmonary and systemic arterial vasculature
  136. What is the indication for Furosemide?
    CHF with severe pulmonary edema
  137. What class/action is Furosemide?
    loop diuretic
  138. What is the adult dose for Furosemide?
    2X the patient's PO; 20-40mg; or 0.5-1.0mg/kg
  139. What is the pediatric dose for Furosemide?
    1mg/kg SIVP
  140. What respiratory disease is glucagon indicated in?
    anaphylaxis refractory to epinephrine
  141. What is the adult dose for glucagon?
    1-2mg q 5-10 PRN
  142. What is the pediatric dose for glucagon?
    0.1mg/kg up to 1mg
  143. What is the indication for giving hydroxycobalamine?
    Antidote for cyanide poisoning
  144. What is the adult dose for hydroxycobalamine?
    5g over 30 min IV
  145. What is the pediatric dose for hydroxycobalamine?
    (<70kg) 70 mg/kg IV
  146. What is the indication for Xylocaine?
    nasal intubation
  147. How does Xylocaine work?
    local anesthetic; sodium channel blocker
  148. What respiratory disease is an indication for magnesium sulfate?
    Acute asthma refractory to other treatment
  149. What is the action of magnesium?
    smooth muscle relaxant
  150. What is the adult dose for magnesium?
    1-2g SIVP
  151. What is the pediatric dose for magnesium?
    25-50mg/kg IVP max 2g
  152. What is the respiratory indication for morphine?
    CHF with severe pulmonary edema
  153. What is the adult dose for morphine?
    2-10mg SIVP
  154. What is the pediatric dose for morphine?
    0.1mg/kg SIVP max 15mg
  155. What is the respiratory indication for naloxone?
    suspected narcotic overdose to increase respiratory effort
  156. What is the adult dose for naloxone?
  157. What is the pediatric dose for naloxone?
    • 0.1mg/kg <5 years or <20 kg
    • 2mg >5 years or >20kg
    • neonates 0.1mg/kg
  158. What is the respiratory indication for nitroglycerin?
    CHF with pulmonary edema
  159. What is the adult dose for nitro?
    0.4mg X3 q 3-5
  160. What is considered low flow oxygen?
    1-4 lpm
  161. What is considered moderate flow oxygen?
    6-8 lpm
  162. What is considered high flow oxygen?
    10-15 lpm
  163. What is the indication for phenylephrine?
    nasal intubation
  164. How does phenylephrine work?
    pure alpha adrenergic agent; vasoconstriction
  165. What is the "dose" for phenylephrine?
    2 squirts in the selected nostril prior to intubation
  166. What is the indication for promethazine?
    prevention of nausea/vomiting; prevents aspiration
  167. What is the adult dose for promethazine?
  168. What is the pediatric dose for promethazine?
    >2 years 0.25-0.5mg/kg
  169. What is the indication for propofol?
    maintenance of sedation in the intubated mechanically ventilated patient
  170. What is the indication for terbutaline?
  171. What is the most common cause of laryngospasm?
  172. Define mucosal necrosis.
    Perfusion of endothelium in larynx is impaired and causes permanent damage; caused by overinflation of cuffs on tubes
  173. How far do you insert the King airway?
    To the teeth guard
  174. What is one big advantage of the King airway over others?
    The sizes can get down to a much smaller patient size
  175. How can you determine if your placement is correct with a King airway?
    Bag compliance
  176. Define atelectasis.
    the formation of fewer but larger alveoli due to destruction and collapse of alveolar walls
  177. What is the length and gauge of a needle used in a chest dart?
    2-3" long, 12-14 gauge
  178. How can pulsus paradoxus occur with a tension pneumothorax?
    The pressure from the tension pneumothorax can actually cause a cardiac tamponade
  179. What is the principle behind V:Q mismatch?
    you need 5 liters of blood for every 4g of O2 (0.8 is the goal)
  180. V:Q mismatch can occur two ways. Name them.
    Too much blood and not enough O2 or Too much O2 and not enough blood
  181. 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
  182. What kind of edema is created with smoke inhalation and hypothermia?
    Flash edema; needs CPAP but not fluid dump
  183. 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
  184. What are some causes of non-cardiogenic pulmonary edema?
    • Toxic inhalation
    • Near drowning
    • Liver disease
    • Some lymphomas
    • Nutritional deficiencies
    • HAPE
    • ARDS
    • Hypothermia
  185. 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
  186. What does PROP stand for?
    • Position of comfort
    • Reassure patient
    • Oxygen
    • Positive pressure
  187. For adult patients with a perfusing rhythm, but who are in respiratory arrest, you should give ________ breaths per minute.
    10 - 12
  188. A portable suction device generally creates a suction force of:
    - 80 to - 120 mm Hg
  189. A wall-mounted suction unit generally creates a suction force of:
    at least negative 300 mm Hg
  190. What rate should ventilations be provided at in an intubated patient in cardiac arrest?
    8 - 10 bpm without pausing for chest compressions
  191. 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
  192. Define respiration.
    the exchange of oxygen and carbon dioxide between an organism and the environment
  193. Define external respiration.
    the transfer of oxygen and carbon dioxide between the inspired air and pulmonary capillaries
  194. Define pulmonary ventilation.
    the movement of air into and out of the lungs, bringing oxygen into the lungs and removing carbon dioxide
  195. 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
  196. In a healthy person, the energy needed for normal quiet breathing is about what percentage?
    3% of total body expenditure
  197. In a person with pulmonary diseases, the energy needed for normal quiet breathing is about what percentage?
    33% of total body expenditure
  198. Define anatomical dead space.
    the upper respiratory tract and the lower nonrespiratory bronchioles; space where gas exchange cannot occur
  199. Define physiological dead space.
    the anatomical dead space plus the volume of any nonfunctional alveoli
  200. What is tidal volume?
    the volume of gas inhaled or exhaled during a normal breath; normally 500 to 600cc
  201. What is the typical volume of air held in the anatomical dead space?
    150 cc
  202. What is inspiratory reserve volume?
    amount of gas that can be forcefully inhaled after inspiration of the normal tidal volume
  203. What is expiratory reserve volume?
    the amount of gas that can be forcefully exhaled after inspiration of the normal tidal volume
  204. What is residual volume?
    the volume of gas that remains in the respiratory system after forced expiration; normally 1000 to 1200cc
  205. What is inspiratory capacity?
    tidal volume plus inspiratory reserve volume; usually about 3500cc
  206. What is functional residual capacity?
    expiratory reserve volume plus the residual volume; usually about 2300cc
  207. 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
  208. What is total lung capacity?
    the sum of the vital capacity and the residual volume; usually about 5800cc
  209. What is minute volume?
    • the amount of gas inhaled or exhaled in 1 minute
    • multiply the tidal volume by the respiratory rate
  210. 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
  211. How long does it take for brain damage to occur after interruption of breathing and circulation?
    4-6 minutes
  212. What happens after 10 minutes of circulatory arrest?
    some parts of the brain have been irreversibly damaged to the point of death
  213. What is the maximum oxygen concentration obtainable with a nasal cannula?
  214. What is the maximum oxygen concentration obtainable with a simple face mask?
  215. 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
  216. What is the maximum oxygen concentration obtainable with a partial rebreather mask?
  217. What is the maximum oxygen concentration obtainable with a nonrebreather mask?
    above 95%
  218. When might mouth-to-nose ventilations be appropriate?
    patients who have injuries to the mouth and lower jaw or have missing teeth or dentures
  219. What is the ventilation rate for children and infants during mouth to mouth and nose breathing?
    12-20 bpm
  220. How far should the suction catheter be entered into the trachea when suctioning a patient's stoma?
    no more than 3-5 inches
  221. 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
  222. When using a mouth to mask device, what oxygen liter flow should be attached?
    10-12 lpm
  223. What is the liter flow for most automatic transport ventilators?
    40 lpm
  224. Most ATVs are not to be used in children under ____ years of age.
  225. ATVs should have a default rate of ___ bpm for adults and ___ bpm for pediatrics.
    10 and 20
  226. 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
  227. Colormetric devices can be affected by what two factors?
    vomitus and carbonated beverages
  228. 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
  229. How does the LMA affect aspiration possibilities?
    it does not offer full protection but aspiration is uncommon with it; blocks the esophagus fairly effectively
  230. When performing RSI, what drug may be given prior to a neuromuscular blocker to blunt an increase in ICP?
  231. What are the Mallampati signs of difficult intubation?
    Class I-IV; indicates how difficult an intubation may be
  232. What is the Class I Mallampati sign?
    soft palate, uvula, fauces, pillars all visible; no difficulty
  233. What is the Class II Mallampati sign?
    soft palate, uvula, fauces visible; no difficulty
  234. What is the Class III Mallampati sign?
    soft palate, only base of uvula visible; moderate difficulty
  235. What is the Class IV Mallampati sign?
    hard palate only visible; severe difficulty
  236. Rib fractures most commonly occur in which ribs and why?
    3-8, where the ribs are least protected by musculature
  237. 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
  238. 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
  239. Define traumatic asphyxia.
    a severe crushing injury to the chest and abdomen resulting from an increase in intrathoracic pressure
  240. 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)
  241. What is a common cause of myocardial contusion?
    blunt chest trauma; often MVAs; often seen with sternal and multiple rib fractures
  242. What are the SXS of a myocardial contusion?
    • chest pain similar to MI
    • ECG abnormalities
    • new cardiac murmur
    • pericardial friction rub
    • persistent tachycardia
    • palpitations
  243. Define pulsus paradoxus.
    systolic BP that drops more than 10-15 points during inspiration compared with expiration; can be seen with cardiac tamponade
  244. 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
  245. 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
  246. What are the common mechanisms of injury that produce traumatic aortic rupture?
    • high speed MVAs
    • falls from great heights
    • crushing injuries
  247. 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
  248. 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)
  249. 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
  250. Diaphragmatic rupture is most often seen on which side of the body?
    the left
  251. 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
  252. Some protocols may advise that a _______ _____ be placed to empty the stomach and reduce abdominal pressure.
    nasogastric tube
  253. 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
  254. A slowing respiratory rate in a patient who is not improving suggests what?
    exhaustion and impending respiratory insufficiency
  255. Yellow or pale gray sputum may be realted to what kind of causes?
    allergic or inflammatory causes
  256. Pink frothy sputum is associated with...
    late stages of pulmonary edema
  257. What causes peripheral cyanosis?
    a large amount of the hemoglobin in the blood is not carrying oxygen
  258. What is bronchiectasis?
    an abnormal dilation of the bronchi; caused by a pus-producing infection of the bronchial wall
  259. What does inspiratory wheezing indicate?
    • large and midsize muscular airways are obstructed
    • may also suggest that the large airways are filled with secretions
  260. What are some SXS of pneumonia?
    • chest pain
    • cough
    • fever
    • dyspnea
    • hemoptysis (occasionally)
    • acute shaking chills
    • tachypnea
    • tachycardia
    • sputum production
    • flank pain
  261. 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
  262. What is the most common cause of lung cancer?
    cigarette smoking
  263. What are some SXS of lung cancer?
    • coughing
    • sputum production
    • lower airway obstruction (wheezing)
    • respiratory illness (i.e. bronchitis)
  264. 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
  265. What are some cardiovascular effects seen with severe allergic reactions?
    • mild hypotension
    • profound shock
    • dysrhythmias are common
  266. What is angiodema?
    a localized edematous reaction of the deep dermis or subcutaneous or submucosal tissues; appears in the form of giant wheals
  267. What drugs may be used in anaphylactic reactions?
    • epinephrine
    • beta-agonists
    • glucagon
    • corticosteroids
    • possibly vasopressors
  268. 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
  269. Cardiac arrest from anaphylaxis requires what aggressive treatment?
    volume replacement 2-4L to support circulation
  270. What are the "great vessels" located either partially or fully within the thoracic cavity?
    • aorta
    • pulmonary arteries
    • pulmonary veins
    • vena cava
  271. Where do the intercostal nerve, artery, and vein lie?
    along the bottom of the rib
  272. Where does the phrenic nerve (that helps control the diaphragm) originate in the spinal column?
    C3 C4 C5
  273. What is the anatomical difference in a child's airway vs. an adult?
    in a child the epiglottis is omega shaped
  274. What is a normal PO2?
    80 mmHg
  275. What is the most challenging thing about providing ventilations through a BVM?
    obtaining and maintaining adequate seal
  276. When suctioning, when should the suction force be applied?
    on extrication of the catheter
  277. What is the approximate depth of insertion in cm for an ET tube in a 10-year-old child?
    17 cm
  278. Before a second attempt at intubation is made, how long must the patient be ventilated for?
    15-30 seconds
  279. What is the volume that a pediatric BVM should hold?
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