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?
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?
The term "blue bloater" refers to someone with what disease?
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?
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?
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?
Define status asthmaticus.
A prolonged asthma attack that does not respond to bronchodilators
What is the first-line treatment for asthma in the US?
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...
The most common cause of children's pneumonia is what?
What is the major side effect of administering bronchodilators to a patient with exascerbated asthma?
Increased myocardial oxygen demand
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
The process of air moving in and out of the lungs
All disorders that result in ARDS cause what?
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?
Which lung sounds are most commonly associated with asthma?
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
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?
When do patients with emphysema have increased airway resistance?
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
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?
A PEFR that varies by 20-30% from previous readings indicates what level of exascerbation was present?
A PEFR that varies by more than 30% from previous readings indicates what level of exascerbation was present?
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?
After placing an ET tube, there are no lung sounds and positive epigastric sounds. The tube is most likely in the...
What is the most adequate indicator that adequate tidal volumes are being delivered during artificial ventilation?
adequate chest rise
What is normal PCO2?
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...
What concentration of oxygen can be delivered using a simple face mask at 10lpm?
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?
The safe residual (i.e. when an oxygen cylinder is considered empty) is?
What is the primary cause of airway obstruction in unconscious patients?
A BVM with a reservoir and an oxygen source of 15lpm delivers what oxygen concentration?
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
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?
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?
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?
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?
A patient with chronic bronchitis is likely to rely on what mechanism to stimulate their respiratory drive?
What is an intubation technique that may be performed without the use of specialized equipment?
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?
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...
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?
Define flail segment.
Three or more adjacent ribs fractured in two or more places
What is the definitive treatment for a cardiac tamponade?
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?
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?
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?
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?