Respiratory Emergencies

Question 1

Inspiration (inhalation)

Answer 1

an active process in which the intercostal (rib) muscles and the diaphragm contract, expanding the size of the chest cavity and causing air to flow into the lungs

Question 2

Expiration (exhalation)

Answer 2

a passive process in which the intercostal (rib) muscle and the diaphragm relax, causing the chest cavity to decrease in size and forcing air from the lungs

Question 3

Normal Breathing rates

Answer 3

Adult: 12-20
Child: 15-20
Infant: 25-50

Question 4

Pediatric airways

Answer 4

airway structures are smaller
tongue is proportionately larger and therefore take up more space in the mouth
Trachea is smaller, softer, and more flexible (cricoid cartilage is less developed and less rigid.)
Diaphragm is more dependent for respiration since the chest wall is softer

Question 5

Adequate Breathing: EMT intervention

Answer 5

oxygen by nonrebreather mask or nasal cannula

Question 6

Inadequate breathing: EMT intervention

Answer 6

Assisted ventilation with pocket face mask, bag-valve mask, or FROPVD

Question 7

Patient is not Breathing at all: EMT intervention

Answer 7

Immediately verify a pulse, if present, provide ventilations with pocket face mask, bag valve mask, or FROPVD at 12/minute for an adult and 20/ minute for an infant or child
if pulse is absent immediately begin chest compressions followed by ventilations and apply and AED

Question 8

Pedal Edema

Answer 8

swelling around the calves, ankles and feet

Question 9

Sacral Edema

Answer 9

swelling around the low back in bedridden patients

Question 10

Continuous Positive airway Pressure (CPAP)

Answer 10

form of noninvasive positive pressure ventilation (NPPV0 consisting of a mask and a means of blowing oxygen or air into the mask to prevent airway collapse or to help alleviate difficulty breathing
patients with obstructive sleep apnea sometimes have these devices
blowing oxygen or air continuously at a low pressure into the airway prevents the alveoli from collapsing at the end of exhalation and pushes fluid out of the alveoli back into the capillaries that surround them

Question 11

Contraindications for CPAP

Answer 11

two classes: anatomic-physiologic and pathologic
Anatomic -physiologic contraindications include mental status so depressed that the patient cannot protect their airway or follow instructions; lack of a normal, spontaneous respiratory rate; inability to sit up; hypotension, generall considered to be less than 90mmHg; and inability to get and maintain a good mask seal
Pathologic Contraindications include nausea and vomiting; penetrating chest trauma, particularly when a pneumothorax is possible; shock; upper gastrointestinal bleeding or recent gastric surgery

Question 12

Side effects to CPAP

Answer 12

CPAP maintains a positive pressure throughout the respiratory cycle, less blood is able to return to the heart through the veins. Ordinarily, when inspiration occurs, the pressure in the thoracic cavity decreases enough that it promotes the return of blood to the heart. When CPAP is being used the pressure in the lungs causes less blood to return to the heart, so the cardiac output decreases, resulting in drop in blood pressure systolic pressure needs to be over 90mmHg.
risk that the pressure may cause a weak are to rupture, leading to lung collapse (pneumothorax).
risk of gastric distention
drying of the corneas of the eyes

Question 13

Chronic Obstructive Pulmonary Disease (COPD)

Answer 13

Emphysema, chronic bronchitis, black lung, and many undetermined respiratory illnesses are classified as COPD.
mainly problem of middle-aged or older patients because these disorders take time to develop as tissues in the respiratory tract
smoking causes the overwhelming majority of cases of COPD. chemicals, air pollutants, or repeated infections cause this condition

Question 14

Chronic Bronchitis

Answer 14

the bronchiole lining is inflamed and excess mucus is formed. the cells in the bronchioles that normally clear away accumulation of mucus are not able to do so. the swelling apparatus on these cells, the cilia, have been damaged or destroyed.

Question 15

emphysema

Answer 15

the walls of the alveoli break down, greatly reducing the surface area for respiratory exchange. the lungs begin to lose elasticity. these factors combine to allow stale air laden with carbon dioxide to be trapped in the lungs, reducing the effectiveness or normal breathing efforts

Question 16

Patients without COPD breathing

Answer 16

the brain determines the breathe based on increased levels of CO2 in the blood

Question 17

Patients with COPD breathing

Answer 17

since COPD patients develop a tolerance to their body’s high levels of CO2, the brain learns to rely, instead, on low oxygen levels as the trigger to breath. The higher oxygen levels that result from oxygen administration may, in rare cases, signal the patient to reduce breathing or even to stop breathing (develop respiratory arrest)

Question 18

Asthma

Answer 18

seen in young and old patients alike, is a chronic disease that has episodic exacerbations or flares (disease that only seems to affect the patient at irregular intervals) and asthma attack or flare can be life threatening. many patients use steroid inhalers

Question 19

Causes of Asthma attacks

Answer 19

Attacks can be precipitated by insect stings, air pollutants, infection , strenuous exercise, or emotional stress

Question 20

When Asthma Attacks occur

Answer 20

small bronchioles lead to the air sacs of the lungs become narrowed because of contractions of the muscles that make up the airway. there is an overproduction of thick mucus. causing the small passages to practically close down severely restricting air flow.
air flow is usually constricted in one direction. when the patient inhales, the expanding lungs exert an outward pull, increasing the diameter of the airway and allowing air to flow into the lungs. during exhalation, however, the opposite occurs and the stale air becomes trapped in the lungs. causing the patient to forcefully exhale.

Question 21

Pulmonary Edema

Answer 21

abnormal accumulation of fluid in the alveoli of the lungs.
typically occurs because the left side of the heart has been damaged, often by a myocardial infarction or chronic hypertension. since the left side of the heart receives blood from the lungs, the inability to pump blood out results in pressure building up and going back to the lungs, only one layer of cells lines the alveolus and one layer covering the adjoining capillaries, when pressure builds up, it is relatively easy for fluid to cross this thin barrier and accumulate in the alveoli.

Question 22

Jugular Vein Distention

Answer 22

Bulging of the neck veins, and accumulation of fluid in the abdominal cavity

Question 23

Patient with Pulmonary Edema Lies down

Answer 23

fluid in the body moves back into the circulation, this means it can easily overload the system and leak into the lungs, leading at first to mild dyspnea that can be relieved by sleeping propped up. each night patient will feel worse

Question 24

Symptoms and signs of Pulmonary Edema

Answer 24

fluid back up into lungs when lying down feels like they are drowning, noticed a weight gain in just a few days, anxiety, pale, sweaty, tachycardia, hypertension, respirations that are rapid and labored, low SpO2, hear crackles or gurgling when auscultate the lungs

Question 25

Treatment of Pulmonary Edema Patients

Answer 25

High Concentration O2 with mask unless patients breathing is inadequate and you need to ventilate. keep patients legs (if possible) into a dependent position (hanging down). CPAP will push fluid out into interstitial space.

Question 26

Causes of PUlmonary Edema

Answer 26

most cases well be the result of heart failure or MI, some noncardiac causes are when exposed to low atmospheric pressure of high altitudes

Question 27

Pneumonia

Answer 27

infection of one or both lungs caused by bacteria, viruses, or fungi. results from the inhalation of certain microbes that grow in the lungs and cause inflammation (COPD and other respiratory disease patients and chronic health problems are more likely to obtain)

Question 28

Signes and Symptoms of Pneumonia

Answer 28

coughing (mucus-greenish, yellow, or bloody), fever, chest pain, severe chills. most patients complain of shortness of breath, either with or without exertion; chest pain that is sharp and pleuritic (worsens on inhalation); headache; pale, sweaty, fatigue, and confusion. When auscultating may hear crackles on just one side

Question 29

Prehospital Care for Pneumonia

Answer 29

supportive treatment

Question 30

Spontaneous Pneumothorax

Answer 30

When a lung collapses without injury or any other obvious cause. usually result of rupture of a bleb, a small section of the lungs that is weak. once the bleb ruptures the lung collapses and air leaks into the thorax.

Question 31

Causes of Spontaneous pneumothorax

Answer 31

tall, thin people are more likely to have a weak spot that can rupture with just a cough. smokers are also at high risk

Question 32

Signs and Symptoms of Spontaneous Pneumothorax

Answer 32

patient typically has sharp, pleuritic chest pain and shortness of breath. if its in a large area patient will often tire easily, be tachycardic, breath fast, have low SpO2 and exhibit cyanosis. Auscultation will reveal breath sounds that are decreased or absent on the side with the injured lung (this test is not reliable)

Question 33

Treatment For Spontaneous Pneumothorax

Answer 33

administer oxygen and treat like any other patient short of breath (more advanced personal will use a catheter.)

Question 34

Pulmonary Embolism

Answer 34

When something that is not blood like a blood clot, air, or fat tries to go through this blood vessel, it gets stuck and blocks an artery in the lungs. common for blood clot to start in a vein in the leg or pelvis (Deep Vein Thrombosis DVT)

Question 35

Deep vein thrombosis (DVT) factros that increase risk

Answer 35

limb immobility, local trauma to an extremity, and/or abnormally fast blood clotting with cancer, patients with lower extremity injuries (such as casted fractures), and anyone who is in the same position for a long period of time (airplane)

Question 36

Signs and Symptoms of Pulmonary Embolus

Answer 36

Extremely variable, making it difficult to detect. typical patient has sudden onset of sharp, pleuritic chest pain; shortness of breath; anxiety; a cough (sometimes with bloody sputum); sweaty, pale or cyanotic; tachycardia; tachypnea. Unfortunately few patients show these symptoms. patien may complain of lightheaded or dizzy with pain and swelling in one or both legs. wheezing sometimes when auscultation of chest. if large enough hypotensive or go into cardiac arrest.

Question 37

Treatment of Pulmonary Embolism

Answer 37

administer oxygen and treat like anyone else who is short of breath. keep high index of suspicion for pulmonary embolism in patients with recent immobilization or previous history of DVT

Question 38

Prevention of Pulmonary Emobolism

Answer 38

avoiding long periods of inactivity, refraining from smoking, taking appropriate medication when there is a high risk of forming clots, and getting early care for DVT

Question 39

Epiglottitis

Answer 39

When an infection inflames the area around and above the epiglottis, the tissue swells. if it swells enough, it can actually occlude, or close off, the airway. use to be disease of children, but it is now much less common in children than in adults in the United States. Primarily result of childhood vaccination against Haemophilus influenzae type B.

Question 40

Symptoms and Signs of Epiglottitis

Answer 40

Male in his forties who may have had a recent cold. symptoms include sore throat and painful or difficult swallowing. the patient is typically in the tripod position to increase the glottic opening. Other signs include sick appearance, muffled voice, fever, and drooling (because of pain and difficulty swallowing). alarming sign is stridor.
Children who have this disease often experience a sudden onset. child appears still leaning forward in tripod position, drooling and appearing to be in distress.

Question 41

Treatment for Epiglottitis

Answer 41

Do as much as possible to keep the patient calm and comfortable. DO NOT inspect the throat administer high concentration O2 and transport ASAP. prevention for children is the Haemophilus influenza type B vaccine

Question 42

Cystic Fibrosis (CF)

Answer 42

genetic disease that typically appears in childhood. causes thick, sticky mucus that accumulates in the lungs and digestive system. the mucus can cause life threatning infections and problems with digestion. most patiens are children

Question 43

Signs and Symptoms of Cystic Fibrosis

Answer 43

Coughing with large amounts of mucus from lungs
fatigue
frequent occurrence of pneumonia 
abdominal pain and distention
coughing up blood
nausea
weight loss

Question 44

Viral Respiratory Infections

Answer 44

Starts with sore or scratchy throat with sneezing, runny nose, feeling of fatigue. may be fever and chills. infection can spread into the lungs, causing shortness of breath. cough can be persistent and may produce sputum. symptoms usually persist for 1 to 2 weeks

Question 45

Treatment of Viral Respiratory Infections

Answer 45

administer oxygen and care for the patient like any other patient with respiratory destress

Question 46

Preventions of Viral Respiratory Infections

Answer 46

good hygiene

Question 47

Bronchoconsriction

Answer 47

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