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FISDAP Airway Exam 3
What is minute volume? What does it measure? ----CORRECT ANSWER--------Minute volume = RR x tidal volume. Volume of air moving through lungs in 1 minute. Can be estimated quickly. Count RR rate. If normal check to see chest rise and fall (tidal volume). If chest rise and fall is weak and/or little air coming out of nose, then the person has small minute volume. Alveolar Minute Volume ----CORRECT ANSWER--------Volume of air moved through lungs in 1 minute minus the dead space. Alveolar Minute Volume = (tidal volume - dead space) x RR Alveolar Ventilation ----CORRECT ANSWER--------Volume of air that reaches alveoli. Alveolar ventilation = tidal volume - dead space Name the characteristics of normal breathing ----CORRECT ANSWER--------1. Normal rate (12-20)
- regular pattern of inhalation/exhalation
- clear bilateral lung sounds
- regular and equal chest rise/fall
- adequate depth (tidal volume) What are the characteristics of inadequate breathing (adults)? ----CORRECT ANSWER---- ----Chapter 6
- labored breathing (activating accessory muscles of respiration)
- 12< or >20 breaths/minute
- muscle retractions above clavicles or between ribs and below rib cage
- pale/cyanotic skin
- cool, damp, clammy skin
- tripod position Chapter 10
- 12< or 20>
- irregular rhythm
- diminished, absent or noisy auscultated breath sounds
- reduced flow of expired air at nose/mouth
- unequal or inadequate chest expansion
- labored breathing
- shallow depth
- pale, cyanotic, cool or moist skin
- retractions around ribs or above clavicles What are agonal gasps? What should you do if a pt has agonal gasps? ----CORRECT ANSWER--------Pt in cardiac arrest has occasional gasping breaths because respiratory center in brain continues to send signals to breathing muscles. Artificial ventilations and chest compressions. From the atmosphere, what structures does air pass through during ventilation? - --- CORRECT ANSWER--------Starts in atmosphere, then nose, nasopharyngeal space/orophargyneal space (if mouth breather), then pharynx, larynx, trachea, bronchi, bronchioles, alveoli What is the purpose of the nasal passages and nasopharynx? ----CORRECT ANSWER---- ----To warm/humidify air as it passes through What is the difference between respiration and ventilation? ----CORRECT ANSWER-------- Respiration refers to the exchange of gases in the alveoli, ventilation refers to the movement of air into the lungs. Respiration is needed to provide O2 to cells and remove waste products. Also regulates pH of blood. What are the structures of the upper airway? ----CORRECT ANSWER--------nose, mouth, tongue, jaw, pharynx and larynx What structure is considered a landmark that divides the upper airway from lower? ---- CORRECT ANSWER--------The larynx, anything above is upper. The larynx and below are lower. What are the structures of the lower airways? ----CORRECT ANSWER--------larynx (includes adam's apple/thyroid cartilage, cricothyroid membrane, cricoid cartilage), trachea, bronchi, bronchioles, alveoli Describe the anatomy of the larynx. ----CORRECT ANSWER--------From superior to inferior. Thyroid cartilage, cricothyroid membrane, and cricoid membrane. The thyroid cartilage and cricoid cartilage are anterior to the larynx, and the cricothyroid membrane is posterior to both structures.
What two areas of the brain are involved in respiration? ----CORRECT ANSWER-------- medulla-controls rhythm, initiates inspiration, sets base pattern for respirations, and stimulates diaphragm to contract. pons-changes depth of inspiration, expiration or both. True or false: arteries bring oxygenated blood to organs/capillaries ----CORRECT ANSWER--------True in most cases with one exception. Arteries (away) bring blood away from the heart. Usually this is oxygenated blood. But the pulmonary arteries bring oxygen poor blood away from the heart, to the lungs to be oxygenated. What is the tidal volume? ----CORRECT ANSWER--------amount of air moved in/out of lungs in single breath. Usually 500 ml in adult What is inspiratory reserve volume? ----CORRECT ANSWER--------Deepest breath you can take after normal respiration What is expiratory reserve volume/Vital Capacity? ----CORRECT ANSWER-------- maximum amount you can breathe out after normal breath. What is residual volume? ----CORRECT ANSWER--------Remaining gas in lungs after exhalation. This is to keep lungs inflated What is dead space? What structures are considered part of dead space? ----CORRECT ANSWER--------Part of respiratory system not involved in active respiration. Air moves through here but little to no respiration occurs. Mouth, trachea, bronchi and bronchioles considered dead space Where are the alpha-1 receptors located? What is their effect? ----CORRECT ANSWER---- ----location-blood vessels constricted blood vessels, skin is pale, cool, clammy They essentially increase BP Where are the Beta-1 receptors located? What is their effect? ----CORRECT ANSWER----- ---location-heart effect- increased HR, increased force of contraction They essentially increase CO since CO = HR x SV
Where are the Beta-2 receptors located? What is their effect? ----CORRECT ANSWER----- ---location - lungs (beta-2 is beta-tube) effect - bronchodilation (more air enters lungs) Where are the muscarinic receptors located? What is their effect? ----CORRECT ANSWER--------location - heart effect - decreased HR, decreased force of contraction Muscarinic is parasympathetic system and do complete opposite of Beta-1 which is sympathetic What hormones activate the sympathetic nervous system? ----CORRECT ANSWER-------- Epineprhine and norepineprhine, which are released from he adrenal gland after stimulation by the sympathetic nervous system. These hormones stimulate heart and blood vessels. What is pathophysiology? ----CORRECT ANSWER--------Study of how normal physiologic processes are affected by disease What is respiratory compromise? ----CORRECT ANSWER--------Inability of body to move gas effectively. Can result in decreased O2 (hypoxia) and increased CO2 (hypercarbia) What factors can impair ventilation? ----CORRECT ANSWER--------1. Obstruction a. foreign objects - toys, food, teeth tongue etc b. physiological - induced by asthma, allergic rxns, infection
- Impairment a. brain injury - to medulla/pons b. breathing muscles - diaphragm, c. nerves - neuromuscular disease like cerebral palsy can affect phrenic nerve
- Other factors a. drugs - opioids can reduce RR b. loss of consciousness - can cause impaired ventilation c. trauma to chest wall - impair expansion of lungs What factors can impair respiration? ----CORRECT ANSWER--------1. air (too little O2, too much CO2, toxins like CO)
- impaired movement of gas across cell membrane (due to fluid in alveoli, mucus or other secretions)
- Blood vessels become clogged (pulmonary embolism)
How is regulation of breathing different in those with COPD? What does research indicate about assisting in respiration with COPD sufferers? ----CORRECT ANSWER--------COPD sufferers have difficulty removing CO2 from body. Overtime, respiratory control centers in brain adjust to this new baseline of CO2. In late stage COPD hypoxic drive is activated. Some research suggests that providing high flow O2 could negatively affect body's drive to breathe. What is Dyspnea? ----CORRECT ANSWER--------Shortness of breath Signs and symptoms of Hypoxia? ----CORRECT ANSWER--------Early
- Restlessness
- Irritability
- apprehension
- tachycardia
- anxiety Late
- mental status changes
- weak (thready) pulse
- cyanosis
- Dyspnea Cellular respiration (Metabolism)? ----CORRECT ANSWER--------Cells take energy from nutrients through series of chemical processes. What is the difference between external and internal respiration? ----CORRECT ANSWER- -------External - process of breathing fresh air into respiratory system and exchanging O and CO2 between alveoli and blood in pulmonary capillaries internal - exchange of oxygen and CO2 between systemic circulatory systems and cells of body What are the critical periods in which a cell needs O2? ----CORRECT ANSWER-------- 0 - 1 minute: cardiac irritability 0 - 4 minute: brain damage not likely 4 - 6 minute: brain damage possible 6 - 10 minute: brain damage likely more than 10: irreversible brain damage What is intrapulmonary shunting? What is the cause of it? ----CORRECT ANSWER-------- It's when blood enters lungs from right side of heart bypasses alveoli and return to left side of heart in unoxygenated state. Can be caused by nonfunctional alveoli due to diseases
What factors can lead to hypoxia due to circulatory compromise? ----CORRECT ANSWER--------1. obstruction of blood flow due to a. pulmonary embolism b. pneumothorax c. heart failure d. cardiac tamponade
- Decreased ability of blood to carry O a. blood loss b. anemia c. shock (vasodilatory shock) What is labored breathing? How do you tell someone has it? ----CORRECT ANSWER------ --Pt with inadequate breathing may appear to be working hard to breathe. Look for use of accessory muscles which are not used during normal breathing What are Cheyne-Stokes Respirations? What do they indicate? ----CORRECT ANSWER-- ------Irregular respiration where pt breathes w/ increasing rate/depth that is followed by apnea, followed again by period of increasing rate/depth of respiration. Can occur in people with strokes/head trauma What are ataxic respirations? ----CORRECT ANSWER--------When pt has irregular ineffective respirations that may or may not have identifiable pattern What are Kussmaul respirations? What do they indicate? ----CORRECT ANSWER-------- Deep, rapid respirations Seen in pt's with metabolic acidosis, or those with diabetes You arrive on scene with a pt that is conscious but experiencing respiratory distress. What are two devices that can assess their respiration? ----CORRECT ANSWER--------1. Pulse oximetry (measures O2 bound to hemoglobin)
- Capnography device (measures end tidal CO2) How would you use a pulse oximeter? ----CORRECT ANSWER--------1. clean pt's finger, and remove nail polish as needed. Place finger into probe and turn on.
- Palpate radial pulse to ensure accuracy and correlation w/ pulse ox Normal reading between 98-100. Less than 90% pt requires treatment unless chronic condition. Oxygen applied when SPO2 drops below 94% What can cause an inaccurate pulse ox? ----CORRECT ANSWER--------1. Hypovolemia
Often due to RSV infection, severe bronchiole inflammation. Occurs most frequently in infants, especially boys. Provide O2 therapy, allow pt to remain in comfortable position. Reassess frequently and be prepared to manage airway/positive pressure ventilation Bronchitis Signs and Symptoms ----CORRECT ANSWER--------1. Chronic cough w/ sputum production
- Wheezing
- cyanosis
- Tachypnea Type of COPD, can be due to tobacco. When excess mucus created. Carbon Monoxide Poisoning ----CORRECT ANSWER--------1. flu like symptoms
- headache
- dizziness
- fatigue
- nausea
- vomiting
- chest pain remove them from scene, administer high flow o2 by nonrebreathing mask. May need full airway control w/ airway adjunct and bvm ventilation CHF ----CORRECT ANSWER--------1. Dependent edema
- Crackles (pulmonary edema)
- Orthopnea
- Paroxysmal nocturnal dyspnea Common Cold ----CORRECT ANSWER--------1. cough
- runny/stuffy nose
- sore throat COPD ----CORRECT ANSWER--------slow process of dilation/disruption of airways/alveoli caused by chronic bronchial obstruction Croup ----CORRECT ANSWER--------1. fever
- barking cough
- stridor
- mostly seen in pediatric patients inflammation/swelling of pharynx, larynx and trachea. Typically seen in young children Treat w/ humidified O
Diphtheria ----CORRECT ANSWER--------1. difficulty breathing/swallowing
- sore throat
- thick gray buildup in throat/nose
- fever Emphysema ----CORRECT ANSWER--------1. barrel chest
- pushed lip breathing (pink puffers)
- dyspnea on exertion
- cyanosis
- wheezing/decreased breath sounds Most common form of COPD. Loss of elastic material in lungs Epiglottitis ----CORRECT ANSWER--------1. Dyspnea
- High fever
- stridor
- drooling
- difficulty swallowing
- severe sore throat
- tripod/sniffing position Life threatening, caused by bacterial infection of epiglottis in children, risk of complete airway obstruction. Try to keep them from crying. Do not put anything in mouths. Provide quick transport to ER, focus on maintaining patent airway Flu ----CORRECT ANSWER--------1. cough
- fever
- sore throat
- fatigue Hay Fever ----CORRECT ANSWER--------coldlike symptoms, caused by allergic response. Hyperventilation ----CORRECT ANSWER--------over breathing to the point of arterial CO falls below normal. Alkalosis of blood occurs.
- anxiety
- dizziness
- numbness
- tingling of hands/feet
- painful spasms of hand/feet
- Pt's feel they cannot catch breathe occurs when someone experiences psychological distress. Maybe be as high as 40 breaths/min or low as 20. Verbally instruct pt to slow breathing, and if that doesn't work, give supplemental O2 and provide transport
- sudden onset
- dyspnea
- tachycardia
- clear breath sounds initially
- hemoptysis (coughing up blood)
- tachypnea tension pneumothorax ----CORRECT ANSWER--------1. severe shortness of breath
- decreased/altered level of consciousness
- neck vein distension
- tracheal deviation (late sign)
- hypotension, signs of shock (late sign) Respiratory syncytial Virus (RSV) ----CORRECT ANSWER--------1. cough
- wheezing
- fever
- dehydration Look for signs of dehydration, infants w/ RSV often refuse liquids. Humidified O2 can be helpful TB ----CORRECT ANSWER--------1. cough
- fever
- fatigue
- productive/bloody sputum bacterial infection, can be dormant for years. High prevalence for people living in close contact. Need to wear gloves, eye protection, N-95 respirator How would you differentiate COPD and CHF? ----CORRECT ANSWER--------COPD emphysema - thin w/ barrel chest, pink puffer, tripod position, flat neck veins, dry lungs, shortness of breath on exertion, rhonchi, wheezing, no mucus bronchitis - obese, difficulty w/ expiration, flat neck veins, blue bloat, lungs wet, shortness of breath on exertion, rhonchi, wheezing, frequent/chronic cough, excessive thick mucous CHF - abdominal distention, edema (sacral/pedal), tachycardia, increased RR, anxiety, inability to lie flat, cyanotic, confused LOC, blue skin, wet lungs, shortness of breath all the time, sudden onset of shortness, crackles, wheezing, coughing may be present, pink frothy sputum What are the types of normal breath sounds? ----CORRECT ANSWER--------1. Vesicular
- Bronchol-vesicular
- Bronchial (tubular)
What are vesicular breath sounds? ----CORRECT ANSWER--------description - soft pitched, low intensity gentle sighing location - over peripheral lung, best heard at base characteristics - best heard on inspiration (5:2) ratio What are bronchiole-vesicular sounds? ----CORRECT ANSWER--------description - moderate intensity and moderate pitch blowing sounds, created by air moving through larger bronchi location - between scapula and lateral to sternum characteristics - equal inspiratory and expiratory What are bronchial (tubular) lung sounds? ----CORRECT ANSWER--------description - high pitched, loud harsh sounds created by air moving through trachea location - anteriorly over trachea, generally not heard over lung tissue characteristics - louder than vesicular sounds, have short inspiratory phase and long expiratory phase (1:2 ratio) What are the types of adventitious lung sounds? ----CORRECT ANSWER--------1. crackles (rales)
- gurgles (rhonchi)
- friction rub
- wheeze
- stridor What are crackles? ----CORRECT ANSWER--------description - fine short, interrupted crackling sounds, best approximated by rolling hair between fingers. Best heard on inspiration but can be heard on both. May not be cleared by coughing cause - air passing through fluid/mucous in air passageway location - most often heard in lower lung lobes associated w/ - pulmonary edema, CHF, pneumonia, pulmonary fibrosis, bronchitis What are gurgles (rhonchi)? ----CORRECT ANSWER--------description - continuous low pitched gurgling sounds w/ moaning/snoring quality. Best heard on inspiration but can be heard on both. Can be altered by coughing. cause - Air passing through narrowed air passages as a result of secretions, swelling, tumors
a. conscious pt's b. any pt (conscious or unconscious) w/ BVM Indications/contraindications for NPA? ----CORRECT ANSWER--------indications a. semiconscious/unconscious pt w/ intact gag reflex b. pat's who otherwise will not tolerate OPA contraindications a. severe head injury w/ blood draining from nose b. history of fractured nasal bone What is the recovery position? ----CORRECT ANSWER--------used to help maintain clear airway in unconscious pt who is not injured and is breathing on his or her own w/ normal respiratory rate and adequate tidal volume Bag Valve Mask ----CORRECT ANSWER--------use w/ or w/o oxygen. Use for pt's in respiratory arrest, cardiopulmonary arrest, and respiratory failure. CPAP ----CORRECT ANSWER--------Continous Positive Airway Pressure increases pressure in lungs, opens collapsed alveoli, pushes more oxygen across alveolar membrane, and forces interstitial fluid back into pulmonary circulation. indications - alert pt able to follow commands, obvious signs of moderate to severe respiratory distress, pt is breathing rapidly (over 26 breaths/min), pulse oximetry is less than 90 contraindications - pt who is in respiratory arrest, Si/sx of pneumothorax or chest trauma, pt who has a tracheostomy, active Gi bleeding/vomiting, pt unable to follow verbal commands
FISDAP Airway Exam 2 (Answer Key located at the End
of the Exam)
- Where does the stimulus to breathe originate? A. Spinal cord B. Diaphragm C. Heart D. Brainstem
- What is the proper way to measure an oropharyngeal airway? A. The nose to the xyphoid process. B. From the center of the mouth to the angle of the jaw. C. From the tip of the nose to the lobe of the ear. D. By the size of the patients thumb.
- During respiration, where does the process of the gas exchange occur? A. Trachea B. Aveoli C. Epiglottis D. Bronchioles
- A conscious 32 year old complains of difficulty breathing. He is coughing while pointing to his throat. What should you do? A. Give four strong blows to the back. B. Place him supine and begin CPR. C. Encourage him to keep coughing. D. Administer abdominal thrusts.
- A 34 year old female has fallen from a height of 10 feet. She is unresponsive with snoring respirations. What should you do? A. Use the jaw-thrust maneuver. B. Support her head and neck with a rolled towel. C. Attempt the chin-lift maneuver. D. Apply a cervical collar.
- How much oxygen will a pocket mask on room air deliver? A. 92% B. 17% C. 10% D. 23%
- An unresponsive 44 year old male has an oral airway and is being ventilated. He suddenly regains consciousness and starts to gag. What should you do? A. Insert a nasal airway. B. Request ALS to sedate the patient. C. Remove the airway and apply high-flow oxygen. D. Suction the airway and leave the adjunct in place.
A. Vallecula B. Alveoli C. Carina D. Bronchi
- A 57 year old female is found unresponsive in bed. How should you assess her breathing? A. Look for chest rise and fall. B. Apply oxygen via non-rebreather mask. C. Apply a pulse oximetry monitor. D. Look for changes in skin color.
- Which tissues create the greatest surface area for gas exchange in the lungs? A. Trachea B. Bronchioles C. Alveoli D. Pleura
- A 4 year old male is choking on a marble. He is coughing and drooling. What should you do? A. Perform 5 abdominal thrusts. B. Perform 5 back blows. C. Visualize and remove the marble. D. Coach him to cough.
- Which of the following structures serves as a passageway for both the respiratory and digestive system? A. Trachea B. Esophagus C. Cricoid cartilage D. Pharynx
- When providing mouth to mouth ventilations, what percentage of oxygen are you providing? A. 35 B. 100 C. 21 D. 16
- The air that we exhale contains approximately how much oxygen? A. 6% B. 21% C. 35% D. 16%
- A 20 year old male was involved in a motorcycle accident. He has bits of broken teeth and blood in his airway. After 10 seconds of suctioning his mouth there is still active bleeding. What should you do? A. Insert a roll of gauze to soak up the blood. B. Give two rescue breaths. C. Roll him onto his side. D. Remove the pieces of teeth with a finger sweep.
- A 22 year old intoxicated male responds to voice by moaning. You note vomit in his airway, what should you do? A. Suction the mouth. B. Insert a nasal airway. C. Turn the patient on his side. D. Manually stabilize c-spine.
- A 24 year old male is lying supine and is unresponsive. You have opened his airway with a head-tilt/chin-lift maneuver and determined that he is apneic with a bradycardic pulse. You attempt to ventilate, but are unsuccessful. What should you do? A. Check for a carotid pulse. B. Begin continuous chest compressions. C. Reposition the airway and give 2 ventilations. D. Attempt to give 2 more forceful ventilations.
- What is the name of the tracheal ring that sits directly inferior to the larynx? A. Cuneiform cartilage B. Corniculate cartilage C. Thyroid cartilage D. Cricoid cartilage
- Which structure contains the vocal cords? A. Larynx B. Trachea C. Pharynx D. Sternum
- How much air is inspired in during a single inhalation? A. 200 mL B. 150 mL C. 500 mL D. 750 mL Scenario:
- A 33 year old male has respirations of 22 per minute. How should you administer oxygen to him? A. Non-rebreather mask at 15 lpm.
