EMT Chapter 10: Airway Management Flashcards
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Questions and Answers

What should you administer to a conscious patient who is alert and able to speak in complete sentences?

Oxygen via a nonrebreathing mask.

How should a nasopharyngeal airway be inserted?

With the bevel facing the septum if inserted into the right nare.

What occurs when there is a ventilation/perfusion (V/Q ratio) mismatch?

A disruption in blood flow inhibits the exchange of oxygen and carbon dioxide in the lungs, even though the alveoli are filled with fresh oxygen.

When should an oxygen cylinder be taken out of service and refilled?

<p>When the pressure inside it is less than 500 psi.</p> Signup and view all the answers

Why must an unconscious patient found in a prone position be placed in a supine position?

<p>In case he or she requires CPR.</p> Signup and view all the answers

What is the preferred initial method for providing ventilations as the single EMT managing an apneic patient's airway?

<p>Mouth-to-mask technique with a one-way valve.</p> Signup and view all the answers

At a flow rate of 6 L/min, what is the approximate oxygen concentration a nasal cannula can deliver?

<p>44%</p> Signup and view all the answers

In which situation should supplemental oxygen be administered?

<p>Exposure to carbon monoxide and an oxygen saturation of 95%</p> Signup and view all the answers

What do central chemoreceptors located in the medulla sense to increase the rate and depth of breathing?

<p>Slight increases in carbon dioxide or a decrease in the pH of the cerebrospinal fluid.</p> Signup and view all the answers

What complications are associated with using a manually triggered ventilation device?

<p>Lung tissue injury and gastric distention.</p> Signup and view all the answers

What should you do if a conscious young female continues to hyperventilate with a marked reduction in tidal volume?

<p>Explain to her that you will assist her ventilations.</p> Signup and view all the answers

What facilitates gas exchange in the lungs?

<p>Adequate amounts of surfactant.</p> Signup and view all the answers

Exhalation is a passive process caused by increased intrathoracic pressure.

<p>True</p> Signup and view all the answers

What happens during inhalation?

<p>The diaphragm and intercostal muscles contract and cause a decrease in intrathoracic pressure.</p> Signup and view all the answers

Intrapulmonary shunting occurs when blood coming from the right side of the heart bypasses nonfunctional alveoli.

<p>True</p> Signup and view all the answers

What must be ensured before applying a nonrebreathing mask to a patient?

<p>The reservoir bag is fully inflated.</p> Signup and view all the answers

What is the proper technique for suctioning the oropharynx of an adult patient?

<p>Suctioning while withdrawing the catheter from the oropharynx.</p> Signup and view all the answers

Which of the following structures is NOT part of the lower airway?

<p>Epiglottis</p> Signup and view all the answers

What nerve innervates the diaphragm?

<p>Phrenic nerve.</p> Signup and view all the answers

What influences the hypoxic drive?

<p>Low blood oxygen levels.</p> Signup and view all the answers

What is the name of the leaf-shaped structure located superior to the larynx?

<p>Epiglottis.</p> Signup and view all the answers

What is the main advantage of the Venturi mask?

<p>The use of its fine adjustment capabilities in the long-term management of physiologically stable patients.</p> Signup and view all the answers

What is the MOST significant complication associated with oropharyngeal suctioning?

<p>Hypoxia due to prolonged suction attempts.</p> Signup and view all the answers

What is the partial pressure of oxygen in the alveoli?

<p>104 mm Hg.</p> Signup and view all the answers

What is the partial pressure of carbon dioxide in the alveoli?

<p>40 mm Hg.</p> Signup and view all the answers

What is the pressure of gas in a full cylinder of oxygen?

<p>Approximately 2,000 pounds per square inch (psi).</p> Signup and view all the answers

What is the primary waste product of aerobic metabolism?

<p>Carbon dioxide.</p> Signup and view all the answers

What is the process of exchanging oxygen and carbon dioxide between the alveoli and the blood of the capillaries called?

<p>External respiration.</p> Signup and view all the answers

How should the proper size oropharyngeal airway be selected?

<p>Measure from the corner of the mouth to the earlobe.</p> Signup and view all the answers

Which factors will cause a decreased minute volume in an adult?

<p>Shallow breathing</p> Signup and view all the answers

Which of the following is a late sign of hypoxia?

<p>Cyanosis</p> Signup and view all the answers

Which of the following organs or tissues can survive the longest without oxygen?

<p>Muscle</p> Signup and view all the answers

Which oxygen flowmeter is NOT affected by gravity?

<p>Bourdon-gauge flowmeter</p> Signup and view all the answers

Which statement regarding oxygenation and ventilation is correct?

<p>In mines or confined places, where oxygen levels are low, ventilation may continue despite adequate oxygenation.</p> Signup and view all the answers

Which statement regarding positive-pressure ventilation is correct?

<p>More volume is required to achieve the same effects as normal breathing.</p> Signup and view all the answers

Which statement regarding the one-person bag-valve mask technique is correct?

<p>Adequate tidal volume is often difficult to achieve.</p> Signup and view all the answers

Which structure is contained within the mediastinum?

<p>Esophagus</p> Signup and view all the answers

What would cause an increase in the amount of exhaled carbon dioxide?

<p>Increased cardiac output</p> Signup and view all the answers

What should you do if your partner is choking and exhibits signs of cyanosis?

<p>Stand behind him and administer abdominal thrusts.</p> Signup and view all the answers

What should you do if a patient in severe respiratory distress's heart rate increases by 20 beats/min while on CPAP?

<p>Remove the CPAP device and ventilate him with a bag-valve mask.</p> Signup and view all the answers

With a good mask-to-face seal and an oxygen flow rate of 15 L/min, how much inspired oxygen can the nonrebreathing mask deliver?

<p>Up to 90%.</p> Signup and view all the answers

What happens to the body's cells without adequate oxygen?

<p>They incompletely convert glucose into energy, and lactic acid accumulates in the blood.</p> Signup and view all the answers

What should be done if you are unable to effectively ventilate a critically injured patient with a bag-valve mask?

<p>Begin ventilations using the mouth-to-mask technique.</p> Signup and view all the answers

The pressure of gas in a full cylinder of oxygen is approximately __________ pounds per square inch.

<p>2000</p> Signup and view all the answers

You and your partner are caring for a critically injured patient. Your partner is controlling severe bleeding from the patient's lower extremities as you attempt ventilations with a bag valve mask. After repositioning the mask several times, you are unable to effectively ventilate the patient. You should:

<p>Begin ventilations using the mouth to mask technique.</p> Signup and view all the answers

An oxygen cylinder should be taken out of service and refilled when the pressure inside it is less than:

<p>500 psi</p> Signup and view all the answers

Which of the following structures is contained within the mediastinum?

<p>Esophagus</p> Signup and view all the answers

At a flow rate of 6 L per minute, a nasal cannula can deliver an approximate oxygen concentration of up to:

<p>44%</p> Signup and view all the answers

The hypoxic drive is influenced by:

<p>Low blood oxygen levels</p> Signup and view all the answers

Gas exchange in the lungs is facilitated by:

<p>Adequate amounts of surfactant</p> Signup and view all the answers

The primary waste product of aerobic metabolism is:

<p>Carbon dioxide</p> Signup and view all the answers

The process of exchanging oxygen and carbon dioxide between the alveoli and the blood of the capillaries is called:

<p>External respiration</p> Signup and view all the answers

An unconscious patient found in a prone position must be placed in a supine position in case he or she:

<p>Requires CPR</p> Signup and view all the answers

A ventilation/perfusion (V/Q) ratio mismatch occurs when:

<p>A disruption in blood flow inhibits the exchange of oxygen and carbon dioxide in the lungs, even though the alveoli are filled with fresh oxygen.</p> Signup and view all the answers

A 51-year-old female presents with a sudden onset of difficulty breathing. She is conscious and alert and able to speak in complete sentences. Her respirations are 22 breaths per minute and regular. You should:

<p>Administer oxygen via a non-rebreathing mask.</p> Signup and view all the answers

Which of the following organs or tissues can survive the longest without oxygen?

<p>Muscle</p> Signup and view all the answers

Your protocols state that during the first few minutes of working on a cardiac arrest patient, you should provide passive ventilation. This means that you will:

<p>Allow recoil of the chest between compressions to draw air into the lungs.</p> Signup and view all the answers

Which of the following statements regarding the one person bag valve mask technique is correct?

<p>Adequate tidal volume is often difficult to achieve when one EMT is operating the bag valve mask.</p> Signup and view all the answers

Inhalation occurs when the:

<p>Diaphragm and intercostal muscles contract and cause a decrease in intrathoracic pressure.</p> Signup and view all the answers

Which of the following factors will cause a decreased minute volume in an adult?

<p>Shallow breathing</p> Signup and view all the answers

The diaphragm is innervated by the _________ nerve, which allows it to contract.

<p>Phrenic</p> Signup and view all the answers

Prior to applying a non-rebreathing mask to a patient, you must ensure that the:

<p>Reservoir bag is fully inflated</p> Signup and view all the answers

You are ventilating a 40-year-old injured man who is apneic but has a pulse. When your partner reassesses his blood pressure, she notes that it has decreased significantly from previous readings. You should:

<p>Reduce the rate or volume of the ventilations you are delivering.</p> Signup and view all the answers

Without adequate oxygen, the body's cells:

<p>Incompletely convert glucose into energy, and lactic acid accumulates in the blood.</p> Signup and view all the answers

The main advantage of the Venturi mask is:

<p>The use of its fine adjustment capabilities in the long-term management of physiologically stable patients.</p> Signup and view all the answers

The MOST significant complication associated with oropharyngeal suctioning is:

<p>Hypoxia due to prolonged suction attempts.</p> Signup and view all the answers

While providing CPAP to a patient in severe respiratory distress, you note that his heart rate has increased by 20 bpm. He is conscious but is no longer following verbal commands. You should:

<p>Remove the CPAP device and ventilate him with a bag valve mask.</p> Signup and view all the answers

To select the proper size oropharyngeal airway, you should measure from the:

<p>Corner of the mouth to the earlobe.</p> Signup and view all the answers

Intrapulmonary shunting occurs when:

<p>Blood coming from the right side of the heart bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state.</p> Signup and view all the answers

Which of the following statements regarding positive pressure ventilation is correct?

<p>With positive pressure ventilation, more volume is required to have the same effects as normal breathing.</p> Signup and view all the answers

As the single EMT managing an apneic patient's airway, the preferred initial method of providing ventilations is the:

<p>Mouth to mask technique with a one-way valve.</p> Signup and view all the answers

Which of the following would cause an increase in the amount of exhaled carbon dioxide?

<p>Increased cardiac output.</p> Signup and view all the answers

Which of the following is a late sign of hypoxia?

<p>Cyanosis.</p> Signup and view all the answers

A 19-year-old female is found unconscious by her roommate. Your primary assessment reveals that her breathing is inadequate. As you insert an oropharyngeal airway, she begins to gag violently. You should:

<p>Remove the airway and be prepared to suction her oropharynx.</p> Signup and view all the answers

A man was found unresponsive in his bed at home. There is no evidence of injury and the patient's medical history is not known. The patient's face is cyanotic, yet the pulse oximeter reads 98%. Which of the following would MOST likely explain this?

<p>Carbon monoxide poisoning.</p> Signup and view all the answers

A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a:

<p>Non-rebreathing mask.</p> Signup and view all the answers

During your assessment of a patient with respiratory distress, you hear wheezing when listening to breath sounds. This indicates:

<p>A lower airway obstruction.</p> Signup and view all the answers

How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?

<p>It forces the alveoli open and pushes oxygen across the alveolar membrane.</p> Signup and view all the answers

In which of the following patients would the head tilt-chin lift maneuver be the MOST appropriate method of opening the airway?

<p>A 37-year-old female who is found unconscious in her bed.</p> Signup and view all the answers

Irregular respirations characterized by an increasing rate and depth of breathing followed by periods of apnea are called:

<p>Cheyne-Stokes respirations.</p> Signup and view all the answers

The nasopharyngeal airway is MOST beneficial because it:

<p>Can maintain a patent airway in a semiconscious patient with a gag reflex.</p> Signup and view all the answers

The physical act of moving air into and out of the lungs is called:

<p>Ventilation.</p> Signup and view all the answers

What occurs when a patient is breathing very rapidly and shallowly?

<p>Air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchange.</p> Signup and view all the answers

When testing a mechanical suctioning unit, you should turn on the device, clamp the tubing, and ensure that it generates a vacuum pressure of more than:

<p>300 mm Hg.</p> Signup and view all the answers

Which of the following is the MOST reliable indicator of adequately performed bag-valve mask ventilations in an apneic adult with a pulse?

<p>Adequate rise of the chest when squeezing the bag.</p> Signup and view all the answers

Which of the following patients is breathing adequately?

<p>A conscious male with respirations of 19 breaths/min and pink skin.</p> Signup and view all the answers

Which of the following patients should you place in the recovery position?

<p>A 31-year-old semiconscious male with low blood sugar and adequate breathing.</p> Signup and view all the answers

Which of the following statements regarding breathing adequacy is correct?

<p>Patients breathing shallowly may require assisted ventilation despite a normal respiratory rate.</p> Signup and view all the answers

Which of the following statements regarding normal gas exchange in the lungs is correct?

<p>Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries.</p> Signup and view all the answers

Which of the following statements regarding oxygen is correct?

<p>Oxygen supports the combustion process and may cause a fire.</p> Signup and view all the answers

Which of the following structures is NOT found in the upper airway?

<p>Bronchus.</p> Signup and view all the answers

You are performing mouth-to-mask ventilations with oxygen connected and set at a flow rate of 15 L/min. What percentage of oxygen is your patient receiving?

<p>55%.</p> Signup and view all the answers

You are ventilating a patient with a stoma; however, air is escaping from the mouth and nose. To prevent this, you should:

<p>Seal the mouth and nose.</p> Signup and view all the answers

After ___________ minutes without oxygen, brain damage is very likely.

<p>6 to 10</p> Signup and view all the answers

All of the following are signs of hypoxia, EXCEPT:

<p>Dehydration</p> Signup and view all the answers

Suctioning the oral cavity of an adult should be accomplished within:

<p>15 seconds.</p> Signup and view all the answers

The proper technique for sizing an oropharyngeal airway before insertion is to measure the device from:

<p>The corner of the mouth to the earlobe.</p> Signup and view all the answers

While assisting with respirations, you note gastric distention. In order to prevent or alleviate the distention, you should:

<p>Ensure that the patient's airway is appropriately positioned, ventilate the patient at the appropriate rate, and ventilate the patient at the appropriate volume.</p> Signup and view all the answers

You come upon an unresponsive patient who is not injured and is breathing on her own with a normal rate and an adequate tidal volume. What would be the advantage of placing her in the recovery position?

<p>It helps to maintain a clear airway.</p> Signup and view all the answers

You respond to a construction site and find a worker lying supine in the dirt. He has been hit by a heavy construction vehicle and flew more than 15 feet (4.6 m) before landing in his current position. There is discoloration and distention of his abdomen about the right upper quadrant. He is unconscious, and his respirations are 10 breaths/min and shallow, with noisy gurgling sounds. What method will you use to keep his airway open?

<p>Oropharyngeal airway.</p> Signup and view all the answers

A 23-year-old male experienced severe head trauma after his motorcycle collided with an oncoming truck. He is unconscious, has rapid and shallow breathing, and has copious bloody secretions in his mouth. How should you manage his airway?

<p>Alternate 15 seconds of oral suctioning with 2 minutes of assisted ventilation.</p> Signup and view all the answers

Study Notes

Oxygen Cylinder Pressure

  • A full oxygen cylinder has a pressure of approximately 2000 pounds per square inch.
  • Oxygen cylinders should be refiled when the pressure is less than 500 psi.

Ventilation Techniques

  • If unable to effectively ventilate a patient with a bag valve mask, use the mouth-to-mask technique.
  • Positive pressure ventilation requires more volume than normal breathing to achieve the same effect.

Airway Structures

  • The mediastinum contains the esophagus; bronchus and larynx are not part of it.
  • The nasopharyngeal airway is beneficial for maintaining airway patency in semiconscious patients with a gag reflex.

Gas Exchange and Respiration

  • Gas exchange is facilitated by adequate amounts of surfactant in the lungs.
  • External respiration refers to the gas exchange between alveoli and blood.

CPR Protocol

  • An unconscious patient in a prone position should be repositioned to supine in case CPR is needed.

Hypoxia Indicators

  • Late signs of hypoxia include cyanosis, while early signs include restlessness and anxiety.
  • Carbon monoxide poisoning can cause cyanosis with a falsely normal pulse oximeter reading.

Oxygen Delivery Methods

  • A non-rebreathing mask can deliver oxygen to adequately breathing but hypoxic patients.
  • The Venturi mask has fine adjustment capabilities for delivering consistent oxygen levels.

Breathing Dynamics

  • Inhalation occurs when the diaphragm and intercostal muscles contract, reducing intrathoracic pressure.
  • Rapid and shallow breathing leads to ineffective air movement mainly in the anatomic dead space.

Adequate Breathing Assessment

  • Breathing adequacy is confirmed through signs like adequate rise of the chest during bag-valve-mask ventilation.
  • Patients with shallow breathing may need assisted ventilation despite a normal respiratory rate.

Airway Management Strategies

  • An oropharyngeal airway should be sized from the corner of the mouth to the earlobe.
  • In an emergency, if a patient is gagging upon insertion of an airway, it should be removed immediately.

Suctioning Guidelines

  • Oral suctioning of adults should not exceed 15 seconds to prevent hypoxia.
  • Mechanical suction units should generate a vacuum pressure of over 300 mm Hg.

Complications and Precautions

  • Complications from oropharyngeal suctioning can include hypoxia due to prolonged suction attempts.
  • Central chemoreceptors stimulate increased respiratory rate when detecting increased carbon dioxide levels.

Special Cases in Airway Management

  • When ventilating an apneic patient with a pulse, reduce the volume or rate of ventilations if blood pressure decreases.
  • A manually triggered ventilation device may risk lung injury and gastric distention.

General Knowledge

  • The hypoxic drive is influenced primarily by low blood oxygen levels.
  • After 6 to 10 minutes without oxygen, brain damage is likely to occur.

Signs of Respiratory Issues

  • Wheezing indicates lower airway obstruction, often due to conditions like asthma.
  • Indications for supplemental oxygen include conditions like carbon monoxide exposure with a pulse oximeter reading of 95%.### Respiration and Ventilation
  • Coaching a patient with hyperventilation may necessitate assistance in ventilations to ensure adequate oxygen delivery.
  • Gas exchange in the lungs is enhanced by sufficient surfactant, which reduces surface tension and prevents alveolar collapse.
  • Exhalation is a passive process resulting from increased intrathoracic pressure, contrasting with the active process of inhalation.
  • Inhalation involves contraction of the diaphragm and intercostal muscles, resulting in lowered intrathoracic pressure.

Alveolar Function

  • Intrapulmonary shunting occurs when blood bypasses nonfunctional alveoli, resulting in unoxygenated blood returning to systemic circulation.
  • To ensure a proper seal on a nonrebreathing mask, the reservoir bag must be fully inflated before use.

Airway Management

  • Proper oropharynx suctioning technique requires withdrawing the catheter while suctioning to clear obstructions effectively.
  • The lower airway structures exclude the epiglottis, which is part of the upper airway and serves as a protective flap over the larynx.
  • The diaphragm is innervated by the phrenic nerve, enabling its contraction to facilitate breathing.

Oxygenation and Waste Products

  • Hypoxic drive is influenced by low arterial blood oxygen levels, prompting respiratory efforts.
  • The epiglottis is a leaf-shaped structure superior to the larynx, playing a critical role in protecting the airway during swallowing.
  • The Venturi mask advantageously allows precise adjustments of oxygen delivery in stable patients.

Complications and Risks

  • A significant risk of oropharyngeal suctioning is hypoxia, particularly from prolonged suction attempts.
  • Partial pressure measurements: oxygen in the alveoli is 104 mm Hg, and carbon dioxide is 40 mm Hg, vital for assessing gas exchange.
  • A full cylinder of oxygen exerts approximately 2000 psi, crucial for understanding oxygen availability in emergency settings.

Respiratory Physiological Concepts

  • Aerobic metabolism primarily produces carbon dioxide as a waste product, necessitating effective carbon dioxide removal for cellular health.
  • External respiration describes the gas exchange of oxygen and carbon dioxide between alveoli and capillary blood.
  • To select the appropriate oropharyngeal airway size, measure from the corner of the mouth to the earlobe.

Signs of Hypoxia and Medical Intervention

  • Shallow breathing can lead to decreased minute ventilation, impacting overall oxygen availability.
  • Cyanosis is a late sign of hypoxia, indicating severe oxygen deprivation in tissues.
  • Muscle tissues can survive longer without oxygen compared to other organs, highlighting their resilience.

Oxygen Delivery Systems

  • The Bourdon-gauge flowmeter remains unaffected by gravity, making it suitable for any position on an oxygen cylinder.
  • In low oxygen environments, ventilation may persist despite inadequate oxygenation, emphasizing the need for monitoring ventilation efficacy.
  • Positive-pressure ventilation requires greater volume compared to normal breathing to achieve similar effects due to pressure differentials.

Bag-Valve Mask Technique

  • The one-person bag-valve mask technique often struggles with achieving adequate tidal volume alone due to the challenge of maintaining a proper seal.
  • The mediastinum contains essential structures, including the esophagus, which is critical in the context of respiratory emergencies.
  • Increased cardiac output can lead to higher carbon dioxide exhalation rates, indicating metabolic demands.

Emergency Responses

  • In cases of choking with stridor and cyanosis, abdominal thrusts should be administered from behind the patient.
  • If a patient becomes unresponsive while on CPAP, it is crucial to remove the device and use a bag-valve mask for ventilation.
  • A properly fitted nonrebreathing mask at 15 L/min can deliver up to 90% inspired oxygen, offering high levels of supplemental oxygen during critical care.
  • Cells deficient in oxygen cannot fully metabolize glucose, leading to lactic acid buildup and metabolic complications.

Critical Care Procedures

  • When unable to effectively ventilate a patient with a bag-valve mask, switching to a mouth-to-mask technique may enhance ventilation in emergencies.

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These flashcards cover key concepts from EMT Chapter 10 on airway management. Test your knowledge on gas pressure in oxygen cylinders and practical ventilation skills with real-life scenarios. Perfect for EMT students or those in healthcare training.

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