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Questions and Answers
What is the primary condition characterized by excessive mucous secretions and inflammation in the bronchial tree?
What is the primary condition characterized by excessive mucous secretions and inflammation in the bronchial tree?
Which inhaler is NOT a beta-agonist inhaler?
Which inhaler is NOT a beta-agonist inhaler?
What is a common side effect of using beta-agonist inhalers?
What is a common side effect of using beta-agonist inhalers?
Which of the following is a contraindication for using an inhaler?
Which of the following is a contraindication for using an inhaler?
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What is the appropriate action to take if the inhaler has been left at room temperature?
What is the appropriate action to take if the inhaler has been left at room temperature?
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What is tidal volume?
What is tidal volume?
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How does the trachea of infants and children differ from that of adults?
How does the trachea of infants and children differ from that of adults?
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Which anatomical feature of infants and children takes up proportionately more space in the mouth compared to adults?
Which anatomical feature of infants and children takes up proportionately more space in the mouth compared to adults?
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What is a characteristic of the chest wall in infants and children?
What is a characteristic of the chest wall in infants and children?
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Which of the following is a part of the OPQRST assessment model?
Which of the following is a part of the OPQRST assessment model?
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What does the 'S' in SAMPLE stand for?
What does the 'S' in SAMPLE stand for?
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Which of the following statements about the cricoid cartilage in children is true?
Which of the following statements about the cricoid cartilage in children is true?
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What is more likely to be a concern in the respiratory anatomy of infants compared to adults?
What is more likely to be a concern in the respiratory anatomy of infants compared to adults?
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In the context of respiratory health, what does hematemesis refer to?
In the context of respiratory health, what does hematemesis refer to?
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Which aspect is crucial when assessing infants and children compared to adults?
Which aspect is crucial when assessing infants and children compared to adults?
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What characteristic of blood in hemoptysis indicates the source is from the upper gastrointestinal tract?
What characteristic of blood in hemoptysis indicates the source is from the upper gastrointestinal tract?
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In which conditions might hemoptysis be observed?
In which conditions might hemoptysis be observed?
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What is the most critical intervention for a patient in respiratory distress?
What is the most critical intervention for a patient in respiratory distress?
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What should be done first in the focused history and physical examination of a responsive patient?
What should be done first in the focused history and physical examination of a responsive patient?
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How should patients be positioned during transport when they are comfortable?
How should patients be positioned during transport when they are comfortable?
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Which of the following statements about oxygen administration is true?
Which of the following statements about oxygen administration is true?
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What should you do if a patient is non-responsive and has respiratory distress?
What should you do if a patient is non-responsive and has respiratory distress?
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What does the presence of blood mixed with sputum indicate?
What does the presence of blood mixed with sputum indicate?
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In the context of emergency care, what is the primary goal when administering oxygen?
In the context of emergency care, what is the primary goal when administering oxygen?
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What role does a physical examination play in patient assessment?
What role does a physical examination play in patient assessment?
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Which term refers to the movement of air in the respiratory system?
Which term refers to the movement of air in the respiratory system?
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What structure prevents food and liquid from entering the trachea during swallowing?
What structure prevents food and liquid from entering the trachea during swallowing?
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Which part of the respiratory system is primarily responsible for gas exchange?
Which part of the respiratory system is primarily responsible for gas exchange?
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During inhalation, which muscle contracts to increase the size of the thoracic cavity?
During inhalation, which muscle contracts to increase the size of the thoracic cavity?
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What is the primary function of the respiratory system?
What is the primary function of the respiratory system?
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Which component of the respiratory system is NOT part of the lower airway?
Which component of the respiratory system is NOT part of the lower airway?
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What action creates a negative pressure in the chest cavity during inhalation?
What action creates a negative pressure in the chest cavity during inhalation?
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Which of the following describes respiration?
Which of the following describes respiration?
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What causes air to flow into the lungs?
What causes air to flow into the lungs?
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What happens during exhalation?
What happens during exhalation?
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What is alveolar respiration primarily responsible for?
What is alveolar respiration primarily responsible for?
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What occurs during cellular respiration?
What occurs during cellular respiration?
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What characterizes normal breathing?
What characterizes normal breathing?
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What is the normal respiratory rate for an adult?
What is the normal respiratory rate for an adult?
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What should be assessed when evaluating breathing?
What should be assessed when evaluating breathing?
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The use of accessory muscles during breathing indicates what condition?
The use of accessory muscles during breathing indicates what condition?
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What type of air enters the alveoli during inhalation?
What type of air enters the alveoli during inhalation?
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What is the primary role of the diaphragm during breathing?
What is the primary role of the diaphragm during breathing?
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Study Notes
Respiratory Emergencies
- BLS stands for basic life support
- CPR stands for cardiopulmonary resuscitation
- AED stands for Automated External Defibrillator
- ALS stands for Advance Life Support
Overview
- Respiratory System Review
- Anatomy
- Physiology
- Breathing Assessment
- Adequate Breathing
- Breathing Difficulty
- Focused History and Physical Examination
- Emergency Medical Care
- Oxygen
- Position and Transport
- Artificial Ventilation
- Inhalers
The Respiratory System
- The respiratory system takes oxygen from the air and makes it available for the bloodstream to transport to every cell and then removes excess carbon dioxide from the body.
The Airway
- Upper airway
- Extends from the nose and mouth to the trachea
- Lower airway
- Extends from the trachea to the alveoli
The Upper Airway
- Nose and mouth
- Pharynx
- Oropharynx
- Nasopharynx
- Epiglottis (leaf-shaped structure that prevents substances like food and liquid from entering the trachea during swallowing)
The Lower Airway
- Trachea (windpipe)
- Cricoid cartilage (firm ring forming the lower portion of the larynx)
- Larynx (voice box)
- Bronchi (two major branches of the trachea that subdivide into smaller air passages, ending at the alveoli)
- Lungs
- Diaphragm
Respiratory Terminology
- Ventilation: The movement of air.
- Respiration: The exchange of gases.
Ventilation
- Inhalation (active)
- Diaphragm and intercostal muscles contract, increasing the thoracic cavity size
- Diaphragm moves slightly downward, rib cage flares
- Ribs move upward/outward
- This creates negative pressure in the chest cavity and air flows into the lungs
- Exhalation
- Diaphragm and intercostal muscles relax, decreasing the thoracic cavity size
- Diaphragm moves upward
- Ribs move downward/inward
- Air is expelled from the lungs
Respiration
- Alveolar Respiration:
- Gas exchange in the lungs
- Alveolar/capillary exchange: Oxygen-rich air enters the alveoli during inspiration. Oxygen-poor blood passes into the alveoli, oxygen enters the capillaries as CO2 enters the alveoli
- Cellular Respiration:
- Gas exchange in the tissues of the body
- Capillary/cellular exchange: Cells give up CO2 to the capillaries; capillaries give oxygen to the cells
Normal Breathing
- Normal respiration should be effortless
Normal Respiratory Rates
- Adult: 12-20 breaths per minute
- Child: 15-30 breaths per minute
- Infant: 25-50 breaths per minute
Assessing Breathing
- Rate
- Rhythm
- Quality
- Breath sounds
- Chest expansion
- Effort of breathing
- Depth (tidal volume)
Effort of Breathing
- Accessory muscles
- Additional muscles used to draw air into the chest
- Includes the muscles of the neck, abdomen, and chest
- Use of accessory muscles is a sign of respiratory distress
Tidal Volume
- The amount of air exchanged in one breath
Considerations for Infants and Children
- Mouth and nose: Generally all structures are smaller and more easily obstructed than in adults.
- Tongue: Infants' and children's tongues take up proportionately more space in the mouth than adults.
- Trachea: Narrower tracheas that are obstructed more easily by swelling; softer and more flexible in infants and children
- Cricoid cartilage: Less developed and less rigid
- Chest wall: Softer
- Breathing: Tend to depend more heavily on the diaphragm for breathing
Focused History and Physical Examination
-
OPQRST
- Onset
- Provocation
- Quality
- Radiation
- Severity
- Time
-
SAMPLE
- Signs and symptoms
- Allergies
- Medications
- Past medical history
- Last oral intake
- Events leading to injury or illness
-
Remember that a physical exam is required for all patients
-
In responsive patients, assess the body systems associated with the chief complaint
Hematemesis and Hemoptysis
- Hematemesis: Vomiting of blood (dark red or coffee ground); shows upper gastrointestinal bleeding
- Hemoptysis: Coughing out blood (bright red mixed with sputum); seen in severe pneumonia, terminal stages of cancer and tuberculosis
Emergency Medical Care
- Administer high-flow oxygen
- Oxygen is the most important medication you can administer to a patient with respiratory distress
- Position and Transport: Patients should be transported in a position most comfortable for them
- Artificial Ventilation:
- Preferred ventilation techniques
- Mouth-to-mask
- Two-person bag-valve-mask
- Flow-restricted, oxygen-powered ventilation device
- One-person bag-valve-mask.
- Preferred ventilation techniques
Chronic Obstructive Pulmonary Disease (COPD)
- COPD encompasses several disease processes:
- Emphysema
- Chronic bronchitis
- Asthma
Emphysema
- An abnormal condition of the lungs characterized by overinflation and destructive changes in the alveoli, resulting in decreased lung elasticity and impaired gas exchange
Chronic Bronchitis
- A chronic condition characterized by excessive mucous secretions and inflammatory changes in the bronchial tree
Asthma
- A lung disorder characterized by recurring episodes of breathing difficulty, wheezing due to constriction and spasm of the bronchi, coughing, and lung secretions
Inhalers
-
Typical inhaler devices
-
Most inhalers used to treat respiratory distress are beta-agonist inhalers
- List of trade names and generic names for common inhalers given
-
Indications
- Exhibits signs and symptoms of respiratory emergency
- Has physician-prescribed, hand-held inhaler
- Specific authorization by medical direction
-
Contraindications
- Inability of patient to use device
- Inhaler is not prescribed for the patient
- No permission from medical direction
- Patient has already met maximum prescribed dose prior to EMT-Basic's arrival
-
Assisting with an inhaler
- Check inhaler's expiration date
- Determine if patient has previously taken any doses
- Make sure the inhaler is at room temperature
- Shake inhaler vigorously several times
- Remove oxygen mask
- Nasal cannula can be left in place
- Have patient place inhaler in mouth
- Have patient inhale slowly and deeply while depressing the inhaler
- Have the patient inhale deeply and hold his or her breath so medication can be absorbed
- Allow patient to breath a few times, then repeat the dose if it is ordered
- Record time, dose, medication name, vital signs, and any changes in the patient's condition
-
Side effects
- Increased heart rate
- Tremors
- Nervousness
- Nausea or vomiting
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