Handout_ch10-1.pdf

Handout 10-1 Student’s Name CHAPTER 10 QUIZ Write the letter of the best answer in the space provided. 1. The first step of emergency care for a patient with inadequate breathing is...

Handout 10-1 Student’s Name CHAPTER 10 QUIZ Write the letter of the best answer in the space provided. 1. The first step of emergency care for a patient with inadequate breathing is A. checking the patient’s pulse. B. manually stabilizing the cervical spine. C. opening and maintaining the patient’s airway. D. looking for and controlling severe bleeding. 2. Inadequate breathing or inadequate blood circulation can cause A. kyphosis. C. lordosis. B. hyperglycemia. D. hypoxia. 3. Signs of inadequate breathing include all of the following except A. retractions above the clavicles, between the ribs, and below the rib cage. B. cyanosis of the lips, ear lobes, or nail beds. C. bradypnea. D. pink skin and a respiratory rate between 10 and 24 breaths per minute. 4. Stimulation of the back of a patient’s throat when suctioning may cause A. convulsions. C. unequal pupils. B. a slowed heart rate. D. cyanosis. 5. A 24-year-old female patient has fallen from the roof of her house and is unconscious. The best method of opening her airway is the A. head-tilt, chin-lift maneuver. C. head-tilt, neck-lift maneuver. B. jaw-thrust maneuver. D. tongue-jaw lift maneuver. 6. What is the order of preference for methods of artificial ventilation, from most to least preferable? 1. One-person bag-valve mask 2. Mouth-to-mask 3. Flow-restricted, oxygen-powered ventilation device 4. Two-person bag-valve mask A. 2, 4, 3, and 1 C. 1, 4, 3, and 2 B. 2, 4, 1, and 3 D. 4, 3, 1, and 2 7. Signs of inadequate artificial ventilation of an adult patient include A. a heart rate that returns to normal. B. failure of the patient’s skin color to improve. C. the patient’s chest rising and falling with each ventilation. D. a ventilation rate of 10–12 breaths per minute. 8. When high-concentration oxygen is attached to a bag-valve mask, the concentration of oxygen delivered to the patient is approximately A. 16 percent. C. 100 percent. B. 24 percent. D. 90 percent. ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Ventilation, and Oxygenation Prehospital Emergency Care, 11th Ed. Handout 10-1 (continued) 9. All of the following are important features of bag-valve-mask systems except a A. non-jam valve system. C. nonrebreathing valve. B. 15/22-mm respiratory fitting. D. pop-off valve. 10. The most difficult part of delivering BVM artificial ventilations for a single rescuer is A. obtaining an adequate mask seal. B. squeezing the bag completely. C. maintaining an open airway. D. preventing the patient from vomiting. 11. Oropharyngeal airways can be used on unconscious patients, except those who A. are in cardiac arrest. B. have a gag reflex. C. are younger than 8 years. D. have a contagious respiratory disease. 12. Because the oropharyngeal airway is likely to stimulate the patient’s gag reflex, the rescuer should A. use only nasal airways. C. be prepared to suction. B. use the next smaller size. D. not use an oropharyngeal airway. 13. The nasopharyngeal airway is often used because it A. comes in more sizes than the oropharyngeal airway. B. often does not stimulate the patient’s gag reflex. C. can be used even if clear (CSF) fluid is seen in the nose or ears. D. is made of rigid, clear plastic, which is less likely to cause bleeding. 14. Which of the following is true regarding suctioning a patient’s airway? A. Never suction the airway for longer than 15 seconds. B. Suction only as you insert the catheter into the mouth. C. BSI precautions are not important if there is no visible blood. D. You may hyperventilate a patient before and after suctioning. 15. One advantage of a “tonsil tip” catheter over a “French” catheter is that it A. is flexible and can be inserted deeper into the pharynx. B. is more effective for removing particulate matter. C. can suction the nose. D. can be inserted well beyond the base of the tongue. 16. Before suctioning, a patient who is artificially ventilated should be A. placed in a position of comfort. C. hyperventilated. B. hypoventilated. D. fully immobilized. 17. A nasal cannula should be used to deliver oxygen to a patient who A. is being ventilated with a BVM. B. requires a high flow and high concentration of oxygen. C. will not tolerate a nonrebreather mask. D. is in respiratory arrest. ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Respiration, and Oxygenation Prehospital Emergency Care, 11th Ed. Handout 10-1 (continued) 18. Oxygen should be administered to any patient who needs supplemental oxygen unless A. the patient is an infant. B. the patient has COPD. C. medical direction instructs otherwise. D. the patient has TB. 19. Oxygen cylinder sizes vary, but all are considered “full” when pressure is equal to psi. A. 1000 C. 2000 B. 1500 D. 2500 20. An insufficiency in the supply of oxygen to the body’s tissues is called A. hypoxia. C. respiratory compromise. B. hyperventilation. D. bronchoconstriction. 21. The use of which of the following methods is contraindicated with children? A. Mouth-to-mask B. Flow-restricted, oxygen-powered ventilation device C. Two-person bag-valve mask D. One-person bag-valve mask 22. To ease insertion, nasopharyngeal airways must be lubricated with A. a lubricant containing petroleum jelly. B. any petroleum-based lubricant, such as WD-40. C. any silicone-based lubricant. D. any water-soluble lubricant. 23. When a patient who has a full set of dentures needs ventilations, the EMT should A. leave the dentures in place if they are secure and then ventilate. B. remove the dentures in all circumstances before ventilating. C. perform an endotracheal intubation. D. use an ATV. 24. A suction device, whether portable or mounted, must generate a vacuum of A. 100 mmHg. C. 300 mmHg. B. 200 mmHg. D. 400 mmHg. 25. When a nasal cannula is used, the flow rate should be no more than A. 6 liters per minute. C. 12 liters per minute. B. 10 liters per minute. D. 14 liters per minute. ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Ventilation, and Oxygenation Prehospital Emergency Care, 11th Ed. Handout 10-2 Student’s Name IN THE FIELD Review the following real-life situation. Then answer the questions that follow. You and your EMT partner, Cindy, are assigned to a suburban station on a cold February morning. At 0613 hours, you are dispatched to an apartment building for a patient with a breathing problem. You arrive at the building about 7 minutes later and are met by the patient’s wife, who is quite anxious. You put on your personal protective equipment, get the ambulance cot and your equipment, and follow the woman to the sixth floor of the building. On the way up in the elevator, the patient’s wife tells you that her husband, Mike, is having a very hard time breathing, and he looks a little blue. You arrive at the apartment and find the patient, a 23-year-old man, seated in a chair, leaning forward on his legs. His skin is pale, his lips are cyanotic, and you hear wheezing as he breathes. You introduce yourself and Cindy to the patient as you begin assessing his condition. It is obvious he is quite anxious, so you attempt to calm him as you explain what you are doing. Mike cannot speak in full sentences but tells you that he has had asthma for about 15 years. He usually uses an inhaler but ran out of the medicine about five days ago. His breathing got worse two days ago, when the elevator was not working and he had to climb up the five flights of stairs to his apartment. You obtain a pulse oximeter reading and place the patient on oxygen, using a nonrebreather mask at 15 liters per minute. Cindy begins taking Mike’s vital signs. His blood pressure is 96/74 mmHg; his pulse is 110; and his respirations are 28 breaths per minute. You decide that Mike needs immediate transport to the hospital, about 25 minutes away. As you get Mike settled on your cot, sitting up for comfort, you use your portable radio to request an ALS rendezvous. 1. As you begin patient contact, describe your initial impression, and explain why you feel this way. 2. Is this patient considered a high priority for immediate transport? Explain your rationale. 3. Which signs and symptoms suggest that the patient is having severe respiratory difficulty? 4. Why was an ALS rendezvous requested for this patient? ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Respiration, and Oxygenation Prehospital Emergency Care, 11th Ed.  Handout 10-3 Student’s Name CHAPTER 10 REVIEW Write the word or words that best complete each sentence in the space provided. 1. The most basic components of emergency medical care are to establish and maintain a(n) , ensure effective ventilation, and provide oxygen to the patient. 2. The EMT’s chief responsibilities are finding and correcting immediately all __________________ -__________________ problems. 3. Respiratory occurs when the respiratory rate and/or tidal volume is insufficient. 4. When breathing stops completely, the patient is in __________________. 5. Minimal or uneven chest movements, diminished breath sounds, and noisy breathing are signs of. 6. A blue or gray color to the patient’s skin or nail beds is called __________________, which is a sign of breathing difficulty. 7. The procedure commonly used for opening the airway of a patient when no trauma is suspected is the , maneuver. 8. The two passageways found at the lower end of the pharynx are the and the. 9. The trachea is protected by a small flap of tissue called the. 10. When one rescuer is using a bag-valve-mask device, the most difficult part of delivering artificial ventilations is maintaining an. 11. When delivering artificial ventilations to a nonbreathing patient, give one ventilation every seconds to an adult and one ventilation every _____________________ seconds to a child. 12. is the process by which the blood and cells become saturated with oxygen. 13. The most common cause of an obstructed airway in the unresponsive patient is the. ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Ventilation, and Oxygenation Prehospital Emergency Care, 11th Ed. Handout 10-3 (continued) 14. An EMT would use an oropharyngeal airway for all unresponsive patients who do not exhibit a(n). 15. A properly sized oropharyngeal airway should extend the distance from the level of the patient’s to the angle of the patient’s. 16. The outside of a nasopharyngeal airway should be lubricated with a sterile - soluble lubricant. 17. _____________________________ is an excessive rapid breathing rate and may indicate inadequate oxygenation and breathing. 18. It is possible to add moisture to oxygen by adding a(n) to the regulator. 19. A nonrebreather mask is the EMT’s best way to deliver high flows and high concentrations of oxygen to a breathing patient because it can provide concentrations of oxygen ranging from to percent. 20. A surgical opening into the neck and trachea, also known as a tracheostomy, is a(n). ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Respiration, and Oxygenation Prehospital Emergency Care, 11th Ed. Handout 10-4 Student’s Name AIRWAY: LISTING 1. List four factors of breathing that must be assessed when determining whether a patient’s breathing is adequate. 2. List and describe four sounds that may indicate airway obstruction. 3. List eight signs of inadequate breathing. 4. List four methods of providing positive pressure ventilations to a patient who is breathing inadequately. ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Respiration, and Oxygenation Prehospital Emergency Care, 11th Ed. Handout 10-5 Student’s Name AIRWAY: TRUE OR FALSE Indicate if the following statements are true or false by writing T or F in the space provided. 1. The trachea is the passageway through which food travels into the stomach. 2. The nose, mouth, pharynx, and trachea are all parts of the respiratory system. 3. During mouth-to-mask ventilations of infant and child patients, each breath should be delivered over 2 to 2.5 seconds. 4. A pinkish skin coloration is one sign of adequate breathing. 5. Excessive use of the neck and intercostal muscles is a sign of inadequate breathing in an adult. 6. Cyanosis is the term used to describe a bluish skin color. 7. A nonrebreather mask is the preferred method for delivering high-concentration supplemental oxygen to patients in the prehospital setting. 8. Head, neck, or spinal injury should be suspected in any unconscious trauma patient. 9. The head-tilt, chin-lift maneuver should be used to open the airway of a patient with a suspected neck injury. 10. When using the head-tilt, chin-lift maneuver to open a patient’s airway, you would place your fingertips on the bony part of the chin, not the soft tissues under the lower jaw. 11. When opening an unconscious patient’s airway, you may need to insert your thumb into the patient’s mouth. 12. When using the jaw-thrust maneuver to open a patient’s airway, you would stabilize the patient’s head with your knees. 13. Use of a pocket mask with supplemental oxygen to ventilate a patient can deliver a higher tidal volume of air than use of a bag-valve-mask device. 14. A pop-off valve is an undesirable feature of some older bag-valve-mask devices. 15. BVMs should have a standard 15/22-mm connection to properly fit face masks and endotracheal tubes. 16. If a nasopharyngeal airway is too long, it can enter the esophagus and cause massive gastric distention. 17. With a BVM device, a mask seal can more easily be maintained when ventilations are performed by two rescuers. 18. Nonbreathing adult patients should be ventilated at a rate of 10–12 breaths per minute. ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Respiration, and Oxygenation Prehospital Emergency Care, 11th Ed. Handout 10-5 (continued) 19. If the patient’s chest does not rise and fall during BVM ventilation, you should reposition the patient’s head to ensure an open airway. 20. Using a nasal cannula with supplemental oxygen will deliver a nearly 100 percent oxygen concentration to the patient. 21. A pediatric-sized BVM mask can be used to establish a seal around a stoma. 22. Flow-restricted, oxygen-powered ventilation devices may give an audible alarm when the relief valve is activated. 23. If a patient rejects an oropharyngeal airway at your first attempt, you should reopen the patient’s airway and insert the oropharyngeal airway more aggressively. 24. To ease insertion of a nasopharyngeal airway, it should be lubricated with petroleum jelly. 25. The EMT should never suction a patient for more than 5 seconds at a time. ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Respiration, and Oxygenation Prehospital Emergency Care, 11th Ed. Handout 10-6 Student’s Name AIRWAY: MATCHING Write the letter of the term in the space next to the appropriate description below. 1. The active process of drawing air into the lungs A. ATV 2. A small flap of tissue that closes over the trachea during B. bilaterally swallowing C. bradypnea 3. The portion of the pharynx that extends from the nostrils to the soft palate D. cyanosis 4. On both sides E. diaphragm F. epiglottis 5. Inflation of the stomach G. exhalation 6. A bluish color of the skin and mucous membranes that indicates poor oxygenation of tissue H. gastric distention 7. Innermost covering of the lungs I. hypoxia 8. A reduction of oxygen delivery to the tissues J. inhalation 9. A breathing rate that is faster than the normal rate K. intercostal 10. A breathing rate that is slower than the normal rate L. nasopharynx 11. A positive pressure ventilation device that delivers M. tachypnea ventilations automatically N. stridor 12. A harsh, high-pitched sound heard on inspiration, which indicates swelling of the larynx O. visceral pleura 13. The passive process of breathing air out of the lungs 14. The major muscle of respiration, which separates the chest cavity from the abdominal cavity 15. Describing the muscles between the ribs ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Respiration, and Oxygenation Prehospital Emergency Care, 11th Ed.  CHAPTER 10 ANSWER KEY HANDOUT 10-1: Chapter 10 Quiz HANDOUT 10-4: Airway: Listing 1. C 8. C 14. A 20. A 1. Rate, rhythm, quality, and depth of breathing. 2. D 9. D 15. B 21. B 2. Snoring—sonorous sounds; crowing—air rushing through 3. D 10. A 16. C 22. D a spasming larynx makes a crow-like sound; gurgling—a 4. B 11. B 17. C 23. A sound like gargling; stridor—harsh, high-pitched sound 5. B 12. C 18. C 24. C heard during inspirations. 6. A 13. B 19. C 25. A 3. Any eight of the following: chest expansion is absent, 7. B minimal, or unequal; use of accessory muscles; no air can be felt or heard at the nose or mouth, or the amount of air HANDOUT 10-2: In the Field exchanged is evaluated as less than normal; respiratory rate is too fast or too slow; rhythm of breathing is 1. Your general impression would be of a 23-year-old male, irregular; patient’s skin is cool and clammy; patient seated in a tripod position, pale skin, and audibly exhibits nasal flaring; patient is unable to speak or cannot wheezing. He is having a difficult time breathing and is a speak in full sentences; cyanosis is visible in skin, lips, priority patient. tongue, ear lobes, or nail beds; breathing is very shallow, 2. Any patient with breathing difficulty is considered a high very deep, or labored; breath sounds are diminished or priority. absent; noises such as wheezing, crowing, stridor, 3. The patient was seated in a tripod position, leaning snoring, gurgling, or gasping are heard; retractions above forward. His skin color was pale, he is cyanotic, and you the clavicles and between and below the ribs, especially in can hear wheezing. These are all signs of inadequate children. breathing. 4. Mouth-to-mask; two-person bag-valve mask; flow- 4. An ALS rendezvous was requested due to the real restricted, oxygen-powered ventilation device; one- possibility that his condition could worsen, requiring a person bag-valve mask. higher level of treatment. The paramedics could establish an IV line for medications, if needed; intubate the patient, HANDOUT 10-5: Airway: True or False if necessary; and administer medication in the form of a breathing treatment while en route. 1. F 8. T 14. T 20. F 2. T 9. F 15. T 21. T HANDOUT 10-3: Chapter 10 Review 3. F 10. T 16. T 22. T 4. T 11. F 17. T 23. F 1. airway 5. T 12. F 18. T 24. F 2. life-threatening 6. T 13. T 19. T 25. F 3. failure 7. T 4. respiratory arrest 5. inadequate breathing HANDOUT 10-6: Airway: Matching 6. cyanosis 7. head-tilt, chin-lift 1. J 5. H 9. M 13. G 2. F 6. D 10. C 14. E 8. trachea, esophagus 3. L 7. O 11. A 15. K 9. epiglottis 4. B 8. I 12. N 10. adequate seal 11. 4 to 5, 3 12. Oxygenation 13. tongue 14. gag reflex 15. front teeth, jaw 16. water 17. Tachypnea 18. humidifier 19. 80, 100 20. stoma ©2018 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Respiration, and Oxygenation Prehospital Emergency Care, 11th Ed.