Airway and Ventilation Flashcard 1
Rationale
C. Rationale: Respiratory arrest is the absence of ventilation and oxygenation in the presence of a pulse. If left untreated, a respiratory arrest eventually leads to cardiac arrest. Thus it is necessary to provide positive pressure ventilation in these patients, especially in the pre-hospital setting. (Case: Respiratory Arrest)
Question
The absence of adequate oxygenation and ventilation with the presence of a pulse is called:
a. Kussmaul sign
b. Acute respiratory distress syndrome
c. Respiratory arrest
d. Agonal gasp
Answer
c. Respiratory arrest
Rationale
D. Rationale: Continuous waveform capnography is the recommended method to confirm the correct placement of an ET tube. Other nonwaveform CO2 detectors, such as an esophageal detector device, colorimetric devices, or ultrasound, can be used confirm ET tube placement if continuous waveform capnography is unavailable. (ACLS Case: Respiratory Arrest: Primary Assessment)
Question
You successfully intubate a cardiac arrest patient on the 5th minute of CPR. Which of the following is the most accurate method to confirm the correct placement of an endotracheal tube?
a. Via stethoscope
b. Ultrasound
c. Esophageal detector device
d. Waveform capnography
Answer
d. Waveform capnography
Rationale
D. Rationale: Iatrogenic effects of bag-mask hyperventilation include aspiration, stomach insufflation, tension pneumothorax, and neurologic deterioration. (ACLS Case: Respiratory Arrest: Primary Assessment)
Question
While providing positive pressure ventilation with OPA and bag-mask, your team leader asks you to slow down giving ventilations to prevent which of the following iatrogenic effects of bag-mask hyperventilation?
a. Decreased ventilatory effort
b. Decreased oxygenation
c. Cardiac tamponade
d. Stomach insufflation
Answer
d. Stomach insufflation
Rationale
D. Rationale: Cardiac arrest in status asthmaticus is due to hypoxia. Due to the constricted bronchioles, air trapping is likely to occur within the lungs. This further burdens the efforts to provide adequate ventilation to the patient. To relieve air trapping, the team should temporarily disconnect the ventilator or bag-mask during chest compressions.
Question
A 21-year-old woman is in cardiac arrest due to acute respiratory failure from asthma in your emergency department. CPR has been started. The emergency response team has inserted an endotracheal tube and intravenous lines. What extraordinary procedure is necessary to ensure optimal resuscitation in this patient?
a. Increase supplemental oxygen
b. Lateral chest compressions
c. Emergency tracheostomy
d. Temporarily disconnect the bag-mask device
Answer
d. Temporarily disconnect the bag-mask device
Rationale
A. Rationale: Bradypnea is slow breathing with a respiratory rate < 12 breaths/minute.
Question
A 24-year-old man is transported to the emergency department with blunt force trauma to the head after a vehicular crash. CT scan indicates edema with impending uncal herniation that potentially affects the respiratory centers. The attending neurologist wants you to monitor the patient for bradypnea. Which respiratory rate is defined as bradypnea?
a. < 12 breaths/minute
b. < 14 breaths/minute
c. < 16 breaths/minute
d. < 18 breaths/minute
Answer
a. < 12 breaths/minute
Rationale
A. Rationale: A nasopharyngeal airway is best used for conscious, semi-conscious, or unconscious patients to ensure airway patency. The patient’s drug abuse with cocaine has also caused bruxism, making it difficult to place an oral airway adjunct.
Question
A 24-year-old woman has overdosed with cocaine, and she is semi-conscious. She has respiratory depression with a pulse, and her jaw is clenched. As the first responder, you would like to give adequate ventilations to the patient. What possible airway adjunct or procedure is best in this situation?
a. Nasopharyngeal airway
b. Laryngeal mask
c. Oropharyngeal airway
d. Emergency tracheostomy
Answer
a. Nasopharyngeal airway
Rationale
D. Rationale: All of the above should be performed for a patient in respiratory arrest with a pulse.
Question
A 25-year-old man is found unresponsive and in respiratory arrest. He has a pulse with a heart rate of 50 bpm. What is the proper treatment?
a. Activate the emergency response system
b. Provide rescue breathing ventilation with 6 breaths every minute
c. Do a pulse check every 2 minutes
d. All of the above
Answer
d. All of the above
Rationale
B. Rationale: The provider should immediately provide rescue breathing and continue to monitor the patient.
Question
A 25-year-old man is seen unresponsive and in respiratory arrest. He has a heart rate of 50 beats per minute. Treatment should include:
a. Using the AED
b. Providing rescue breathing
c. Beginning CPR
d. Performing a precordial thump
Answer
b. Providing rescue breathing
Rationale
D. Rationale: Respiratory failure is the end-stage of respiratory distress from an airway obstruction, lung tissue disease, or disordered control of breathing. One of its characteristic clinical signs is cyanosis. The rest of the choices can also be manifestations of respiratory distress.
Question
A 33-year-old man is brought to the emergency department due to an asthma attack. He is tachypneic and cyanotic, has labored breathing and intercostal retractions, and looks agitated. Which of these clinical signs indicates the patient is in respiratory failure?
a. Tachypnea
b. Cyanosis
c. Agitated
d. Intercostal retractions
Answer
d. Intercostal retractions
Rationale
C. Rationale: For patients with a pulse but not spontaneously breathing, the delivery of basic ventilations with a bag-mask device; one ventilation cycle every 6 seconds is recommended.
Question
A 35-year-old man who slipped and fell from a 10-foot-high roof is transported by EMS to the emergency department. The patient has a pulse but is not breathing. What is the treatment of choice?
a. Intubate the patient and connect to a mechanical ventilator
b. Attach to a biphasic defibrillator and treat with shocks as indicated
c. Apply bag-mask ventilations; one ventilation cycle every 6 seconds
d. Perform high-quality CPR
Answer
c. Apply bag-mask ventilations; one ventilation cycle every 6 seconds