Airway and Ventilation Flashcard 2
Rationale
D. Rationale: This is a case of cardiac arrest with pulseless electrical activity. The most likely cause of the patient’s cardiac arrest is hypoxia from smoke inhalation. In this case, the team must prioritize the treatment of hypoxia, and placing an advanced airway is the priority while minimizing interruptions in chest compressions.
Question
A 38-year-old woman was rescued by firefighters from her burning apartment and brought to the ED by paramedics, arriving with no pulse and no spontaneous breathing. Surveying the patient reveals no other injuries. The following ECG tracing is recorded:
The emergency team immediately initiates high-quality CPR. What is the next most important step in management for this patient?
a. High-quality CPR is adequate at this time
b. Defibrillation
c. IV or IO access
d. Intubation
Answer
d. Intubation
Rationale
B. Rationale: While performing continuous chest compressions, a provider must deliver 1 breath every 6 seconds during CPR with an advanced airway such as an endotracheal tube.
Question
A cardiac arrest patient has been successfully intubated. During CPR with an advanced airway, the provider must deliver one breath every:
a. 3 seconds
b. 6 seconds
c. 7 seconds
d. 10 seconds
Answer
b. 6 seconds
Rationale
E. Rationale: The ACLS provider must be able to distinguish the severity of respiratory distress in a patient. Severe respiratory distress bordering on respiratory failure will manifest as diminishing respiratory effort, changes in skin color, and altered mental status.
Question
A patient presents with tachypnea, stridor, tachycardia, bluish skin discoloration, and altered mental status. Which of the following points to severe or imminent respiratory failure?
a. Tachypnea
b. Changes in skin color
c. Altered mental status
d. All of the above
e. B and C
Answer
e. B and C
Rationale
B. Rationale: Airway protection must be prioritized before the administration of multiple-dose activated charcoal because these patients are at risk for aspiration. Endotracheal intubation is recommended.
Question
A patient who is suicidal has swallowed a handful of phenobarbital tablets. He is scheduled for multiple-dose activated charcoal administration in the emergency department. What must the team do first before administering the activated charcoal?
a. Gastric lavage
b. Endotracheal intubation
c. Toxicology screen
d. Administer naloxone
Answer
b. Endotracheal intubation
Rationale
A. Rationale: Respiratory arrest refers to a patient with absent oxygenation and ventilation but with the presence of a pulse. Cardiac arrest is the absence of a pulse and no normal breathing.
Question
A patient with absent oxygenation and ventilation but presenting with a pulse is said to have which one of the following medical conditions?
a. Respiratory arrest
b. Cardiac arrest
c. Pulmonary arrest
d. Sudden cardiac death
Answer
a. Respiratory arrest
Rationale
C. Rationale: The rescuer is over-ventilating the patient, giving 15 breaths per minute. 1 breath every 4 seconds is 15 breaths per minute. Equation: 1 breath/4 seconds x seconds = 15 breaths.
Question
A rescuer is providing ventilations through an advanced airway at a rate of 1 breath every 4 seconds. How many breaths is the patient receiving per minute?
a. 10
b. 12
c. 15
d. 20
Answer
c. 15
Rationale
C. Rationale: Hypercapnia is a term referring to the increased carbon dioxide content of arterial blood. Carbon dioxide is a product of cellular metabolism and is increased when there is poor ventilation. Ventilation occurs at the level of the alveoli that involves oxygen exchange for carbon dioxide in the pulmonary arteries.
Question
An effect of hypoventilation that increases the arterial carbon dioxide content is known as which one of the following?
A. Hypoxia
B. Hypoxemia
C. Hypercapnia
D. Hypocapnia
Answer
C. Hypercapnia
Rationale
C. Rationale: Agonal gasps are an abnormal breathing pattern often occurring at a very slow rate. They may sound like moaning or snorting and are a sign of imminent cardiac arrest. (ACLS Case: Respiratory Arrest)
Question
An office worker chokes while eating and had been trying to relieve the obstruction for quite a while. When you see the patient, he is laying on the ground and unresponsive. His face is blue, and he appears to be gulping air. You assess that he is displaying agonal gasps. Which of the following is true regarding agonal gasps?
a. They are a normal breathing pattern
b. They occur at a very fast rate
c. They are a sign of imminent respiratory and cardiac arrest
d. They should not be treated
Answer
c. They are a sign of imminent respiratory and cardiac arrest
Rationale
B. Rationale: Suction attempts should last no longer than 10 seconds. The patient should be preoxygenated with 100% oxygen to avoid hypoxia related to suctioning.
Question
Attempts at suctioning via an ET tube should not exceed:
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
Answer
B. 10 seconds
Rationale
A. Rationale: OPAs that are too large can obstruct the larynx. An OPA that is too large can also damage delicate laryngeal structures. OPAs that are too small will push the base of the tongue posteriorly, which may obstruct the airway. OPAs can be used to facilitate suctioning of the mouth and throat. An OPA can prevent the intubated patient from biting down on and occluding an ET tube.
Question
Choose the CORRECT statement regarding OPAs (oropharyngeal airways):
A. OPAs that are too large may obstruct the larynx and/or cause trauma to laryngeal structures.
B. OPAs that are too small may push the base of the tongue anteriorly, obstructing the airway.
C. The OPA cannot be used during suctioning of the mouth and throat.
D. An OPA used in the intubated patient may cause the patient to bite down and occlude the ET tube.
Answer
A. OPAs that are too large may obstruct the larynx and/or cause trauma to laryngeal structures.