Airway and Ventilation Flashcard 7
Rationale
A. Rationale: Overventilation leads to constricted cerebral blood vessels, increased intrathoracic pressure, and tension pneumothorax. To prevent excessive ventilation, a respiratory rate of 10 breaths/minute is advised for assisted ventilations.
Question
Which one of the following is the effect of overventilation?
a. Increased intrathoracic pressure
b. Toxicity-induced reperfusion injury
c. Ventricular fibrillation
d. All of the above
Answer
a. Increased intrathoracic pressure
Rationale
A. Rationale: A visible chest rise must be achieved when providing ventilation. If chest rise is not visible, the patient is receiving inadequate ventilation. Airway obstruction can cause insufficient chest rise. (ACLS Case: Respiratory Arrest)
Question
While providing bag-valve-mask ventilations to a cardiac arrest patient, you do not observe a chest rise. When providing assisted ventilation, what can you assume when a visible chest rise is not achieved?
a. Airway obstruction
b. Adequate ventilation
c. Myocardial infarction
d. Cardiac tamponade
Answer
a. Airway obstruction
Rationale
B. Rationale: Iatrogenic effects of hyperventilation via ET tube include aspiration, stomach insufflation, tension pneumothorax, and neurologic deterioration.
Question
While providing positive pressure ventilation, your team leader asks you to slow down the delivery of ventilations to prevent which of the following iatrogenic effects of ET tube hyperventilation?
a. Aspiration
b. Stomach insufflation
c. Tension pneumothorax
d. All of the above
Answer
b. Stomach insufflation
Rationale
B. Rationale: It is recommended for trained rescuers to provide ventilations during CPR with 100% oxygen supplementation. The best equipment to use is the bag-mask device for providing positive pressure ventilation. Studies have shown that there is no improvement on survival if endotracheal intubation is used compared with a bag-mask device.
Question
With a complete inventory for cardiopulmonary resuscitation, which of the following is best for providing positive pressure ventilation?
a. Mouth-to-mouth resuscitation
b. Bag-mask device
c. Endotracheal tube
d. Oropharyngeal airway
Answer
b. Bag-mask device
Rationale
A. Rationale: Stop as soon as there is resistance felt when inserting a nasopharyngeal airway. Inserting the airway into the other nostril must be tried first. Be very careful using a nasopharyngeal airway if there is suspected trauma in the face, sinuses, or base of the skull.
Question
You are inserting a nasopharyngeal airway into the patient’s right nostril and feel some resistance to it, even after gently rotating the tube. What should you do?
a. Stop, remove the nasopharyngeal airway, lubricate with a water-based product, and try inserting in the left nostril.
b. Stop, remove the nasopharyngeal airway, lubricate with a water-based product, and reinsert in the same nostril.
c. Stop and use an oropharyngeal airway instead.
d. Continue inserting the nasopharyngeal airway with more gentle pressure until it inserts all the way.
Answer
a. Stop, remove the nasopharyngeal airway, lubricate with a water-based product, and try inserting in the left nostril.
Rationale
A. Rationale: Tachypnea in an adult patient is fast breathing with a rate > 20 breaths per minute. (ACLS Case: Respiratory Arrest)
Question
You are monitoring an adult patient with COPD in an ED setting. One symptom of respiratory distress to be alert to is tachypnea. Which respiratory rate is defined as tachypneic?
a. > 20 breaths per minute
b. > 18 breaths per minute
c. > 16 breaths per minute
d. > 14 breaths per minute
Answer
a. > 20 breaths per minute
Rationale
A. Rationale: Tachypnea is rapid breathing with a rate > 20 breaths/minute.
Question
You are monitoring an adult patient with COPD in the emergency department. One symptom of respiratory distress you are monitoring for is tachypnea. Which respiratory rate is defined as tachypneic?
a. > 20 breaths/minute
b. > 18 breaths/minute
c. > 16 breaths/minute
d. > 14 breaths/minute
Answer
a. > 20 breaths/minute
Rationale
B. Rationale: The act of suctioning can cause hypoxia in these patients. High-flow oxygen therapy is delivered via nasal cannula and performed by simply twisting the oxygen regulator to increase the oxygen delivery higher than the standard 2 to 3 liters per minute.
Question
You are suctioning the secretions from an advanced airway of a recently revived patient in the ICU. While suctioning, you note the following vital signs: heart rate decreases from 110 bpm to 58 bpm; oxygen saturation drops to 89%, and the patient is cyanotic around the lips. What is your next course of action?
a. Continue suctioning to remove possible mucus plugs
b. Administer high-flow oxygen to oxygenate the patient
c. Ventilate the patient via bag-mask
d. Titrate vasopressor infusion
Answer
b. Administer high-flow oxygen to oxygenate the patient
Rationale
D. Rationale: Improper suctioning may do more harm than good by causing more hypoxia, trauma to the oropharynx, induce vomiting, etc. When suctioning from an oropharyngeal airway, the catheter must be measured from the tip of the nose to the earlobe.
Question
You are tasked to suction an unconscious patient with an oropharyngeal airway. Which one of the following actions is likely to cause more harm than good to the patient?
a. Gently inserting the suction catheter into the oropharynx beyond the tongue
b. Applying suction by occluding the side opening of the catheter while using a rotating or twisting motion to withdraw it
c. Placing the tip of a rigid suction device into the oral cavity and advancing it by pushing the tongue down to reach the oropharynx
d. Measuring the suctioning catheter from the tip of the nose to the sternal angle
Answer
d. Measuring the suctioning catheter from the tip of the nose to the sternal angle
Rationale
A. Rationale: An increased heart rate, change in the level of consciousness, increased respiratory rate, and nasal flaring are all early signs of respiratory distress. Decreased heart and respiratory rates are late signs that may be seen with progression to respiratory failure.
Question
You are the first responder to a 24-year-old man who is choking. One of the things to monitor for in this case is respiratory distress. Which one of the following is NOT an early sign of respiratory distress?
a. Decreased heart rate
b. Changes in level of consciousness
c. Nasal flaring
d. Increased respiratory rate
Answer
a. Decreased heart rate