ENA Trauma Conference -Resp Emergencies

Respiratory Emergencies : 

ENA Southwest Trauma Conference September 10, 2011 Melissa J Hinton, DNP, APRN, FNP-BC, RN, CEN Respiratory Emergencies

Objectives : 

Be able to identify major respiratory anatomical structures and function Understand basic physiology of respiration Be able to identify restrictive and obstructive respiratory emergencies Review interventions for adult and pediatric respiratory emergencies Objectives 2

Respiratory Anatomy : 

Respiratory Anatomy 3

Upper Airway : 

In through nose Warms Humidifies Filters Past epiglottis Covers glottis (cords) to divert food into the trachea Into trachea Anterior to esophagus Upper Airway 4

Clinical Pearl: What is “The Vallecula?” : 

Vallecula means -- a depression, a ditch, or a fold The epiglottic vallecula is then – the depression between the median and lateral glossoepiglottic folds on either side Macintosh blade placed at the landmark for visualization of the glottis, the opening between the vocal cords Clinical Pearl: What is “The Vallecula?” Vallecula 1-vocal chords/glottis, 2-vestibular fold, 3-epiglottis, 4-plica aryepiglottica, 5-arytenoid cartilage, 6-sinus piriformis, 7-underside of the tongue 5

Thorax Anatomy : 

Thorax Anatomy Stuff you may not have remembered . . . Which pleura does what? Parietal-inner layer of thorax. Has nerve endings Visceral-encases lungs Intrapleural space-space between both pleura with thin layer of fluid (friction rub/pleurisy, pleural effusion What is the hilum? Part of an organ where the blood vessels, lymph nodes, and nerves enter. Each lung has it’s own hilas, or hilum. What is the Mediastinum? Space between the lungs that houses the heart What is the carina and where is it? Carina Hilum lung root 6

Lower Airway : 

Trachea Bronchi Branch off trachea Bronchioles No air exchange until alveoli 500 cc of dead air space Elastic coils Alveoli Diffusion & perfusion Lower Airway Alveoli 7

Pediatric Anatomy Review : 

Pediatric Anatomy Review 8

Pediatric Anatomy & PhysiologyAnatomical Differences : 

Upper Airway Nose breathers to 3 mo Large tonsils, adenoids, highly vascular. Proportionally larger and more swelling. Smaller diameter of larynx and trachea Flexible trachea  easily occluded Proportionally smaller diameter of bronchi, bronchioles  mucus plugs, eventual scarring Alveoli less developed until age 8 (less surface area for gas exchange) Flexible rib cage – negative pressure sucks rib cage inward (retractions) with  tidal volume Immature immune system (immunoglobulins, T cells) Pediatric Anatomy & PhysiologyAnatomical Differences Lower Airway 9 Epiglottis Area of tonsils and adenoids larynx trachea carina

RespiratoryPhysiology : 

RespiratoryPhysiology 10

Respiratory Physiology : 

Respiratory Physiology Inspiration Active process Chest cavity expands Intrathoracic pressure falls Air flows in until pressure equalizes Expiration Passive process Chest cavity size decreases Intrathoracic pressure rises Air flows out until pressure equalizes 11

Respiratory Physiology : 

Respiratory Physiology Takes in oxygen Disposes of wastes Carbon dioxide Excess water O2 + Glucose CO2 + H2O Cell

Physiology : 

Physiology Autonomic Function (Brain) Primary drive: increase in arterial CO2 We normally breathe to remove CO2 from the body, NOT to get oxygen in. Secondary (hypoxic) drive: decrease in arterial O2 13 Availability of oxygen, ability to get the oxygen, AND ability to use the oxygen

Causes of Respiratory Emergencies : 

Failure of: Ventilation: air in/ air out Diffusion: movement of gases Perfusion: movement of blood Compounded by: Inflammation/mucus production Relieved by Epinephrine based medications (beta-2 antagonists), oxygen, ventilation assistance Causes of Respiratory Emergencies 14

Causes of Hypoxia – low oxygen to cells : 

Hypoxic hypoxia – not enough oxygen Anemic hypoxia– not enough hemoglobin Stagnant hypoxia – not enough perfusion shock Histotoxic hypoxia – unable to download Cyanide poisoning Causes of Hypoxia – low oxygen to cells 15

Respiratory EmergenciesAssessment : 

Respiratory EmergenciesAssessment 16

Scene Size-up & Triage Presentation What in and around the patient that suggests a respiratory emergency?What symptoms suggest a respiratory emergency? : 

Scene Size-up & Triage Presentation What in and around the patient that suggests a respiratory emergency?What symptoms suggest a respiratory emergency? Start ABCD pneumonic 17

Assessment : 

Assessment Cause/Pathology Signs and symptoms Management Remember to consider: 18

Assessment - Airway : 

Initial impression Oral cavity (FB, missing teeth, dentures, tongue) Vocalization Neck (short, swollen, poor flexion, trauma) Assessment - Airway 19

Assessment – Breathing : 

Assessment – Breathing Breathing Pattern Kussmaul, labored, restricted, Cheyne-Stokes Respiratory effort Pursed lip, accessory muscles, major inspiratory muscles Position – Tripod position Chest examination Spinal/ sternal deformity, Barrel-chesting , trauma, tracheal deviation Dyspnea with talking 20

Assessment – Breath Sounds : 

Assessment – Breath Sounds 21

Slide 22: 

Wheeze (asthma, CHF, COPD, obstruction) soft straw Stridor (FBO, croup, anaphylaxis, epiglottitis, burn) voiced loud straw Rhonchi (bronchitis, COPD, aspiration) wet straw Friction Rub (pleuritis) foam Fine Rales/Crackles (atelectasis) hair Coarse Rales/Crackles (edema/CHF/PNA) cellophane Breath Sounds: It sounds like what….?Normal lung sounds – like blowing in a straw

Assessment - Circulation : 

Cyanosis Late sign of distress Peripheral Edema (1 mm=+1) Jugular Venous Distention (distention above clavicles at 30-45 ) Capillary refill (<3 sec) Pulses Skin (warm, dry) Conjunctival pallor Oral cyanosis (mucosal membranes) Nail beds (also look for clubbing) Circumoral/Perioral Note: cyanosis also found in anemia Assessment - Circulation Circulatory findings 23

Assessment - Disability : 

Alert? Able to speaking in sentences? Confused? Not responding to verbal commands Obtunded Assessment - Disability 24

Assessment - Focused History : 

Onset (gradual, sudden), what helps or worsens? Associated symptoms? Cough, dry or productive? Sputum color, character, quantity? Wheeze? Fever? Smoking hx? Chest pain? Constant or with chest excursion? Assessment - Focused History OPQRST & COLDERRA are Pain Assessment acronyms: SAMPLE(E) Symptoms, Allergies, Medications, Prior history, Last meal Eaten, Events 25

Assessment – Medication HistoryAntibiotics? Oxygen? Steroids? Inhalers/Nebs? Heart meds? : 

Bronchodilators (Rescue) Beta2 Agonists Albuterol- Proventil, Ventolin, Pro-Air Xopenex Anticholinergics Atrovent Serevent Spiriva (long-acting-not for rescue) Vanceril Aerobid Azmacort Flovent Qvar Combination products Advair Symbicort Dulera Assessment – Medication HistoryAntibiotics? Oxygen? Steroids? Inhalers/Nebs? Heart meds? Glucocorticoids (Steroids) 26 Metered Dose Inhalers (MDIs)Mists=2 inhalations  Powders=1 inhalation

Upper Airway Respiratory EmergenciesUnderlying Problem - Ventilation : 

Upper Airway Respiratory EmergenciesUnderlying Problem - Ventilation 27

Upper Airway Emergencies : 

Due to Foreign bodies – food, toys, blood Tongue/ angioedema Swelling/ trauma Children < 6 months of age Laryngotracheomalacia: chronic, resolves by age 2 Vocal cord paresis or paralysis Arnold-Chiari malformation Children > 6 months of age: acute Viral Croup Retropharyngeal abscess Epiglottitis Upper Airway Emergencies 28

Upper Airway - InfectionsEpiglottitis : 

Upper Airway - InfectionsEpiglottitis H. Influenza (vaccinations have ’d incidence ), Strep, Staph Abrupt high fever, ST, +stridor, dysphagia w/ drooling, usually no cough Exam: Toxic-appearing, apprehensive, tripod or “sniffing” position, muffled voice w/ marked hyoid tenderness on palpation *Some cases may develop over days* 29 “Thumbprint “ supraglottic ballooning and obscured vallecula

Upper airway – InfectionsViral Croup (laryngotracheobronchitis) : 

Children 6 mo.- 3 years highest incidence Most common cause of stridor Narrowest part of airway -1 mm of edema may ↓ airspace by 50-60% Signs & Symptoms Prodrome 1-5 days: Cough, coryza, +/- low grade fever and URI type symptoms followed by 3-4 days of barking cough, worse at night. Duration 3-7 days regardless of tx, usually 3rd and 4th days are worst Unaffected by position, worsened by agitation or crying Diagnosis- made clinically X-rays: Obtain lateral neck films and PA CXR - “Steeple Sign” Upper airway – InfectionsViral Croup (laryngotracheobronchitis) 30

Croup ‘Steeple Sign” : 

Croup ‘Steeple Sign” 31

Upper airway – InfectionsViral Croup (laryngotracheobronchitis) : 

Treatment Pulse ox, and humidified O2 - Often improves in cold night air or moist air from shower Antipyretics if fever present Nebulized Albuterol Stridor only with agitation- doesn’t need epinephrine Stridor at rest or w/respiratory distress-epi neb, steroids Intubation if respiratory failure or pending (use ETT 0.5 to 1.0 mm smaller than typically used) Antibiotics not indicated - IV fluid hydration only if necessary Upper airway – InfectionsViral Croup (laryngotracheobronchitis) 32

Upper Airway - Laryngomalacia : 

Upper Airway - Laryngomalacia 60 % of all neonatal laryngeal problems Developmentally weak larynx Each inspiration collapses epiglottis, aryepiglottic folds and arytenoids Worse with crying and agitation May be exacerbated by URI Improves with neck extentsion and prone position 33

Upper Airway – Foreign Body : 

Upper Airway – Foreign Body Head position, tongue, aspiration, or foreign body. Signs & Symptoms – may be asymptomatic Classically, stridor w/laryngotracheal FB wheeze w/ bronchial FB FB should be suspected in unilateral wheeze Persistent croup, asthma, or PNA after adequate tx Head-tilt/chin-lift to open airway 34

Upper Airway – Peritonsillar Abscess : 

Most common in adolescents w/ antecedent sore throat, improvement prior to worsening sxs Appear acutely ill -toxic Fevers Dysphagia Trismus Drooling Muffled “hot potato” voice Ipsilateral ear pain and torticollis Uvular deviation/ Airway compromise Severe trismus Airway compromise Localized areas of fluctuance Upper Airway – Peritonsillar Abscess Signs , Symptoms, & Exam 35

Peritonsillar Abscess : 

Peritonsillar Abscess 36

Upper AirwayRetropharyngeal Abscess : 

Upper AirwayRetropharyngeal Abscess Rare, 6 months to 4 years - repeated URIs have obliterated retropharyngeal lymphnodes after age 4 Evolve over days after minor URI or after localized trauma to posterior pharyngeal wall. i.e. fall with stick or object in mouth. Treatment Intubation if acute respiratory distress Retropharyngeal cellulitis and very small abscess may be tx’d with ATBX alone Large abscess will need I&D by ENT ENT for definitive TX options Requires ABX 37

Upper Airway – Allergic Response : 

Angioedema is swelling that happens just below the surface of the skin, most often around the lips and eyes. Can occur anywhere Rapid intervention – antihistamine, steroid, H2Blocker, Epi, bronchodilator, intubation May be hereditary (tx: Fresh frozen plasma) Upper Airway – Allergic Response 38

Upper Airway Management : 

Epiglottitis – Rapid transport, keep pt calm Croup – Humidified oxygen Foreign Body – Heimlich maneuver, ALS Magill Forceps Abscess – I & D, ENT and antibiotics Allergic Reaction – Antihistamine, H2 blockers, steroids, ALS protocol Upper Airway Management 39

Lower Airway Respiratory EmergenciesUnderlying Problem: VENTILATION AND INFLAMMATION : 

Lower Airway Respiratory EmergenciesUnderlying Problem: VENTILATION AND INFLAMMATION 40

Lower Airway – COPDChronic Obstructive Pulmonary Disease : 

Includes damage from Chronic Asthma, Chronic Bronchitis, and Emphysema Pathophysiology Edema, inflammation and excessive mucus production of the bronchioles/bronchi Restricted air movement Gas exchange is compromised Retained CO2 Lower Airway – COPDChronic Obstructive Pulmonary Disease 41 Physiologic changes in the large (central) airways, the small (peripheral) bronchioles, and the lung parenchyma

Lower Airway – COPDAsthma : 

Lower airway obstruction Bronchospasm Edema Mucus Caused by Irritants Respiratory infection Emotional distress Lower Airway – COPDAsthma 42

Lower Airway – COPDAsthma : 

Assessment/Associated Symptoms Non productive cough Wheezing Breath sounds – Silence ; Bronchioles totally obstructed Speech dyspnea – one word sentences Use of accessory muscles Steroids, IV access, MDI/nebs, oxygen Status Asthmaticus (prolonged sx’s despite appropriate tsx) Lower Airway – COPDAsthma Intubation Bronchodilators per ETT Ketamine ( lower airway resistance , lung compliance) 43

Lower Airway – COPDChronic Bronchitis : 

Increased mucus production = Decreased alveolar ventilation Assessment/Associated Symptoms Usually has a productive cough for 3 months out of the year for 2 years History of long term exposure to toxins Frequent respiratory infections Heavy sputum production Obese and cyanotic (blue bloater) Control underlying causes, control secretions, steroids Lower Airway – COPDChronic Bronchitis 44

Lower Airway – COPDEmphysema : 

Destruction of alveolar walls Loss of alveolar elasticity with distention Air trapping and Loss of air movement causes retention of CO2 Lower Airway – COPDEmphysema Underlying Problem: Diffusion 45

Lower Airway – COPDEmphysema : 

Assessment/Associated Symptoms Dyspnea with exertion Barrel chest Prolonged expiratory phase, pursed lip breathing Muscle wasting Pink puffer (extra hemoglobin to make up for poor oxygen pick up) Management Secure airway Correct hypoxia Respiratory drive from low oxygen not high CO2 IV access (dehydration) Albuterol for Bronchodilation if wheezing ~Usually won’t call until in failure~ Lower Airway – COPDEmphysema 46

Lower Airway - Costochondritis : 

Underlying problem: VENTILATION AND INFLAMMATION Viral chest wall pain from inflammation of muscle walls and cartilage of chest Assessment/Associated Symptoms Sudden onset No trauma Pain on deep inhalation Pain on palpation May have fever or history of cold Treatment (sputum culture) Supportive care Oxygen support if severe Lower Airway - Costochondritis 47

Lower Airway – Pneumonia : 

Underlying Problem: DIFFUSION Bacterial, viral, atypical pathogens Alveoli and interstitial spaces fill with fluid Includes Severe Acute Respiratory Syndrome (SARS) and tuberculosis Lower Airway – Pneumonia Assessment Looks ill Fever and chills Productive cough Chest pain with respiration Management Supportive care Oxygen IV access (dehydration) and antibiotics If wheezing -- Bronchodilators ALS – secure airway if in distress 48

Pulmonary Perfusion Emergencies : 

Pulmonary Perfusion Emergencies 49

Pulmonary Emergencies – Toxic InhalationUnderlying Problem: VENTILATION, INFLAMMATION, DIFFUSION : 

Super heated air Chemicals & fumes Combustion products Steam Pulmonary Emergencies – Toxic InhalationUnderlying Problem: VENTILATION, INFLAMMATION, DIFFUSION 50

Pulmonary Emergencies – Toxic Inhalation : 

Pulmonary Emergencies – Toxic Inhalation Assessment Lower airway edema Bronchospasm Burns to face, nose, mouth Stridor Management Rescuer safety & decontamination Secure airway – may need intubation Correct hypoxia IV access Correct wheezing with beta2 agonist-- albuterol 51

Pulmonary Emergencies – Carbon Monoxide Poisoning : 

Underlying Problem: CELLULAR HYPOXIA Inhalation of gas that binds with hemoglobin Assessment/Associated Symptoms Headache Irritability Errors in judgment Confusion Vomiting Flu symptoms Pink color Pulmonary Emergencies – Carbon Monoxide Poisoning Management Rescuer safety Remove from source Secure airway High flow oxygen Hyperbaric chamber 52

Pulmonary EmergenciesPulmonary EmboliUnderlying problem: PERFUSION, DIFFUSION : 

Blood clot (or other emboli) in pulmonary circulation blocking blood flow Fluid collects in space between alveoli and capillaries Two Kinds Cardiogenic Non-cardiogenic Ventilation perfusion (VQ) mismatch Pulmonary EmergenciesPulmonary EmboliUnderlying problem: PERFUSION, DIFFUSION 53

Pulmonary EmergenciesPulmonary Emboli : 

Cardiogenic Inadequate pumping action of the heart (A Fib/Flutter, surgical blood loss, immobility) Increased pressure in the pulmonary capillaries Fluid is forced to leak into the space between alveoli and capillaries Eventually fluid will enter the alveoli Destruction of the capillary bed allows fluid to leak out Pneumonia, aspiration, near-drowning, narcotic overdose, inhalation of smoke or other toxic gases, high altitudes, trauma Pulmonary EmergenciesPulmonary Emboli Noncardiogenic 54

Pulmonary EmergenciesPulmonary Emboli : 

Assessment/Associated Symptoms: Sudden onset acute chest pain Sudden onset acute dyspnea Tachypnea Tachycardia Recent history of being inactive or surgery/trauma Management Secure Airway Correct hypoxia IV Access, thrombolytics Pulmonary EmergenciesPulmonary Emboli 55

Pulmonary Emergencies Pneumothorax – Spontaneous PneumoUnderlying Problem: DIFFUSION : 

Sudden loss of pleural seal, usually thin, young, athletes, high elevation, high recurrence rate Assessment Non traumatic Sudden onset dyspnea No pain on palpation May develop tension pneumo and JVD Unilateral breath sounds Management May need a chest tube Oxygen, outpatient referral Pulmonary Emergencies Pneumothorax – Spontaneous PneumoUnderlying Problem: DIFFUSION 56

Pulmonary Emergencies Hyperventilation : 

Underlying problem: too much oxygen and not enough carbon dioxide (ACID/BASE DISRUPTION) Assessment/Associated Symptoms Tachypnea Numbness/tingling of fingers, toes, mouth (Carpopedal spasms) Breath sounds present bilaterally Oxygen Saturation > 94% on room air Management Correct respiratory rate – slow down Oxygen by mask 6 liters IV access Pulmonary Emergencies Hyperventilation 57

Pulmonary Emergencies Central Nervous System Dysfunction : 

Underlying Problem: VENTILATION Head trauma, stroke, brain tumor, insulin shock, drug toxicity Assessment/Associated Symptoms slow shallow breathing decreased tidal volume and minute volume cyanosis Pulmonary Emergencies Central Nervous System Dysfunction 58

Central Nervous System Dysfunction– Spinal Cord : 

Underlying problem: Ventilation Trauma, polio, multiple sclerosis, myasthenia gravis, ALS Assessment/Associated Symptoms: Slow shallow respirations Poor use of chest muscles Decreased tidal volume and minute volume Management Secure airway Correct hypoxia Assist ventilations IV access Treat underlying cause if able Central Nervous System Dysfunction– Spinal Cord 59

Pulmonary Emergencies Respiratory Failure : 

Underlying Problem: VENTILATION, PERFUSION, DIFFUSION Inability of the to meet the basic demands for tissue oxygenation Assessment/Associated Symptoms: Gradual onset of Inadequate oxygen production Inadequate CO2 removal Tachycardia and Tachypnea End stages Bradycardia and Bradypnea Cyanosis Poor chest wall movement Profound acidosis Cardiac Arrest Pulmonary Emergencies Respiratory Failure 60

Pulmonary Emergencies Respiratory Failure Management : 

Open airway and mechanically ventilate IV access and correct hypovolemia Correct underlying problem Pulmonary Emergencies Respiratory Failure Management 61

What do you know? Question 1 : 

You are in a restaurant when a middle-aged man at the next table begins to act strangely while eating steak. He appears to be in acute distress but is completely silent. His eyes are open wide and he is staggering about. As you approach him, he slumps into your arms unconscious. What has possibly happened to this man? A. Acute asthma attack B. Emphysema C. Foreign body airway obstruction D. Hyperventilation What do you know? Question 1 62

Question 1 part B : 

How do you want to manage the patient in question 1? A. Call 911 and apply oxygen B. Call 911 and attempt BLS maneuvers to remove a foreign body C. Call 911 and administer an epi-pen D. Begin CPR Question 1 part B 63

Question 2 : 

You are called to attend a 56-year old man whose chief complaint is dyspnea. He states that he has a chronic cough that has gotten worse over the last few days. The sputum he is coughing up has changed in color from white to yellow/green. The man is heavy set and has a cyanotic color. He has loud wheezes and gurgling in his chest. His vitals are BP 150/90, Pulse 110 and respirations 28. Oxygen saturation on room air is 88%. What is wrong with this man? A. Acute foreign body airway obstruction B. Allergic reaction to the environment C. Asthma D. Chronic bronchitis with an acute infection Question 2 64

Question 2 part B : 

How do you want to manage the patient in question 2? A. Apply oxygen B. Attempt BLS maneuvers to remove a foreign body C. Administer an epi-pen D. Begin CPR Question 2 part B 65

Question 3 : 

You are called to help a 24 year old woman with difficulty breathing. She is sitting up when you find her, bending forward and fighting to breathe. Her chest is not moving much and only faint wheezing can be heard when you listen to her chest. She is so short of breath that she cannot talk. She takes inhalers daily. What is wrong with this patient? A. Acute asthma attack B. Airway obstruction from a Foreign body C. Hyperventilation syndrome D. Pneumonia Question 3 66

Question 3 part B : 

How do you want to manage the patient in question 3? A. Apply oxygen B. Attempt BLS maneuvers to remove a Foreign body C. Administer an epi-pen D. Apply oxygen and assist the patient with taking her inhaler or (advanced providers) administer albuterol Question 3 part B 67

Question 4 : 

You are called to a restaurant to attend a patient in respiratory distress. Speaking hoarsely, he tells you that he was eating shrimp cocktail and that his throat feels swollen. He tells you that he has been allergic to lobster in the past. You notice that he has swelling of his lips and hives on his face. His respiratory distress is increasing and his respirations are wheezing and shallow. What is wrong with this patient? A. Acute asthma attack B. Acute allergic reaction C. Acute foreign body airway obstruction D. Chronic bronchitis Question 4 68

Question 4 part B : 

How do you want to manage the patient in question 4? A. apply oxygen B. attempt BLS maneuvers to remove a Foreign Body C. apply oxygen and administer an epi-pen D. begin CPR Question 4 part B 69

Question 5 : 

A 60 year old woman has been unable to walk since surgery. She has been either in bed or in a chair for several weeks. She only walks to the bathroom and back. Suddenly she feels extremely short of breath and has developed sharp chest pain . You find her anxious with labored respirations. Her vitals are BP 100/60, pulse 120, respirations 28, oxygen saturation 90% on room air. What is most likely wrong with this woman? A. Acute asthma attack B. Pulmonary emboli C. Acute myocardial infarction D. Acute allergic reaction Question 5 70

Question 5 part B : 

How do you want to manage the patient in question 5? A. apply oxygen and transport immediately B. apply oxygen and administer albuterol by nebulizer C. apply oxygen and administer an epi-pen D. begin CPR and prepare to defibrillate Question 5 part B 71

Question 6 : 

You are called to a large party for a man who is short of breath. You find a thin 19 year old man who is breathing 40 times a minute. His respirations are not wheezing and his skin is pink, warm and dry. He is very anxious and complaining of tightness in his chest. His fingers are painful and cramped. What is wrong with this patient? A. Acute asthma attack B. Acute myocardial infarction C. Hyperventilation syndrome D. Foreign body airway obstruction Question 6 72

Question 6 part B : 

How do you want to manage the patient in question 6? A. Apply oxygen by mask at 6 liters and attempt to slow breathing B. Attempt BLS maneuvers to remove a foreign body C. Apply oxygen and administer an epi-pen D. Begin CPR and prepare to defibrillate Question 6 part B 73

Question 7 : 

You respond to a house fire to assist a 30 year old woman. She has facial burns with singed eyebrows and nasal hairs. Her voice is very hoarse and she has soot in her sputum. What two airway emergencies are going on with this lady? A. Toxic inhalation and chronic bronchitis B. Acute asthma attack and airway burns C. Foreign body obstruction and chronic bronchitis D. Toxic inhalation and airway burns Question 7 74

Question 7 part B : 

How do you want to manage the patient in question 7? A. Apply oxygen, if advanced provider prepare to intubate B. Attempt BLS maneuvers to remove a foreign body C. Apply oxygen and administer an epi-pen D. Begin CPR and prepare to defibrillate Question 7 part B 75

Question 8 : 

Most respiratory emergencies are due to a failure of: A. Perfusion B. Ventilation C. Diffusion of gases D. All of the above Question 8 76

Question 9 : 

Respiratory emergencies are frequently complicated by: A. Inflammation B. Mucus production C. History of toxic exposure such as cigarette smoke D. All of the above Question 9 77

Question 10 : 

Hypoxia, low oxygen delivery to the cells can be caused by: A. Hypoxic hypoxia – insufficient oxygen B. Anemic hypoxia – insufficient red blood cells C. Stagnant hypoxia – shock D. Histotoxic hypoxia – oxygen unable to download at the cell E. All of the above Question 10 78

Answers : 

1. C Part B. B 2. D Part B. A 3. A Part B. D 4. B Part B. C 5. B Part B. A 6. C Part B. A 7. D Part B. A 8. D 9. D 10. E Answers 79