Airway And Breathing I

Flail chest is a condition characterized by multiple rib fractures, causing a segment of the chest wall to become detached from the rest. During exhalation, the detached segment moves paradoxically inward instead of outward, leading to a paradoxical motion of the chest. This occurs because the detached segment is no longer able to expand and contract normally with the rest of the chest wall. Pneumothorax, hemopneumothorax, and fractured clavicle do not typically cause paradoxical motion of the chest during exhalation.

Hyperventilation is the rapid breathing that leads to excessive intake of oxygen and expulsion of carbon dioxide. This causes a decrease in the levels of carbon dioxide in the body.

When the alveoli contain fluid, it causes the air to pass through the fluid-filled spaces, creating crackling sounds known as crackles. These sounds are typically heard during inspiration and can indicate conditions such as pneumonia, congestive heart failure, or pulmonary edema. Wheezes, on the other hand, are high-pitched whistling sounds caused by narrowed airways, while rhonchi are low-pitched snoring sounds caused by airway blockage. Stridor is a harsh, high-pitched sound that occurs when there is a blockage or narrowing of the upper airway.

The correct answer is "make the chest rise." According to the newest AHA CPR guidelines, the tidal volume for rescue breaths should be sufficient to make the chest rise. This ensures that enough air is being delivered to the lungs to support respiration. The guidelines do not specify a specific volume range, as the focus is on achieving visible chest rise during rescue breaths.

During intubation, the teeth can be used as a place to align the mark on a Combitube. This means that the teeth can serve as a reference point or guide for correctly positioning the Combitube device during intubation. By aligning the mark on the Combitube with the teeth, healthcare professionals can ensure that the device is inserted at the correct depth and angle, optimizing its effectiveness and minimizing potential complications.

The needle is inserted on top of the rib during chest decompression to avoid nerves, veins, and arteries. This is important to prevent potential damage or injury to these structures, which could lead to complications and further medical issues. By avoiding these vital structures, the procedure can be performed safely and effectively.

Based on the given information, the patient's history of diabetes, deep and rapid breathing, and unconsciousness, it is likely that she is experiencing a diabetic coma. Diabetic coma is a life-threatening complication of diabetes characterized by severe hyperglycemia (high blood sugar) and metabolic acidosis (excess acid in the body). The deep and rapid breathing is a compensatory mechanism to try to eliminate the excess acid.

The patient's pursing of the lips during exhalation creates a smaller opening for air to pass through, causing an increase in airway resistance. This increased resistance can lead to the creation of a back pressure on collapsed alveoli, which are small air sacs in the lungs responsible for gas exchange. By creating a back pressure, the collapsed alveoli can be opened up and allow for better ventilation and oxygenation of the lungs.

In addition to the symptoms mentioned in the scenario, a patient with severe stomach pain may also exhibit tachycardia (rapid heart rate), hypotension (low blood pressure), and fever. These additional signs and symptoms can indicate a more serious condition such as an infection or inflammation in the abdomen. Tachycardia and hypotension may be the body's response to pain and inflammation, while fever can be a sign of infection. These findings would prompt further assessment and intervention to determine the underlying cause and provide appropriate treatment.

Based on the given information, the patient is experiencing symptoms that are consistent with left sided heart failure. The labored breathing, wet breath sounds, and pink foam dripping from the mouth suggest pulmonary edema, which is a characteristic feature of left sided heart failure. The lack of response to stimuli and the vital signs, such as elevated pulse and low blood pressure, further support this diagnosis. There are no indications of hypoglycemia, right sided heart failure, or tension pneumothorax mentioned in the scenario.

In a 23-year-old female patient with good respiratory health, you would expect to find vesicular breath sounds. Vesicular breath sounds are normal, low-pitched, soft, and heard over most of the lung fields. They are produced by air moving through the smaller airways and alveoli. Bronchovesicular breath sounds are heard in the area between the bronchi and alveoli, and are typically heard in certain areas of the lungs. Bronchial breath sounds are loud and high-pitched, and are abnormal if heard over peripheral lung areas. Moist breath sounds are abnormal and indicate the presence of fluid or mucus in the lungs.

A Macintosh blade is a medical instrument used for endotracheal intubation, a procedure in which a tube is inserted into the trachea to assist with breathing. During this procedure, the epiglottis, a flap of cartilage in the throat, needs to be lifted or elevated in order to visualize the vocal cords and guide the insertion of the tube. The correct answer, Vallecula, refers to the space between the base of the tongue and the epiglottis where the Macintosh blade is inserted to elevate the epiglottis and visualize the vocal cords.

Based on the patient's height of 5 foot, 6 inches, the most appropriate size King LT tube would be size 4. This is because the King LT tube size is determined based on the patient's height, with size 4 typically recommended for patients between 5 foot and 6 foot tall. Therefore, size 4 would be the correct choice for this patient.

After the baby has crowned during delivery, it is important to suction the mouth and nose to clear any fluids or mucus that may obstruct the baby's airway. This helps to ensure that the baby can breathe properly once fully delivered. Additionally, checking for a prolapsed cord is crucial at this stage. A prolapsed cord occurs when the umbilical cord slips through the cervix and precedes the baby, which can lead to compression and compromise the baby's oxygen supply. Therefore, checking for a prolapsed cord is essential to address this potentially life-threatening situation promptly.

The mnemonic "light, tight, bright" is a helpful way to remember the steps for checking if an intubation blade is in working condition. The first step is to ensure that the light source on the blade is functioning properly by checking if it turns on. The second step is to ensure that the blade is securely attached and tightened to the handle. Finally, the last step is to confirm that the light on the blade is bright enough to provide adequate illumination during intubation.

Albuterol is classified as a sympathomimetic because it mimics the effects of the sympathetic nervous system. Sympathomimetic drugs stimulate the adrenergic receptors in the body, leading to bronchodilation and relaxation of the smooth muscles in the airways. Albuterol is commonly used as a bronchodilator to relieve symptoms of asthma and other respiratory conditions.

When administering etomidate to a patient in respiratory failure, two large bore IVs are not required. Etomidate is a short-acting intravenous anesthetic used for induction of anesthesia or sedation. While it is important to have two EMS providers trained at the ALS level or higher, airway and resuscitative equipment on hand and ready to go, and medical command orders, the administration of etomidate does not specifically require two large bore IVs. These IVs may be necessary for other purposes, but they are not directly related to the administration of etomidate in this scenario.

Supplemental oxygen is the least appropriate treatment for this patient because his oxygenation status is not compromised. The patient's skin is pink, indicating good perfusion, and his breathing is fast with adequate tidal volume, suggesting that he is effectively oxygenating. Additionally, the patient's symptoms are consistent with a panic attack, which is a psychological condition rather than a respiratory or oxygenation issue. Therefore, providing supplemental oxygen would not address the underlying cause of the patient's symptoms and would not be the most appropriate treatment option.

A cerebrovascular accident, also known as a stroke, is least likely to be the cause of respiratory distress in this scenario. Respiratory distress is typically caused by problems in the lungs or airways, such as sepsis (a severe infection), leukemia (a type of blood cancer), or anemia (a decrease in red blood cells). A stroke primarily affects the brain and may cause neurological symptoms such as weakness or paralysis, but it is less likely to directly cause respiratory distress.

The presence of bilateral lung sounds is the least reliable form of confirming placement of an ET tube because it does not guarantee that the tube is in the correct position. Lung sounds can be heard even if the tube is in the esophagus or if it is only partially obstructing the trachea. Therefore, relying solely on the presence of bilateral lung sounds may lead to a false confirmation of tube placement. Other methods such as direct visualization, capnographic waveform, and EDD reinflation are more accurate and should be used in conjunction with lung sounds for confirmation.