Airway And Breathing IV

Establishing and maintaining a clear airway is the most critical lifesaving maneuver that a paramedic can perform because it ensures that the patient is able to breathe properly. Without a clear airway, the patient may suffer from respiratory distress or even stop breathing altogether, leading to a life-threatening situation. By clearing the airway of any obstructions and maintaining it, the paramedic can ensure that the patient is able to breathe and receive the necessary oxygen to sustain life. This maneuver takes priority over other interventions as it directly addresses the most immediate threat to the patient's life.

A LEMON assessment is a systematic approach used to evaluate the likelihood of difficult airway management. If the assessment indicates that the airway is likely to be difficult, it is necessary to have a backup airway device readily available for the unconscious patient with respiratory failure. Therefore, a sufficiently bad LEMON assessment justifies starting with a backup airway device, making the statement true.

Increased number = increased difficulty.

When a patient becomes unresponsive, the muscles in their body relax, including the muscles in the tongue. This relaxation can cause the tongue to fall back and block the airway, leading to airway obstruction. Edema refers to swelling, which can also cause airway obstruction but is not specifically mentioned in the question. Steak and vomitus can cause airway obstruction in a conscious patient, but in an unresponsive patient, the leading cause is the tongue falling back and blocking the airway.

The modified jaw thrust is the most appropriate basic airway management approach for an unconscious patient with a suspected cervical spine injury. This technique involves using the fingers to lift the jaw forward without tilting the head, which helps to open the airway while minimizing movement of the neck. The head tilt, chin lift maneuver and extended jaw thrust may cause unnecessary movement of the cervical spine, potentially worsening the injury. The Sellick maneuver, also known as cricoid pressure, is used to prevent regurgitation during intubation and is not specifically indicated for managing the airway in a patient with a cervical spine injury.

When assessing breathing as part of the initial assessment, the least concern would be odor. While rate, effort, and regularity are important factors to consider in evaluating a person's breathing, odor is not typically a significant concern in this context. Odor may be relevant in other assessments, such as assessing for potential infections or respiratory conditions, but it is not a primary consideration when initially assessing breathing.

ETT (Endotracheal Tube) is a tube that is inserted into the trachea to maintain a patient's airway during surgery or other medical procedures. The purpose of intubation is to ensure that the patient can breathe properly, and it typically involves the use of general anesthesia to induce unconsciousness. Therefore, it is not possible for a conscious patient to talk while intubated. Hence, the correct answer is False.

The correct answer is Look, Evaluate, Mallampati Score, Obstructions, Neck Mobility. The LEMON mnemonic is a systematic approach used to assess the ease of intubation. It reminds healthcare providers to look for any potential difficulties or abnormalities in the airway, evaluate the patient's condition and medical history, assess the Mallampati score (which evaluates the visibility of the back of the throat), check for any obstructions or anatomical abnormalities, and assess the patient's neck mobility. This mnemonic helps guide clinicians in assessing and predicting the ease of intubation in order to ensure patient safety during the procedure.

The statement is true because hypocapnia, which is a decrease in carbon dioxide levels in the blood, can occur in cardiac arrest patients. This can lead to a false negative confirmation of endotracheal tube (ETT) placement. Hypocapnia causes vasoconstriction and reduces blood flow to the lungs, making it difficult to detect the presence of exhaled carbon dioxide, which is typically used to confirm correct ETT placement. Therefore, it is important to consider this possibility and use additional methods to confirm ETT placement in cardiac arrest patients.

Pulmonary aspiration refers to the inhalation of foreign material into the lungs. It can lead to various complications, such as occlusion of the airway and hypoventilation of distal lung tissue, which can cause respiratory distress. It can also damage the lung parenchyma, leading to inflammation and impaired lung function. Additionally, aspiration can result in pneumonia, as the inhaled material can introduce bacteria into the lungs. However, it is not associated with stimulating a spontaneous pneumothorax, which is the abnormal collection of air in the pleural space.

Crackles (rales) are abnormal lung sounds that are associated with fluid accumulating in the smaller airway passages. These sounds are often heard on inspiration and can indicate conditions such as pneumonia, heart failure, or pulmonary edema. Crackles are characterized by a popping or bubbling sound and can be heard with a stethoscope during a physical examination of the lungs.

Bradypnea is a medical term used to describe abnormally slow breathing. In the given options, option B is the correct answer because it represents a slower breathing pattern compared to normal breathing (option A).

Increased number = increased difficulty.

According to PA BLS protocol 227, measurements of SpCO should not be used to drive oxygenation decisions.

Placing a nasopharyngeal airway in a patient with suspected basilar skull fracture is not recommended. A basilar skull fracture can lead to leakage of cerebrospinal fluid (CSF) through the nose or ears. Inserting a nasopharyngeal airway can potentially cause further damage to the skull base and exacerbate CSF leakage, leading to complications such as meningitis. It is important to prioritize the patient's safety and consider alternative methods for airway management in this scenario.

The Venturi mask is capable of delivering fairly precise concentrations of oxygen. It works by mixing oxygen with room air through a series of small holes and valves, allowing the healthcare provider to adjust the oxygen concentration to the desired level. This makes it a suitable option for patients who require specific oxygen concentrations, such as those with chronic respiratory conditions. The other options, such as the nasal cannula, nonrebreather mask, and small-volume nebulizer, may not provide as accurate or adjustable oxygen concentrations.

Hypoxemia refers to an abnormal deficiency in the concentration of oxygen in the blood. It occurs when there is a low level of oxygen saturation in the bloodstream, which can lead to various symptoms and health complications. Hypocarbia refers to a low level of carbon dioxide in the blood, hypoventilation refers to inadequate breathing, and hypoxia refers to a deficiency in oxygen supply to the tissues. However, hypoxemia specifically focuses on the low concentration of oxygen in the blood.

The gum elastic bougie is not an example of a supraglottic airway. Supraglottic airways are devices that are placed above the glottis to maintain an open airway during anesthesia or in emergency situations. The laryngeal mask airway, King LTD, and Combitube are all examples of supraglottic airways commonly used in clinical practice. However, the gum elastic bougie is a device used to assist with difficult intubation by guiding the endotracheal tube into the trachea.

The pharynx is the correct answer because it is a shared structure between the respiratory system and the digestive system. It serves as a passage for both air and food, allowing air to pass through to the trachea and food to pass through to the esophagus. The larynx is primarily involved in the respiratory system, the trachea is solely involved in the respiratory system, and the vallecula is a depression in the pharynx, not a separate structure.

Tachypnea refers to rapid breathing, which is characterized by an increased respiratory rate. In the given options, option C represents tachypnea as it indicates a breathing pattern that is faster than normal.

Breathing pattern J represents ataxia. Ataxia is a neurological condition that affects coordination and balance. In the context of breathing, ataxic breathing is characterized by irregular and unpredictable breathing patterns, with varying depths and rates of breaths. This can include periods of apnea (temporary cessation of breathing) followed by rapid, shallow breaths. Therefore, breathing pattern J is the correct answer as it represents ataxia.

Crackles are abnormal lung sounds that indicate the presence of fluid in the lungs. This fluid can interfere with the diffusion of oxygen, making it harder for oxygen to pass from the lungs into the bloodstream. However, the diffusion of carbon dioxide, which is the waste product that needs to be removed from the body, is not as affected by the presence of fluid in the lungs. Therefore, it is true that crackles indicate a fluid problem in the lungs that interferes with the diffusion of oxygen, but not so much the diffusion of carbon dioxide.

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Cheyne-Stokes respirations are characterized by a cyclical pattern of gradually increasing and then decreasing depth of breathing, followed by a period of apnea. In option G, there is a clear pattern of gradually increasing and then decreasing depth of breathing, with a period of apnea between each cycle. Therefore, option G represents Cheyne-Stokes respirations.

Three failed ETT placement attempts is not a contraindication for placing a Kind LTD. A Kind LTD (Laryngeal Tube Device) is a supraglottic airway device used for emergency airway management. It is inserted blindly into the oropharynx, providing an alternative to endotracheal intubation. While failed ETT placement attempts may indicate difficulty in intubation, it does not specifically contraindicate the use of a Kind LTD. The other options listed, ingestion of bleach or Drain-O, patients with known esophageal disease, and intact gag reflex, are all contraindications for placing a Kind LTD.

The statement is true because if a patient is suspected to have a tension pneumothorax and a chest needle is placed using proper technique, there is minimal risk involved. This is because the procedure is performed with caution and precision, ensuring that the needle is inserted in the correct location to relieve any potential tension. However, it is important to note that this answer assumes the proper technique is followed and the healthcare professional is skilled in performing the procedure.

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A Mallampati score is used to assess the visibility of certain structures in the mouth to predict the difficulty of intubation during anesthesia. In Class 1, the soft and hard palate, uvula, and tonsils are all visible. In Class 2, the soft and hard palate, uvula, and base of the tonsils are visible. In Class 3, only the soft and hard palate and base of the uvula are visible, without any visibility of the tonsils. Therefore, the correct answer is Class 3 for a patient whose soft and hard palate and base of the uvula are visible, but without any visibility of the tonsils.

The correct answer is "Inferior thorax, adjacent to the 8th intercostal border." This is not an ideal place to auscultate lung sounds during a time-limited physical exam in the back of an ambulance because it is not a typical location for listening to lung sounds. The other options are all commonly used areas for auscultation and are more likely to provide accurate lung sound assessment.

External assistance is not a typical descriptor for respiratory effort. The other options such as work of breathing, accessory muscle use, nasal flaring, chest excursion, pursed-lip breathing, retractions, positioning, and adventitious sounds are all commonly used to describe the effort exerted by an individual during respiration. External assistance refers to the use of devices or interventions from outside sources to aid in breathing, which is not a direct measure of the individual's own respiratory effort.

The correct answer is "Failure to ensure that oxygen tanks are changed when needed." This answer is the exception because it does not pertain to a neglected skill related to airway management. The other options all involve important aspects of airway management that can be overlooked, such as recognizing respiratory distress, using manual methods to open the airway, ensuring proper oxygenation, performing BLS before ALS skills, and protecting the airway.

A BAM (Bougie-Assisted Nasotracheal Intubation) is used for nasotracheal intubation. This procedure involves inserting a thin, flexible tube through the nose and into the trachea to establish an airway. It is commonly used in situations where oral intubation is not feasible or contraindicated, such as in patients with facial trauma or limited mouth opening. The bougie, a rigid stylet, is used to guide the endotracheal tube into the trachea through the nasal passage.

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Per Fick's principle, ventilation, diffusion, and perfusion are the three main factors related to respiratory pathophysiology. Ventilation refers to the movement of air in and out of the lungs, diffusion is the process by which oxygen and carbon dioxide are exchanged between the alveoli and the blood, and perfusion is the flow of blood through the pulmonary capillaries. These three factors work together to ensure efficient gas exchange in the lungs.

Must be done with the cuff deflated.

Carboxyhemoglobin is a compound formed when carbon monoxide binds to hemoglobin in the blood. Smokers have higher levels of carboxyhemoglobin due to the inhalation of carbon monoxide in cigarette smoke. A normal carboxyhemoglobin value for smokers is typically between 5-10%. This range indicates that the individual has been exposed to some level of carbon monoxide but is not experiencing dangerously high levels.

Hyperpnea is a breathing pattern characterized by an increase in the depth and rate of breathing. Option D represents hyperpnea because it shows an increase in both the depth and rate of breathing compared to normal breathing represented by option A.

Mandibular trauma is a contraindication for the use of a dual lumen airway because it can result in a compromised airway. The mandible, or jawbone, plays a crucial role in maintaining the patency of the airway. If the mandible is fractured or injured, it can lead to displacement or obstruction of the airway, making the use of a dual lumen airway ineffective or potentially harmful. Therefore, it is important to avoid using a dual lumen airway in patients with mandibular trauma and consider alternative airway management techniques.

Kussmaul's respirations are characterized by deep, labored breathing. In this breathing pattern, the breaths are abnormally deep, rapid, and may be accompanied by a fruity or acetone-like odor. The correct answer, H, represents Kussmaul's respirations because it is the only option that describes abnormal breathing patterns, which is consistent with Kussmaul's respirations.

Nasal Cannulas
- 25%-45% oxygen
- Flow rate 1-6 L/min

Simple face mask
- 40%-60% oxygen
- Flow rate 6 -10 L/min

Partial Rebreather Mask
- 35%-60% oxygen
- Flow rate 6-10 L/min

Nonrebreathing Mask
- 80%-95% oxygen (yes, text says 100% but this is very hard to achieve due to poor mask seal around face)
- Flow rate10-15 L/min –generally do not use below 12 L/min, make sure reservoir bag stays inflated

Venturi mask
- 24%-50% oxygen
- Flow rate: 4-8 L/min

When suctioning a correctly placed ET tube, it is important to minimize the amount of time the suction is applied to prevent complications such as hypoxia or damage to the airway. Suctioning for 5 or fewer seconds ensures that the procedure is quick and efficient, reducing the risk of any adverse effects.