Chapter 10 Respiration and Artificial Ventilation

Question 1

Key Terms

the amount of air that reaches the alveoli

Answer 1

Alveolar Ventilation

Question 2

Key Terms

forcing air or oxygen into the lungs when a patient has stopped breathing or has inadequate breathing. Also called “positive pressure ventilation”.

Answer 2

Artificial Ventilation

Question 3

Key Terms

a device that provides positive pressure ventilation. It includes setting designed to adjust ventilation rate and volume, is portable, and is easily carried on an ambulance

Answer 3

Automatic Transport Ventilator (ATV)

Question 4

Key Terms

a handheld device with a face mask and self-refilling bag that can be squeezed to provide artificial ventilations to a patient. It can deliver air from the atmosphere or oxygen from a supplemental oxygen supply system

Answer 4

Bag-Valve Mask (BVM)

Question 5

Key Terms

the exchange of oxygen and carbon dioxide between cells and circulating blood

Answer 5

Cellular Respiration

Question 6

Key Terms

a blue or gray color resulting from lack of oxygen in the body

Answer 6

Cyanosis

Question 7

Key Terms

a process by which molecules move from an area of high concentration to an area of low concentration

Answer 7

Diffusion

Question 8

Key Terms

a valve that indicates the flow of oxygen in liters per minute

Answer 8

Flowmeter

Question 9

Key Terms

a device that uses oxygen under pressure to deliver artificial ventilations. Its trigger is placed so the rescuer can operate it while still using both hands to maintain a seal on the face mask. It has automatic flow restriction to prevent overdelivery of oxygen to the patient

Answer 9

Flow-Restricted, Oxygen-Powered Ventilation Device (FROPVD)

Question 10

Key Terms

a device connected to the flowmeter to add moisture to the dry oxygen coming from an oxygen cylinder

Answer 10

Humidifier

Question 11

Key Terms

an insufficiency of oxygen in the body’s tissues

Answer 11

Hypoxia

Question 12

Key Terms

a device that delivers low concentrations of oxygen through two prongs that rest in the patient’s exhaled air escapes through a valve and is not rebreathed

Answer 12

Nasal Cannula

Question 13

Key Terms

a cylinder filled with oxygen under pressure

Answer 13

Oxygen Cylinder

Question 14

Key Terms

a face mask and reservoir oxygen bag with no one-way valve to the reservoir bag so some exhaled air mixes with the oxygen; used in some patients to help preserve carbon dioxide levels in the blood to stimulate breathing

Answer 14

Partial Rebreather Mask

Question 15

Key Terms

a device, usually with a one-way valve, to aid in artificial ventilation. A rescuer breathes through the valve when the mask is placed over the patient’s face. It also acts as a barrier to prevent contact with a patient’s breath or body fluids. It can be used with supplemental oxygen when fitted with an oxygen inlet

Answer 15

Pocket Face Mask

Question 16

Key Terms

a device connected to an oxygen cylinder to reduce cylinder pressure so it is safe for delivery of oxygen to a patient

Answer 16

Pressure Regulator

Question 17

Key Terms

the exchange of oxygen and carbon dioxide between the alveoli and circulating blood in the pulmonary capillaries

Answer 17

Pulmonary Respiration

Question 18

Key Terms

the diffusion of oxygen and carbon dioxide between the alveoli and the blood (pulmonary respiration) and between the blood and the cells (cellular respiration). Also used to mean, simply, breathing

Answer 18

Respiration

Question 19

Key Terms

when breathing completely stops

Answer 19

Respiratory Arrest

Question 20

Key Terms

increased work of breathing; a sensation of shortness of breath

Answer 20

Respiratory Distress

Question 21

Key Terms

the reduction of breathing to the point where oxygen intake is not sufficient to support life

Answer 21

Respiratory Failure

Question 22

Key Terms

a permanent surgical opening in the neck through which the patient breathes

Answer 22

Stoma

Question 23

Key Terms

a device designed to be placed over a stoma or tracheostomy tube to provide supplemental oxygen

Answer 23

Tracheostomy Mask

Question 24

Key Terms

breathing in and out (inhalation and exhalation), or artificial provision of breaths

Answer 24

Ventilation

Question 25

Key Terms

a face mask and reservoir bag device that delivers specific concentrations of oxygen by mixing oxygen with inhaled air

Answer 25

Venturi Mask

Question 26

Short Answer

Describe the signs of respiratory distress.

Answer 26

Signs of respiratory distress include rapid respiration, accessory muscle use, anxiety, pursed lip breathing, and the tripod position. In the case of respiratory distress, the patient should have a relatively normal pulse oximetry and have a relatively normal mental status as increased respiratory efforts are meeting the metabolic needs of the body.

Question 27

Short Answer

Describe the signs of respiratory failure.

Answer 27

Signs of respiratory failure include all the signs of respiratory distress plus signs that the body is no longer compensating for the respiratory challenge. These signs include altered mental status, dropping pulse oximetry, cyanosis, slowing/irregular respirations, and respiratory fatigue.

Question 28

Short Answer

Name and briefly describe the techniques of artificial ventilation (mouth-to-mask, BVM, FROPVD).

Answer 28

The techniques of artificial ventilation are:

• Mouth-to-mask: Connect oxygen to the inlet on the mask, and run at 15 liters per minute. Position the mask on the patient’s face. Hold the mask firmly in place while maintaining head tilt. Take a breath and exhale into the mask port or one-way valve at the top of the mask port with just enough volume to make the chest rise. Remove your mouth from the port, and allow for passive exhalation.
• BVM: Position yourself at the patient’s head, and establish an open airway. Suction and insert an airway adjunct as necessary. Select the correct size mask for the patient. Position the mask on the patient’s face. Form a “C” around the ventilation port with your thumb and index finger. Use the middle, ring, and little fingers under the patient’s jaw to hold the jaw to the mask. With your other hand, squeeze the bag once every five seconds, causing the patient’s chest to rise. Release pressure on the bag, and let the patient passively exhale.
• FROPVD: Follow the same procedures for mask seal as recommended for the BVM. Trigger the device until the chest rises, and repeat every five seconds.

Question 29

Short Answer

For BVM ventilation, describe recommended variations in technique for one or two rescuers and for a patient with trauma suspected or trauma not suspected.

Answer 29

A lone rescuer will need to perform all the tasks of BVM ventilation. With two rescuers, however, one person will hold the mask seal on the patient’s face while the other squeezes the bag. For a patient with suspected trauma, the provider holding the mask must perform a jaw-thrust maneuver. For a patient with no suspected trauma, the head-tilt, chin-lift maneuver may be used to open the airway.

Question 30

Short Answer

Describe how positive pressure ventilation moves air differently from how the body normally moves air.

Answer 30

Under normal circumstances, the body flexes the diaphragm and expands the chest cavity to create a negative pressure and pull air in through the glottic opening. Artificial ventilation, such as BVM ventilation, relies on positive pressure to “push air in.”

Question 31

Short Answer

Name patient problems that would benefit from administration of oxygen, and explain how to decide what oxygen delivery device (nonrebreather mask, nasal cannula, or other) should be used for a particular patient.

Answer 31

Any condition that causes hypoxia will benefit from supplemental oxygen. These conditions include bronchospasm, acute pulmonary edema, and shock. Hypoxic patients most commonly benefit from high-concentration oxygen delivered through a nonrebreather (NRB) mask, but in some cases, these patients may not tolerate highconcentration rates. In cases where patients will not tolerate an NRB mask, lower-flow delivery delivery devices such as a nasal cannula may be a better choice. Some EMS systems may also allow providers to use alternative devices such as Venturi masks or titrate the level of oxygen administration based on patient condition and oxygen levels (always follow local protocols).