1356 Exam Flashcards
(131 cards)
1
Q
What is the most common size ET tube for a female?
A
7.0 (7.5 for obese woman)
2
Q
What is the most common size ET tube for a male?
A
8.0 (8.5 for obese man)
3
Q
ET tube size depth measured by:
A
tube size x 3cm at the teeth.
4
Q
ET tube placement in the trachea should result in:
A
chest rise
5
Q
If tube mark is too far its a:
A
right mainstem
6
Q
If a tube mark is too short its an:
A
esophagus.
7
Q
What is the most effective securing device for an ET tube?
A
Commercial device
8
Q
What happens when an OPA is too short?
A
creates tongue obstruction
9
Q
What happens when an OPA is too long?
A
Creates epiglottis obstruction
10
Q
When responding to a chocking patient, first:
A
confirm choking then begin back blows or Heimlich chest thrusts.
11
Q
If/when a choking patient goes unconscious:
A
begin CPR
12
Q
A patient with this is complaining of SOB
A
respiratory distress
13
Q
A patient with this breathing problem may present with altered LOC and/or unresponsive.
A
Respiratory failure
14
Q
What defines adequate breathing?
A
good chest rise and fall, breathing 12-20 times a minute/pulse oximetry >96%.
15
Q
What defines inadequate breathing?
A
No rise and fall of the chest, unable to talk.
16
Q
What is the pulse ox reading?
A
saturation of oxygen on hemoglobin. Based on saturation percentage. SA02
17
Q
What is PO2?
A
Partial oxygen concentration (pressure reading)
18
Q
What is the purpose of listening to breath sounds?
A
Making sure air is moving in and out/listening for inappropriate noises such as stridor, wheezing, rales, etc.
19
Q
What are the steps for deep suction?
A
Go all the way down and suction on the way back up. Max 10-15 seconds of suction. Usually measured from lips to earlobe.
20
Q
What medical emergencies are indications for intubation?
A
cardiac arrest, respiratory failure w/o gag reflex, inadequate rise and fall of the chest.
21
Q
Describe king tube
A
2 cuffs and 1 pilot ballon
22
Q
Describe LMA tube
A
1 cuff and 1 pilot
23
Q
Describe ET tube
A
1 cuff and 1 pilot balloon.
24
Q
Describe Combi Tube
A
2 cuffs and 2 pilot balloons.
25
____: performed by applying gentle pressure to the anterior neck (in a posterior direction) at the level of the cricoid cartilage.
Sellick maneuver.
26
_____ is most often used to help align the airway structures during endotracheal intubation.
Sellic maneuver.
27
What is the maneuver called that moves the chin and forehead to open the airway?
head tilt chin lift.
28
What maneuver is used to open the airway when a patient has a cervical collar on?
Modified jaw thrust.
29
The maneuver uses the index finger at jaw to push forward and tilt the head back:
Modified jaw thrust.
30
What does clear fluid in the patients mouth possible indicate?
Basal skull fracture where CSF is leaking out.
31
What are the three ways we check for adequate breathing?
look, listen, and feel.
32
short and explosive, bubbling or drinking. Located typically in the lower airway but can be high. Happens during inhalation.
Rales
33
Low pitched wheezing while breathing out, rubbing.
Rhonchi
34
Harsh, squeaking with every breath (blocked upper airway)
Stridor
35
High pitched whistling (lower airway)
Wheezing.
36
Gasp followed by long bout of coughing.
Whooping.
37
What is the best way to secure and ET tube?
Commercial/manufacture device that has integral bite block.
38
How is a stroke patients airway managed?
See if they can maintain their own airway. Gag then bag. Gag reflex then bag, but if no gag then RSI. BLS first.
39
Breathing too fast
hyperventilation
40
Breathing too slow
Hypoventilation
41
Choking patient with partial obstruction:
Coughing vs full obstruction with no coughing.
42
How is a complete airway obstruction with unconscious patient handled?
Either use forceps to try and reach in to retrieve the object. Use an ET tube and shove the object down, but if all else fails, do CPR.
43
How is a nasal intubation timed?
ET tube is pushed in conjunction with the patients own breathing.
44
What is an indication that a patient with respiratory distress is improving?
rising SPO2.
45
What is the cycle of blood through the vascular system? (heart)
Deoxygenated blood comes from the vena cava into the RA, RA to RV, RV to pulmonary arteries where the blood is oxygenated by the lungs and CO2 is breathed off, then to the LA, LA to LV, LV to the aorta and pushed through the peripheral vascular system.
46
When is soft suction used?
With a ET tube.
47
When is rigid suction used?
To suction the mouth (not the tube)
48
What is the normal capnography range?
35-45
49
What does the wave form look like for a patient not in respiratory distress?
box
50
What would you expect to hear from a drowning patient?
Bubbling or gurgling with poor BVM compliance.
51
What does a shark fin indicate for breathing waveform?
bronchospasm.
52
______= breaths per min x tidal volume
average tidal volume.
53
Average air in and out in 1 min:
minute volume = rate x depth.
54
What observation would be a sign for pneumonia?
green/yellow mucus.
55
What is the highest priority in SOB? Helps to determine what is causing it.
Lung sounds
56
What is PEEP?
Positive end expiratory pressure.
57
What does PEEP do?
improves oxygen saturation by accumulation of air and increases alveolar pressure at the end or expiration, which is referred to as auto-PEEP.
58
What are the steps for extubating a patient?
Use standard precautions
Ensure adequate oxygenation
Prepare intubation equipment and suction
confirm patient responsiveness
Position patient on side if possible.
Suction oropharynx
Deflate cuff
Remove ETT on cough or expiration
Provide O2
Reassess patient ventilation and oxygenation.
59
Why do we confirm tube placement with breath sounds?
Ensure we did not tube the esophagus. ETCO2
60
Fatigue, blueness of lips or fingernails, wheezing, and SOB are all signs/symptoms of what illness?
COPD
61
Cough, wheezing, coughing up mucus (smokers cough) are signs of what illness?
Chronic bronchitis.
62
What does it mean if you have hyperresonance
too much air in the lungs
63
what does it mean if you have hyporesonance?
Fluid in the lungs.
64
Managing airway for unresponsive or altered patient.
check for gag. no gag and no/unequal rise and fall of the chest, need to make it rise and fall with positive pressure ventilation.
65
How far does a rigid catheter go?
Predetermined depth of measured length from patients earlobe to lips.
66
What happens to someone hypoventilating?
Breathing too slow will allow CO2 to build up in the body causing them to become acidotic.
67
What happens to some hyperventilating?
Breathing off all CO2 which could cause light headedness
68
What are we allowed to assist with while off duty?
Bronchodilator
69
Mask with one way side port, an attached reservoir bag to hold oxygen ready to inhale is a:
Non-rebreather.
70
This is indicated for low to moderate oxygen requirement and long term oxygen therapy
Nasal canula.
71
Gurgling, snoring, and stridor are all:
upper airway sounds
72
Rails, ronchi, and wheezing are all:
lower airway sounds
73
How is esophageal intubation recognized?
distention of the abdomen and absent lung sounds
74
How is orotracheal intubation recognized?
Confirmed by ETCO2, equal rise and fall of the chest, breath sounds, no epigastric sounds.
75
How is an OPA measured?
properly sized airway will extend from the patients mouth to the angle of the jaw.
76
How is an unconscious patient with an airway block managed?
Be concerned about aspiration.
Need 95-100% OXYGEN.
77
What is the treatment for asthma?
bronchodilator (albuterol), fluids, steroids.
78
What is considered the gold standard for managing a patients airway?
ET intubation.
79
How to manage a patient with a stoma?
connect BVM and may suction like ET tubes of suction goes in till it reaches the carina or meets resistance then suction 10-15 seconds on the way out.
80
What increases and decreases CO2 levels in the body?
quality of breathing and rate of breathing.
81
Airway is always the ____ priority.
first.
82
How is a catheter cleaned after it is used?
while with sterile cloth or wash with sterile water.
83
What airway devices require lubrication?
ETT, king, LMA, NPA, combi
84
Always use ____ with NPA
lube
85
What to expect with a patient with burned airway?
difficult to bag.
86
____ will be bagged slower to help displace water.
Drowning patient.
87
What is the O2 flow rate for a BVM?
high enough to keep reservoir bag inflated
88
What is the O2 flow rate for non-rebreather?
10-15LPM
89
What is the preferred method for caring for distended stomach?
nasogastric tube placement.
90
Why would you use a modified jaw thrust instead of head tilt chin lift?
suspected cervical spine injury.
91
What is the oxygen concentration of room air?
20.94%
92
What is the carbon dioxide concentration of room air?
0.04%
93
What is atmospheric pressure at sea level?
14.7 PSI or 760 mm mercury
94
Where is the Mac blade placed?
On the vallecula
95
Where is the Miller blade placed?
on the epiglottis?
96
What is bronchovesicular breathing?
sounds are heard in the posterior chest between the scapulae and in the center part of the anterior chest. Bronchovesicular breathing sounds are softer than bronchial sounds but have aa tubular quality.
97
What is Vesicular breathing?
soft, blowing, or rustling sounds normally heard throughout most of the lung fields.
98
Where will a tube most likely go when placed too deep?
Right mainstream.
99
12-15 lpm flow on non-rebreather will never deflate more than ___ when breathing
1/3
100
What are the parameters for tubing someone with a dual lumen (combi tube)?
must be between 4'9" and 6'7"
no gag reflex
101
____ is below normal level of oxygen in your blood, specifically in the arteries.
Hypoxemia
102
____ is the sensation of breathlessness in the recumbent position, relieved by sitting or standing.
Orthopnea
103
_______ is a sensation of shortness of breath that awakens the patients, often 1-2 hours after falling asleep, and is usually relieved in the upright position.
Paroxysmal nocturnal dyspnea
104
____ is mechanical and involves the movement of air.
ventilation.
105
______ is physiological and involves the exchange of gases in alveoli and in the cells.
respiration.
106
_____ respirations are a rare abnormal breathing pattern that can occur while awake but usually while sleeping. This pattern involves a period of fast, shallow, breathing followed by slow, heavier breathing and moments without any breathing at all (apnea)
Cheyenne-stokes respiration
107
Bronchiolitis is ___
viral
108
Bronchitis is ____
bacterial
109
If a 7.0 ET tube is showing 24 at the teeth, where is the tube likely at?
Right mainstem. Went too far. Tube length should be size of the tube x3 at the teeth.
110
If a 7.0 ET tube is showing 16/17/18 at the teeth, where is the tube likely placed?
Esophagus
111
What are the best reasons for securing an ET tube?
Prevents it from coming out. Prevents aspiration, and movement will cause the tube to displace.
112
Which RSI drug has little effect on blood pressure?
Etomidate
113
Maximum depth of a soft catheter?
Measure from the end of ETT to the earlobe to the suprasternal notch.
114
Maximum depth of a rigid catheter?
Corner of the mouth to the earlobe
115
What does a low capnography number indicate?
acidosis.
116
What does a high capnography number indicate?
alkalosis.
117
This technique uses one person to squeeze the BVM bag and one person to open the airway and maintain the mask seal.
2 person BVM technique.
118
When is cricoid pressure used?
to assist with intubation. (also called the Sellick maneuver.)
119
What is the best way to clear secretions in a patients mouth?
rigid suction catheter.
120
Patient not maintaining airway with missing jaw is an example of a need for?
Surgical Cric.
121
What can you do to keep blood from clotting in a soft suction catheter?
Dip the suction catheter in water to rinse.
122
Where is the primary location of the body monitoring of CO2 concentrations?
Receptors in the Medulla
123
For which of the following patients showing signs of severe respiratory distress should you limit the amount of oxygen you provide?
You should initially provide oxygen for any patient in distress.
124
What condition is an absolute contraindication for applying an automatic transport ventilator?
Suspected pneumothorax.
125
Which of the following is the most important reason why we confirm breath sounds after placing an airway.
An improperly placed advanced airway can be fatal .
126
The percentage of arterial hemoglobin saturated oxygen molecules is known as?
SaO2
127
You are called to treat a patient with severe dyspnea. Which of the following tank sizes would be the most appropriate to bring to the patient side when you anticipate a 10-minute transfer from the patient's bed to the ambulance?
D tank with 1200PSI
128
during the resuscitation of a traumatic Cardiac Arrest patient, the patient is being ventilated with an automatic transport ventilator. You were aware that the patient's color has not improved at all during CPR and no Carotid pulse is or felt. Most likely there is no change in this patient because the ventilation is causing:
Reduced blood return to the heart
129
which of the following describes the proper technique when performing the jaw thrust maneuver?
Retract the lower lip with your thumb to keep the mouth open.
130
When is the glottic opening the largest?
upon inspiration
131
Which of the following is the most dangerous result of an undetected esophageal placement of an endotracheal tube?
hypoxia
