Airway Management - Oxygen & Ventilation Flashcards
(137 cards)
1
Q
Always give oxygen to patients who are ___
A
Hypoxic
2
Q
When ventilating any patient in cardiac or respiratory arrest, use ___
A
High-concentration supplemental oxygen
3
Q
Oxygen is usually stored as ___
A
Compressed gas in green, seamless, steel or aluminum cylinders
4
Q
Aluminum cylinders are tested every ___
A
5 years
5
Q
Composite cylinders are tested every ___
A
3 years
6
Q
Two common sizes of oxygen cylinders
A
D (or jumbo D): Can be carried
M: Remains onboard your unit as the main supply tank
7
Q
Less common sizes of oxygen cylinders
A
A, E, G, H, & K
8
Q
New naming convention for oxygen cylinders
A
M (for medical) followed by a number
9
Q
Liquid oxygen cylinders need to be stored ___
A
Upright
10
Q
Volume of D cylinder
A
350 L
11
Q
Volume of Jumbo D cylinder
A
500 L
12
Q
Volume of E cylinder
A
625 L
13
Q
Volume of M (MM) cylinder
A
3000 L
14
Q
Volume of G cylinder
A
5300 L
15
Q
Volume of H, A (M4), K cylinder
A
6900 L
16
Q
Computing oxygen cylinder flow duration
A
((Gauge pressure - Safe residual pressure) x Cylinder constant) / Flow rate in L/min = Duration of flow in minutes
17
Q
Do not handle an oxygen cylinder by ___
A
The neck alone
18
Q
When oxygen cylinders are on the ambulance, store them ___
A
In brackets
19
Q
A system established for portable cylinders to ensure that a regulator is not connected to a cylinder containing the wrong type of gas
A
Pin-indexing system
20
Q
The outlet valves on portable oxygen cylinders are designed to accept ___
A
Yoke-type pressure-reducing gauges, which conform to the pin-indexing system
21
Q
A safety system for large oxygen cylinders, designed to prevent the accidental attachment of a regulator to a cylinder containing the wrong type of gas
A
American Standard Safety System
22
Q
How does the American Standard Safety System prevent attaching the wrong regulator valve to the wrong cylinder?
A
The thread pitches are different in different cylinders
23
Q
Pressure of oxygen in a full cylinder
A
About 2000 psi
24
Q
Pressure regulators typically reduce the pressure to ___
A
40 to 70 psi
25
After the pressure is reduced, the final attachment for delivering the oxygen to the patient is usually ___
1. A quick-connect female fitting that will accept a quick-connect male plug from a pressure hose or ventilator/resuscitator
2. A flowmeter that will permit the regulated release of gas measured in L/min
26
Flowmeters are usually permanently attached to ___
Pressure regulators on emergency medical equipment
27
Two types of flowmeters
1. Pressure-compensated flowmeters
2. Bourdon-gauge flowmeters
28
Incorporates a float ball within a tapered calibrated tube. The flow of gas is controlled by a needle valve located downstream of the float ball
Pressure-compensated flowmeter
29
A pressure-compensated flowmeter must be kept ___
Upright
30
A pressure gauge that is calibrated to record flow rate
Bourdon-gauge flowmeter
31
Newer flowmeters incorporate a ___
Fixable setting with either a dial or a knob that sets the flow, making the bourdon gauge not necessary
32
If the cylinder was commercially filled, it will have a ___
Plastic seal around the valve stem covering the opening in the stem
33
Purpose of cracking the cylinder open briefly before use
Make sure that dirt particles and other possible contaminants do not enter the oxygen flow
34
On one side of the valve stem, you will find ___
Three holes, the larger one on top is the true opening
35
What is found at the oxygen outlet on the valve stem?
A metal-bound elastomeric sealing washer
36
Most EMS systems consider a cylinder with a pressure less than ___ to be too low to keep in service
500 to 1000 psi
37
The flowmeter will have a second gauge or selector dial that indicates the ___
Oxygen flow rate
38
Damage to cellular tissue due to excessive oxygen levels in the blood
Oxygen toxicity
39
Increased cellular oxygen levels contribute to the production of ___
Oxygen free radicals
40
Free radicals may lead to ___
Tissue damage and cellular death in some patients
41
Some patients that may react negatively to excessive supplemental oxygen include ___
COPD, cerebral vascular incidents, and myocardial infarction
42
Oxygen may be administered to patients experiencing signs of a myocardial infarction when they ___
Have signs of heart failure, are short of breath, or have a room air oxygen saturation less than 94%
43
Patients experiencing signs of shock should be placed on ___
Oxygen
44
Hypoxemia is immediately life-threatening, whereas oxygen toxicity ___
Is not
45
When in doubt, or if unable to measure oxygen saturation, supplemental oxygen should be ___
Administered
46
Exceptions to the minimum oxygen saturation of 94%
Patients who have been exposed to CO, patients with potential anemia, or patients with shock
47
Oxygen delivery equipment used in the field should be limited to ___
Nonrebreathing masks, bag-mask devices, and nasal cannulas
48
Nasal cannula flow rate
1 - 6 L/min
49
Nonrebreathing mask with reservoir flow rate
10 - 15 L/min
50
Bag-mask device with reservoir flow rate
15 L/min
51
Nasal cannula oxygen delivered
24% to 44%
52
Nonrebreathing mask with reservoir oxygen delivered
Up to 90%
53
Bag-mask device with reservoir oxygen delivered
Nearly 100%
54
Used to administer high concentrations of oxygen to significantly hypoxemic patients who are otherwise breathing adequately
Nonrebreathing mask
55
When using a nonrebreathing mask, you must ___
Make sure the reservoir bag is full before the mask is placed on the patient
56
How to adjust the nonrebreathing mask
Adjust the flow rate so that the bag does not fully collapse when the patient inhales, to about 2/3 of the bag volume, or 10 - 15 L/min
57
Delivers oxygen through two small, tubelike prongs that fit into the patient's nostrils
Nasal cannula
58
Typically, the nasal cannula is used in patients with ___
Mild hypoxemia
59
With the nasal cannula, if you anticipate long transport time, consider the use of ___ to prevent ___
1. Humidification
2. Causing dryness or irritating the mucous membrane lining the nose
60
Humidification may be associated with an increased generation of ___
Aerosolized droplets of fluid that may increase the degree to which the patient can transmit disease to other people in the same space
61
The partial rebreathing mask is similar to a nonrebreathing mask except that ___
There is no one-way valve between the mask and the reservoir
62
Ideal mask for patients who are experiencing hyperventilation syndrome
Partial rebreathing mask
63
The partial rebreathing mask is useful if you want to increase the patient's ___
PaCO2
64
With a partial rebreathing mask, the patient will rebreathe a ___
Small amount of their exhaled air
65
Has a number of attachments that enable you to vary the percentage of oxygen being delivered to the patient while a constant flow is maintained from the regulator
Venturi mask
66
Venturi mask oxygen delivery
24% to 40%
67
The main advantage of the Venturi mask
The use of its fine adjustment capabilities in the long-term management of physiologically stable patients
68
When you need to adjust oxygen concentration in an emergency, it is typically done by ___
Adjusting the flow rate or changing the delivery device
69
If you do not have a tracheostomy mask, you can improvise by ___
Placing a face mask over the stoma
70
An oxygen humidifier consists of ___
A small single-patient-use bottle of sterile water through which the oxygen leaving the cylinder becomes moisturized before it reaches the patient
71
A patient who is not breathing needs ___
Artificial ventilation and 100% supplemental oxygen
72
Fast, shallow breathing moves air primarily in the ___ and does not allow for ___
1. Larger airway passages (dead air space)
2. Adequate exchange of air and CO2 in the alveoli
73
Patients with inadequate breathing require ___
Assisted ventilations with some form of positive-pressure ventilation
74
Two treatment options for a patient in severe respiratory distress or respiratory failure and not breathing adequately
1. Assisted ventilation
2. CPAP
75
CPAP
Continuous positive airway pressure
76
Signs of altered mental status and shallow breathing are indications for ___
Assisted ventilation
77
Excessive accessory muscle use and fatigue from labored breathing are signs of potential ___
Respiratory failure
78
Steps to assist a spontaneously breathing patient's ventilations with a bag-mask device
1. Explain the procedure to the patient
2. Place the mask over the patient's nose and mouth
3. Squeeze the bag each time the patient breaths, maintaining the same rate as the patient
4. After the initial 5 to 10 breaths, slowly adjust the rate and deliver an appropriate tidal volume
5. Adjust the rate and tidal volume to maintain an adequate minute volume
79
Once you determine a patient is not breathing, begin ___ immediately
Artificial ventilation
80
Methods to provide artificial ventilations
1. Mouth-to-mask technique (only in non-work situations when a bag-mask is not available)
2. One- or two-person bag-mask device technique
81
When providing positive-pressure ventilations, this affects ___
Drawing venous blood back to the heart
82
When positive-pressure ventilation is initiated, more air is needed to ___
Achieve the same oxygenation and ventilatory effects of normal breathing
83
During positive-pressure ventilation, the increase in airway wall pressure causes the walls of the chest cavity to ___, resulting in ___
1. Push out of their normal anatomic shape
2. An increase in the overall intrathoracic pressure
84
The intrathoracic pressure increase affects the ___
Return of venous blood to the heart
85
Reduced venous return results in ___
Reduced cardiac output
86
It is imperative that you ___ of artificial ventilations to help prevent the drop in cardiac output
Regulate the rate and volume
87
The amount of blood ejected by the left ventricle in one minute
Cardiac output
88
Ventilation rate for apneic adult with a pulse
1 breath every 6 seconds
89
Ventilation rate for apneic infant or child with a pulse
1 breath every 2 to 3 seconds
90
Barrier devices don't provide protection from ___
Diseases transmitted by airborne pathogens or aerosolized droplets such as SARS-CoV2 or TB
91
Mouth-to-mouth ventilations with or without a barrier device should be provided only in ___
Extreme situations
92
What is safer than a barrier device for mouth-to-mouth ventilations?
Pocket mask containing a one-way valve with an adequate filter
93
Mouth-to-mouth ventilations should only be used when ___
The EMT is off-duty, and no bag-mask device is available
94
Air movement with normal ventilation
Air is sucked into the lungs due to the negative intrathoracic pressure created when the diaphragm contracts
95
Air movement with positive-pressure ventilation
Air is forced into the lungs through a means of mechanical ventilation
96
Blood movement with normal ventilation
Normal breathing allows blood to naturally be pulled back to the heart
97
Blood movement with positive-pressure ventilation
Intrathoracic pressure is increased as air is driven into the lungs, which can reduce blood return to the heart and therefore reduce the amount of blood pumped by the heart
98
Airway wall pressure with positive-pressure ventilation
More volume is required to have the same effects as normal breathing. As a result, the walls are pushed out of their normal anatomic shape
99
Esophageal opening pressure with positive-pressure ventilation
Air may be forced into the stomach, especially with aggressive ventilation, causing gastric distention that could result in vomiting and aspiration
100
Overventilation with positive-pressure ventilation
Too much volume and/or a fast ventilation rate results in increased intrathoracic pressure, gastric distention, and decrease in cardiac output, resulting in hypotension
101
The bag-mask device provides less ___ than mouth-to-mask ventilation; however, is delivers a higher ___
1. Tidal volume
2. Oxygen concentration
102
If you have difficulty ventilation a patient with a bag-mask device, you should ___
Immediately switch to an alternative method, such as the mouth-to-mask technique
103
Components of an adult bag-mask device
1. Disposable self-inflating bag
2. No pop-off valve
3. Outlet valve that is a true valve for nonrebreathing
4. Inline viral filter
5. Oxygen reservoir
6. One-way, no-jam inlet valve system that provides a maximum of 15 L/min with standard 15/22-mm fittings for face mask and endotracheal tube connection
7. Transparent face mask
8. Ability to perform under extreme environmental conditions
104
Total volume of an adult bag-mask
1200 to 1600 mL
105
Total volume of a pediatric bag-mask
500 to 700 mL
106
Total volume of an infant bag-mask
150 to 240 mL
107
The volume of air delivered to the patient is based on one key observation
Chest rise and fall
108
How much to squeeze the bag in the bag-mask device?
Enough to cause a noticeable rise of the chest, about 600 mL (about 6 to 7 mL/kg) over one second
109
By delivering just enough tidal volume to see the chest rise, and not ventilating at a rate that is too fast, ___
The risks of gastric distention and cardiac compromise are reduced
110
With a bag-mask, for a patient with ongoing CPR and an advanced airway in place, use a ventilation rate of ___
1 breath every 6 seconds (10 breaths/min), without pausing chest compressions
111
When using the bag-mask device during a pandemic or if the patient is highly contagious, ___
A HEPA filter should be placed between the mask and the bag
112
Inflation of the stomach with air
Gastric distention
113
Gastric distention most commonly affects ___
Children
114
Gastric distention is most likely to occur when ___
1. Ventilate too forcefully or rapidly with a bag-mask device or pocket mask
2. Air way is obstructed as a result of a foreign body or improper head position
115
Gastric distention can reduce lung volume by ___
Elevating the diaphragm, especially in children and infants
116
If gastric distention makes it impossible to ventilate the patient and an ALS provider is not available to perform ___, consider ___
1. Orogastric tube or nasogastric tube decompression
2. Positioning the patient onto their side and applying manual pressure over the upper abdomen (anticipate vomiting and have suction ready)
117
Manual decompression should be used only as ___
A last resort and is reserved for extreme circumstances
118
The act of air moving into and out of the lungs during chest compressions
Passive ventilation
119
Passive ventilation is also called ___
Passive oxygenation or apneic oxygenation
120
Prior to and during placement of an endotracheal tube (by and ALS provider), consider ___
Applying a nasal cannula and setting the flow rate at 15 L/min to initiate the process of preoxygenation and denitrogenation
121
Attempts to replace alveolar nitrogen with oxygen
Denitrogenation
122
Goal of denitrogenation
Increase oxygen reserve in the lungs, minimizing risk of oxygen desaturation during periods of forced apnea during an intubation attempt
123
Indications that artificial ventilation is adequate
1. Visible and equal chest rise and fall
2. Ventilations delivered at the appropriate rate
3. Heart rate returns to normal range
4. Patient's color improves (pink)
5. Oxygen saturation increases
124
Indications that artificial ventilation is inadequate
1. Minimal or no chest rise and fall
2. Ventilations are delivered too fast or slow for patient's age
3. Heart rate does not return to normal range
4. Patient's color remains cyanotic, mottled, or deteriorates
5. Oxygen saturation does not increase or decreases
125
When you are performing chest compressions, passive ventilation can be enhanced by ___
Inserting and oropharyngeal airway and providing supplemental oxygen to the patient
126
You can improve oxygenation during passive ventilation by ___
Applying supplemental oxygen with a nasal cannula or a nonrebreathing mask
127
A ventilation device attached to a control box that allows the variables of ventilation to be set
Automatic transport ventilator
128
ATV
Automatic transport ventilator
129
An EMT must be ___ to use an ATV
Approved and credentialed by the medical director
130
Most models of ATV have adjustments for ___
Tidal volume and rate
131
ATV respiratory rate is set to ___
Midpoint or average for the patient's age
132
ATV tidal volume is calculated by ___
6 to 7 mL/kg of ideal body weight
133
The tidal volume of the ATV can be adjusted based on ___
The patient's chest rise and physiologic response
134
The ATV is ___ powered
Oxygen
135
The ability of the alveoli to expand when air is drawn in during inhalation
Compliance
136
When ventilating a patient, you would recognize poor lung compliance by ___
Noting an increase in resistance when you attempt to ventilate
137
___trauma can occur in patients being ventilated
Baro
