Ch. 6 Manual Resuscitation Techniques/Emergency (Test 2) Flashcards
The respiratory therapist is performing bag-mask ventilation on a severe COPD patient during CPR. Which of the following describes the best method for ventilating this patient?
A. The bag should be connected to an air wall outlet.
B. The flow to the bag should be 10 L/min with no reservoir attachment.
C. The bag should be connected to an O2 blender set at 30%.
D. The bag should have a reservoir attachment and a flow of 15 L/min.
The bag should have a reservoir attachment and a flow of 15 L/min.
All patients, including severe COPD patients, should be ventilated using 100% O2. This is accomplished using high-flow O2 with a reservoir attachment on the bag. There is no need to be concerned about delivering excessive O2 to a COPD patient in this situation since the patient is apneic.
While manually ventilating an intubated apneic patient with a manual resuscitator, there is very little resistance when the bag is compressed, and the patient’s chest rises only minimally. Which of the following may be the cause of this problem?
A. Excessive endotracheal (ET) tube cuff pressure.
B. Exhalation valve jammed in the closed position.
C. The patient’s lungs are noncompliant.
D. Inadequate ET tube cuff pressure.
Inadequate ET tube cuff pressure.
This situation suggests a leak since the bag compressed easily, with little resistance and with only minimal chest excursion. The leak can occur around the mask of a nonintubated patient, or the ET cuff of an intubated patient. Leaks can also occur through valves in the bag.
A patient has been intubated, and CPR is being performed. The patient’s ECG strip indicates asystole, and the physician is unable to start an intravenous (IV) line. The respiratory therapist should recommend which of the following immediately?
A. Instill sodium bicarbonate directly down the ET tube.
B. Continue to attempt to start an IV in a peripheral vein.
C. Perform intraosseous (IO) infusion of epinephrine.
D. Inject epinephrine directly into the myocardium.
Perform intraosseous (IO) infusion of epinephrine.
Epinephrine is a cardiac stimulant that is indicated for asystole. It may be injected directly into the bone marrow when an IV line is not available.
Which of the following drugs is used to treat ventricular fibrillation during CPR?
- Epinephrine
- Amiodarone
- Atropine sulfate
1 and 2
Epinephrine and amiodarone are both indicated when ventricular fibrillation is present.
During CPR, the patient’s ECG strip indicates ventricular fibrillation. The patient has been defibrillated with 200 joules (J) using a biphasic defibrillator with no change in the ECG reading. Two minutes of CPR is performed with no change in the arrhythmia. The respiratory therapist should recommend which of the following?
A. Repeat defibrillation with 200 J.
B. Repeat defibrillation with 360 J.
C. Instill sodium bicarbonate directly down the ET tube.
D. Instill atropine directly down the ET tube.
Repeat defibrillation with 200J.
According to advanced cardiac life support (ACLS) guidelines, if ventricular fibrillation is not reversed with an initial defibrillation level of 200 J from a biphasic defibrillator, start CPR and continue for 2 minutes. If the arrhythmia is not reversed after CPR, continue to defibrillate with 200 J. Although not commonly used anymore, a mono- phasic defibrillator uses 360 J initially, and that dose is continued as needed.
A patient’s ECG strip indicates atrial fibrillation, and synchronized cardioversion is to be attempted. The defibrillator should be set at what level to return the heart to normal function?
A. 50 J
B. 150 J
C. 250 J
D. 400 J
150 J
To reverse atrial fibrillation, 120 to 200 J is used to restore normal cardiac function. Emergency airway equipment such as a laryngoscope, blades, ET tubes, and suction equipment, along with O2 and a manual resuscitator, should be set up at the bedside during this procedure.
A patient in cardiogenic shock has a blood pressure of 70/40. The respiratory therapist should recommend which of the following medications?
A. Dopamine (Intropin)
B. Lidocaine (Xylocaine)
C. Nitroprusside (Nipride)
D. Furosemide (Lasix)
Dopamine (Intropin)
The patient is hypotensive and is best treated with a vasopressor such as dopamine. Vasopressors constrict blood vessels, resulting in an increase in blood pressure. Lidocaine is indicated for PVCs, ventricular fibrillation, and ventricular tachycardia. Nitroprusside (Nipride), a vasodilator, is indicated for hypertension, and Lasix is a diuretic used to treat hypervolemia.
A patient presents in the ED with a blood pressure of 176/110. Which of the following drugs is indicated?
A. Procainamide
B. Nipride
C. Dopamine
D. Dobutamine
Nipride
Nipride (a vasodilator) treats hypertension. Procainamide is indicated for ventricular fibrillation, ventricular tachycardia, and PVCs. Dopamine is indicated for hypotension, and dobutamine is indicated for depressed myocardial contractility.
Which one of the following drugs is indicated for the treatment of symptomatic sinus bradycardia?
A. Epinephrine
B. Lidocaine
C. Vasopressin
D. Atropine
Atropine
Atropine is a cardiac stimulant that increases heart rate and the force of contraction of the heart and is recommended for symptomatic bradycardia. Epinephrine is indicated for cardiac arrest. Lidocaine is indicated for PVCs, ventricular fibrillation, and ventricular tachycardia.
Which of the following may occur during air transport in an unpressurized aircraft?
A. Reduction in size of an untreated pneumothorax
B. Increase in the PaO2
C. Increase in ET tube cuff pressure
D. Leaks around the ET tube
Increase in ET tube cuff pressure
Since atmospheric pressure decreases at higher altitudes, the pressure in the cuff will begin to increase, possibly obstructing blood flow to the tracheal wall.
Uses of Manual Resuscitators
- Manual ventilation
- Hyperinflation of lungs before tracheal suctioning
- During transport of patient who requires artificial ventilation
Most resuscitators use
self-inflating bags by means of a bag intake valve. (The bag may still be used to ventilate, even without gas flowing to it.)
Some resuscitators, such as those used in surgery and in neonatal ICU, are
flow-inflating bags. They cannot operate without oxygen flow.
A reservoir attachment should be connected to the bag intake valve so that, as the bag reinflates, it fills with supplemental O2 instead of room air.
This ensures that higher O2 levels (approaching 100%) will be delivered to the patient. If a reservoir is not attached, the delivered FiO2 is only 40% to 50%.
Know
Some resuscitator bags have pressure-relief devices that open to the atmosphere at a pressure of
40 cm H2O so that excessive pressures are not delivered to the patient’s lungs.
To achieve the highest delivered O2 levels possible, use the following criteria:
a. Always use a reservoir attachment.
b. Use the highest flow rate available (10 to
15 L/min).
c. Use the longest possible bag refill time (meaning a slower ventilation rate). Allow the bag to fully refill before the next breath.
( a faster ventilation rate decreases the percentage of delivered O2, reduces cardiac output, increases the risk for aspiration, and decreases blood flow to the brain if the patient is hyperventilated)
