Chapter 15 - Provide Respiratory Care in High-Risk Situations Flashcards Preview

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Flashcards in Chapter 15 - Provide Respiratory Care in High-Risk Situations Deck (19)
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1

Although treated with several antiarrhythmic drugs, a patient with ventricular tachycardia begins to exhibit hypotension and decreased consciousness. Which of the following actions would you recommend at this time?

  1. defibrillate the patient
  2. immediately initiate CPR
  3. apply cardioversion
  4. administer epinephrine

3

Ventricular tachycardia is initially treated with antiarrhythmic drugs such as lidocaine, procainamide, amiodarone or sotalol. If drug management fails, if the ventricular rate exceeds 150/min, or if the patient becomes hemodynamically unstable, synchronous cardioversion is indicated.

2

The following monitoring equipment is mandatory when transporting a critically ill patient within or outside of the hospital:

  1. cardiac monitor/defibrillator
  2. end-tidal CO2 monitor
  3. compressed air cylinder
  4. CVP monitor

1

An arterial blood pressure monitor (or standard blood pressure cuff), an oxygen source and delivery device, as well as a cardiac monitor/defibrillator should accompany every critically ill patient on transport.

3

During the response to a chemical plant explosion, the RT department assigned responsibility for transporting patients according to their triage priority. Which of the following patients would you move to the designated critical care area?

  1. triage priority Green
  2. triage priority Yellow
  3. triage priority Red
  4. triage priority Black

3

Triage priority Red is designated for patients with life-threatening but treatable injuries requiring rapid medical attention (within 60 minutes); includes any condition that compromises the patient’s airway, breathing, or circulation. These patients should be moved to ICU or converted critical tertiary care areas ASAP.

4

Two attempts by a resident to intubate a patient fail and the SpO2 is now falling into the 80's. Which of the following actions would you recommend?

  1. perform an emergency cricothyrotomy
  2. initiate transtracheal jet ventilation
  3. insert an intubating LMA, e.g., Fastrach
  4. perform an emergency tracheotomy

3

There are several options to consider when an ET tube cannot be properly positioned using standard direct laryngoscopy. These include increasing neck flexion, head extension (unless contraindicated), applying external laryngeal pressure, using a longer blade if indicated, using a tracheal tube introducer (aka "gum elastic bougie"), using a lighted stylet, using an intubating LMA ("Fastrach"), using optical/video-assisted laryngoscopy, or using fiberoptic-guided intubation. An emergency percutaneous airway (transtracheal jet ventilation, cricothyrotomy or tracheostomy) should only be recommended if a third attempt (using an alternative method or device) fails and insertion of a supraglottic airway cannot re-establish ventilation and oxygenation.

5

A patient admitted to the emergency department with a suspected cervical spine injury requires emergency intubation. Which of the following methods would you recommend for this patient?

  1. use a fiberoptic laryngoscope
  2. intubate via the nasal route
  3. use an illuminating stylet
  4. perform retrograde intubation

1

The ideal emergency method for intubating a patient with a suspected cervical spine injury is that which (1) requires the least head/neck movement, (2) results in the least potential airway trauma and (3) provides direct visualization of the larynx. Only fiberoptic intubation (inserting the tube via direct visualization over a fiberoptic laryngoscope) meets all these criteria.

6

An adult stroke victim is brought to the ER in cardiac arrest. CPR is continued, proper tube placement is confirmed, and IV access is established. After 5 minutes of CPR no pulse is present and the following rhythm is observed. You should recommend which of the following?

  1. Continue chest compressions
  2. Perform cardioversion
  3. Perform defibrillation
  4. Administer epinephrine

1

The presence of a normal sinus rhythm with the absence of a pulse indicates pulseless electrical activity (PEA). CPR with chest compressions should continue while ruling out possible causes of the PEA.

7

After initiating ventilation with 100% O2 via bag-valve resuscitator and facemask on an unconscious adult, you feel resistance to inflation and the chest does not rise. Which of the following would be your next action?

  1. Begin mouth-to-mouth breathing
  2. Recommend a cricothyrotomy
  3. Reposition the patient's head
  4. Squeeze the bag harder

3

Resistance to inflation and failure of the chest to rise indicates an obstructed airway. The first step in this scenario is to reposition the patient’s head (e.g., head tilt/jaw thrust) and re-attempt ventilation. If still ineffective, you should insert an oropharyngeal airway. If after repositioning and airway insertion ventilation is still inadequate, intubation may be necessary.

8

The first priority in the management of a patient who has a tension pneumothorax is which of the following?

  1. Obtain an arterial blood gas analysis
  2. Obtain a STAT chest x-ray
  3. Administer CPAP
  4. Release air from the pleural space

4

A tension pneumothorax is a life-threatening event. Unless the pressure (tension) is relieved, the lungs will not be able to expand and heart function will be compromised. Therefore, the first priority is to release the pressure from the pleural space.

9

When using a transport ventilator with a single-limb breathing circuit, the low volume and low PEEP/CPAP alarms sound simultaneously. The most likely cause of this problem is:

  1. condensate buildup in the circuit
  2. a disconnected expiratory valve line
  3. a kink in the main tubing circuit
  4. blockage of the expiratory port

2

Simultaneously sounding of the low volume and low PEEP/CPAP alarms on a ventilator that uses a single-limb breathing circuit usually indicates a loss of pressurization of the expiratory valve, the most common cause of which is a disconnected expiratory valve line.

10

While assisting in a treadmill cardiopulmonary stress test procedure, the patient complains to you that she is developing severe shortness of breath and some chest pain. Which of the following actions would you recommend at this time?

  1. Increase the O2 flow rate
  2. Decrease the treadmill speed
  3. Decrease the treadmill incline
  4. Terminated the procedure at once

4

Patient responses that justify terminating a cardiopulmonary exercise test include the following: 1) a fall in systolic blood pressure > 10 mm Hg from baseline when accompanied by other evidence of ischemia such as ECG changes; 2) a hypertensive response (systolic BP > 250 mm Hg and/or diastolic > 115 mm Hg); 3) moderate-to-severe angina; 4) increasing nervous system symptoms such as ataxia, dizziness, or near-syncope; 5) signs of poor perfusion, such as cyanosis or pallor; 6) sustained ventricular tachycardia or other serious arrhythmias; 7) Major ST segment changes; 8) severe wheezing or dyspnea

11

The proper rate of external chest compressions for infants during resuscitation is:

  1. 80-100/min
  2. 70-80/min
  3. ≥ 100/min
  4. 60-80/min

3

The proper rate of cardiac compressions for all age groups is at least 100/min. Compression depth for adults should be at least 2 inches (5 cm), for children at least 1/3 the AP chest diameter (about 2 inches), and for infants also at least 1/3 the AP chest diameter (about 1-1/2 inches).

12

A 66-year-old patient is found unresponsive after an apparent suicide attempt. Resuscitation efforts have been initiated by EMS. Upon arrival in the emergency room, the patient is cyanotic, apneic, and pulseless. While providing bag-mask ventilation, you observe the following cardiac rhythm on the monitor. Which of the following should you recommend?

  1. Administer chest compressions
  2. Perform cardioversion
  3. Perform defibrillation
  4. Administer epinephrine

3

The ECG indicates that the patient has ventricular fibrillation. Defibrillation should be initiated without delay, using a shock energy of 120-200 J (biphasic).

13

After a patient has received three shocks and epinephrine during CPR, ventricular fibrillation persists. The next step should include the following:

  1. administering Atropine 0.5 mg every 3–5 minutes
  2. administering a bolus of bicarbonate
  3. administering an antiarrhythmic, e.g. amiodarone
  4. administering a high dose epinephrine

3

If ventricular fibrillation or tachycardia persist after administering three shocks to a patient during CPR, 1) an additional 5 cycles of chest compression with ventilation (ratio of 30:2) should be provided; 2) if not already given, an antiarrhythmic (e.g., amiodarone) should be administered; and 3) vasopressor administration should be repeated (epinephrine or vasopressin). Routine use of sodium bicarbonate is not recommended for patients in cardiac arrest.

14

During the response to a chemical plant explosion, the RT department is assigned responsibility for transporting patients according to their triage priority. Which of the following patients would you move to the designated critical care area?

  1. triage priority Green
  2. triage priority Yellow
  3. triage priority Red
  4. triage priority Black

3

Triage priority Red is designated for patients with life-threatening but treatable injuries requiring rapid medical attention and includes any condition that compromises the patient’s airway, breathing, or circulation. These patients should be moved to ICU or converted critical tertiary care areas ASAP.

15

While assessing a 72 year old patient during therapy, you note a sudden drop in her heart rate to about 38/min, with respirations increasing from about 20/min to over 30/min. Which of the following actions would be appropriate?

  1. call a Code Blue and initiate CPR
  2. stop therapy and report the situation to nurse
  3. request continuous ECG + SpO2 monitoring
  4. activate the Rapid Response Team

4

The Rapid Response or Medical Emergency Team should be activated whenever a patient exhibits signs and symptoms of physiologic instability. Common criteria necessitating team activation include one or more of the following: (1) acute change in mental status or overall clinical appearance; (2) heart rate < 40 or > 130, or respiratory rate < 8/min or > 30/min; (3) systolic blood pressure < 90 mm Hg; and (4) SpO2 < 90%, especially with supplemental O2.

16

Medical record documentation of a patient transport should include which of the following?
 


   patient status                      List of all equipment           indications for 

   throughout the                   and supplies used              the transport

    transport 

A     Yes                                                 No                                  Yes

B     Yes                                                 Yes                                 Yes

C      No                                                 Yes                                 Yes

D      Yes                                                Yes                                 No

  1. A
  2. B
  3. C
  4. D

1

Medical record documentation of a patient transport should include (1) the indications for transport and (2) the patient status throughout the time away from the unit of origin.

17

You are transporting a patient in an unpressurized airplane at a cruising altitude of 10000 feet (Pb = 523 mm Hg). The patient was receiving 40% oxygen at sea level. What FIO2 should be provided to this patient at this cruising altitude?

  1. 0.3
  2. 0.5
  3. 0.6
  4. 0.7

3

To compute the FIO2 needs of a patient at altitude compared to sea level, multiply the FIO2 at sea level times [760/PB altitude]. In this case, FIO2 needed at altitude = 0.40 x [760/523] = .58 or about 60% O2.

18

What is the ideal route for the administration of most drugs used in emergency life support situations?

  1. a peripheral IV line
  2. an endotracheal tube
  3. intramuscular injection
  4. direct intracardiac injection

1

The ideal route for the administration of most drugs used in emergency life support is a peripheral IV line, followed by the intraosseous route. Lidocaine, epinephrine, atropine and naloxone (L-E-A-N) all can be administered via the endotracheal tube, but only if neither the IV or intraosseous routes are unavailable.

19

After warming, positioning, suctioning and providing positive pressure ventilation for 30 seconds, a newborn infant's heart rate is 55/min. What should you do now?

  1. continue ventilation for another 30 seconds
  2. begin external cardiac chest compressions
  3. administer epinephrine and atropine
  4. provide supplemental O2, observe and monitor

2

If a newborn infant's heart rate is less than 60/min after warming, positioning, suctioning and providing positive pressure ventilation for 30 seconds, you should begin external cardiac chest compressions at a rate of at least 100/min.