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______________ is also commonly referred to as ventilation or breathing

RESPIRATION

1

What are the four kinds of respiration?

PULMONARY VENTILATION

EXTERNAL RESPIRATION

INTERNAL RESPIRATION

CELLULAR RESPIRATION and METABOLISM

2

Physiologically, the term respiration refers to the ___________________

GAS EXCHANGE PROCESS THAT OCCURS BETWEEN THE ALVEOLI OR CELLS AND THE CAPILLARIES

3

____________________ is the process of breathing air into and out of the lungs

PULMONARY VENTILATION

4

__________________ is the gas exchange process that occurs between the alveoli and the surrounding pulmonary capillaries

EXTERNAL RESPIRATION

5

_______________ can also be referred to as the alvoli/capillary gas exchange

EXTERNAL RESPIRATION

6

_________________ serves to oxygenate the blood and eliminate carbon dioxide in the lungs

EXTERNAL RESPIRATION

7

__________________ is the gas exchange process that occurs between the cells and the systemic capillaries

INTERNAL RESPIRATION

8

__________________ can also be referred to as cell/capillary exchange

INTERNAL RESPIRATION

9

_________________ is responsible for delivering oxygen to the cells and removing carbon dioxide from the cell

INTERNAL RESPIRATION

10

__________________ is also known as aerobic metabolism, and occurs in the cell

CELLULAR RESPIRATION AND METABOLISM

11

_________________ is the process that breaks down glucose in the presence of oxygen, produces high amounts of energy in the form of ATP, and releases carbon dioxide and water as a by product

CELLULAR RESPIRATION AND METABOLISM

12

The respiratory system is divided anatomically into the ___________ and the ______________

UPPER AIRWAY

LOWER AIRWAY

13

The ________________ extends from the nose and mouth to the cricoid cartilage

UPPER AIRWAY

14

Air normally enters the body through the ______________

NOSTRILS

15

When air travels through the nostrils, is flows over the damp, sticky _______________ lining of the nose

MUCOUS MEMBRANE

16

The _____________ is a common cause of airway obstruction in the patient with an altered mental status.

TOUNGUE

17

Tongue obstruction occurs when ____________________ relax.

THE MUSCLES CONTROLLING THE TONGUE (submandibular muscles)

18

Air entering the body through the mouth and nostrils travels into the ____________

PHARYNX

19

Air from the nasal passages enters through what is referred to as the _____________________

NASOPHARYNX

20

Air entering through the mouth travels through the __________________

OROPHARYNX

21

Both the oropharynx and the nasopharynx enter into the pharynx at ______________________

THE BACK OF THE THROAT

22

Why must the pharynx be kept clear?

Because obstructions in it can prevent air from traveling to the lower airways, or the substance may be aspirated into the lungs

23

What happens if something is aspirated into the lungs?

It would interfere with oxygen and carbon dioxide exchange in the alveoli

24

What are the two passageways that are found at the lower end of the pharynx?

TRACHEA

ESOPHAGUS

25

The ___________ is the passageway for air traveling into the lungs

TRACHEA

26

Food and water are routed to the ________________, which leads to the stomach

ESOPHAGUS

27

The trachea is proctected by a small, leaf shaped flap of cartilaginous tissue called the ___________________

EPIGLOTTIS

28

At times, the epiglottis may fail to close, and food or liquid can enter the larynx and the upper portion of the trachea causing ________________

A PATIENT TO CHOKE

29

If a patient is unresponsive, the ____________________ may not work during swallowing, so that foreign objects, blood, secretions, etc., can enter the trachea and cause an airway obstruction or lung infection

PROTECTIVE REFLEXES

30

When the muscles controlling the tongue relax in a patient with an altered mental status, the muscles controlling the ________________ also relax

EPIGLOTTIS

31

In the event that both the tongue and the epiglottis relax, what is the opening that is blocked?

The opening of the larynx (glottic opening)

32

What is the best method to use to relieve a situation in which the epiglottis and tongue relax closing the path to the trachea and airway?

Perform "head tilt, chin lift maneuver" , or a "jaw thrust maneuver" which will pull the epiglottis up away from the opening of the larynx

33

The ______________________ contains the vocal cords

LARYNX

34

The anterior portion of the the larynx is composed of large bulkky ________________

THYROID CARTIALAGE

35

What is thyroid cartilage normally known as?

ADAM'S APPLE

36

The ____________________ forms the most inferior portion of the larynx

CRICOID CARTILAGE

37

The _________________ is the only completely circular cartilaginous ring of the upper airway

CRICOID CARTILAGE

38

Pressure applied to the ________________ is often used in airway management

CRICOID RING

39

Pressure applied to the cricoid ring is used to help prevent ________________ and to _______________

FILLING OF THE STOMACH

PREVENT REGURGITATION

40

The _____________ is a common site of airway obstruction in adults, infants, and children

LARYNX

41

The ________________ extends from the cricoid cartilage at the lower edge of the larynx to the alveoli of the lungs

LOWER AIRWAY

42

The ______________ is commonly known as the windpipe

TRACHEA

43

The _____________ is the passageway for air entering the lungs

TRACHEA

44

The trachea extends fro mthe larynx to the ______________

CARINA

45

The ______________ is the point in which the trachea splits into the right and left mainstem bronchi

CARINA

46

The anterior portion of the trachea is composed of strong ______________________ that provide support and structure

C-SHAPED CARTILAGINOUS RINGS

47

The posterior wall of the trachea is made up of _________________ and is therefore not a rigid structure

MUSCLE

48

The _______________ are the two major branches of the trachea, that extend from the carina into the lungs

BRONCI

49

The __________________ extend from the carina into the lungs, where they continue to divide into smaller sections or branches known as __________________

BRONCHI

BRONCHIOLES

50

The ________________ become increasingly smaller as they continue to branch

BRONCHIOLES

51

The _______________ are larger airways that contain cartilage

BRONCHI

52

The ________________ are lined with msooth muscle and mucous membranes

BRONCHIOLES

53

The narrowing of the bronchioles causes an increase in __________________ inside the bronchiole, which makes it more difficult for the patient to move air into and out of the alveoli

AIRWAY RESISTANCE

54

An increase in __________________ causes the patient to work harder to breathe, which may lead to _______________ and failure of the respiratory muscles

AIRWAY RESISTANCE

FATIGUE

55

The bronchioles terminate in millions of tiny air sacs in the lungs called _________________

ALVEOLI

56

Each alveoli is wrapped in a web of thin-walled capillaries reffered to as the _________________

PULMONARY CAPILLARIES

57

The alveoli and pulmonary capilaries is the site for ____________________________

GAS EXCHANGE BETWEEN THE ALVOLI AND THE BLOOD IN THE CAPILLARIES

58

The _____________ are made out of elastic tissue

LUNGS

59

The elastic tissue of the lungs causes the lungs to react like a _____________; thus, the lungs material tendency is to recoil and collapse

RUBBER BAND

60

The lungs are surrounded by two layers of connective tissue called the _________________

PLEURA

61

What are the two layers of connective tissue called?

VISCERAL PLEURA
PARIETAL PLEURA

62

The ______________ is the outermost covering of the lung

VISCERAL PLEURA

63

The ________________ is the thicker more elastic layer of pleura that adheres to the inner portion of the chest wall

PARIETAL PLEURA

64

Between the two layers of pleura is the __________________

PLEURAL SPACE

65

The ________________ is a small space that is at negative pressure

PLEURAL SPACE

66

The pleural space contains a small amount of ________________ that acts as a lubricant to reduce friction when the layers of the pleura rub against each other during breathing

SEROUS FLUID

67

Since the lung tissue wants to recoil and collapse, it is always tugging inward toward the ______________ of the body

MIDLINE

68

The ________________ pleura, connected to the chest wall, retains the lung structure nad prevents them from collapsing

PARIETAL PLEURA

69

The ___________________ between the attached parietal pleura and visceral pleura, creates a "water-glass" effect

SEROUS FLUID

70

The _______________ is "if a water glass is placed open end down on a flat surface covered with water, then pulled striaght upward, a vaccuum is created between the flat surface and the glass. The water creates a seal. If the seal is broken, air is sucked inward and allows the glass to be moved off the flat surface.

WATER GLASS EFFECT

71

VISCERAL PLEURAL PULL

The __________________ is continuously creating a vacuum so air from outside the chest gets sucked into the pleural space through the hole in the pleura

72

The ___________________ is a muscle that separates the chest cavity from the abdominal cavity

DIAPHRAGM

74

The diaphragm is responsible for approximately ________________ percent of the effort of ventilation.

60-70 percent

75

The passage of air into and out of the lungs is called ________________________

VENTILATION

76

______________________ is ofte nreferred to as breathing

VENTILATION

77

__________________ is the process of breathing air in

INHALATION OR INSPIRATION

78

________________ is the process of breathing air out

EXHALATION OR EXPIRATION

79

During inhalation, the _________________ and the external _____________________ contract

DIAPHRAGM

INTERCOSTAL MUSCLES

80

The process of inhalation bring air into the lungs until the pressure inside the lungs is _______________________

EQUAL TO THE ATMOSPHERIC PRESSURE OUTSIDE THE BODY

81

Inhalation is an _____________________ because it requires energy to contract the muscles

ACTIVE PROCESS

82

During exhalation, the diaphragm and intercostal muscles ________________

RELAX

83

Because the process of inhalation involves relaxation of muscles and little energy is expended, it is considered to be _______________

PASSIVE

84

In some respiratory diseases affecting the lower airway, the patient has a difficult time moving air into and out of the lungs making both inhalation and exhalation ____________ processes

ACTIVE PROCESSES

85

Respirations are controlled by the _______________ in a variety of ways.

NERVOUS SYSTEM

86

What are the three respiratory rhythm centers that control impulses being sent to the respiratory muscles from the brain stem?

DORSAL RESPIRATORY GROUP (DRG)

VENTRAL RESPIRATORY GROUP (VRG)

PONTINE RESPIRATORY CENTER (PNEUMOTAXIC CENTER)

87

The ____________________ continuously monitor levels of oxygen, carbon dioxide, and pH in the arterial blood

CHEMORECEPTORS

88

The ___________________ also stimulate an increase or decrease in impulses fro the respiratory rhythm centers to control the rate and depth of ventilation

CHEMORECEPTORS

89

The __________________ located in the medulla are most sensitive to changes in blood pH and carbon dioxide, whereas the _________________ located in the carotid areteris and aortic arch are more sensitive to changes in arterial oxygen

CENTRAL chemoreceptors

PERIPHERAL chemoreceptors

90

tHE RESPIRATORY SYTEM RESPONDS PRIMARILY TO CHANGES IN THE ________________ LEVELS

carbon dioxide

91

If the carbon dioxide level in arterial blood increases, the chemoreceptors sense the increase and the brainstem sens impulses to the respiratory muscles to increase the __________________ and ____________ of respiration.

RATE AND DEPTH

92

An increase in respirations results in the increased elimination of _______________

CARBON DIOXIDE

93

Healthy people breath on a _______________ drive

HYPERCARBIC DRIVE (HIGH CARBON DIOXIDE DRIVE)

94

When the carbon dioxide level decereases in the blood, the chemoreceptors sense this and send signals to the respiratory muscles to slow down the _____________________

RESPIRATORY RATE

95

_______________ is much less of a stimulus for breathing in healthy people

OXYGEN

96

In patients with a category of conditions known as COPD, the ______________ level in arterial bloodis typically chronically elevated as a result of the disease process.

CARBON DIOXIDE

97

Because of the high carbon dioxide levels as a result of COPD, the chemoreceoptors become relatively ______________________ to changes in carbon dioxide

INSENSITIVE

98

Chemoreceptors of COPD patients tend to rely on _________ levels in the blood to regulate their breathing

OXYGEN

99

COPD patients breath on a ___________ drive, since they breathe to increase their oxygen and not to dreduce their carbon dioxide levels

HYPOXIC

100

If oxygen is provided at high concentrations to a patient with COPD over a long period of time, the oxygen levels in the arterial blood will ___________ beyond a normal level for the patient

RISE

101

If oxygen is provided at high concentrations to a COPD patient, the _______________ will sense this rise and may send signals to the respiratory muscles to slow down or even stop respirations

CHEMORECEPTORS

102

Even though respiratory failure could be a complication in the COPD patient _____________ should never be withheld from a patient if he or she needs it

OXYGEN

103

If respiratory failure should occur in a COPD patient, _____________________ the patient artificially, just as with any patient who suffers respiratory failure or arrest.

VENTILATE

104

___________________ is the process by which the blood and the cells become saturated with oxygen

OXYGENATION

105

Oxygenation happens as a result of __________________ and ___________________

INTERNAL RESPIRATION and EXTERNAL RESPIRATION

106

Internal respiration and external respiration are processes in which fresh oxygen replaces _________________

CARBON DIOXIDE

107

_________________ is the mechanical process of moving air into and out of the lungs

VENTILATION

108

________________ is the physiological process of gas exchange

RESPIRATION

109

______________________ is a low oxygen content in arterial blood

HYPOXEMIA

110

Hypoxemia typically occurs from a ___________________ mismatch.

VENTILATION-PERFUSION

111

A ____________________________ occurs when there is a lack of available oxygenated air in the alvoli even though perfusion to the alveoli is adequate, or when the alveoli are adequately oxygenated but perfusion to the alveoli is poor, or when there is a combination of both poor ventilation and poor perfusion in the alveolar-capillary structures.

VENTILATION-PERFUSION MISMATCH

112

Other possible causes of ________________ include inadequate ventilator drive, anemia, and carbon monoxide poisoning

HYPOXEMIA

113

________________ refers to an inadequacy in the amount of oxygen being delivered to the cells

HYPOXIA

114

________________ is a more general term than hypoxemia which refers only to low oxygen content in the arterial blood

HYPOXIA

115

____________________ can occur or result from an occluded airway, inadequate breathing, inadequate delivery of oxygen to the cells by blood, or inhalation of toxic gases

HYPOXIA

116

Tachypnea

Dyspnea

Pale, cool, clammy skin

Tachycardia

Elevation in blood pressure

Restlessness and agitation

Disorientation and confusion

Headache

These are signs of what level of hypoxia?

MILD TO MODERATE HYPOXIA

117

Tachypnea
]
Dyspnea

Cyanosis

Tachycardia that may lead to dysrthmias and eventually bradycardia

Severe confusion

Loss of coordination

Sleepy appearance

Head bobbing

Slow reaction time

Altered mental status

Seizure

These are all signs of what level of hypoxia?

SEVERE HYPOXIA

118

In a newborn, _________________ may be an early sign of hypoxia

BRADYCARDIA

119

Infants and young children normally have higher ____________________ than adults

HEART RATES

120

An early sign of hypoxia is an alteration in the patint's _____________________

MENTAL STATUS

121

______________________ , a bluish gray color is a late sign of hypoxia and may be found in and around several areas of the body, including the lips, mouth, nose , fingernail beds, conjunctiva, and oral mucosa

CYANOSIS

122

___________________ occurs when adequate amounts of oxygen are no longer attached to the hemoglobin molecules

CYANOSIS

123

If the patient is displaying any signs of hypoxia, immediately _____________________________________>

ASSESS THE AIRWAY AND ADEQUACY OF BREATHING

124

If breathing status is inadequate, immediately begin __________________________

POSITIVE PRESSURE VENTILATION

125

The blood moving into the capillaries is ____________________

DEOXYGENATED

126

____________________ is found on the surface of red blood cells, is responsible for picking up the majority of oxygen in the blood and carrying it through hthe arterial system to the capillaries throughout the body

HEMOGLOBIN

127

A disturbance in pulmonary ventilation, oxygenation, external respiration, internal respiration, or circulation can lead to _______________________ and the conversion from aerobic to anaerobic metabolism

CELLULAR HYPOXIA

128

A severe alteration in perfusion can also cause a decrease in __________________ delivery to the cells

GLUCOSE

129

without A FUEL SOURCE, the cells will fail to produce energy and will __________________

EVENTUALLY DIE

130

The noses and mouths of _______________ and ______________ are smaller than those of adults making it easier to be obstructed by foreign bodies, swelling, blood, mucus, and secretions

INFANTS AND CHILDREN

131

______________ are obligate nose breathers

INFANTS

132

____________________ MEANS THAT IT IS PREFERRED TO BREATHE THROUGH THE NOSE AND NOT THROUGH THE MOUTH

obligate nose breathing

133

The ___________________ of an infant or a child is realtively large in proportion to the size of the mouth

TONGUE

134

An infant or a child is more prone to airway obstruction by _________________________

POSTERIOR DISPLACEMENT OF THE TONGUE

135

In infants and children less than 10 years of age, the ___________________ is typically the narrowest portion of the upper airway

CRICOID CARTILAGE

136

tHE CHEST WALL IN AN INFANT OR A CHILD IS _____________ NAD MORE _____________ THAN IN AN ADULT .

softer and more pliable

137

Infants and children rely more on the _____________ for breathing

DIAPHRAGM

138

When you perform artificial ventilation on an infant or child, the chest should ___________________

EXPAND AND RISE EASILY

139

Because the chest expands so easily on an infant or child, it is much easier for the EMT to ___________________ the lungs and cause possible lung injury

OVERINFLATE

140

Infants and children are smaller and have more limited _________________ than adults

OXYGEN RESERVES

141

Children and infants have twice the _______________ rate of adults

METABOLIC

142

The smaller reserve of oxygen and greater metabolic rate of infants and children will cause them to become ___________________ more rapidly than adult patients

HYPOXIC

143

_____________________ is the most common cause of cardiac arrest in chldren

HYPOXIA

144

A _________________ is necessary for adequate breathing and oxygenation

PATENT AIRWAY

145

The airway and respiratory tract is the conduit that allows air to move from the atmosphere and into the _________________________ for gas exchange

ALVEOLI

146

No matter what the patient's condition, the ____________ must remain open at all times

AIRWAY

147

The degree of the ______________________ will directly affect the amount of air available for gas exchange

OBSTRUCTION

148

The mental status of a patient typically correlates well with the status of his or her __________________

AIRWAY

149

An alert, responsive patient who is talking to you in a normal voice has an ____________________

PATENT AIRWAY

150

A patient who has an altered mental status by continues to maintain a gag or cough reflex could still ________________________

ASPIRATE

151

Snoring

Crowing

Gurling

Stridor

These are all __________________

ABNORMAL UPPER AIRWAY SOUNDS

152

Snoring and obstruction can be corrected by performing a __________________________

HEAD TILT CHIN LIFT MANEUVER

153

If the patient is "gurgling" immideiatley ___________________

SUCTION THE SUBSTANCE FROM THE AIRWAY

154

It is necessary to open the mouth of an unresponsive or an altered metnal status patient to ______________________________

ADEQUATLEY ASSESS THE AIRWAY

155

Opening the mouth is done by using the ________________ technique

CROSSED FINGERS TECHNIQUE

156

Before a patient who is breathing inadequately can receive positive pressure ventilation, or breating assistance in which air is forced into his lungs he must have an ___________________

OPEN AIRWAY

157

What are the two manual airway maneuvers?

HEAD TILT, CHIN LIFT

JAW THRUST

158

What are the two mechanical airways?

OROPHARYNGEAL AIRWAY

NASOPHARYNGEAL AIRWAY

159

The _________________________ should be used for opening the airway in a patient who has no suspected spinal injury

HEAD TILT, CHIN LIFT

160

The ___________________ is only a temporary maneuver and must be supplemented with a mechanical airway edevice if the airway can't be adequetly maintained

HEAD TILT, CHIN LIFT

161

What airway maneuver would be used on an unresponsive patient with no suspicion of spinal injury or trauma?

HEAD TILT, CHIN LIFT

162

What manual airway maneuver would be used on a patient with cardiac arrest not due to trauma?

HEAD TILT, CHIN LIFT

163

What airway maneuver would be used on an apneic patient with no signs of trauma?

HEAD TILT, CHIN LIFT

164

The preferred method of opening the airway in infants nad children without suspected spinal injury is the _______________________

HEAD TILT CHIN LIFT

165

When doing the head tilt, chin lift position on infants the head should be tilted back gently into a _____________ position

SNIFFING OR NEUTRAL POSITION

166

If a ________________ is suspected, the patient's head and neck must be brought into and maintained in a neutral inline position.

SPINAL INJURY

167

The _________________________ is used to open the airway in such a patient in which there is a suspected spinal injury

JAW-THRUST MANEUVER

168

If the head tilt, chin lift maneuver is unsuccessful in opening the airway of the non spine injured patient, perform the _________________________

JAW-THRUST MANEUVER

169

Both the head tilt, chin lift and the jaw-thrust maneuvers must be supplemented with a __________________________ device if the airway can't be adequately maintained

MAECHANICAL AIRWAY DEVICE

170

If the jaw thrust does not establish an open airway __________________ the jaw

REPOSITION

171

The ________________________ would be used in unresponsive patients with suspected spinal injury or trauma patients in need of a manual maneuver to open the airway

JAW THRUST MANEUVER

172

To position a patient with an altered mental status for airway control, place the patient in a modified ____________________________

LATERAL RECOVERY POSITION

173

________________________ are fixed or installed units that should be part of the required on board ambulance equiopment.

MOUNTED SUCTION DEVICES

174

Mounted suction devices should be powerful enough to provide an airflow of greater than _________________ at the end of the delivery tube and create a vacuum of more than _______________ mmHg on the gauge when the tubing is clamped or kinked

GREATER THAN 40 LPM

300 MMHG

175

A _________________________ msut produce a vacuum adequate to suction substances from the pharynx

PORTABLE SUCTION DEVICE

176

A portable suction device generally needs a pressure of ____________________ mmHg to provide adequate suction

80 TO 120 mmHg

177

_____________________ units can be electric, oxygen, air, or hand owered

PORTABLE SUCTION UNITS

178

_______________________ devices must have fully charged batteries to function effectively

ELECTRIC SUCTION DEVICES

179

____________________ devices function only as long as a source of oxygen is available

OXYGEN POWERED DEVICES

180

__________________ suction devices do not require any energy source other than an EMT to create the vacuum

HAND POWERED

181

____________________ must be disposable and capable of being connected to the suction unit's tubing

SUCTION CATHETERS

182

What are the two different types of suction catheters?

HARD OR RIGID CATHETERS

SOFT CATHETERS

183

The ____________________ catheter is commonly referred to as a "tonsil tiop" or "tonsil sucker."

HARD OR RIGID

184

The ______________________ is used to suction the mouth and oropharynx aof an unresponsive patient

HARD OR RIGID CATHETER

185

The _____________________ should be inserted only as far as you can see, typically not farther than the base of the tongue

CATHETER

186

The tip of the suction catheter may stimu8late a _______________ reflex and cause vomiting

GAG

187

If you are using a _________________ on a child or infant, be careful when applying suction, bercause doing so might cause soft tissue trauma and may also stimulate bradycardia

HARD CATHETER

188

When using a suction catheter on infants and children, never _______________________

TOUCH THE BACK OF THE AIRWAY

189

The _____________________ is also called a "French" catheter

SOFT CATHETER

190

The ___________________ is used in suctioning the nose and nasopharynx and in other siuations where the rigid catheter cannot be used.

SOFT CATHETER

191

_________________ is defined as the air remaining in the lungs after a maximal exhalation

RESIDUAL VOLUME

192

Even though the nasopharyngeal airway is lubricated, insertion is painful and may cause injury to the _________________ causing the nose to bleed and allowing blood to enter the airway, resulting in possible obstruction or aspiration.

NASAL MUCOSA

193

Adequate and inadequate breathing depend on what two variables ?

The RATE at which the patient is breathing and the DEPTH of each breath

194

_______________________ deals with both depth and rate

MINUTE VOLUME

195

__________________ typically correlates with how adequately the patient is breathing

MINUTE VOLUME

196

A decrease in either the ________________ or the respiratory rate may lead to a decrease in minute volume so severe that the patient is no longer moving an adequate amount of air per minute in and out of the lungs

TIDAL VOLUME

197

Typically, an increase in either _________________ or respiratory rate would increase the respiratory minute ventilation

TIDAL VOLUME

198

What is the best method to assess for tidal volume?

LOOK FOR ADEQUATE CHEST RISE AND LISTEN FOR AIR MOVEMENT FORM THE NOSE AND MOUTH

199

___________________ is the amount f air breathed in that reaches the alvoli

ALVOLAR VENTILATION

200

Only the air that reaches the ______________ can be used for gas exchange sicne the trachea and bronchi do not participate in gas exchange

ALVEOLI

201

Because of the effect of _________________ on ventilation, deceases in tidal volume can dramatically reduce the amount of air reaching the alveoli for gas exchange.

DEAD AIR SPACE

202

If an adult is breathing at 12 times per minute, but has a condition that depresses the respiratory system and is only breathing In 200 mL of air with each breath, what is his "Minute Volume" ?

200mL x 12 per minute

Minute Volume = 2,400 mL

203

What are the four steps of assessment for adequate breathing?

LOOKING

LISTENING

FEELING

AUSCULTATING

204

When assessing for adequate breathing, what does it mean to look (inspect)? What are the four steps?

INSPECT THE CHEST

OBSERVE THE PATIENT'S GENERAL APPEARANCE

DECIDE IF THE BREATHING PATTERN IS REGULAR OR IRREGULAR

LOOK AT THE NOSTRILS AND SEE IF THEY ARE OPEN WIDE DURING INHALATION

205

When assessing for adequate breathing, what does it mean to listen?

Listen to how the patient speaks to you. If he speaks with only few words at a time, or has to catch his breath, it could mean he would need ventilation

206

When assessing for adequate breathing, what does it mean to "feel"?

It means to feel with your ear next to the patien'ts nose and mouth, and feel for air escaping during exhalation

207

When assessing for adequate breathing, what does it mean to "Auscultate"?

It means to place your stethoscope at the second intercostal space, about 2 inches below the clavicle at the midclavicular line, and listening to one full inhalation and exhalation and determine if the breath sounds are present and equal bilaterally

208

When "Auscultating", where are you to place your stethoscope?

About 2 inches below the clavicle at the midclavicular line, or at the fourth or fifth intercostal space on the mixaxillary line

209

What are the four characteristics of quality or adequate breathing?

RATE

RHYTHM

QUALITY

DEPTH

210

When checking for adequate breathing, what are the respiratory rates for adults, children, and infants respectively

8-24

15-30

25-30

211

What is "rhythm" in respect to a characteristic of adequate breathing?

It just means that the pattern is regular, and that each breath is of about the same volume

212

What is "quality" in respect to a characteristic of adequate breathing?

It means that the breath sounds are equal and full bilaterally, indicating a good expansion of each lung

213

What is "depth" (tidal volume) in respect to a characteristic of adequate breathing?

It means that the chest will rise fully with each inhalation, and that the volume of air felt and heard by placing your ear next to the patient's mouth and nose will be full and adequate with each breath

214

___________________ is a condition where the patient is working harder to breathe

RESPIRATORY DISTRESS

215

Respiratory distress may be from the patient working harder to move _____________ into the lungs, out of the lungs or both

AIR

216

The key to respiratory distress is that, even though the patient is working harder to breathe, the ______________ and the ______________ are still inadequate

RESPIRATORY RATE AND TIDAL VOLUME

217

If at any time, either the respiratory rte, or tidal volume becomes inadequate the patient ____________________________

NEEDS TO BE VENTILATED

218

For the patient to have adequate breathing he must have both an adequate ______________ and an adequate __________________

TIDAL VOLUME
RESPIRATORY RATE

219

_________________________ occurs when the respiratory rate and or tidal volume is insufficient enough that it results in hypoxia to the cells and organs

RESPIRATORY FAILURE

220

_______________________ is also called apnea

RESPIRATORY ARREST

221

_______________ occurs when the patient completely stops breathing, and there is no movement of air

RESPIRATORY ARREST

222

Stroke

Myocardial infarction

Drug overdose

Toxic inhalation

Succocation

Traumatic injuries to the head, spine, chest, or abdomen

Infection to the epiglottis

Airway obstruction

These are all common causes of what?

RESPIRATORY ARREST

223

A patient who exhibits signs of respiratory failure or respiratory arrest requires immediate intervention with ___________________________

POSITIVE PRESSURE VENTILATION

224

A type of respiratory pattern that is compldetely inadequate and may be seen in witnessed cardiac arrest or in some conditions is called _________________

AGONAL RESPIRATIONS

225

__________________ are gasping type breaths

AGONAL RESPIRATIONS

226

_____________________ in the cardiac arrest patient usually appear soon after the person goes into cardiac arrest

AGONAL RESPIRATIONS

227

When agonal respiratiosn are found in a patient who does not yet seem to be in cardiac arrest, immediately ______________________

CHECK THE PERSON' PULSE

228

If air is being forced ito the patient's lungs, the technique is referred to as ___________________

POSITIVE PRESSRUE VENTILATION

229

What are the four methods of artificial ventilation?

MOUTH TO MASK

BAG VALVE MASK OPERATED BY TWO PEOPLE

FLOW RESTRICTED, OXYGEN POWERED VENTILATION DEVICE

BAG VALVE MASK OPERATED BY ONE PERSON

230

When performing artificial ventilation, regardless of the device being used, it is necessary to monitor the patient continuouysly to ensure that the _______________ is adequate

VENTILATION

231

Ventilation must not be interrupted for greter than ________________

30 seconds

232

Infants and children must be ventilated at a rate of ____________________

12-20 per minute

Once every 3 seconds or every 5 seconds

233

The ventilation rate for adults WITH A PULSE is ______________

10-12 times per minute

ONce every 6 seconds or every 5 seconds

234

Each ventilation should be delivered over how long?

1 second

235

If the adult patient has no pulse, the ventilations are performed in conjunction with chest compressions at a ratio of ____________________

30 COMPRESSIONS to 2 VENTILATIONS

236

If the child patient has no pulse, the ventilatonis are performed in conjunction with chest compressions at a ratio of ______________

15 COMPRESSIONS to 2 VENTILATIONS

237

The rate of ventilation for a newborn infant WITH a pulse is _______________________

40-60 ventilations per minute

238

In the newborn with no pulse, the ratio of chest compressions to ventilations is 3:1 or ___________________________

90 compression to 30 ventilations

239

The ventilation rate is too fast or too slow

The chest does not rise and fall with artificial ventilation

The heart does not return to normal with artificial ventilation

Color does not improve

These are all indications of what?

INADEQUATE VENTILATION

240

Ventilation a patient too rapidly does not allow for adequate exhalation and can also cause _________________________

GASTRIC DISTENTION

241

Ventilating a patient too slowly will not provide an adequate amount of _______________

OXYGEN

242

_________________ was once thought to reduce complications associated with positive pressure ventilation when the unresponsive patient's airway is not protected by an advanced airway device

CRICOID PRESSURE

243

____________________ was intended to reduce the incidence of gastric inflation, regurgitation, and aspirations of gastric contents

CRICOID PRESSURE

244

According to the American heart Association, ________________f is not recommended for routine use but can be used fto facilitate insertion of an endotracheal tube in an adult

CRICOID PRESSURE

245

In the pediatric patient, ______________________ can be considered only if an ___________________ is available to apply pressue without comporomising the airway or effective ventilation and to guard against collapse of the trachea from excessive pressure

CRICOID PRESSURE

EXTRA EMT

246

Because exhaled breath contains about ________________ percent oxygen, a patient can be oxygenated with the rescuer's exhaled breath

16

247

In a "mouth to mouth and mouth to nose technique" the EMT forms a seal with his mouth around the patient's mouth or nose and uses ___________________ to ventilate

HIS EXHALED AIR

248

The ________________ is pinched during mouth to mouth ventilation

NOSE

249

What are the major disadvangaes or limitations of the mouth to mouth technique?

The inability to deliver high concentrations of oxygen

Risk posed to the EMT by contact with the patient's body fluids

250

Use __________________ ventilation when the patient's mouth cannot be opened, or when you cannot achieve a tight mouth to mouth seal

MOUTH TO NOSE

251

When ventilation a patient it is necessary o adjust the volume and rate of ventilation based on whether the patient has a ______________________

PULSE

252

If the patient has a pulse, the amount of air volume delivered to the patient should be approximately __________________, enough to make the chest rise adequately and effectively with each ventilation

10ml/kG (700-100 ml)

253

If the patient has an advanced airway in place, the ventilation in the patient without a pulse is reduced to ____________________

8-10 ventilations per minute

Every 6 to 8 seconds

254

It is extremely important to not to _______________________ the patient by providing either too fast a rate or too great a volume

OVERVENTILATE

255

_____________________ may cause the blood flow to the brain and heart to be reduced

OVERVENTILATON

256

Decreasing the ____________________ is aimed at reducing the incidence of gastric distention and the potential regurgitation and aspiration that can occur during motuh to mask or bag valve mask ventilation

VENTILATION VOLUME

257

________________ should be connected to the pocket mask or BVM at a liter flow of 15 lpm as early as possible when ventilating a patient

SUPPLEMENTAL OXYGEN

258

What are the five steps to correctly identifying proper ventilation problems

REPOSTION THE HEAD AND NECK TO ENSURE THE AIRWAY IS OPEN

CHANGE FROM A HEAD TILT, CHIN LIFT TO A JAW THRUST AND VICE VERSA

READJUST THE FACE MASK AND MAKE SURE THERE ARE NO SEAL LEAKS BETWEEN TEH FACE AND THE MASK

ADMINISTER A GREATER TIDAL VOLUME

INSERT AN OROPHARYNGEAL OR NASOPHARYNGEAL AIRWAY TO ASSIST IN MAINTAINING AN OPEN AIRWAY

259

________________________ is a manual resuscitator used to provide positive pressure ventilaton

BAG VALE MASK DEVICE

260

The _____________________ consists of a self- inflating bag, a one way non rebreathe valve, a face mask, an intake/oxygen reservoir valve, and an oxygen reservoir

BAG VALVE MASKE DEVICE

261

Most adult sized BVM devices have a volume of approximately ____________________

1600 mL

262

In the adult, deliver approximately _________________ with each ventilation

600 mL

263

Ensure that each ventilation delivered is enough to produce _________________ over _____________ second(s)

CHEST RISE

1 SECOND

264

Bag valve mask devices used for ventilation of full term newborns, infants, and children should have a minimum volume of ___________________

450-500 mL

265

In children 8 years or greater, use an _______________ BVM device

ADULT

266

Regardless of the size of the BVM, be sure to use only enogh volume to cause _______________

CHEST RISE

267

If you suspect a patient has a spinal injury, you must establish and maintain ____________________ as a priority

SPINAL STABILIZATION

268

A ____________________ is powered by oxygen and, with a proper mask seal, will deliver 100 percent oxygen to thee patient

FLOW RESTRICTED OXYGEN POWERED VENTILATION DEVICE (FROPVD)
AKA
MTV

269

In fa normal breathing patient the valve of the MTV is opened automatically by the negative pressure created by the ____________________

PATIENT'S INHALATION

270

The MTV is designed to be used only _______________________

ON ADULT PATIENTS

271

Accordign to the American Heart Associatoin guidelines, the FROPVD is an aid in ventilating a patient in ________________ when used in the manual mode, which requires the EMT to trigger the device to dleliver a ventilation

CARDIAC ARREST

272

What is the peak flow rate on a MTV?

40lpm and 100 percent oxygen

273

Most ________________ use oxygen as their power source, thereby delivering 100 percent oxygen during ventilation

ATV'S

274

The ____________ can deliver oxygen at lower inspiratory flow rates and for longer inspiratory times therefore the devices have a lesser likelihood of causing gastric distention compared to other methods of positive pressure ventilation, including mouth to mask and GBM ventilation

ATV

275

Some _____________ have a demand valve built in, in the event that the patient begins to breathe spontaneously

ATVS

276

The valve of an ATV should be able to deliver a peak inspiratory flow rate of ________________

120 lpm

277

The ATV should have an appropriate inspiration to exhalation ratio of ____________

1:2 seconds

278

Some _______________ have alarms that indicate low oxygen levels, disconnecjtion from the mask, or a low battery

ATV'S

279

The ________________ may also have the ability to provide positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP)

ATV

280

If the patient presents with either inadequate respiratory rate or tidal volume, even though he is still breathing, it is necessary to ventilate the patient and provide supplementary oxygen to ensure that he is receiving an adequate _____________________

ALVEOLAR VENTILATION VOLUME

281

_________________ is a form of noninvasive positive pressure ventilation used in the awake and spontaneously breathing patient who needs ventilator support

CPAP

282

CPAP is applied typically to patients with ____________ or ________________ with pulmonary involvement who are in moderate to severe respiratory distress or early respiratory failure who have an intact mental status and airway reflex

RESPIRATORY DISEASE

CARDIAC FAILURE

283

CPAP is often used to avoid the need to place an ______________________ to artificially ventilate the patient

ADVANCED AIRWAY

284

CPAP is delivered via a tightly fitted mask and a device that generates a continuous flow of air through the airway under positive pressure that is __________________ than normal air pressure

HIGHER

285

_________________ can also be used to deliver CPAP

NASAL PRONGS

286

The continuous delivery of air under positive pressure is intended to inflate collapsed alveoli, improve oxygenation, improve pulmonary compliance, and ____________________

REDUCE THE PATIENT'S WORK OF BREATHING

287

It takes a great deal of work and energy to ____________________ with each breath

REINFLATE THE ALVEOLI

288

By keeping the alveoli open with the __________________, less work is required and less energy is used

CPAP

289

The _____________________ typically averts complete respiratory failure or arrest and allows the patient to continue to breathe on his own

CPAP

290

___________________ increases hydrostatic pressure inside the pulmonary capillaries, forcing fluid out of the capillaries and into the adjoining aveloli displacing the air in the alvoli and inhibiting gas exchange

LEFT VENTRICULAR FAILURE

291

The continuous pressure created by the alvoli by CPAP prevents ___________________ into the alvoli and actually forces fluid that may already have accumulated out of the alvoli and back into the interstitial space and the capillaries

FURTHER FLUID LEAKAGE

292

______________________ improves the heart rate and blood pressure and reduces the sympathetic tone by improving gas exchange and oxygenation

CPAP

293

CPAP is delivered at a continuous airway pressure from ___________ cmH20 to ___________ cmH20

2-20

294

Most often, CPAP is initiated at the ____________ setting and titrated up to ________ cmH20

LOWEST

5

295

In most protocols, a CPAP pressure of ____________ cmH20 is never exceeded because of the increased risk of barotrauma

10

296

Most orders recommend using a CPAP of __________cmH20 and titrating upward based on the patient's physiological response

5

297

__________________ IS USED TO SUPPORT VENTILATIONS, NOT AS A DEVICE TO PROVIDE ARTIFICAL VENTILATION

cpap

298

Awake, alert, and oriented enough to obey commands

Able to maintain his own airway

Able to breathe on his own and has a respiratory rate greater than 25 breaths a minute

Exhibits signs and symptoms of moderate to severe respiratory distress or early respiratory failure

These are all criteria for use of

CPAP

299

____________________ should be used with caution in patients with hypotension nad hypovolemia

CPAP

300

CPAP creates an increase in _________________ pressure that may result in decrease in cardiac output, worsening the state of hyptension or hypperfusion

INTRATHORACIC

301

When administering a CPAP procedure, be sure to completely _______________________ the patient, how it will feel, and its benefits

INFORM

302

When administering a cpap procedure, it is vital that you continuously _________________ the patient in order to lessen his anxiety and fear

COACH

303

When using the CPAP machine, it may take only ___________________ minutes before the patient begins to show improvement

5-10 MINUTES

304

When using the CPAP you must do a continuous Sp02 moniootoring and eassess the vital signs every _________ minutes

5 minutes

305

When using CPAP you must ensure that you have an adequate __________________ since most CPAP devices use oxygen as their source of pressure

OXYGEN SOURCE

306

When using the CPAP machine place the patient in a seated or ___________________________ position

SEMI-FOWLER'S POSITION

307

When using the CPAP machine, assemble the ________________ to the CPAP device and ensure it is properly functioning

BREATHING CIRCUIT

308

When using the CPAP machine, increase the CPAP pressure by increments of _____ cmH20 until the patient's response improves

TWO

309

When using the CPAP, DO NOT ECEED _____CMh20 UNLESS DIRECTED BY MEDICAL DIRECTION

10

310

When using CPAP, do not ______________ unless directed by medical direction

DISCONTINUE

311

When transferring a patient on CPAP, it is important to _________________________ the receiving medical facility that the patient is on CPAP so they can prepare to transfer the patient ot theirCPAP device upon arrival without discontinuation to the patient

NOTIFY

312

________________ is similar to CPAP but allows for different airway pressures to be set for inspiration and expiration

BILEVEL POSITIVE AIRWAY PRESSURE

BiPAP

313

A ____________ is a surgical opening in the front of the neck that may be permanent or temporary

STOMA

314

One reason for the presence of a stoma in the patient's neck is that a ____________________ has been performed

TRACHEOSTOMY

315

Often, a _________________, a curved hollow tube made of rubber, plastic or metal, is inserted into the stoma to help hold it open.

TRACHEOSTOMY TUBE

316

When ventilating through the tracheostomy tube, it may be necessary to seal the patient's _____________ and __________________ to prevent air fro mescaping

MOUTH AND NOSE

317

________________ can cause excessive swelling that may partially or completely occlude the airway.

BLUNT INJURY

318

If the patient is responsive and choking but is effectively moving air when inhaling nad exhaling, instruct him to _______________

COUGH

319

Cough that becomes silent

Stridr heard on inhalation

Increase in labored breathing

These are all signs of ?

PARTIAL AIRWAY OBSTRUCTION WITH POOR AIR EXCHANGE

320

If the airway is completely occluded and there is no air movement, perform ________________ cycles of foreign body airway obstruction maneuver

THREE

321

In a choking patient, once the obstruction is relieved, closely asses the patient's ___________ and ___________________

BREATHING STATUS AND PULSE

322

If the patient has dentures that are secure in the mouth ___________________

LEAVE THEM IN PLACE

323

Liquid oxygen is stored in _____________ or ____________ cylinders under a pressure of about 2,000lbs per square inch

STEEL OR ALUMINUM

324

What are the five sizes of oxygen cylinders used in prehospital care from least to greatest?

D cylinder- 350 liters

E culinder- 625 liters

M cylinder- 3,000 liters

G cylinder- 5,300 liters

H cylinder- 6,900 liters

325

The only way to truly determine the amount of oxygen in the tank is to apply the gauge and identify the _____________ remaining in the tank

PRESSURE

326

Because oxygen is a gas that acts as an accelerant for combustion and oxygen cyliners are under high pressure, the must be handled _____________________

VERY CAREFULLY

327

When using oxygen, never allow __________________ to touch the cylinder, regulator, fittings, valves, or hoses

COMBUSTIBLE MATERIALS

328

When using oxygen, never __________ or allow others to ______ in any area where oxygen cylinders are in use or on standby

SMOKE

329

When using oxygen, store the cylinders below _____________

125 *F

330

Gas flow from an oxygen cylinder is controlled by a _________________ that reduces the high pressure in the cylinder to a safe range

PRESSURE REGULATOR

331

The pressure regulator reduces the high pressure in the cylinder to a safe range from ________ to ________ psi

30-70 psi

332

The _________ prevents a regulator from being attached accidentally or purposefully to another type of gas.

YOKE

333

Oxygen cylinders in the US are generally ___________ green or ____________ gray

STEEL

ALUMINUM

334

What are the two types of regulators that may be attached to an oxygen cylinder?

HIGH PRESSURE REGULATOR

THERAPY REGULATOR

335

The ___________________ can provide 50 psi to power a flow restricted, oxygen powered ventilation device

HIGH PRESSURE REGULATOR

336

The ________________________ has only one gauge, which registers the cylinder contents, and a thereded outlet

HIGH PRESSURE REGULATOR

337

The _________________ can administer oxygen from .5lpm up to 25lpm

THERAPY REGULATOR

338

The therapy regulator tpically has _______ gauges.

TWO

339

Oxygen exits the tank in a dry ____________ form

GASEOUS

340

It is possible to add moisture to the oxygen by attaching an _______________________ to the regulator

OXYGEN HUMIDIFIER

341

The _________________is a container that is filled with sterile water

OXYGEN HUMIDIFIER

342

humidified OXYGEN IS RECOMMENDED IN _______________ patients

ASTHMA

343

______________ is actually a drug

OXYGEN

344

Oxygen should be used any patient in ____________ or ___________ arrest

CARDIAC OR RESPIRATORY ARREST

345

Oxygen should be used with any patient who is being _____________

VENTILATED

346

Oxygen should be used when any signs of _________________ in a patient with an adequate respiratory rate and an adequate tidal volume

HYPOXIA

347

Oxygen should be used with any patient who is ___________________

UNRESPONSIVE

348

Oxygen should be used if there is any exposure to ______________

TOXINS

349

If there is any doubt, it is better to err on the side of benefiting the patient ,and deliver the ________________

OXYGEN

350

Never withhold _____________ from a patient who you think may need it

OXYGEN

351

Patients with acute coronary syndrome who are exhibiting evidence of hypoxia or hypoxemia, have a complaint of dyspnea, have signs of heart failure, and have an SpO2 of less than __________ should receive supplemental oxygen

94%

352

_________________ is no longer a standard treatment

OXYGEN THERAPY

353

The oxygen levels in the arterial blood in the patient with adequate perfusion and gas exchange can be increased significantly with the use of a simple nasal cannula at _____________________

2 to 6 lpm

354

The preferred method for delivering oxygen in the prehospital setting when a high concentration is desirable is with a _____________________

NONREBREATHER MASK

355

The __________________ has an oxygen reservoir bag attached to the mask with a one-way valve between them that prevents the patien's exhaled air form mixing the oxygen with the reservoir.

NONREBREATHER MASK

356

A poorly inflated nonrebreather mask reservoir may cause a decrease in the patient's ___________________ and worsen the patient's ventilation and oxygen status

TIDAL VOLUME

357

The contents of the reservoir bag is _________ percent oxygen

100

358

When using the nonrebreather mask, because some ambient air is inhaled from around the edges of the mask, the oxygen concentration actually delivered is usally around ______________ percent

90

359

When using a nonrebreather mask, the flow from the oxygen cylinder should be set at a rate that prevents ____________________

The reservoir bag form collapsing when the patient exhales

360

An alternative oxygen delivery device is a ________________________

NASAL CANULA

361

The nasal canula provides a very limited oxygen concentration from approximately ________ to _________ percent

22-44 percent

362

The main indication for use of a nasal canula if for a patient who is not able to tolerate a ____________________

NONREBREATHER MASK

363

The nasal canula is a __________ system that does not supply enough oxygen to provide the entire tidal volume during inhalation

"LOW FLOW"

364

As a general rule of use of the nasal canula, for every liter per minute of flow delivered, the oxygen concentration the patient inhales increases by ___________ percent

four

365

The liter flow for the nasal cannula should be set at no less than _________ lpm and no greater than ______ lpm

1

6

366

When using the nasal canula, connect the tubing to the regulator and set the liter volume flow between _____________ nad ______________ lpm

4 and 6 lpm

367

A ___________________ is an oxygen delivery device that has no rewervoir and can deliver up to 60 percent oxygen, depending on the patient's tidal volume and the oxygen flow rate

SIMPLE FACE MASK

368

The ________________ is an oxygen delivery device that looks very similar to the nonrebreather mask but is equipped with a two way valve that allows the patient to rebreathe about 1/3 of his exhaled air

PARTIAL REBREATHER MASK

369

The oxygen flow rate for a simple face mask oxygen delivery device is usually set at ____________ lpm but must not be set less than _______ lpm

10

6

370

The flow rate for a partial rebreather mask is typically set at _________ lpm but should be no less than _____ lpm

10

6

371

Partial rebreather masks can provide oxygen concentrations of between ______ and ______ percent

35 and 60 percent

372

The ______________ is an oxygen device that is a low flow oxygen system that provides precise concentrations of oxygen through an entrainment valve connected to the face mask

VENTURI MASK

373

The ________________ is commonly used for a patient with a history of COPD because of its ability to deliver precise concentration of oxygen

VENTURI MASK

374

The ________________ is a oxygen delivery device that is used to deliver aerosolized medication, bland aersol therapy, or oxygen to a patient with a tracheostomy tube

TRECHEOSTOMY MASK