Respiratory System

Question 1

Describe Boyle’s law, in simple terms.

Answer 1

Pressure and volume are inversely proportional such that as volume decreases, pressure increases. The inverse is also true.

Question 2

Describe Charles’ law, in simple terms.

Answer 2

Pressure is directly proportional to temperature such that as temperature increases, so does pressure (and vise-versa).

Question 3

Describe Dalton’s law, in simple terms.

Answer 3

The total pressure of all gases in a system is equal to the sum of the partial pressures exerted by all the gases in the system.

Question 4

Describe Henry’s law, in simple terms.

Answer 4

The pressure of a gas above a liquid is directly proportional to the amount of that gas dissolved in the liquid.

Question 5

What is the difference between inadequate ventilation and inadequate perfusion?

Answer 5

Ventilation: refers to the passage of air into the lungs
Perfusion: refers to the flow of blood to the lungs allowing gas exchange into the blood vessels.

Either or both can be impaired.

Question 6

A patient presents initially with coughing and shortness of breath. They stop coughing and begin to exhibit decreases in LOC. What condition are they likely experiencing?

Answer 6

A foreign body airway obstruction (choking).

Question 7

A patient presents with a sore throat lasting >48h, difficulty swallowing, headache, fever, chills, and a hoarse/raspy voice. What condition are they likely experiencing?

Answer 7

Tonsilitis.

Question 8

A patient is presenting with a non-productive cough and wheezes on auscultation. They are thin except for an enlarged chest. What condition are they likely experiencing? What anatomical structure has become damaged through this illness?

Answer 8

This is a presentation indicative of emphysema secondary to COPD in which the alveoli of the lungs have been destroyed.

Question 9

A patient says they have been experiencing a productive cough for the last 6 months and have been short of breath. They appear overweight and have a history of heavy smoking. On auscultation you hear expiratory crackles and coarse ronchi. What condition are they likely experiencing?

Answer 9

This is a presentation indicative of chronic bronchitis secondary to COPD in which the bronchi are inflamed and filled with mucous.

Question 10

A patient complains of severe shortness of breath. They have edema in their lower legs as well as clubbed fingers. What are they likely suffering from?

Answer 10

Late-stage COPD presents this way and can also be accompanied by peripheral cyanosis.

Question 11

Healthy individuals are stimulated to breathe by excess CO2 in the blood. Is this still true of a patient suffering from COPD? Describe.

Answer 11

No. A Pt suffering from COPD is driven to breathe by lack of O2 rather than excess CO2, because CO2 levels in their blood are already so high from poor gas exchange.

Question 12

How does a continuous positive airway pressure (CPAP) device work to improve breathing?

Answer 12

By splinting open alveoli that have otherwise collapsed.

Question 13

Name at least 2 mechanisms of injury in which CPAP may be indicated?

Answer 13

Any of:
- CHF or Cardiogenic pulmonary edema
- Asthma
- Submersion injuries (ex: drowning)
- Pneumonia
- COPD
+ Any more you can justify!

Question 14

A patient is sitting in a tripod position and is speaking to you with only 1 or 2 words between breaths. You note rapid a pulse, and rapid respirations with obvious accessory muscle use. On auscultation you hear obvious wheezing. What condition are they experiencing?

Answer 14

This seems like an acute asthma exacerbation.

Question 15

Give at least 3 examples of factors - extrinsic (E) and intrinsic (I) - which can cause an asthma exacerbation.

Answer 15

Any of:
- Infection (I)
- Physical activity (I)
- Medications (I)
- Smoke/fumes (I)
- Cold air (I)
- Anxiety (I)
- Inhaled allergen (E)
- Pollen (E)
- Dander (E)

Question 16

What term describes a prolonged asthma exacerbation leading the patient to become exhausted and acidodic?

Answer 16

Status asthmaticus.

Question 17

What do the letters in the acronym WHIPS describe in terms of an airway emergency?

Answer 17

W - Worst ever?
H - Hospitalizations?
I - Intubations/ICU stays?
P - Precipitation (what caused this)?
S - Steroids

Question 18

Give at least 3 examples of mechanisms which could cause acute respiratory distress syndrome.

Answer 18

Any of:
- Sepsis
- Aspiration
- Pneumonia
- Trauma
- Hypothermia/tension/oxia
- High altitude
- Cardiac arrest
- Pancreatitis
+ Many more…

Question 19

What is acute respiratory distress syndrome?

Answer 19

A form of pulmonary edema resulting from direct or indirect injury. It can be characterized by acute lung inflammation and leads to severe hypoxemia and eventually death.

Question 20

What is pulmonary edema? How do we typically detect this in the pre-hospital environment?

Answer 20

An accumulation of fluid in the lungs. We typically detect this as a coarse crackling on auscultation of the base of the lungs.

Question 21

What treatments can we consider if we notice a patient is experiencing pulmonary edema?

Answer 21

Support oxygenation and consider CPAP or BVM with PEEP.

Question 22

What is pneumonia? How can this impede respiration?

Answer 22

Pneumonia is a viral or bacterial infection of the lungs and can impede respiration by filling the alveoli with cellular debris (pus), thereby preventing gas exchange.

Question 23

Define the term “atelectasis”. What are the 3 types?

Answer 23

Atelectasis is the collapse of the alveoli in the lungs. It is characterized as being either:
1. Resorption atelectasis
2. Compression atelectasis
3. Contraction atelectasis

Question 24

How will atelectasis typically present in the pre-hospital environment?

Answer 24

Can be varied but the Pt will typically have:
- One-sided pain
- Decreased BP
- Tachycardia
- Increased temp
- Signs of shock
- Dullness with percussion
+ May also have tracheal deviation and diminished air entry

Question 25

A patient complains of “sharp/stabbing” chest/side pain that gets worse with breathing or movement. On auscultation you hear a kind of “rubbing” sound. What condition are they likely experiencing?

Answer 25

A form of pleuritic disease called pleurisy, in which the pleura of the lungs become inflamed and rub against each other.

Question 26

Besides pleurisy, what is another form of pleuritic disease? Describe it.

Answer 26

Pleural effusion is characterized by excessive blood in the pleural space. This can be the result of excessive production or impaired removal and can cause dyspnea. It is not usually painful unless pleurisy is also present.

Question 27

Give at least 2 examples of risk factors which would increase a persons chances of experiencing a pulmonary embolism.

Answer 27

Any of:
- Recent surgeries
- Long-bone fractures
- Pregnancy/postpartum
- Oral contraceptive use
- Tobacco use
- Air travel

Question 28

How are we likely going to identify a pulmonary embolism in the pre-hospital environment?

Answer 28

Sudden onset of severe dyspnea with pain along with a history including one or more risk factors. Will likely present with unilateral pain and abnormal lung sounds on that painful side.

Question 29

What is a pneumothorax? How are we likely going to detect it in the prehospital environment?

Answer 29

Lung collapse is caused by air buildup in the pleural space. This can present as shortness of breath/hypoxia and absent lung sounds on the affected side on auscultation.

Question 30

A patient presents with excessive tachypnea and is complaining of numbness in the extremities and diffuse chest pains. They appear nervous but otherwise have no other injuries. What condition are they likely experiencing?

Answer 30

Hyperventilation due to an acute anxiety episode.

Question 31

A 3yo pediatric patient has suddenly developed a fever accompanied by a distinctive-sounding cough. What condition are they likely experiencing?

Answer 31

Croup presents this way, and is particularly common during the winter months.

Question 32

A 3yo pediatric patient has suddenly developed a fever accompanied by a sore throat, flushed skin, and stridor. What condition are they likely experiencing? What causes this?

Answer 32

A bacterial or viral infection of the epiglottis causes epiglottitis.