EMT Airway and Breathing Practice Test 1
The lower airway ends at the Alveoli, where gas exchange occurs. Oxygen moves to the hemoglobin by passing through a semipermeable membrane. Where does this occur?
Within each air sac, the oxygen concentration is high, so oxygen passes or diffuses across the alveolar membrane into the pulmonary capillary. At the beginning of the pulmonary capillary, the hemoglobin in the red blood cells has carbon dioxide bound to it and very little oxygen. The oxygen binds to hemoglobin and the carbon dioxide is released. Carbon dioxide is also released from sodium bicarbonate dissolved in the blood of the pulmonary capillary. The concentration of carbon dioxide is high in the pulmonary capillary, so carbon dioxide leaves the blood and passes across the alveolar membrane into the air sac. This exchange of gases occurs rapidly (fractions of a second). The carbon dioxide then leaves the alveolus when you exhale and the oxygen-enriched blood returns to the heart. Thus, the purpose of breathing is to keep the oxygen concentration high and the carbon dioxide concentration low in the alveoli so this gas exchange can occur! Source:http://science.howstuffworks.com/environmental/life/human-biology/lung2.htm
In order to provide Oxygen Therapy at "100%" what should the flow rate be?
12-15 LPM administered via a NBR or Non Rebreather mask is considered "100% O2"
You are transporting an elderly male patient in respiratory distress with a history of COPD... The patient has very shallow, rapid respirations with minimal chest wall motion and slight wheezing in the upper lung fields. Given this situation, what would you expect the arterial carbon dioxide levels to be?
The patient would be hypercapnic as he is probably only ventilating dead space. The patient is not breathing deep enough for air exchange to occur in the alveoli, hence the elevated levels of carbon dioxide.
When the diaphragm relaxes, it regains its domed shape. This action causes an increase in thoracic pressure which forces air out of the lungs. To have air forced out of the lungs, the pressure in the thorax must rise above _______________ pressure?
For air to be pushed out of the lungs, the trans thoracic pressure must rise above atmospheric (barometric) pressure. The diaphragm will relax and dome upward and the intercostal muscles will contract and pull the rib cage inward. This action increases the trans thoracic pressure above atmospheric pressure which forces air out.
In order to assist intubation, a paramedic may utilize Sellick's maneuver. In this procedure, which cartilage are you compressing?
While all of theses structures are in the same general area, the paramedic specifically utilizes the Cricoid cartilage. This is particularly important since this is the only "full ring" cartilage.
The tongue often is a source of airway obstruction; it falls back and occludes the _________?
The pharynx or throat is often occluded by the tongue falling back and obstructing air flow. When air enters the nostrils it passes through the nasopharynx, then the oropharynx, and then the pharynx before it enters the trachea. Jaw thrust or chin lift will pull the tongue off the back of the pharynx to open the airway allowing air flow to the lungs. The trachea is too distal for the tongue to occlude it.
To create negative pressure in the thorax (chest cavity) the diaphragm contracts and moves _____________. This action expands the volume of the thorax, allowing air to rush into the lungs.
The diaphragm is a thin tough muscle which separates the thorax and abdomen. The diaphragm is domed upward in its relaxed state, so when it contracts the diaphragm flattens out causing the volume of the thorax to increase. Since the pressure in the thorax is lower than atmospheric pressure, air will rush into the lungs and allow gas exchange. While the chest wall does expand, the diaphragm is the primary respiratory muscle. Chest muscles have a smaller role in regard to normal respiration.
The anatomy of the airway consists of the upper and the lower airways. The upper airway starts at the mouth and Nares and ends at the _________?
The airway is divided into two different anatomical locations; the upper airway and lower airway. The upper airway starts where air enters the body - the nose (Nares) and the mouth. Air will pass through the nose and is filtered and warmed before passing through the remainder of the upper airway and entering the lower airway. The upper airway ends at the Cricoid cartilage, the distal end of the larynx. The Thyroid cartilage is located at the proximal end of the larynx. Reference: Jeremy P. T. Ward; Jane Ward; Charles M. Wiener (2006). The respiratory system at a glance. Wiley-Blackwell. pp. 11–. ISBN 978-1-4051-3448-4. Retrieved 26 April 2010.
What is the following device ? A device designed to facilitate the blind intubation of a patient. It consists of a cuffed double-lumen tube with one blind end. Inflation of the cuff allows the device to function as an endotracheal tube and closes off the esophagus, allowing ventilation and preventing reflux of gastric contents.
This device is also known as a Combi-Tube
What airway opening maneuver should be used on a man that has fallen off a ladder and is suffering from respiratory distress?
The "Jaw Thrust" maneuver should be used to open the airway of any patient who has suffered a traumatic injury
What is the maximum flow rate for a Nasal Cannula?
A nasal cannula used to administer O2 at flow rates from 2 - 6 LPM, delivering an O2 concentration so 28 - 44%
Which of the following ventilatory techniques is likely to yield the LOWEST tidal volumes?
With both mouth-to-mouth and mouth-to-mask ventilation, it is relatively easy to maintain a good seal with the patient's mouth, allowing for delivery of adequate tidal volumes. Likewise, two person bag-valve-mask techniques dedicate one rescuer solely to ensuring adequate mask seal and the second rescuer to squeeze the ventilation bag with two hands (again allowing for adequate tidal volumes to be delivered). One person bag-valve-mask usage is a difficult technique to master, as the single rescuer must maintain a manual airway maneuver, an adequate mask seal, and squeeze the bag simultaneously.
A device that delivers a specific amount of medication to the lungs, in the form of a short burst of aerosolized medicine that is inhaled by the patient is known as a(n)?
A Metered Dose Inhaler is commonly used to treat Asthma, Chronic Obstructive Pulmonary Disease, and other respiratory problems.
Which of the following is the most effective method for administering ventilations to an apneic patient?
The two person bag-valve-mask is the most effective method to administer ventilations with a BVM; however, it is not always practical for field application due to limited resources and limited space. The use of mouth to mask ventilations is also identified as a viable form of artificial ventilations, but the risk of cross contamination in mouth to mouth ventilations renders it less desirable to health care providers.
You are transporting a 48-year-old male patient between medical facilities... During the history, you learn that the patient was involved in a fall at work and suffered a hip fracture and a head injury. The patient is now presenting with labored breathing at 30/min that has progressively worsened over the last 24 hours, a heart rate of 104, and a blood pressure of 98/70. On auscultation, you hear diffuse rales. The patient denies any complaints of pain other than those related to his recent fall. What is the most likely cause of the patient's respiratory distress?
Adult respiratory distress syndrome involves non-cardiogenic pulmonary edema that presents 12-72 hours post injury or surgery. Congestive heart failure and cardiogenic shock, while they may occur from the ARDS, have an initial cardiac compromise. Flash pulmonary edema has a rapid onset and deterioration over as little as 30 minutes and is associated with renal dysfunction.
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