To create negative pressure in the thorax (chest cavity) the diaphragm contracts and moves _____________ which expands the volume of the thorax allowing air to rush into the lungs.
Answer(s): C
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, air will rush into the lungs allowing for 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.
When the diaphragm relaxes it regains its domed shape causing an increase in thoracic pressure forcing air out of the lungs. To have air forced out of the lungs, the pressure in the thorax must rise above _______________ pressure.
Answer(s): B
For air to be pushed out of the lungs, the trans thoracic pressure must rise above atmospheric (barometric). The diaphragm will relax and dome upward and the intercostal muscles will contract and pull the rib cage inward increasing the trans thoracic pressure above atmospheric, forcing air out.
Which of the following ventilatory techniques is likely to yield the LOWEST tidal volumes?
Answer(s): A
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.
In order to assist intubation, a paramedic may utilize Sellick's maneuver. In this procedure, which cartilage are you compressing?
While all of these 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.
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?
Answer(s): D
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.
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.
Which of the following is the most effective method for administering ventilations to an apneic patient by health care providers?
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.
A blue or greyish coloration of the skin caused be lack of oxygen in the blood is called:
Cyanosis occurs when the oxygen saturation of arterial blood falls below 85-90%. It is often present in the lips and nail beds first.
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