Airway
A 45-year-old male is complaining of severe dyspnea. You note he is sitting in a tripod position, using accessory muscles to breathe, and can only speak in two-word phrases. His skin is cool and diaphoretic. Which of the following conditions is this patient experiencing?
A. Respiratory Distress
B. Respiratory Failure
C. Respiratory Arrest
D. Respiratory Insufficiency
This patient is showing classic signs of respiratory failure. He can no longer maintain adequate gas exchange on his own. Critical signs include altered mental status/inability to speak fully, accessory muscle use, and cool, diaphorectic skin (indicating systemic hypoxia and sympathetic nervous system failure).
You are treating an unresponsive 6-year-old female who is cyanotic and has a respiratory rate of 6 breaths/min. Her pulse is 52 beats/min. Which intervention should you perform first?
A. Apply a non-rebreather mask at 15 L/min.
B. Initate chest compressions at a ration of 15:2.
C. Begain positive pressure ventilations with a bag-valve mask.
D. Insert an oropharyngeal airway and administer high-flow oxygen via nasal cannula.
Answer: C
The patient is in respiratory failure/imminent arrest with severe bradycardia (pulse < 60 beats/min with poor perfusion in a child.) Immediate positive pressure ventilation via BVM at a rate of 1 breath every 2 to 3 seconds (20-30 breaths/min for a pediatric patient) is the highest priority to reverse hypoxia before cardiac arrest occurs.
An 18-year-old female with a history of asthma is wheezing and alert. She requests assistance with her prescribed metered-dose inhaler (MDI). What is the primary physiological effect of this medication?
A. Bronchoconstriction
B. Bronchodilation
C. Decreased Heart Rate
D. Vasoconstriction
Answer: B
Beta-2 agonist MDIs (like albuterol) cause bronchodilation, relaxing the smooth muscles surrounding the bronchioles to open the airways and improve airflow.
While ventilating an adult patient in respiratory arrest with a bag-valve mask, you notice the abdomen is becoming progressively distended. What is the most appropriate action to correct this?
A. Increase the volume of each ventilation.
B. Deliver ventilations more rapidly.
C. Re-evaluate and readjust the patient's airway position.
D. Apply firm, direct pressure to the abdomen to expel the air.
Answer: C
Gastric distention during BVM use is usually caused by an improperly opened airway or ventilating too forcefully/rapidly, forcing air down the esophagus instead of the trachea. The immediate correction is to re-adjust the head-tilt/chin-lift or jaw-thrust and ensure gentle chest rise.
A 72-year-old male with a history of congestive heart failure (CHF) presents with severe orthopnea, crackles in both lung bases, and juglar venous distention. His oxygen saturation is 84% on room air. He is conscious, alert, and able to follow commands. Which oxygen delivery device is most appropriate?
A. Nasal cannula at 4 L/min.
B. Non-rebreather mask at 12 L/min.
C. Continuous Positive Airway Pressure (CPAP).
D. Bag-valve mask at 15 L/min.
Answer: C
CPAP is highly effective for patients with acute cardiogenic pulmonary edema (CHF) who are alert and able to follow commands. The continuous positive pressure pushes fluid out of the alveoli back into the pulmonary capillaries, improving gas exchange and lowering the work of breathing.