CHAPTER 17

Respiratory Emergencies

Handout 17-1: Evaluating Content Mastery Student’s Name

EVALUATION

CHAPTER 17 QUIZ

Write the letter of the best answer in the space provided.

______ 1. The respiratory structure that allows air to flow in and out of the lungs

through contraction and relaxation of its muscles is the:

A. larynx. C. diaphragm.

B. epiglottis. D. alveoli.

______ 2. An adequate rate of breathing, or breaths per minute, for most adults is:

A. 25–50. C. 15–30.

B. 20–40. D. 12–20.

______ 3. All of the following are signs of inadequate breathing EXCEPT:

A. present and equal breath sounds. C. cyanotic skin color.

B. shallow respirations. D. use of accessory muscles.

______ 4. The preferred method of providing artificial ventilation is:

A. pocket face mask with supplemental oxygen.

B. two-person bag-valve mask with supplemental oxygen.

C. flow-restricted, oxygen-powered ventilator.

D. one-person bag-valve mask with supplemental oxygen.

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______ 5. An adequate number of breaths per minute for artificial ventilation of

infants and children are:

A. 40. C. 20.

B. 30. D. 12.

______ 6. In an infant or a child, bradycardia is a sign of:

A. circulatory collapse. C. respiratory failure.

B. cardiac arrest. D. fatigue.

______ 7. If a patient is experiencing breathing difficulty but is breathing

adequately, she should be placed in a:

A. sitting position. C. prone position.

B. supine position. D. position of comfort.

______ 8. All of the following are examples of chronic obstructive respiratory

disease (COPD) EXCEPT:

A. emphysema. C. black lung.

B. chronic bronchitis. D. asthma.

______ 9. The whistling sound from a narrowed bronchial airway is called:

A. snoring. C. wheezing.

B. stridor. D. rhonchi.

______10. A condition in infants and small children in which the movement of the

diaphragm causes the chest and abdomen to move in opposite

directions is called:

A. nasal flaring. C. retractions.

B. seesaw breathing. D. grunting.

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______11. A harsh, high-pitched sound during breathing is called:

A. gurgling. C. stridor.

B. crackles. D. retractions.

______12. All of the following are examples of medications delivered via

prescribed inhalers, EXCEPT:

A. albuterol. C. Ventolin.

B. aspirin. D. Atrovent.

______13. An active process in which the intercostal (rib) muscles and the

diaphragm contract, causing air to flow into the lungs, is known as:

A. bronchoconstriction. C. expiration.

B. exhalation. D. inspiration.

______14. A possible side effect from a prescribed inhaler is:

A. increased pulse rate. C. cyanosis.

B. hypotension. D. altered mental status.

______15. Sporadic, irregular breaths that are usually seen just before respiratory

arrest are called:

A. seesaw breathing. C. diaphragmatic breathing.

B. agonal respirations. D. hypoxic drive.

______16. All of the following are contraindications for CPAP use EXCEPT:

A. tachycardia. C. hypotension.

B. apnea. D. poor mask seal.

______17. Wet, gurgling lung sounds are an indication of:

A. COPD. C. asthma.

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B. anaphylaxis. D. pulmonary edema.

______18. Respiratory distress caused by an infection is most likely from:

A. COPD. C. anaphylaxis.

B. pneumonia. D. CHF.

_______19. Patients with absent or diminished lung sounds on one side only are suffering from:

A. pulmonary edema. C. pneumothorax.

B. pulmonary embolism. D. COPD.

_______20. A person who collapses from a clot in the pulmonary artery is suffering from:

A. pulmonary edema. C. pulmonary hypertension.

B. pulmonary embolism. D. pulmonary effusion.

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HANDOUT 17-2: Reinforcing Content Mastery Student’s Name

REINFORCEMENT

IN THE FIELD

Read the following real-life situation. Then answer the questions that follow.

Your unit has just received a call from the emergency medical dispatcher. A 73-year-old woman

at 154 Adams Way reports difficulty breathing. You and your partner head to the scene, arriving

12 minutes after the call.

Upon entry into the house, you find the patient sitting in a chair, leaning forward with her hands

on her knees. She appears anxious and has difficulty speaking in full sentences without gasping

for air. She tells you, “I can’t seem to get enough air.” As she struggles to catch her breath, the

patient adds, “My chest is so tight.”

You position yourself at eye level with the patient and try to calm her fears. You introduce

yourself and explain that you will need to ask several questions before beginning treatment.

From your questions, you learn that the patient has a history of emphysema and that she takes

Lasix, atenolol, and Ventolin. However, she has not taken these medications for several days in

an effort to prolong the prescriptions. “Refills are so expensive,” she explains.

Upon physical examination, you find the patient alert but restless. Her pulse rate is 120 beats per

minute, her blood pressure is 110/68 mmHg, her respiratory rate is 20 per minute. Breaths are

labored and noisy. Her skin is warm and pale.

1. Is the patient’s breathing adequate or inadequate?

2. When you elicited a focused history of the condition, what questions

should you have asked the patient?

3. What steps would you take to treat this patient?

4. How would you administer oxygen to the patient?

5. Should you assist this patient in taking her prescribed inhaler?

6. In what position should this patient be transported to the hospital?

HANDOUT 17-3: Reinforcing Content Mastery Student’s Name

REINFORCEMENT

CHAPTER 17 REVIEW

Write the word or words that best complete each sentence in the space provided.

1. ______________________ complaints are among the most common reasons that people

call EMS.

2. The ______________________ is a muscular structure that divides the chest cavity from

the abdominal cavity.

3. ______________________ is an active process that uses the contraction of several muscles

to increase the size of the chest cavity.

4. Normal breathing may be determined by observing for ______________________,

______________________, and ______________________.

5. ______________________ ______________________ are sporadic, irregular breaths that

are usually seen just before respiratory arrest.

6. Infants and small children in respiratory distress exhibit ______________________

______________________, in which the movement of the diaphragm causes the chest and

abdomen to move in opposite directions.

7. A low, or ______________________, pulse in infants and small children in the setting of a

respiratory emergency usually means trouble!

8. A high-pitched sound during breathing is called ______________________.

9. Use the letters ______________________ to remember which questions to ask when

eliciting a history of a respiratory disorder.

10. Never withhold ______________________ from a patient in respiratory distress.

11. Emphysema—as well as chronic bronchitis and black lung—are examples of

______________________ ______________________ ______________________

______________________.

12. A patient who uses several pillows to prop himself up when sleeping may be suffering from

____________________ ______________________ ______________________.

13. A(n) ______________________ attack may be triggered by an allergic reaction to

something inhaled, swallowed, or injected into the body.

14. Blockage, due to narrowing of the bronchi that lead from the trachea to the lungs, is known

as ______________________.

15. Contact ______________________ ______________________ for specific authorization to

help a patient self-administer a prescribed inhaler.

HANDOUT 17-4: Reinforcing Content Mastery Student’s Name

ADEQUATE AND INADEQUATE BREATHING

Complete the following table to review the characteristics of adequate and inadequate

breathing.

Adequate Breathing Inadequate Breathing

Rate Adult: Adult:
Child: Child:
Infant: Infant:
Rhythm
Quality
Breath sounds
Chest expansion
Effort of breathing
HANDOUT 17-5: Reinforcing Content Mastery Student’s Name

PRESCRIBED INHALER COMPLETION

Write in the missing information on the following medication flash card, and save the

completed card for future reference.

Prescribed Inhaler
Medication Names
1. Generic:

______________________________________________________________________________
2. Trade:

______________________________________________________________________________
Indications
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
Contraindications
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________
Medication Form:

______________________________________________________________________________
Dosage:

______________________________________________________________________________
Action:

______________________________________________________________________________
Side Effects
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
Chapter 17 Answer Key
HANDOUT 17-1: Chapter 17 Quiz

1. C 4. A 7. D 10. B 13. D
2. D 5. C 8. D 11. C 14. A
3. A 6. C 9. C 12. B 15. B
16. A 17. D 18. B 19. C 20. B

HANDOUT 17-2: In the Field

1. Adequate, but with the potential to progress to inadequate.

2. OPQRST. When did the condition begin? What were you doing when it came on? Can you

describe the feeling you have? Does the feeling seem to spread to any other part of your

body? On a scale of 1 to 10, how bad is your breathing problem? How long have you had this

feeling? Have you taken any prescribed medications or done anything else to help relieve the

condition?

3. Perform an initial assessment, administer high-flow oxygen, phone medical direction for

permission to help the patient with her prescribed inhaler, and transport her rapidly to the

hospital.

4. Use a nonrebreather mask to administer 12 to 15 lpm of high-flow oxygen.

5. Assisting the patient with her prescribed inhaler should only be done after consulting medical

control online and receiving a direct order from medical control to assist the patient with her

inhaler. Depending on whether the breathing difficulty originates in the heart or the lungs, her

inhaler may be either beneficial or potentially harmful.

6. In a position of comfort, most likely a seated position.

HANDOUT 17-3: Chapter 17 Review

1. Respiratory

2. diaphragm

3. Inspiration

4. rate, rhythm, quality

5. Agonal respirations

6. seesaw breathing

7. bradycardic

8. stridor

9. OPQRST

10. oxygen

11. chronic obstructive pulmonary diseases

12. pulmonary edema

13. asthma

14. bronchoconstriction

15. medical direction

HANDOUT 17-4: Adequate and Inadequate Breathing

Adequate Breathing Inadequate Breathing

Rate Adult: 12–20/min Above or below normal rates for the

Child: 15–30/min patient’s age group

Infant: 25–50/min
Rhythm Regular May be irregular
Quality
Breath sounds Present and equal Diminished, unequal, or absent
Chest expansion Adequate and equal Inadequate or unequal
Effort of breathing Unlabored, normal Labored—increased respiratory effort; use

respiratory effort of accessory muscles (may be pronounced in

infants and children with nasal flaring,

seesaw breathing, grunting, and retractions

between the ribs and above the clavicles and

sternum)

HANDOUT 17-5: Prescribed Inhaler Completion

Medication Names

1. Generic: albuterol, isoetharine, metaproterenol

2. Trade: Proventil, Ventolin, Bronkosol, Bronkometer, Alupent, Metaprel

Indications

1. Patient exhibits signs and symptoms of respiratory emergency.

2. Patient has physician-prescribed, handheld inhaler.

3. Medical direction gives specific authorization to use.

Contraindications

1. Patient is unable to use the device (e.g., not alert).

2. Inhaler is not prescribed for the patient.

3. Medical direction has not authorized its use.

4. Patient has already taken the maximum dosage prior to EMT’s arrival.

Medication Form: Handheld, metered-dose inhaler

Dosage: Based on medical direction’s order or physician’s order

 Action: Beta-agonist bronchodilator that dilates bronchioles, reducing airway resistance

Side Effects

1. Increased pulse rate

2. Tremors

3. Nervousness