PLATINUM FINAL EXAM EMTP 3.3 LATEST UPDATE 2023 -2024 ACTUAL EXA MS WITH CORRECT QUESTIONS AND VERIFIED RATIONALES ANSWERS ALREADY GRADED A+ 100% GUARANTEED PASS!!! When to use what airway device given a scenario / When to use what ventilation device given a scenario: Non -Rebreather Used for patients that require more than 6L of oxygen, and can be used with a nebulizer for maximum efficiency. When to use what airway d evice given a scenario / When to use what ventilation device given a scenario: BVM BLS airway that is used initially before an advanced airway, and connected to one if one is placed. TX of a patient in anaphylaxis when epinephrine has failed to improve the patient's condition and he/she is deteriorating If 0.3mg IM 1:1000 Epi does not work, peripheral perfusion isn't good enough to circulate the medication! IV EPI: 1:10,000 is the only solution to get the epinephrine to the patient. Know the advantages and disadvantages of a surgical vs needle cricothyrotomy. Which one is the quickest to perform? Once established, surgical cricothyroidotomy has a number of advantages over use of a cannula – provision of a definitive airway (protection by a cuffed tube) being just one. Despite this, the technique is used far less frequently. This may be due to fears about the complication of hemorrhage. Research suggests that needle cricothyroidotomy can provide effective ventilation in the presence of increasing airway obstru ction. The failure of the needle systems in the presence of upper airway obstruction results from inadequate exhalation via the narrow 1.5mm lumen of the 13G cannula. Which can lead to: Barotrauma/pneumothorax = from over -inflation* Bleeding Subcutaneous e mphysema Survey data from the prehospital and hospital settings show the needle airway to be the most frequently used emergency cricothyroidotomy method, whereas the surgical airway is rarely used . Assessment findings in a patient with a spontaneous pneumo thorax Shortness of breath, sudden onset of sharp chest pain, pallor, tachypnea, diaphoresis. Severe symptoms include tachycardia, AMS, cyanosis, decreased breath sounds on the affected side. Best method to protect a patient's airway who vomits each time you try to intubate Inadequate depth of anesthesia or unexpected responses to surgical stimulation may evoke gastrointestinal motor responses, such as gagging or recurrent swallowing, increasing gastric pressure over and above LOS pressure facilitating ref lux. In the setting of aspiration, regurgitation occurs three times more commonly than active vomiting. An unprotected airway, excessively light depths of anesthesia, and one or more predisposing risk factors for aspiration combine to significantly increas e the risks of aspiration. A summary of the available strategies for reducing aspiration risk: Reducing gastric volume (NRB instead of BVM) Second -generation supra -glottic airway devices Cricoid pressure Rapid sequence induction Position ( left lateral , hea d down or upright) What are the advantages / disadvantages of tracheal intubation vs using an extraglottic airway device? Insertion of a supraglottic airway device is simpler and faster than tracheal intubation, and proficiency requires less training and o ngoing practice. Tracheal intubation is a more complex skill than supraglottic airway device insertion and requires 2 practitioners, additional equipment, and good access to the patient's airway The strategy of using a supraglottic airway device first al so achieved initial ventilation success more often. Although regurgitation and aspiration occurred with similar frequency overall, regurgitation and aspiration during or after advanced airway management were significantly more common in the supraglottic ai rway device group. Conversely, patients in the tracheal intubation group were significantly more likely to regurgitate and aspirate before advanced airway management, possibly due to less frequent use of advanced techniques to secure the airway in this gro up and the increased time required for tracheal intubation compared with insertion of a supraglottic airway device. What would cause a patient's respirations to be shallow after striking his/her head while diving Breathing problems: If the spine is severel y compressed, your lungs may not work properly and you can have trouble breathing. Specifically, the C3, C4, and C5 spinal nerves innervate the diaphragm. After a spinal cord injury at or above the C5 level , messages from the brain may not be able to get p ast the damage, resulting in loss of control over the diaphragm. This causes breathing to be weakened, therefore it’s essential to seek immediate medical attention. With the help of a ventilator, respiratory functions may be restored . First step in treatin g a patient with a slow pulse, slow respirations, and low BP ABCs -> BVM patient with inadequate ventilations! What is the first assessment you perform for each and every patient? PRIMARY SURVEY/RESUSCITATION: Verbalizes the general impression of the patie nt Determines responsiveness/level of consciousness (AVPU) Determines chief complaint/apparent life -threats 1-2. Assesses airway and breathing: Assessment Assures adequate ventilation Initiates appropriate oxygen therapy 3. Assesses circulation: Assesses /controls major bleeding Checks pulse Assesses skin [either skin color, temperature or condition] 4. Identifies patient priority and makes treatment/transport decision What to do if a patient cannot tolerate a NRB Switch to a nasal cannula at a max of 6L flow rate. First step in treating a diabetic patient who has overdosed and has slow, shallow respirations Assess and support ABCs: Begin mouth -to-mask rescue breathing. Why would a capnography reading start to decrease in an artificially ventilated patient ? Know your ETCO2 values and how it correlates to ventilatory status. If your patient is breathing at a rate above 20 breaths per minute, they’re eliminating a lot more CO2 than average . This excess elimination results in a decreased concentration of carbo n dioxide in the body. Which respiratory sound would be most concerning in a patient with a possible allergic reaction? Absence of lung sounds (from field experience) S/S of pneumonia Assessment: A patient with bacterial pneumonia will generally appear ill . He may report a recent history of fever and chills. These chills are commonly described as "bed shaking." There is usually a generalized weakness and malaise. The patient will tend to complain of a deep, productive cough and may expel yellow to brown spu tum, often streaked with blood. Many cases involve associated pleuritic chest pain. Therefore, pneumonia should be considered in any patient who presents complaining of chest pain, especially if accompanied by fever and /or chills. In pneumonia involving t he lower lobes of the lungs, a patient may complain of nothing more than upper abdominal pain. Physical examination will commonly reveal fever, tachypnea, tachycardia, and a cough. Respiratory distress may be present. Auscultation of the chest usually demo nstrates crackles (rales) in the involved lung segment, although wheezes or rhonchi may be heard. There usually is decreased air movement in the areas filled with infection. Percussion of the chest may reveal dullness over these areas. Egophony (a change i n the spoken "E" sound to an "A" sound on auscultation) may also be noted. In the forms of pneumonia involving viral, fungal, and rare bacterial causes, the typical symptoms as described are not seen. Instead, these patients may report a nonproductive coug h with less prominent lung findings. Systemic symptoms such as headache, malaise, fatigue, muscle aches, sore throat, and abdominal complaints including nausea, vomiting, and diarrhea are more prominent. Fever and chills are not as impressive as in bacteri al pneumonia . S/S of emphysema Symptoms start gradually and include: -Shortness of breath, even with routine activities of walking, climbing stairs etc -Barrel chest may be a symptom of a related condition. -Long lasting cough which can be dry or with mucu s -Wheezing -Fatigue -Frequent respiratory infections -Nails and lips turning blue even with the slightest of exertion How to correct snoring respirations Snoring: caused by the tongue obstructing the airway. Treat by head -tilt chin -lift or jaw thrust and / or insert airway adjunct. TX of a patient with a closed head injury and S/S of ICP. How do we ventilate these patients? Increased ICP results in a lack of oxygen in brain tissue and a restriction of cerebral blood flow in the brain. This is most commonly caused by a head injury, bleeding in the brain (i.e. hematoma or hemorrhage), tumor, infection, stroke, excess cerebrospinal fluid, or swelling of the brain. Increased ICP activates the Cushing reflex, a nervous system response resulting in Cushing’s tria d. As the ICP begins to increase, it eventually becomes greater than the mean arterial pressure, which typically must be greater than the ICP in order for the brain tissue to be adequately oxygenated. This difference in pressure causes a decrease in the ce rebral perfusion pressure (CPP), or the amount of blood and oxygen the brain is receiving, therefore leading to the brain not receiving enough oxygen (also known as a brain ischemia). To compensate for the lack of oxygen, the sympathetic nervous system is activated,
