Chapter 10 Respiration and Artificial Ventilation: Critical Thinking Exercises

Critical Thinking Exercises
1. After assuring the scene is safe, the EMT should open this patient’s airway and, if necessary, support it with an airway adjunct. Her altered mental status, slow respiratory rate, and cyanosis all point to respiratory failure. This patient needs immediate respiratory assistance with a bag-valve mask and supplemental oxygen.

2. At a minimum, this patient needs immediate supplemental oxygen. Further assessment will be necessary to identify respiratory failure, but his inability to speak and position certainly point to at least impending failure. If your assessment identifies further indications of respiratory failure, then immediate artificial ventilation is necessary.
3. Although this patient may just be anxious after the motor-vehicle crash, a thorough assessment must be completed to assure the fast rate is not due to an injury. Rapid respiratory rates can indicate inadequate breathing, but further assessment will be necessary to identify respiratory failure.

Pathophysiology to Practice

1. To identify respiratory failure, both oxygenation and ventilation must be assessed. Mental status, skin color, and pulse oximetry all can be used to assess oxygenation. Listening to lung sounds, observing respiratory effort, and looking for accessory muscle use help assess ventilation. If no deficits in oxygenation or ventilation are noted during these assessments, the patient is breathing adequately. Any deficits with either element point to inadequate
breathing and respiratory failure.
2. A breathing patient may need artificial ventilation if his breathing is deemed to be inadequate. Signs include altered mental status, cyanosis, slowing or irregular respi-
rations, and respiratory fatigue.

3. When using a bag-valve mask, watch for chest rise to assure adequate volume.

Answers

1. After assuring the scene is safe, the EMT should open this patient’s airway and, if necessary, support it with an air- way adjunct. Her altered mental status, slow respiratory rate, and cyanosis all point to respiratory failure. This patient needs immediate respiratory assistance with a bag-valve mask and supplemental oxygen.

2. At a minimum, this patient needs immediate supplemental oxygen. Further assessment will be necessary to identify respiratory failure, but his inability to speak and position certainly point to at least impending failure. If your assessment identifies further indications of respiratory failure, then immediate artificial ventilation
is necessary.
3. Although this patient may just be anxious after the motor-vehicle crash, a thorough assessment must be completed to assure the fast rate is not due to an injury. Rapid respiratory rates can indicate inadequate breathing, but further assessment will be necessary to identify respiratory failure.

Pathophysiology to Practice

1. To identify respiratory failure, both oxygenation and ventilation must be assessed. Mental status, skin color, and pulse oximetry all can be used to assess oxygenation. Listening to lung sounds, observing respiratory effort, and looking for accessory muscle use help assess ventilation. If no deficits in oxygenation or ventilation are noted during these assessments, the patient is breathing adequately.
Any deficits with either element point to inadequate breathing and respiratory failure.
2. A breathing patient may need artificial ventilation if his breathing is deemed to be inadequate. Signs include altered mental status, cyanosis, slowing or irregular respirations, and respiratory fatigue.

3. When using a bag-valve mask, watch for chest rise to assure adequate volume.