Chapter 10 Respiration and Artificial Ventilation: Street Scene Questions

Street Scene Questions
1. What is your first priority when starting to assess this patient?

2. Assuming his airway is patent, what are the essential elements in assessing this patient’s breathing?

3. What type of emergency care should you be prepared to give? As you assess the patient, you note he is breathing rapidly with an audible wheeze. He seems very tired. He can speak only one or two words at a time, and you notice that his fingernails are blue. You also notice that his respiratory rate slows down and becomes slightly irregular from time to time.
4. Is this patient’s breathing adequate (why or why not)?
5. Does this patient require artificial ventilation?
The team decides that this patient is in respiratory failure, is tiring out, and needs immediate ventilation. You connect the BVM to high-concentration oxygen and begin to ventilate the patient. At first the patient is uncooperative and you find it difficult to time your ventilations with his. However, after a few breaths, your timing begins to work. About every fourth patient breath, you administer a breath to help increase tidal volume. The patient becomes more and more comfortable with this.
Jim continues the assessment while Danielle requests Advanced Life Support backup and prepares for rapid transport. You continue ventilating as the team loads the patient and initiates transport.

Answers

1. After assuring scene safety and gathering a general impression, you should complete a primary assessment. If problems are found, immediate treatment must be initiated.

2. The essential elements of assessing this patient’s breath-ing include observing his effort and mental status; assessing his skin color; listening to his chest for air movement and unusual lung sounds; and obtaining a pulse oximetry reading.

3. Immediate treatment must include supplemental high concentration oxygen. It may also be important to assist this patient with his inhaler (if protocols allow). Assess-ment may also indicate respiratory failure. As such, you should be prepared to provide artificial ventilations.

4. The breathing is not adequate. Fatigue, cyanosis, and difficulty speaking all point to respiratory failure.

5. This patient requires artificial ventilations.