1. Respiratory Transport

2. Determining the mode of transport for a pt with a respiratory problem includes all of the following problems except:
Ventilation needs
Oxygenation
Altitude changes
Medical or surgical in nature
In determining the mode of transport, oxygenation and ventilation should be considered, taking in consideration potential altitude and pressure changes encountered in the RW and FW environment. The nature of the illness is not factored, although time in transport may reflect the illness.

3. Characteristics of an ideal transport ventilator include:
Intermittent mandatory ventilation
Volume limited ventilation
PEEP settings of 0-50 cm water
Audio alarms
Characteristics of the ideal ventilator for transport include provision of IMV (intermittent mandatory ventilation), variable TV, alarms that are audio as well as visual – audible alarms may not be heard in the transport environment, PEEP ranging from 0-20 cm H2O (not 50). Additionally the ventilator should monitor airway pressures and provide for pressure (not volume) limited ventilation and variable flow rates.

4. A pleural friction rub is described as:
A harsh, grating sound usually present throughout respiratory cycle
High-pitched, continuous, musical quality occurring in small airways
As fine or coarse; discontinuous crackles or popping sounds of short duration
Continuous sounds, similar to wheeze but lower pitched, occurring in larger airways
Pleural friction rub is a harsh grating sound, usually present throughout the respiratory cycle. Crackles are fine or course, wheezes are high-pitched, continuous, musical quality, and rhonchi are continuous sounds of low pitch.

5. Acute Respiratory Failure with the pathology of primary acute pulmonary dysfunction presents with the following blood gas abnormalities:
Hypoxemia, hypercarbia
Hypoxemia, hypocarbia
Normal oxygen level, hypercarbia
Normal oxygen level, hypocarbia
Acute respiratory failure occurs when illness of impairment of the respiratory system results in an inability to maintain adequate oxygenation. It is defined by ABG’s with decreased oxygenation; in addition it is often accompanied by hypercarbia (elevated CO2), however in the pathology of primary acute pulmonary dysfunction is still characterized by hypoxemia but may have normal or low pCO2 initially.

6. The most common sign of respiratory distress in a pt without Acute Respiratory Failure during transport is:
Cough
Dyspnea
Tachypnea
Wheezing
Acute respiratory failure has many signs including diaphoresis, hypoxia, tachypnea, cough, stridor, possibly wheezing, tachycardia, pulses, and altered mental status. The most common sign is dyspnea.

7. Obstruction to expiratory airflow with enlarged alveoli and loss of elasticity of lung tissue along with destruction of the alveolar wall describes
Status Asthmaticus
Acute Respiratory Failure
Adult Respiratory Distress Syndrome
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease is the broad term used to describe conditions associated with chronic obstruction to expiratory airflow. Alveoli enlarge and loss of elasticity of lung tissue and destruction of the alveolar wall occurs. Acute Respiratory Failure occurs when illness or impairment of respiratory system results in inability of lungs to maintain adequate oxygenation of arterial blood. Adult Respiratory Distress Syndrome is an acute lung injury of impaired oxygenation resulting from a variety of insults. Status Asthmaticus is a severe asthmatic attack that is refractory to initial conventional treatment; producing severe airway narrowing or obstruction and airway inflammation.

8. Which is the most likely 2ndary medications used during transport for a pt with status asthmaticus unresponsive to nebulized bronchodilator treatments?
Antianxiety agent
Methylxanthines
Anticholinergics
Neuromuscular blocking agents
Anticholinergics are indicated in pts who do not respond well to initial beta agonists.

9. While transporting a pt with a respiratory illness you note an acute anterior T wave inversion on the EKG. This change causes you to suspect:
COPD
Pneumonia
Pneumothorax
Pulmonary embolus
Pulmonary embolus ECG changes include right axis deviation, new right bundle branch block and with massive pulmonary embolus an anterior T wave may occur. Additionally sinus tachycardia is a frequent occurrence and occasionally new onset atrial fibrillation or flutter.

10. Chest radiographic changes that indicate a pulmonary contusion can occur in what time frame?
24 to 72 hours after injury
12 to 18 hours after injury
6 to 12 hours after injury
1 to 2 hours after injury
The chest radiograph for a pt with trauma to the chest wall that indicates a pulmonary contusion shows white opacity in peripheral lung area near the injured chest wall, these acute changes are usually not seen until 24 to 72 hours after injury. ABG’s deteriorate over 24 to 48 hours.

11. Chest tube insertion is indicated for the immediate treatment of which of the following respiratory diseases or injuries?
Pulmonary contusion
Tension Pneumothorax
Aspiration pneumonia
ARDS
Tension pneumothorax should be treated immediately with a needle thoracostomy and should be followed by insertion of a chest tube.

12. You are preparing to transport a 76 kg pt with ARDS who is on a ventilator. Which of the following would be an appropriate tidal volume range for this pt?
Tidal for the ARDS pt should be 6-10 cc/kg. A tidal volume of 8-10 cc/kg is used for the asthma and COPD pt.

13. Which of the following is used to definitively diagnosis a pulmonary embolus?
D-dimer test
V/Q scan
CT scan of the chest
Pulmonary angiogram
An angiogram is the most definitive diagnosis for pulmonary embolus. D-Dimer negative or positive is not conclusive. V/Q scan is highly sensitive, but has a low specificity. CT scan is highly specific for PE, but an angiogram would be the most definitive.

14. Which of the following pneumonias result in necrosis of alveolar walls, multiple abscesses, loss of lung volume, and friable blood vessels?
Streptococcus Pneumonia
Staphylococcus Aureus
Klebsielle Pneumoniae
Haemophilus Influenzae
Klebsiella Pneumoniae results in necrosis of alveolar walls, multiple abscesses, loss of lung volume, and friable blood vessels. In Streptococcus Pneumonia damage occurs from overwhelming growth of bacteria which impairs gas exchange. Staphylococcus Aureus is caused by aspiration from upper respiratory tract which leads to infection. Haemophilus Influenzae occurs from bacterial infection that produces inflammation.

15. Which of the following is the primary effect of drowning?
Pulmonary injury followed by hypoxia and cerebral edema
Pulmonary injury followed by an increase in pulmonary vascular resistance and pulmonary capillary permeability which causes pulmonary edema
Hypoxia followed by an increase in pulmonary vascular resistance and pulmonary capillary permeability which causes pulmonary edema
Hypoxia followed by an increase pulmonary edema and cerebral edema
The primary effect of drowning is pulmonary injury followed by hypoxia and cerebral edema. Infraglottic injury will manifest as an increase in pulmonary vascular resistance and pulmonary capillary permeability which causes pulmonary edema; also hypoxemia occurs resistant to oxygen therapy.

16. You recognize percussion of tympany as:
A sound over normal lung fields
An indication of increased air in the chest
As an indication of fluid in the chest
As an indication of a solid organ
Tympany of hyperresonance indicates increased air as seen with conditions such as emphysema. Resonance is heard over normal lung fields. Dullness of flatness indicates fluid or solid such as hemothorax or masses.

17. Upon viewing the chest film of a pt you note a low, flat diaphragm
Upon viewing the chest film of a pt you note a low, flat diaphragm. You know this to be consistent with:
Pulmonary embolus
COPD
Diaphragmatic rupture
Status asthmaticus
In COPD the chest film will show evidence of a low, flat diaphragm. In pulmonary embolus a chest film will be nonspecific and frequently normal. A diaphragmatic rupture will show absence of the normal contour of the diaphragm. In status astmaticus the chest film may be normal or hyperlucent.

18. You are preparing to transport a pt with no history of trauma
You are preparing to transport a pt with no history of trauma. The pt is anxious and has dyspnea, tachypnea, and decreased breath sounds on the left side with hyperresonance. The pt states he is “unable to catch his breath”. You suspect:
COPD
Pneumonia
Spontaneous pneumothorax
Asthma
The symptoms are those of a spontaneous pneumothorax. COPD presents with tachypnea, dyspnea on exertion, wheezes, crackles, breath sounds may be diminished. Pneumonia presents with sudden onset of fever, chills, and productive cough. The pt will have dullness to percussion over effected area. Asthma presents with chest tightness, prolonged expiration, and wheezing.

19. You are transporting a pt with the following blood gas results pH 7
You are transporting a pt with the following blood gas results pH 7.30, pCO2 55, HCO3 24, pO You interpret this as:
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
The blood gas represents a respiratory acidosis. A blood gas pH <7.35 indicates acidosis, and >7.45 indicate alkalosis. Respiratory alkalosis is present when the PaCO2 is <45 mmHg and the pH > Respiratory acidosis is present when the PaCO2 is >45 mmHg and the pH is < Metabolic alkalosis is present when the bicarbonate is >36mEq/L and the pH is > Metabolic acidosis is present when the bicarbonate is <22mEq/L and the pH is <7.35.

20. The blood gas represents an uncompensated metabolic acidosis.
You interpret the following blood gas pH 7.34, pCO2 40.3, HCO3 21.4, B.E. 3.6, pO as:
Metabolic acidosis
Uncompensated metabolic acidosis
Respiratory acidosis
Uncompensated respiratory acidosis
The blood gas represents an uncompensated metabolic acidosis.

21. When talking about lung volumes you recognize the volume of air remaining at the end of maximum expiration as:
Tidal volume
Inspiratory reserve volume
Expiratory reserve volume
Residual volume
Residual volume is the volume of air remaining at end of maximum expiration. Tidal volume is the volume of air inspired or expired with normal breaths. Inspiratory reserve volume is the extra air that can be inspired in excess of normal tidal volume. Expiratory reserve volume is the amount of air that can be expired by forceful expiration after normal tidal volume.

22. Which of the following would not cause a shift to the left on the oxyhemoglobin dissociation curve?
Alkalosis
Acidosis
Hypocapnia
Decreased levels of 2,3 DPG
Acidosis occurs in a shift to the right. A shift to the left indicates an increase in the affinity of oxygen for hemoglobin. It can be seen in alkalosis, hypocapnia, hypothermia, and decreased levels of 2, 3-diphosphoglycerate.

23. When talking about ventilation and perfusion you recognize that the normal amount of blood perfusing the alveoli is:
3 L/min
4 L/min
5 L/min
6 L/min
Perfusion is the amount of blood flow to the respiratory capillaries. Normally the amount of blood perfusing the alveoli is 5 L/min.