Respiratory

Respiratory Review

Objectives

• Identify signs and symptoms of acute airway obstruction and respiratory distress in pediatric and adult patients\

• Apply the ESI to triage respiratory emergencies appropriately​

• Differentiate between sedation and paralytic agents used in rapid sequence (RSI), including indications and contraindications

• Interpret clinical findings, diagnostic tests, and patient presentations to guide emergency nursing priorities and interventions.

Multiple Choice

What is the ESI Level?

• Level 1

• Level 2

• Level 3

• Level 4

Multiple Choice

What should be prepared for intubation in case of airway obstruction?

• Larger ETT

• Smaller ETT

• No ETT needed

• Only sedatives

Multiple Choice

What is the maximum dosage of Dexamethasone for airway swelling reduction?

• 10 mg

• 16 mg

• 20 mg

• 12 mg

Multiple Choice

What are the clinical manifestations of acute airway obstruction?

• Decreased breath sounds

• Increased heart rate

• Coughing

• Fever

Multiple Choice

What are the different conditions that can be observed during a bronchoscopy as shown in the images?

• Blood clot

• Mucus plug

• Embedded foreign body

• All of the above

Multiple Choice

What is the purpose of an emergency cricothyrotomy?

• To relieve airway obstruction

• To perform a tracheostomy

• To administer medication

• To provide oxygen

Multiple Choice

Which finding signals complete obstruction?

• Hoarse voice

• Productive cough

• Stridor

• Silent chest

Multiple Choice

After abdominal thrusts fail and the patient becomes unconscious, what should you do first?

• Intubate

• CPR

• Apply Oxygen

• Wait for a provider

Multiple Choice

When giving abdominal thrusts, you should give quick _______ thurst into the abdomen.

• Upward

• Downward

• Inward

Multiple Choice

When is a cricothyrotomy indicated in the ED?

• Facial burns with airway collapse

• Hypoxia from COPD

• Anxiety attack

• Mild anaphylaxis

Multiple Choice

What are the differences between a normal airway and an asthmatic airway during an attack?

• Normal airway

• Asthmatic airway

• Wall inflamed and thickened

• Tightened smooth muscles

Multiple Choice

What actions should be taken for a patient with a PAS score greater than 7?

• ED Discharge

• Admit to Med-Surg Floor

• Continuous Duoneb x 1 hr

• Methylprednisolone IV

Multiple Choice

What are the criteria for classifying asthma exacerbation severity based on the Pediatric Asthma Score (PAS)?

• Mild, Moderate, Severe

• Normal, Mild, Moderate

• Critical, Severe, Mild

• Emergency, Urgent, Routine

Multiple Choice

What is the recommended treatment for a patient with a Pediatric Asthma Score (PAS) of 4-6?

• Albuterol MDI with spacer

• Continuous Duoneb x 1 hr

• Admit to Med-Surg Floor

• Dexamethasone PO/IM or Prednisone PO

Multiple Choice

What are the three zones of the Asthma Action Plan and what actions should be taken in each zone?

• Green Zone

• Yellow Zone

• Red Zone

• All of the above

Multiple Choice

What are the contents of Kit A for Rapid Sequence Intubation?

• Etomidate, Ketamine, Midazolam

• Rocuronium, Succinylcholine

• 10 mL syringes, Saline Flushes

• Blunt cannula, Alcohol swabs

Multiple Choice

What are the contents of Kit A for sedation?

• Etomidate 2 mg/mL 10 mL vial (2 vials)

• Ketamine 10 mg/mL 5 mL syringe (4 syringes)

• Midazolam 1 mg/mL 2 mL vial (2 vials)

• All of the above

Multiple Choice

What are the side effects of Etomidate?

• Hypotension

• Myoclonus

• Decreased in Cortisol levels

• All of the above

Multiple Choice

What is the recommended dose range for Midazolam in sedation?

• 0.1 - 0.3 mg/kg

• 0.5 - 1.0 mg/kg

• 1.0 - 1.5 mg/kg

• 0.05 - 0.1 mg/kg

Multiple Choice

What are the advantages of using Ketamine as a dissociative anesthetic agent?

• Can be given to a patient who can’t be paralyzed

• Less hemodynamic instability

• May cause bronchodilation

• All of the above

Multiple Choice

What are the contents of Kit B medication?

• Rocuronium and Succinylcholine

• Morphine and Fentanyl

• Aspirin and Ibuprofen

• Lidocaine and Epinephrine

Multiple Choice

What are the advantages of using Rocuronium as a paralytic agent?

• Less side effects compared to Succinylcholine

• Long duration

• Expensive

• Quickly reversed with Sugammadex

Multiple Select

What are the side effects of Succinylcholine?

• Hyperkalemia

• Fasciculations

• Trismus (lockjaw)

• Bradycardia in children

Open Ended

List two advantages of using Succinylcholine as a paralytic agent.

Multiple Choice

What is the dose of Succinylcholine for rapid onset?

• 1.0 mg/kg

• 1.5 mg/kg

• 2.0 mg/kg

• 0.5 mg/kg

Multiple Choice

What condition can occur due to the use of succinylcholine that leads to dangerously high levels of potassium in the system?

• Hypokalemia

• Hyperkalemia

• Acidosis

• Alkalosis

Multiple Choice

What should be checked after intubation to ensure proper placement?

• Waveform Capnography

• Colorimetric CO2 detectors

• Bilateral lung sounds

• All of the above

Multiple Choice

A patient is wheezing and speaking in full sentences. Their SpO2 is 96%. What is their severity?

• Mild

• Moderate

• Severe

• Respiratory Failure

Multiple Choice

Which of the following is the most concerning sign in an asthma patient?

• SpO2 = 92%

• Increased Wheezing

• Silent Chest

• RR = 28

Poll

How confident do you feel about this topic now?

• Very confident
• Somewhat confident
• Not confident