Confusing airway question..

[Jay506]

9. What would be the correct sequence of treatment for a 76 year old female with a pulse of 142. The patient is also cyanotic around the lips and nail beds?

Your Answer: Ventilate her with a BVM and transport

Incorrect

Correct Answer is: Continue assessing en route to the hospital and apply high flow O2

Other answers:

Continue assessment to determine cause and call ALS

Perform a rapid trauma assessment and transport rapidly

Rationale: Getting the patient some oxygen is priority number one under these circumstances. Doing so on the way to the hospital without delay would be necessary.


Hello all, was looking for some words of wisdom for the above question, answer and rationale. If a person is showing signs of inadequate ventilation(cyanotic)...wouldn't you want to ventilate for them(BVM) as opposed to simply applying high flow o2? Or are they one in the same? I thought simply applying high flow o2 would be via NRB mask.

I imagine this is one of those questions where there are more than one correct answer and we should pick the "best", so does anyone know why this would be considered the "best" answer?

Thanks for any info.

 

[MassEMT-B]

They are showing signs of inadequate perfusion, it doesn't mention rate or chest rise and fall/tidal volume to say if they are breathing adequately or not. Perfusion is the actual o2 entering the cells and taking the co2 and other bi products away. The fact they are cyanotic just means not enough o2 is getting the cells. For your class you are suppose to use the BVM based on their breaths per a min and their chest rise and fall. A patient becoming cyanotic would be an indication of o2. If I am confusing at all, ill try and explain it better. I have a tendency to confuse that crap out of other people while it all makes sense to me haha.

 

[Akulahawk]

9. What would be the correct sequence of treatment for a 76 year old female with a pulse of 142. The patient is also cyanotic around the lips and nail beds?

Your Answer: Ventilate her with a BVM and transport

Incorrect

Correct Answer is: Continue assessing en route to the hospital and apply high flow O2

Other answers:

Continue assessment to determine cause and call ALS

Perform a rapid trauma assessment and transport rapidly

Rationale: Getting the patient some oxygen is priority number one under these circumstances. Doing so on the way to the hospital without delay would be necessary.


Hello all, was looking for some words of wisdom for the above question, answer and rationale. If a person is showing signs of inadequate ventilation(cyanotic)...wouldn't you want to ventilate for them(BVM) as opposed to simply applying high flow o2? Or are they one in the same? I thought simply applying high flow o2 would be via NRB mask.

I imagine this is one of those questions where there are more than one correct answer and we should pick the "best", so does anyone know why this would be considered the "best" answer?

Thanks for any info.

Two things jump out at me. One is that NOTHING is said about the patient's respiratory drive. This patient may be ventilating fine... but needs more oxygen. Start with that. Two, you want to be able to continue doing assessments during transport to determine the need for additional therapy. You might eventually have to use the BVM, but at this point, nothing is pointing to needing to...

 

[MrBrown]

Bag mask is only for somebody who has an inadequate tidal or minute volume.

This lady could have adequate ventilation but inadequate oxygenation, remember the two are very different, separate processes.

 

[Jay506]

They are showing signs of inadequate perfusion, it doesn't mention rate or chest rise and fall/tidal volume to say if they are breathing adequately or not. Perfusion is the actual o2 entering the cells and taking the co2 and other bi products away. The fact they are cyanotic just means not enough o2 is getting the cells. For your class you are suppose to use the BVM based on their breaths per a min and their chest rise and fall. A patient becoming cyanotic would be an indication of o2. If I am confusing at all, ill try and explain it better. I have a tendency to confuse that crap out of other people while it all makes sense to me haha.

No, not confusing at all, very helpful actually. I guess I got confused and thought being cyanotic is a direct sign of inadequate breathing when in reality it's inadequate perfusion? So only artificial ventilation when there's signs of poor ventilation such as chest rise, tidal volume? If it seems like there breathing(ventilating) fine a NRB will do, but if not only then use BVM?

 

[Jay506]

Thanks for help everyone

 

[MassEMT-B]

No, not confusing at all, very helpful actually. I guess I got confused and thought being cyanotic is a direct sign of inadequate breathing when in reality it's inadequate perfusion? So only artificial ventilation when there's signs of poor ventilation such as chest rise, tidal volume? If it seems like there breathing(ventilating) fine a NRB will do, but if not only then use BVM?

Its like how all squares are rectangles but not all rectangles are squares. If someone is breathing inadequately eventually they will become cyanotic, but they can become cyanotic while breathing adequately. If they are breathing fine then yea a NRB will do fine. If they are not breathing adequately you will most likely use a BVM with high flow o2. That is it from me, just a basic. I am sure a higher level provider will be around to fill in the gaps or what I missed or go into more in-depth than I can.

 

[medichopeful]

Its like how all squares are rectangles but not all rectangles are squares. If someone is breathing inadequately eventually they will become cyanotic, but they can become cyanotic while breathing adequately. If they are breathing fine then yea a NRB will do fine. If they are not breathing adequately you will most likely use a BVM with high flow o2. That is it from me, just a basic. I am sure a higher level provider will be around to fill in the gaps or what I missed or go into more in-depth than I can.

I'll jump in here really quick and just delve into this a bit more.

First, think of the oxygen cascade, the path of oxygen into the body, and the physiology/pathphysiology of breathing.

When you breath, air is drawn in by a lowering of the diaphragm, which increases the volume of the lungs. This increase in volume leads to a decrease in the pressure in the lungs, which causes air to rush in. Once this air comes in from the atmosphere, it travels through the naso/oropharynx, down the trachea, through the bronchioles, and into the lungs. Once in the lungs, the oxygen is "handed over" to the hemoglobin (and the bloodstream in general, not all oxygen is carried in Hb), where is is then distributed to the cells, where it leaves the hemoglobin and helps with cellular respiration.

This is a pretty basic rundown, but it should give us a good starting point. We're dealing with the different causes of cyanosis, and we'll focus on two causes: lack of air intake, and lack of oxygen exchange.

The purpose of a BVM is to force air into the lungs to make sure that the patient is getting enough oxygen to survive and support cellular respiration. If the problem is that the patient is not drawing in enough air (for example, from diaphragm malfunction, obstruction, tachypnea, dyspnea, etc.), simply putting them on a NRB or NC isn't going to do much good. Sure it will give them oxygen, but how much of that is being put to good use? Not necessarily much if they're not drawing in enough of it to make a difference! So you're going to have to assist them in taking in air. for example, if they have a diaphragm injury and it's not doing its job, you'll have to replace the diaphragm with a BVM. Make sense?

Now let's take a look at the other case, where they're drawing in enough air but there's a problem internally. For example, let's say some of the alveoli aren't functioning correctly, and thus not the correct amount of oxygen is making it's way into the bloodstream. This may not be a case of not taking in enough air, but rather not exchanging enough oxygen at the cellular or alveolar level. So what would be a good way to deal with this? If they're taking in enough air, why force more in with a BVM? What they need is a higher concentration of air, which will (hopefully) increase their SpO2.

Does this make sense or help you out? I hope it does! lol

Eric

 

[jwk]

No, not confusing at all, very helpful actually. I guess I got confused and thought being cyanotic is a direct sign of inadequate breathing when in reality it's inadequate perfusion? So only artificial ventilation when there's signs of poor ventilation such as chest rise, tidal volume? If it seems like there breathing(ventilating) fine a NRB will do, but if not only then use BVM?

Just a couple things...

Cyanosis is a sign of inadequate oxygenation, which may come from any number of different causes.

Breathing(ventilating) are not the same thing. Someone who is breathing may not be ventilating well (hypoventilation).

The two processes we're concerned with are oxygenation (getting oxygen into the lungs and blood and out into the tissues) and ventilation (getting CO2 out of the bloodstream and exhaled out of the lungs. Some patients have problems with one or the other - and some have problems with both.

 

[njemtbvol]

idk about you guys, but pulse of 142 and cyanotic, I'm CYA and calling medics..

 

[MassEMT-B]

idk about you guys, but pulse of 142 and cyanotic, I'm CYA and calling medics..

In real life, yes (well not at my service, all trucks are ALS but I digress) but, these are questions I am guessing for a class. EMT class is for you to learn what to do, not just call ALS and do no real interventions but perform an assessment. But to know how to deal with situations to the best of your ability for when maybe there isn't an ALS intercept available or whatever the case maybe.

 

[usalsfyre]

idk about you guys, but pulse of 142 and cyanotic, I'm CYA and calling medics..

Even if your closer to the ED than to a paramedic unit?

 

[Akulahawk]

idk about you guys, but pulse of 142 and cyanotic, I'm CYA and calling medics..

While that is probably a VERY good idea in real life... testing doesn't assume real life. In any event, aside from calling the medics, how would you treat the cyanotic adult patient who has a pulse rate of 142? Do nothing until the medics arrive? Remember, you may be in a place where BLS transports nearly EVERYTHING and ALS may or may NOT be readily available.

 

[njemtbvol]

While that is probably a VERY good idea in real life... testing doesn't assume real life. In any event, aside from calling the medics, how would you treat the cyanotic adult patient who has a pulse rate of 142? Do nothing until the medics arrive? Remember, you may be in a place where BLS transports nearly EVERYTHING and ALS may or may NOT be readily available.

In real life I'm putting her on O2, doing assessments, taking a history (in testing don't forget last oral, (( funny story about that, on the day of my pratical when I went through sample, my instructor told me that if he ever heard that I asked that on anything other than a diabetic he's revoking my EMT license)) and seeing if medics are more than about 10 mins away, if so i'm transporting with hopes of a rendezvous

 

[usalsfyre]

(( funny story about that, on the day of my pratical when I went through sample, my instructor told me that if he ever heard that I asked that on anything other than a diabetic he's revoking my EMT license))

Your instructor's not looking at the big picture. This can be a VERY important thing to know come airway management time.

 

[njemtbvol]

true true, he was an old schooler..O2 on everyone and smith if he coudn't understand/spell your last name.
not saying he was right, just that it was a funny story

 

[usalsfyre]

true true, he was an old schooler..O2 on everyone and smith if he coudn't understand/spell your last name.
not saying he was right, just that it was a funny story

Just making sure you didn't subscribe to the same theory. I probably want to know if my respiratory failure patient washed down two helpings of clam chowder with a 40oz bottle of Old English 30 minutes ago lol.

 

[medichopeful]

Ignore.

 

[njemtbvol]

a 40oz bottle of Old English 30 minutes ago lol.

If you can't tell if your patient had one of these by the way their breath smells..lol
But I do get what your saying, tho I only ask when I think it's relevant. if my pt. just broke her arm, she could have eaten a 8 course meal laced with acid and it won't make a difference..well on my report sheet for the CC anyway

 

[Jay506]

Just a couple things...

Cyanosis is a sign of inadequate oxygenation, which may come from any number of different causes.

Breathing(ventilating) are not the same thing. Someone who is breathing may not be ventilating well (hypoventilation).

The two processes we're concerned with are oxygenation (getting oxygen into the lungs and blood and out into the tissues) and ventilation (getting CO2 out of the bloodstream and exhaled out of the lungs. Some patients have problems with one or the other - and some have problems with both.

You're right, sorry I meant breathing(respirations), I knew that much haha, but I definitely understand what the problem is now. Very helpful