NREMT Paramedic Level Flashcards: Respiratory Failure And Advanced Respiratory Emergencies

What this deck covers

This deck focuses on Respiratory Failure And Advanced Respiratory Emergencies, giving you a quick way to review the definitions, rules, and examples that matter most for NREMT Paramedic Level.

How to use these flashcards

Work through these flashcards in short sessions. Try to answer each prompt before flipping the card, then revisit any cards you miss until the explanation feels automatic.

Flashcard 1: Which option best indicates worsening asthma: decreasing wheeze with increasing work of breathing or loud wheezing?

Answer: Decreasing wheeze with increasing work of breathing. Diminishing wheezes despite heightened effort signal severe airflow limitation and impending fatigue, worse than audible wheezes indicating some air movement.

Flashcard 2: What is the most likely cause of refractory hypoxemia with clear lungs after intubation and good chest rise?

Answer: Right mainstem intubation or unrecognized pneumothorax (evaluate immediately). These conditions impair oxygenation despite apparent ventilation, requiring prompt assessment to correct tube position or decompress the chest.

Flashcard 3: What is the most reliable method to confirm endotracheal tube placement in the field?

Answer: Continuous waveform capnography. Waveform capnography provides real-time confirmation of tracheal placement by detecting consistent CO2 exhalation, superior to auscultation or colorimetric methods.

Flashcard 4: What is the preferred oxygen delivery device for severe hypoxemia with spontaneous breathing?

Answer: Nonrebreather mask at high flow (or CPAP if indicated). Nonrebreather delivers high FiO2 for hypoxemia correction, with CPAP adding PEEP for alveolar recruitment if work of breathing is increased.

Flashcard 5: What is the key clinical sign of respiratory muscle fatigue indicating impending ventilatory failure?

Answer: Decreasing tidal volume with slowing RR and altered mental status. Fatigue leads to progressive inability to generate sufficient tidal volume and rate, culminating in hypoventilation and CO2 retention with neurological changes.

Flashcard 6: What is the classic triad of anaphylaxis requiring immediate epinephrine?

Answer: Airway edema/bronchospasm, hypotension, and urticaria or mucosal swelling. This triad represents systemic IgE-mediated reaction involving respiratory compromise, circulatory collapse, and cutaneous manifestations from histamine release.

Flashcard 7: Which option best indicates adequate response to naloxone: normal mentation or adequate ventilation?

Answer: Adequate ventilation. The primary goal is restoring effective breathing to correct hypoxemia and hypercapnia, even if full alertness is not immediately achieved.

Flashcard 8: What is the definition of respiratory failure used in EMS assessment?

Answer: Inadequate oxygenation and/or ventilation to sustain life. This definition captures the critical failure of gas exchange where oxygen delivery or CO2 removal is insufficient, leading to life-threatening acidosis or hypoxemia.

Flashcard 9: What is the most common clinical finding suggesting tension pneumothorax in the field?

Answer: Severe respiratory distress with hypotension and unilateral absent breath sounds. These signs indicate mediastinal shift from pleural pressure, compromising ventilation and hemodynamics, though JVD and tracheal deviation are less reliable.

Flashcard 10: What is the preferred initial management for suspected opioid-induced hypoventilation with a pulse?

Answer: Ventilate with BVM; administer naloxone as needed to restore adequate breathing. Supportive ventilation ensures gas exchange while naloxone antagonizes mu-receptors to reverse respiratory depression without oversedation reversal.

Flashcard 11: What is the most appropriate initial airway intervention for apnea with a pulse?

Answer: BVM ventilation with high-flow oxygen and airway adjuncts. BVM provides immediate positive pressure ventilation to restore oxygenation and CO2 clearance when spontaneous breathing is absent but circulation persists.

Flashcard 12: What is the immediate treatment priority for suspected tension pneumothorax with shock?

Answer: Needle decompression without delay. Needle decompression relieves intrathoracic pressure buildup, restoring venous return and cardiac output in life-threatening tension physiology.

Flashcard 13: What ABG pattern defines acute ventilatory (hypercapnic) respiratory failure?

Answer: Elevated $PaCO_2$ with acidemia (low pH). Hypercapnic failure occurs when alveolar hypoventilation causes CO2 retention, resulting in respiratory acidosis as H+ ions increase from carbonic acid dissociation.

Flashcard 14: What does a sudden drop in $EtCO_2$ to near zero most strongly suggest in an intubated patient?

Answer: Tube dislodgement/obstruction or apnea (loss of exhaled $CO_2$). Sudden loss of CO2 detection indicates no exhaled gas reaching the sensor, commonly from tube displacement, blockage, or absent ventilation.

Flashcard 15: Which option best indicates impending respiratory arrest: rising $EtCO_2$ with decreasing RR or stable $EtCO_2$ with tachypnea?

Answer: Rising $EtCO_2$ with decreasing RR. Rising EtCO2 indicates CO2 retention from hypoventilation as respiratory rate decreases, signaling decompensation toward arrest unlike compensatory tachypnea.

Flashcard 16: What is the key clinical difference between asthma and COPD exacerbation in EMS assessment?

Answer: COPD often has chronic hypercapnia and prolonged expiratory phase with pursed-lip breathing. COPD features air trapping and baseline CO2 retention with adaptive breathing patterns, distinguishing it from acute reversible bronchospasm in asthma.

Flashcard 17: What is the typical adult ventilation rate target when ventilating with an advanced airway?

Answer: $10$ breaths/min (about 1 breath every 6 seconds). This rate maintains adequate minute ventilation while avoiding hyperventilation-induced complications like barotrauma or reduced venous return.

Flashcard 18: Which finding is a contraindication to CPAP in respiratory distress: hypotension or wheezing?

Answer: Hypotension. Hypotension contraindicates CPAP as positive pressure can further reduce preload and cardiac output, unlike wheezing which may benefit from improved airflow.

Flashcard 19: What capnography waveform feature is most consistent with bronchospasm?

Answer: Shark-fin waveform with prolonged expiratory upstroke. Bronchospasm prolongs expiratory flow, altering the capnogram to a delayed rise in CO2, resembling a shark fin due to airway obstruction.

Flashcard 20: What is the normal adult range for end-tidal carbon dioxide ($EtCO_2$)?

Answer: $35$–$45$ mmHg. This range reflects normal alveolar CO2 levels, approximating arterial PaCO2 in healthy lungs due to minimal gradient from efficient gas exchange.

Flashcard 21: What is the primary physiologic danger of hyperventilating a patient with a pulse?

Answer: Decreased venous return and cerebral perfusion from increased intrathoracic pressure. Excessive ventilation elevates mean intrathoracic pressure, impeding venous return to the heart and potentially causing cerebral vasoconstriction from hypocapnia.

Flashcard 22: What ABG pattern defines hypoxemic respiratory failure?

Answer: Low $PaO_2$ despite oxygen therapy (often with normal/low $PaCO_2$). Hypoxemic failure reflects impaired oxygen diffusion or V/Q mismatch, where supplemental O2 fails to correct low arterial oxygenation despite adequate ventilation.

Flashcard 23: Which option indicates adequate BVM ventilation: visible chest rise or high delivered $FiO_2$?

Answer: Visible chest rise. Chest rise confirms effective tidal volume delivery to the lungs, whereas high FiO2 alone does not ensure ventilation adequacy without volume confirmation.

Flashcard 24: What is the main physiologic benefit of CPAP in acute pulmonary edema?

Answer: Increases alveolar recruitment and decreases preload/afterload. CPAP applies positive end-expiratory pressure to reopen collapsed alveoli and reduces cardiac workload by decreasing venous return and wall stress.

Flashcard 25: Which medication is first-line for life-threatening bronchospasm from anaphylaxis?

Answer: Epinephrine (IM preferred if not in extremis). Epinephrine rapidly reverses bronchospasm and hypotension via alpha and beta effects, with IM route preferred for faster absorption in non-critical states.