Ventilator Management and Respiratory Support Flashcards

At altitude (e.g., 8,000 ft cabin altitude), which change in a ventilated patient's gas volumes should the flight paramedic anticipate?

Answer: Gas volumes will expand due to decreased atmospheric pressure (Boyle's Law)

Per Boyle's Law, as altitude increases and atmospheric pressure decreases, gas volumes expand, which can affect tidal volume accuracy on some ventilators.

Which of the following is a recognized criterion for initiating non-invasive positive pressure ventilation (NIPPV) during transport?

Answer: Acute hypercapnic respiratory failure with intact airway reflexes

NIPPV (CPAP/BiPAP) is appropriate for cooperative patients with acute hypercapnic respiratory failure who can protect their airway.

CPAP differs from BiPAP primarily in that CPAP:

Answer: Delivers a single continuous pressure throughout the respiratory cycle

CPAP provides a single constant pressure during both inhalation and exhalation, while BiPAP delivers higher inspiratory (IPAP) and lower expiratory (EPAP) pressures.

When ventilating a patient with chronic obstructive pulmonary disease (COPD) exacerbation, which ventilator adjustment is MOST important to prevent air trapping?

Answer: Prolonging expiratory time by using a lower I:E ratio (e.g., 1:3 to 1:4)

COPD patients have obstructed airways requiring prolonged expiratory time; a lower I:E ratio (more expiratory time) reduces auto-PEEP and air trapping.

A patient intubated for respiratory failure has an ETCO2 waveform that shows a rising baseline (capnographic 'shark fin' pattern with elevation). This most likely indicates:

Answer: Air trapping and incomplete exhalation (obstructive pattern)

A rising ETCO2 baseline ('shark fin' waveform) indicates incomplete exhalation and CO2 accumulation between breaths, consistent with obstructive physiology.

During critical care transport, a ventilated patient develops sudden hypotension, rising peak airway pressures, and absent breath sounds on the left side. The PRIORITY intervention is:

Answer: Needle thoracostomy on the left chest at the 2nd intercostal space, midclavicular line

Unilateral absent breath sounds with hypotension and rising airway pressures in a ventilated patient indicates tension pneumothorax requiring immediate needle decompression.

Which parameter is considered the most reliable indicator that a patient is ready for extubation during transport preparation?

Answer: Negative inspiratory force (NIF) more negative than -20 cmH2O with GCS ≥ 10

A NIF more negative than -20 cmH2O indicates adequate respiratory muscle strength, and a GCS ≥ 10 suggests the patient can protect the airway post-extubation.