Are you ready to learn about the management of trauma, obesity, near drowning, and burns in Respiratory Care? If so, you’re in the right place because that is what this study guide is all about.
This study guide is designed for Respiratory Therapy Students and correlates well with Egan’s Chapter 30. So that mean, you should be able to use this information to prepare for your exams. So if you’re ready, let’s go ahead and dive right in.
Treating a Near Drowning Patient
Near drowning is when someone almost dies from not being able to breathe while being immersed under water. When someone is rescued from a near-drowning situation, it is crucial that first aid and medical attention be implemented immediately.
That, along with obesity, burns, and trauma patients are definitely topics you must know as a Respiratory Therapist. The practice questions below can help you learn these topics.
Respiratory Management of Trauma, Obesity, Near Drowning, and Burns Practice Questions:
1. How is drowning defined?
The suffocation and death as a result of submersion in liquid.
2. What is near drowning?
A situation in which a victim survives a liquid submersion, at least temporarily.
3. What is dry drowning?
Glottic spasms and prevents water from passing into the lungs.
4. What is wet drowning?
The glottis relaxes and allows water to flood the tracheobronchial tree and alveoli.
5. What is the response to a parasympathetic-mediated reflex?
The bronchi constrict.
6. What is the pathophysiologic responsible for?
Noncardiogenic pulmonary edema.
7. What are the pathologic and structural changes that occur in drowning?
Laryngospasm and bronchial constriction, interstitial edema, engorged perivascular and parabronchial spaces, alveolar walls, and interstitial spaces, decreased surfactant, alveolar shrinkage and atelectasis, and frothy white secretions.
8. What are the clinical manifestations from drowning?
Atelectasis, alveolar consolidation, increased alveolar-capillary membrane thickness and bronchospasm.
9. What is the clinical data that is obtained with drowning?
Increased respiratory rate, stimulation of peripheral chemoreceptors, decreased lung compliance, increased ventilatory rate relationship, stimulation of J receptors and anxiety, increased heart rate, blood pressure, and cardiac output.
10. What will the chest assessment be for drowning?
Crackles and rhonchi.
11. What will the blood gas be for drowning victims?
Acute Ventilatory Failure with Hypoxemia.
12. What are the radiologic findings in drowning patients?
Fluffy infiltrates, pneumothorax, and pneumomediastinum.
13. What is the patients prognosis if they have been submerged in cold water for less than 60 minutes?
Does not indicate a poor prognosis.
14. What is the primary goal during the transport of near drowning patient?
High-quality CPR with 100% oxygen.
15. What do most near drowning patients suffer from?
Hypoxemia, hypercapnia, and acidosis.
16. What are the anatomic alterations of the lung in near drowning patients?
Laryngospasm/bronchoconstriction, interstitial edema, decreased levels of pulmonary surfactant, increased alveolar surface tension, atelectasis, and frothy white secretions.
17. Interstitial edema in near drowning includes what?
Engorgement of the perivascular and peribronchial spaces, alveolar walls, and interstitial spaces.
18. Decreased surfactant causes what?
It causes increased venous admixture.
19. When does ARDS usually show up?
It usually shows up 24–48 hours after the incident.
20. What is dry drowning?
It occurs when the victim passes out before inhaling any water so the fluid doesn’t get into distal airways.
21. How many people drown each year in the U.S?
22. Children under 5 account for what percent of drowning deaths per year in the United States?
23. What percent of drowning deaths occur in persons between 5 and 20 years old?
24. About how many victims of near drowning are hospitalized annually?
About 8000 each year.
25. Describe the drowning or near drowning sequence?
(1) Panic or violent struggle to return to the surface, (2) period of calmness and apnea, (3) Swallowing fluid and vomiting, (4) gasping inspirations and aspiration, (5) convulsing, (6) coma, and (7) death.
26. What is the mammalian dive reflex?
Optimizes respiration to allow staying underwater for extended periods of time; it is more apparent in young children.
27. What is the clinical data obtained at bedside on near drowning victims?
Increased respiratory rate, heart rate, cardiac output, blood pressure; cyanosis; cough/ frothy pink sputum, stable bubbles; crackles and rhonchi.
28. What would the ABG results show for a near drowning victim?
Acute ventilatory failure with Hypoxemia. There would be combined acidosis: pH – decreased, PaCO2 – increased, PaO2 – decreased, HCO3 – decreased (lactic acid).
29. What would the chest x-ray findings be on a near drowning victim?
Fluffy infiltrates, pneumothorax, and pneumomediastinum.
30. What is the general management of near wet drowning?
CPR should be performed by the first responder, during transport, and at the hospital.
31. What are the two types of chest trauma?
Blunt trauma and Penetrating trauma.
32. What are the assessment findings of respiratory chest trauma?
Dyspnea, respiratory distress, cough with or without hemoptysis, cyanosis, tracheal deviation, decreased breath sounds on the side of injury, decreased oxygen saturation, and frothy secretions.
33. What are the cardiovascular findings of chest trauma?
A rapid thready pulse, decreased blood pressure, narrowed pulse pressure, asymmetric blood pressure values in the arms, distended neck veins, muffled heart sounds, chest pain, crunching sounds with heart sounds, and dysrhythmias.
34. What are the surface findings of chest trauma?
Bruising, abrasions, open chest wound, and subcutaneous emphysema.
35. What should you do first when someone has a chest wound?
Ensure that there is a patent airway, provided oxygen, ensure that there is IV access, and remove clothing to assess the injury.
36. What side do you put the patient on?
Put the patient on the injured side.
37. What is a pneumothorax?
Air in the pleural space.
38. What are the signs and symptoms of pneumothorax?
Dyspnea, decreased movement of the involved chest wall, diminished or absent breath sounds on the affected side, and hyperresonance to percussion.
39. What is the treatment for a pneumothorax?
It may resolve on its own, or it may require chest tube insertion with flutter valve or chest drainage system.
40. What is a hemothorax?
Blood in the pleural space
41. What are the signs and symptoms of a hemothorax?
Dyspnea, diminished or absent breath sounds, dullness to percussion, decreased Hgb, shock depending on blood volume lost.
42. What is the treatment for a hemothorax?
Chest tube insertion with a chest drainage system.
43. What is a tension pneumothorax?
Air in the pleural space that does not escape. This causes the organs to shift and increases intrathoracic pressure.
44. What is flail chest?
Fracture of two or more adjacent ribs in two or more places with loss of chest wall stability.
45. What are the signs and symptoms of flail chest?
Paradoxical movement of the chest wall and respiratory distress.
46. What is cardiac tamponade?
Blood rapidly collects in the pericardial sac, compresses the myocardium and prevents ventricular filling.
47. What are the signs and symptoms of cardiac tamponade?
Muffled heart sounds, decreased output, hypotension, JVD, and increased central venous pressure.
48. What is the treatment of cardiac tamponade?
Medical emergency, pericardiocentesis.
49. What is the most common type of injury from blunt trauma?
50. What are the clinical manifestations of rib fractures?
Pain, shallow breaths, atelectasis, and pneumonia.
51. What are the clinical manifestations of flail chest?
Tachypnea, tachycardia, asymmetric and uncoordinated movement of the thorax, and paradoxical chest movement.
52. What does a chest tube do?
It drains the pleural space, drains air and fluid from the mediastinal space, and it reestablishes negative air pressure.
53. What is a pleural effusion?
An abnormal collection of fluid in the pleural space.
54. What are the clinical manifestations of a pleural effusion?
Muffled heart sounds, distant, trouble breathing, diminished breath sounds, and a sharp chest pain that worsens with inhalation.
55. What metabolic dysfunction is seen in obese patients?
Insulin resistance, Hyperglycemia, Dyslipidemia (increased triglycerides, decreased HDL), Hypertension, Proinflammatory state (increased cytokinesis), Vascular disruption (increased VEGF), and Increased leptin (feeling of fullness).
56. What is the link between obesity and asthma?
Obese patients are 2x more likely to have asthma than overweight patients.
57. What is obesity hypoventilation syndrome?
Severe obesity linked to hypoventilation during both waking and sleeping hours. It is also known as Pickwickian syndrome. Hypoventilation leads to acidosis and hypoxia.
58. What is the pathogenesis of obesity-associated asthma?
Obesity leads to the secretion of leptin which increases eosinophil chemotaxis (migration out of bone marrow), survival, and adhesion to endothelial cells in the blood vessels. Obesity leads to a decreased total number of eosinophils and redistribution of eosinophils from the bones to the lungs. An increased number of eosinophils in the lungs increases the severity of asthma.
59. The severity of burns is based on what?
The depth (degree) of the burn, percent of body surface area involved, location of the burn on the body, association with other injuries, patient’s age, causative agent, and the respiratory involvement and overall health of the patient.
60. What are the body responses with moderate and major burns?
Sympathetic nervous system manifestations, tachycardia, increased respiratory rate, decreased gastrointestinal motility, and increased blood glucose.
61. What is needed for infection protection with moderate and major burns?
Maintain a protective environment, restrict plants and flowers due to the risk of contact with pseudomonas, restrict the consumption of fresh fruits and vegetables, limit visitors, monitor for manifestations of infection and report them to the provider, administer tetanus toxoid, administer antibiotics to treat infection, monitor peak and trough levels, and use strict asepsis with wound care.
62. What are the airway injuries that occur with burns?
They can result from steam or chemical inhalation, aspiration of scalding liquid, and external explosion while breathing. Their effects might not manifest for 24 to 48 hours. It includes progressive hoarseness, brassy cough, difficulty swallowing, drooling, copious secretions, adventitious breath sounds, and expiratory sounds that include audible wheezes, crowing, and stridor.
63. What should the Respiratory Therapist do for airway injuries with burn victims?
Support the airway and ventilation, and administer supplemental oxygen. Educate the patient and family about airway management, such as deep breathing, coughing, and elevating the head of the bed.
64. What are the types of burns and main burn injuries?
Thermal burn, Chemical burn, Smoke and inhalation injury, Metabolic asphyxiation, and Electrical burns.
65. What is a secondary complication to burns that may occur 12-24 hours later?
Pulmonary edema due to inflammation of the airways
66. What are the 3 classifications of burns?
Superficial (1st degree), Deep (2nd degree), and Full thickness (3rd & 4th degree).
67. What are we concerned about with burns to the face, neck, and chest?
Burns may interfere with breathing and you should be concerned with mechanical obstruction.
68. What are we concerned about with burns to the ears and nose?
The patient is at an increased risk for infection due to low blood supply to those areas.
69. How do you treat compartment syndrome?
Fasciotomy – slit in the skin to allow for the swelling and blood to release.
70. How do you manage a burn on the scene?
Remove the patient from the source of the burning, stop the burning process, assess the patient’s ventilation status, and don’t put ice or cold water on the burns.
So there you have it! That wraps up our study guide on the Respiratory Management of Trauma, Obesity, Near Drowning, and Burns patients. These practice questions will help you learn everything you need to know from Egan’s Chapter 30 in order to ace your exams.
Just be sure to go through this information again and again until it sticks. Thank you so much for reading and as always, breathe easy my friend.
The following are the sources that were used while doing research for this article:
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
- Faarc, Heuer Al PhD Mba Rrt Rpft. Wilkins’ Clinical Assessment in Respiratory Care. 8th ed., Mosby, 2017. [Link]
- Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019. [Link]
- “The Effect of Obesity on Chronic Respiratory Diseases: Pathophysiology and Therapeutic Strategies.” National Center for Biotechnology Information, 25 Apr. 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC1435949.
- “The Management of near Drowning.” National Center for Biotechnology Information, 23 Nov. 1985, www.ncbi.nlm.nih.gov/pmc/articles/PMC1418124.
- “INHALATION INJURY: Pathophysiology, Diagnosis, and Treatment.” National Center for Biotechnology Information, 18 Apr. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5458611.
- “Ventilation in Chest Trauma.” PubMed Central (PMC), Apr. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3132366.
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