An adult is breathing at a rate of 6 breaths per minute. You should apply supplemental oxygen via nasal cannula. Closely monitor the patient's respirations. Ventilate the patient via bag-valve mask. Apply high concentration oxygen via non-rebreather mask. A 56-year-old female is struggling to breathe and has audible wheezes. She is unable to hold up her head or follow commands. What should you do? Place her in a supine position and assist her ventilation. Obtain a baseline set of vitals and a pulse oximetry reading. Insert a nasopharyngeal airway and apply a non-rebreather mask. Visually inspect the airway for foreign body obstructions. A 20-year-old female is unable to catch her breath after a minor car crash. She has numbness in and tingling to her hands and face. Vital signs are P118, R24. Insert an OPA. Apply high-flow oxygen by non-rebreather mask. Give her a paper bag to breathe into. Assist her ventilations with a bag-valve mask. A 34-year-old man is saying he is choking. You note stridor and hoarseness in his voice. Suction the airway. Perform abdominal thrusts. Assist him in self-administering his inhaler. Encourage him to cough. A 28-year-old patient is experiencing dyspnea and wheezing. Which medication should you request from medical control? Epinephrine auto-injector. Albuterol inhaler. Sublingual nitroglycerin. High-flow oxygen.
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Twenty-one-year-old Lisa Long has been suffering from asthma and is now experiencing an asthma attack while taking an afternoon walk with her sister. It is a cold, windy, early spring weekend. She complains of acute shortness of breath and has audible wheezing, episodic cough, and chest tightness with itchy red watery eyes and a stuffy, runny, itchy nose. These symptoms become worse within 5 minutes. Her sister called 000 and paramedics promptly attended to Lisa, who was fully conscious, appeared wide-eyed and frightened, and unable to breathe effectively. She was immediately transferred to the nearest hospital for full respiratory function assessment and treatment of acute asthma. A physical test reveals a heart rate (HR) of 120/min, respiratory rate (RR) of 38/min, with signs of accessory muscle use. Chest auscultation reveals decreased breath sounds bilaterally, with inspiratory and expiratory wheezes. Lisa is coughing up small amounts of thin, clear sputum and has an arterial oxygen saturation of 90%. Nebulized salbutamol, oxygen by facial mask, and systemic corticosteroid were administered. A second small-volume nebulizer treatment was ordered 20 minutes later. Chest auscultation revealed diminished wheezes; RR was 24 at this time and HR was 102. Over the next 24 hours, Lisa showed steady improvement and was discharged for follow-up with her local GP to review her asthma action plan and change any medications as needed to help prevent future exacerbations. Question 3/1. List two factors that could have triggered Lisa's acute asthma attack and explain the link between the named factors and her asthma. (4 marks) Question 3/2. Explain the pathophysiological steps leading to an acute asthma attack. In your answer, you are expected to link type 1 hypersensitivity reaction to the role of histamine in acute asthma. (4 marks) Question 3/3. Briefly explain the mechanisms of action of (i) salbutamol and (ii) corticosteroids in the treatment of acute asthma and describe their benefits in Lisa's condition. (4 marks) Question 3/4. Explain the mechanism of action of anticholinergic/anti-parasympathetic medications and their potential benefit(s) in asthma treatment. (3 marks).
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Oxygen therapy uses various devices to provide oxygen to patients having difficulty getting sufficient amounts from air through normal breathing. Among the devices is a nasal cannula, which transports oxygen through small plastic tubes from a supply tank to prongs placed in the nostril. Consider a specific configuration in which the supply tank, whose volume is $6.0 \mathrm{ft}^{3},$ is filled to a pressure of 2100 psig at a temperature of $85^{\circ} \mathrm{F}$. The paticnt is in an environment where the ambicnt temperature is $40^{\circ} \mathrm{F}$. When the cannula is put into use, the pressure in the tank begins to decrease as oxygen flows at $10-15 \mathrm{L} / \mathrm{min}$ through a tube and the cannula into the nostrils. (a) Estimate the original mass of oxygen in the tank using the compressibility-factor equation of state. (b) What is the initial pressure when the temperature is 40 $^{\circ} \mathrm{F} ?$ How much oxygen remains in the tank when application of the ideal-gas equation of state produces a result that is within $3 \%$ of that predicted by the compressibility-factor equation of state (i.e., when $0.97 \leq z \leq 1.03$ )? (c) How long will it take for the gauge on the tank to read 50 psig, assuming an average flow rate of $12.5 \mathrm{L} / \mathrm{min} ?$
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