Airway FISDAP scenarios
Respiratory System Emergencies: Key
Concepts and Management
1. Hyperventilation
Scenario: A 13-year-old female watching a horror movie presents with
shortness of breath and numb fingers. Her respirations are rapid (30
breaths/min) and deep, with a SpO2 of 100%. She is speaking clearly and
has clear and equal breath sounds.
Management: Calmly reassure her, encouraging her to slow her rate of
breathing in a controlled manner. This addresses the likely psychological
trigger and the resulting hyperventilation.
2. Artificial Ventilation with a Bag-Valve Mask (BVM)
Apneic Adult: For an apneic (not breathing) 21-year-old male with an
oropharyngeal airway (OPA) in place, the appropriate ventilation rate with a
BVM is 10 to 12 breaths per minute. This mimics a normal adult
respiratory rate.
3. Airway Suctioning Technique
Proper Technique: The correct method for suctioning a patient's airway
includes:
o Oxygenating and ventilating the patient before suctioning.
o Suctioning for a limited duration (typically ≤ 15 seconds in adults).
o Oxygenating and ventilating the patient after suctioning. This
prevents hypoxia and ensures adequate oxygenation.
4. Mass Casualty Incident (MCI) Triage:
"Immediate" Category
Immediate (Red Tag): A patient classified as "immediate" during an MCI
requires life-saving intervention. An 8-year-old female with no
, respirations after 5 positive pressure ventilations falls into this category,
indicating a critical airway and breathing issue.
5. Bag-Valve Mask (BVM) Oxygen Flow Rate
Appropriate Flow Rate: When ventilating a patient with a BVM, the
appropriate oxygen flow rate is 15 liters per minute (lpm). This ensures
maximal oxygen delivery.
6. Respiratory Distress in an Obese Patient
Scenario: An obese male complains of severe breathing difficulty, cool and
moist skin, and a respiratory rate of 22 breaths/min. He reports infrequent
doctor visits and dizziness after walking.
Initial Management: Apply a non-rebreather mask at 10 lpm. This
addresses the immediate complaint of breathing difficulty and potential
hypoxemia. Further assessment is needed to determine the underlying cause.
7 & 8. Suspecting Pneumonia
Scenario 1: A 42-year-old asthmatic patient presents with chest pain,
shortness of breath, and a violent cough producing brownish sputum.
Scenario 2: An 89-year-old patient complains of worsening difficulty
breathing and a productive cough over the past 12 hours.
Most Likely Cause: In both scenarios, pneumonia is the most likely cause
due to the productive cough, shortness of breath, and potential chest pain (in
the asthmatic patient). Crackles might be auscultated.
9. The Mechanics of Exhalation
Exhalation: As the diaphragm and intercostal muscles relax, the chest
cavity decreases in size, causing air to be forced out of the lungs
(exhalation).
10. Initial Respiratory Assessment in Adults
Key Components: During the initial assessment of an adult's respiratory
status, you should evaluate both:
o The respiratory rate (number of breaths per minute).
, o The rise and fall of the chest (tidal volume and effort).
11. "See-Saw" Breathing
Likely Patient Group: Pediatrics (infants and young children) are the
patient group in whom you are likely to encounter "see-saw" breathing. This
abnormal breathing pattern indicates significant respiratory distress.
12. Path of Oxygen to the Lungs
Correct Sequence: The sequence that correctly traces the path oxygen takes
from the atmosphere to the lungs is: Mouth, Pharynx, Trachea, Bronchi,
Alveoli.
13. Respiratory Distress in an Asthmatic Patient
Scenario: A 16-year-old asthmatic female in a tripod position complains of
increased shortness of breath with an SpO2 of 79%.
Management: You should administer oxygen at 10 lpm via a non-
rebreather mask. The tripod position indicates significant respiratory
distress, and the low SpO2 necessitates high-flow oxygen.
14. Managing a Choking Patient with Stridor
Scenario: A 34-year-old man states he is choking, and you note stridor and
hoarseness in his voice.
Management: Encourage him to cough. As long as the patient can cough
effectively, they should be allowed to attempt to expel the foreign body
themselves. Stridor and hoarseness suggest a partial airway obstruction.
15. Gagging During Oropharyngeal Suctioning
Scenario: An unresponsive trauma patient is gurgling. When you suction the
oropharynx with a rigid catheter, the patient gags.
Management: You should assess the insertion depth of the catheter.
Gagging indicates that the catheter may be stimulating the gag reflex,
suggesting it is inserted too far or improperly placed.
16. Managing Loose Dentures
Respiratory System Emergencies: Key
Concepts and Management
1. Hyperventilation
Scenario: A 13-year-old female watching a horror movie presents with
shortness of breath and numb fingers. Her respirations are rapid (30
breaths/min) and deep, with a SpO2 of 100%. She is speaking clearly and
has clear and equal breath sounds.
Management: Calmly reassure her, encouraging her to slow her rate of
breathing in a controlled manner. This addresses the likely psychological
trigger and the resulting hyperventilation.
2. Artificial Ventilation with a Bag-Valve Mask (BVM)
Apneic Adult: For an apneic (not breathing) 21-year-old male with an
oropharyngeal airway (OPA) in place, the appropriate ventilation rate with a
BVM is 10 to 12 breaths per minute. This mimics a normal adult
respiratory rate.
3. Airway Suctioning Technique
Proper Technique: The correct method for suctioning a patient's airway
includes:
o Oxygenating and ventilating the patient before suctioning.
o Suctioning for a limited duration (typically ≤ 15 seconds in adults).
o Oxygenating and ventilating the patient after suctioning. This
prevents hypoxia and ensures adequate oxygenation.
4. Mass Casualty Incident (MCI) Triage:
"Immediate" Category
Immediate (Red Tag): A patient classified as "immediate" during an MCI
requires life-saving intervention. An 8-year-old female with no
, respirations after 5 positive pressure ventilations falls into this category,
indicating a critical airway and breathing issue.
5. Bag-Valve Mask (BVM) Oxygen Flow Rate
Appropriate Flow Rate: When ventilating a patient with a BVM, the
appropriate oxygen flow rate is 15 liters per minute (lpm). This ensures
maximal oxygen delivery.
6. Respiratory Distress in an Obese Patient
Scenario: An obese male complains of severe breathing difficulty, cool and
moist skin, and a respiratory rate of 22 breaths/min. He reports infrequent
doctor visits and dizziness after walking.
Initial Management: Apply a non-rebreather mask at 10 lpm. This
addresses the immediate complaint of breathing difficulty and potential
hypoxemia. Further assessment is needed to determine the underlying cause.
7 & 8. Suspecting Pneumonia
Scenario 1: A 42-year-old asthmatic patient presents with chest pain,
shortness of breath, and a violent cough producing brownish sputum.
Scenario 2: An 89-year-old patient complains of worsening difficulty
breathing and a productive cough over the past 12 hours.
Most Likely Cause: In both scenarios, pneumonia is the most likely cause
due to the productive cough, shortness of breath, and potential chest pain (in
the asthmatic patient). Crackles might be auscultated.
9. The Mechanics of Exhalation
Exhalation: As the diaphragm and intercostal muscles relax, the chest
cavity decreases in size, causing air to be forced out of the lungs
(exhalation).
10. Initial Respiratory Assessment in Adults
Key Components: During the initial assessment of an adult's respiratory
status, you should evaluate both:
o The respiratory rate (number of breaths per minute).
, o The rise and fall of the chest (tidal volume and effort).
11. "See-Saw" Breathing
Likely Patient Group: Pediatrics (infants and young children) are the
patient group in whom you are likely to encounter "see-saw" breathing. This
abnormal breathing pattern indicates significant respiratory distress.
12. Path of Oxygen to the Lungs
Correct Sequence: The sequence that correctly traces the path oxygen takes
from the atmosphere to the lungs is: Mouth, Pharynx, Trachea, Bronchi,
Alveoli.
13. Respiratory Distress in an Asthmatic Patient
Scenario: A 16-year-old asthmatic female in a tripod position complains of
increased shortness of breath with an SpO2 of 79%.
Management: You should administer oxygen at 10 lpm via a non-
rebreather mask. The tripod position indicates significant respiratory
distress, and the low SpO2 necessitates high-flow oxygen.
14. Managing a Choking Patient with Stridor
Scenario: A 34-year-old man states he is choking, and you note stridor and
hoarseness in his voice.
Management: Encourage him to cough. As long as the patient can cough
effectively, they should be allowed to attempt to expel the foreign body
themselves. Stridor and hoarseness suggest a partial airway obstruction.
15. Gagging During Oropharyngeal Suctioning
Scenario: An unresponsive trauma patient is gurgling. When you suction the
oropharynx with a rigid catheter, the patient gags.
Management: You should assess the insertion depth of the catheter.
Gagging indicates that the catheter may be stimulating the gag reflex,
suggesting it is inserted too far or improperly placed.
16. Managing Loose Dentures
