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197 Cards in this Set
- Front
- Back
- 3rd side (hint)
Septum
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Cartilage that separates the right and left nasal cavaties.
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angioedema
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An allergic reaction that may cause severe swelling of the tongue and lips.
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26.6-7
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Sinus
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Air cavity that conducts fluid from the eustation tubes and tear ducts to and from the nasopharynx
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What is the primary waste product of oxygen metabolism?
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Carbon dioxide
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11.6
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Eustachian Tubes
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A tube that connects the ear with the nasal cavity
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Upper Airway consists of?
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outside chest cavity: nose, nasal cavities, pharynx, larynx.
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Nasolacrimal Ducts
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Tubula vessels that drain teaars and debris from the eyes into the nasal cavity.
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arytenoid cartilages
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Visable when intubating, two pearly white lumps at the distal end of each vocal cord.
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26.7
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Mucous Membrane
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Lining in body cavities that handle air transport; usually contains small, mucous- secreting cells called Goblet Cells. Mucus is a slippery secretion that lubricates and protects airway surfaces.
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How long before permanent damage to the brain if oxygen supply is cut off?
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6 mins
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11.6
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piriform fossa
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Hollow pockets on the lateral side of the glottic opening.
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26.49
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Pharynx
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Amuscular tube that extends from the back of the soft palate to the superior aspect of the esophagus.
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Function of upper airway?
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Fliter, warm, humidify the air, protecting the lower resp tract.
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Gag Reflex
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Mechanism that stimulates retching, or striving to vomit, when the soft palate is touched.
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What is the nasal cavity lined with?
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Ciliated mucous membrane that keeps contaminants out of the respiratory tract.
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11.7
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Lower airway consists of?
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inside chest cavity: trachea, bronchi, bronchioles, alveoli, and lungs.
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What is the most common upper airway obstruction, especially with decrease LOC?
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The tongue
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11.7
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atelectasis
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Collaspe of the alveolar air spaces of the lungs.
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26.48
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Fuction of of lower airway?
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exchange of o2 and Co2
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Pulmonary circulation
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Begins as blood leaves the rt ventricles via the pulmonary artery. The pulmonary capillary bed brings red blood cells very close to the terminal bronchioles. There is more perfusion to the bases of the lungs than to the apices. After picking up oxygen, the blood returns to the left atrium via pulmonary veins.
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26.11
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Adenoids
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Located on the posterior nasopharyngeal wall, lymphatic tissue that filters bacteria.
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11.7
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What type of breathers are we usually?
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Negative-pressure breathers (air suckers) as oppose to positive-pressure.
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26.12
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true Vocal Chords
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White bands of cartilage that regulate the passage of air through the larynx and produce voice by contraction of the laryngeal muscles.
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Nasopharynx function and contains?
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Function is respiration. contains: adenoid tissue, and eustachian tube openings.
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Exhalation
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Usually a passive process with asthma, reactive airway disease, or COPD the pt may need to use the abdominal muscles to push air out, exhalation is no longer a passive process.
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26.13
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Tonsils
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Located in posterior pharynx, made up of lymphatic tissue, help to trap bacteria.
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11.7
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The narrowest Part of adult trachea
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Glottic Opening
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Difficulty in exhalation usually indicates _______________________.
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obstructive pulmonary disease.
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26.13
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Pyriform Fossae
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Recess that form the lateral borders of the larynx.
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Oropharynx function and contains?
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Function in respiration and digestion. contains: teeth, tongue, palate, adenoids, epiglottis and vallecula.
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Difficult in inhalation may indicate ______________________.
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upper airway obstruction.
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26.13
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Vallecula
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"little valley" space or pocket between the base of tongue and epiglottis. Important land mark while intubating with a curved blade.
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Hering-Breuer reflex
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Receptors that stop you when taking too deep a breath causing you to cough.
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26.14
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Soft palate
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back part of roof of mouth
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Uvula
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fleshy tissue, looks like a grape that hangs down the soft palate.
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Neurologic signs of hypoxia
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Early signs are anxeity, late signs are confusion, lethargy, and coma. Also sz and cardiac arrest.
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26.15
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Hard palate
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Bony portion of the roof of mouth that forms the floor of the nasal cavity.
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Cadiovascular status with hypoxia
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Early on it will just cause tachycardia while late on it cause bradycardia.
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26.15
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Laryngopharynx (hypopharynx)
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portion of the throat below the epiglottis, connects to the esophagus. Function resp and digest.
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Soft tissue retraction
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The rigid bones don't move but the soft tissue is pulled around the bones, during inhalation.
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26.16
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Larynx
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connects pharynx and trachea at level of cervial vert. also has nerve endings from the vagus nerve, stimul can cause brady.
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Bony retraction
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Most common in children, on inhalation the sternum or rubs may pull or retract, causing a visible deformity with each breath.
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26.16
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Function of larynx
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conducts air between pharynx and lungs, prevents food and foregin substances from going into trach, house of vocal cords ( involved in speech production)
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orthopnea
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Severe dyspnea experienced when recumbent and relieved by sitting or standing up.
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26.49
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Thyroid cartilage
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adams apple, largest and most superior cartliage,
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stidor
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A harsh, high-pitch sound heard on inhalation, indicates narrowing, usually as a result of swelling (laryngeal edema).
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26.17
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Oropharynx Structures
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Tongue
Valecula (void at base of tongue @ the epiglottis) Landmark for intubation. |
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The trachea begins immediately below the _______ cartilage and descends anterioly down the midline of the neck and chest to the level of the _______________ thoracic vertebra.
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cricoid
fifth or sixth |
11.8
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Nasal flaring
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The nostrils are pulled wide open on inhalation.
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26.17
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glottis
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is true vocal cords and space between them which make it up.
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Pulsus paradoxus
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Profound intrathoracic pressure changes causing the peripheral pulses to weaken, or disappear during inspiration.
Rather rare. |
26.17
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Anatomy of Peds airway
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Large Tongue
Palate much more anterior Epiglottis much more round |
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cricoid cartliage
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most inferior of the 9 laryngeal cartilages.
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Auditory respiration
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As a general rule, any respiratory noises that you can hear without a stethoscope are abnormal noises.
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26.17
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Physiology of Respiratory System
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Diffusion across alveolar membrane.
About 500cc inpired air 150cc dead air space inspired O2 is about equal to expired CO2 |
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sellick maneuver
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compression of the cricoid cart occludes the esophagus, reducing risk of aspiration
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Partial Pressure of Gas
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Pressure exerted by each component of a gas mixture
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Tracheal tugging
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The thyroid cartilage is pulled upward and the area just above the sternum notch is sucked inward with inhalation.
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26.17
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suffactant
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Proteinaceous substance that lines alveoli and decrease surface tension on the alveolar wall and keeps them expanded.
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11.9
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O2 concentration in atmospheric air
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21%
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cricothyroid membrane
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fibrous membrane between the cricoid and thyroid cartilages. used for surgical and alternative airway placements.
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Normal Arterial Partial Pressure
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PaO2= 80 - 100 torr
PaCO2= 35 - 45 torr |
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Epiglottis
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a small leaf shaped cartilage, top of larynx, prevents food from entering the resp trac during swallowing.
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Oxygen concentration in the blood
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O2 saturation = O2 Concentration/O2 Capacity x 100%
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Paradoxical respiratory motion
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The epigastrum is pulled in with inhalation while the abdomen pushes out, creating a seesaw appearance as the two move in opposite directions.
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26.17
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Carina
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point where the trachea divides into the right and left mainstem bronchi.
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Cerebral Spinal Fluid (CSF)
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Carries CO2. Is located in the brain, brain stem and spinal cord
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Hering-Breuer reflex
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Protective mechanism that stops inhalation, preventing over expansion of the lungs.
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11.12
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Pneumotaxic Center
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Located in the Medulla. Stimulated by CO2 levels
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paroxysmal nocturnal dyspnea
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Dyspnea that comes on suddenly in the middle of the night is an ominous sign. It may signal left heart failure, worsening of COPD, or both. It occurs because of accumulation of fluid in the alveoli or pooling of secretions in the bronchi during sleep.
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26.18
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Bronchioles
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responsible for reg the flow of air to the alveoli. subdivide into tiny tubes aka alveolar ducts.
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Total Lung Capacity (TLC)
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Maximum adult capacity is 6 liters
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JVD may indicate
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Often normal, however it may implicate cardiac failure as the source of pt's dyspnea. May also indicate high pressure in the thorax, which keeps blood from draining out of the head and neck. Cardiac tamponade, pneumothrax, heart failure, and COPD can all cause JVD.
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26.19
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Alveolar Volume (Vmin)
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Amount of gas moved in and out of the respiratory tract in one minute. Vmin= VT x respiraatory rate
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Difference between external and internal respiration
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External respiration or pulmonary respiration is the exchange of gases between the lungs and the blood cells in the pulmonary capillaries. Internal respiration or cellular respiration is the exchange of gases between the blood cells and tissue.
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11.14
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hepatojugular reflux
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If you gently press on the liver, and blood further engorge the jugular vein. Ominous sign of right heart failure. When the right ventricle is not pumping effectively, blood backs up, making it difficult for the jugular veins and large reservoirs of blood in the liver to drain into the thorax.
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26.20
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Alveolar Minute Volume (Va-min)
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Amount of gas that reaches the alveolar for gaas exchange in one minute.
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Right mainstem is?
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shorter, wider, and straighter than left.
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inspiratory Reserve Volume (IRV)
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The amount of air that can be maximally inhaled after normal inspiration.
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respiration
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The exchange of gases between a living organism and its environment.
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11.115
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Functional residual Capacity
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Volume of gas that remains in your lungs at the end of normal exhalation
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Stimulation of beta-2 receptor site in bronchioles results in?
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relaxtion of bronchial smooth muscles.
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Expiratory Reserve Volume (ERV)
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The amount of air that can be maximally exhaled after a normal expiration.
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adventitious breath sounds
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The extra noises that you may hear on top of the breath sounds.
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26.22
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Forced Expiratory Volume (FEV)
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Amount of air that can be maximally epired after maximum expiration
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Without _______________, oxygen transport is not possible.
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hemoglobin (blood)
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11.14
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Endotracheal Complications
DOPE |
Dislodgement
Obstruction Pneumothorax Equipment Failure |
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alveoli (300 million ppl have)
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alveolar ducts end in alveoli, tiny hallow air sacs.
o2 passes wall to capillaries and co2 passes from caps to the alveoli. |
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What s/s usually happen with anxiety attacks and why?
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Hyperventilation cause decrease CO2 as it falls back to normal range the pt experiences dizziness and numbness and tingling of the face and extremities.
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11.15
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Tidal volume
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the voule of air moved into or out of lungs during normal breathing.
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Auscultation (in order)
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1-Epigastrum
2-Right Lung 3-Left Lung 4-trachea |
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hypoxemia
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Decrease in arterial oxygen level.
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11.16
hahy-pok-see-mee-uh |
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Minute volume
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amount of air moved in and out of lungs in 1 min.
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croup
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Viral infection of area around glottis. Most common children between 6 months and 3 years of age. Most commonly occurs in the middle of the night when air gets cool (in spring and fall). Child has classic seal-bark cough. May be distressing but is not typically fatal. Also called laryngotracheobronchitis. Do not manipulate the airway.
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26.27
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Rapid Sequence intubation
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Paralizing a PT to facilitate intubation
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hypoxia
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Lack of oxygen to the body's cells and tissues.
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11.16
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atelectasis
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alveolar Collapse due to insufficient surfaactant or deflated alveoli
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Epiglottis
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Severe, rapidly progressive infection of the epiglottis and surrounding tissues that may be fatal because of sudden respiratory obstruction. Pts may present at any and at any time of the year. Pts typically drool, have a fever, hoarse voice, and purposefully hyperextension. Do not manipulate the airway.
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26.27
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Nasal cannula (nasal prongs)
deliever concent and rate? |
about 24-44% rate of 1-6L
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Peritonsillar abscess
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Uncommon in children, more common in young adults. Abscess forms behind pharyngeal tonsil on one side. Pt has a fever and sore throat. May be mistaken for epiglottis until you look in throat and see lateral abscess. Do not manipulate airway.
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26.27
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inspired air concentration
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O2=20.94%
Nitrogen= 79.01% CO2= 0.04% |
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anoxia
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An absence of oxygen that results in cellular and tissue death.
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11.16
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Retropharyngeal abscess
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Most common in children, in whom infection from retropharyngeal lymph nodes can flourish. May also be caused by direct trauma to pharynx. Patient may have fever and sudden stridor. May be mistaken for epiglottis until laryngoscope examination reveals huge retropharyngeal pus sack instead of a cherry-red epiglottis. Do not manipulate the airway.
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26.27
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simple face mask: function?
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produces a reservoir effect, small holes on sides allows the passage of inspired and expired air.
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PA
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alveolar partial pressure
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Diphtheria
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Causative bacterium attacks and kills layer of epithelial tissue, creating pseudomembrane that is often seen in tonsillar area. Membrane along with swelling can obstruct upper airway. Part of immunization. Do not manipulate the airway.
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26.27
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Pa
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arterial partial pressure
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simple face mask conent and rate?
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35-60%, rate 6-10L recommended 8-10L
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Enormous tonsils
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Palatine tonsils can swell excessively resulting in fever, difficulty swallowing, and sore throat. Tonsils can grow to golf ball size in some individuals. Severely swollen tonsils rarely compromise the airway but can cause snoring or stridor. Do not manipulate the airway.
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26.27
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Partial rebreather mask conent and rate?
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35-60%, rate 6-10L
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Diffusion
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Movement of a gas from an area of higher concentration to an area of lower concentration
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asthma
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Means "panting" in greek. Increase reactivity of the airway to a variety of stimuli causing widwpread reversible narrowing of the airways, or bronchospasm.
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26.28
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Signs of choking include...
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...gagging, stridor, dyspnea, aphonia (inability to speak), and dysphonia (difficulty speaking).
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11.24
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Hypoventilation
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reduction in breaathing rate and depth
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What is the asthma triad
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The three primary components of asthma, and the corresponding treatments. 1) Airway edema, tx with corticosteroids, 2) Bronchospasm, tx with bronchodilator, 3) Increase mucous production, tx with water and expectorants.
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26.28
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Pneumothorax
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Accumulation of air or gas in the pleuraal cavity
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Nonrebreather mask delivery and rate
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100%, rate, 10-15L bag at least 2/3 full.
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Hemothorax
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Accumulation in the pleural cavity of blood or fluid containing blood
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Status asthmaticus
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A severe, prolonged asthmatic attack that cannot be broken with conventional tx.
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26.29
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Pulmonary embolism
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Blood clot that travels to the pulmonary circulation and hinders oxygenation of the blood.
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Pulse oximetry
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noninvasive method of measuring the % of o2 sats in the blood. Provides cont measurement of oxygenation.
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FiO2
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concentration of oxygen in inspired air.
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COPD comprises at least two distinct clinical entities:
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emphysema and chronic bronchitis.
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26.29
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IPPV
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Intermittent Positive-Pressure Ventilation.
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Contraindication for Heimlich maneuver
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Pt is too small IE baby, unconscious, advance stages of pregnancy, or morbidly obese. PERFORM chest trust instead.
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11.25
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Hypercarbia
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Excessive pressure of Carbon dioxide in the blood. Treated by increasing the rate and/or volume of ventilation and correcting underlying cause.
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Emphysema
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A chronic weakening and destruction of the walls of the terminal bronchioles and alveoli. Most common cause is cigarette smoking.
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26.29
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Pulse ox cont...
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96-100% adequate o2, 91-95% mild hypoxia, <91% severe hypoxia.
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Main Respiratory Center
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Located in the Medulla, if this fails the apneustic center in the pons takes over.
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Causes of wheezing
|
Not all is asthma, other reasons include acute left heart failure, smoke inhalation, chronic bronchitis, and acute pulmonary embolism or obstruction.
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26.30
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Venturi Mask delivers and rate
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24-50%, rate 4-8L
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Hypoxemia
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decreased partial pressure of O2 in the blood
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Chronic bronchitis
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As sputum production most days of the month for 3 or more months out of the year for more than 2 years. Excessive mucous production in the bronchial tree, which is nearly always accompanied by a chronic or recurrent productive cough. Often related to heavy cigarette smoking.
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26.30
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Hypoxic Drive
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Mechanism that increases respiratory stimulation when PaO2 falls and inhibits respiratory stimulation when PaO2 climbs. Condition found in Pt.s with COPD.
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ATV (automatic transport ventilator)
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Pt who need vent support, 6-7ml/kg (500-600ml) with chest rise and fall over 1 sec, no advan airway 10-12 bpm,if so 8-10bpm.
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Causes of Respiratory Increase
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Fever, Emotion, Pain, Hypoxia, Acidosis, Stimulant Drugs
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hypoxic drive
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A situation in which a person's stimulus to breathe comes from a fall in PaO2 rather than the normal stimulus, a rise in PaCO2.
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26.49
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Causes of Respiraatory Decrease
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Depressant Drugs, Sleep
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NPA are measure from...
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the tip of the nose to the earlobe.
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11.33
|
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The classic presentation of TB
|
Turberculosis includes sudden weight loss, night sweats, fever, and cough with blood-tinged sputum. Put a NRB on pt to contain cough, and wear a N95 mask.
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26.32
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Causes of Upper Airway Obstruction
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Tongue, Foreign Bodies, Trauma, Laryngeal spasm and edema, aspiration
|
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stright blade
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Miller, wisconsin, flagg blade. positioned under the epiglottis lifted anteriorly lifting the epiglottis to expose the glottic opening.
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_______ side heart failure is often a cause of pulmonary edema.
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Left
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26.35
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Extubation
|
Removing a tube from a body opening
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Curved blade
|
macintosh blade, when lifted anteriorly the elevates the tongue and indirectly lifts the epiglottis.
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Paradoxical Breathing
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Assymetrical chest wall movement that lessens respiratory efficiency
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When applying CPAP watch respiratory rate for...
|
the success of CPAP. If the rate increase, the therapy is likely to fail, however if the rate decrease, then then the therapy is likely to succeed.
|
26.44
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S/S Gastric distension
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Increase diameter diameter of the stomach, increase distended abdomen, and increase resistance to BVM ventilation.
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11.48
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Dyspnea
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An abnormality of breathing rate, pattern or effort.
|
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methods used to verify proper placement of ETT
|
visulaizing ETT pass the cords, auscultating both lungs, auscultating epigastrium while vent, observing absence of cords after placement, colorimetric, and espohageal detector.
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Indications for intubation
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Present or impending respiratory failure, apnea, inability of the pt to protect own airway.
|
11.52
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Pulsus Paradoxus
|
drop in blood pressure of greater than 10 torr during inspiration
|
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NG/OG sizing
|
Nose/mouth to ear to xiphoid process.
|
11.49
|
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Kussmauls Respirations
|
Deep, slow or rapid, gasping breathing, commonly found in diabetic ketoacidosis
|
|
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Meds that can be administer via ET route
|
LEAN
Lidocane Epinephrine Atropine Narcan |
11.54
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Cheyne-Stokes
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Progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indicating brainstem injury
|
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Intubation attempt should take no longer than...
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30 seconds.
|
11.59
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Biot's
|
irregular pattern of rate and depth with sudden, periodic episodes of apnea, indicating increased intracranial pressure.
|
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Always use at least __ methods of tube placement confirmation.
|
2
|
11.62
|
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central neurogenic hyperventilation
|
deep rapid respirations indicating ICP
|
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Size of ET tube for nasal intubation
|
1.0 to 1.5 mm smaller, slightly smaller than the nostril.
|
11.66
|
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Agonal Respirations
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Shallow, slow or infrequent breathing, indicating brain anoxia
|
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Size for blade in ped
|
Premature newborn: 0 straight
Fullterm newborn to 1yr: 1 straight 2 yrs of age to adolescent: 2 straight Adolescent and older: 3 straight or curve |
11.80
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Compliance
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The stiffness or flexibility of the lung tissue
|
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Pulse Oxymetry
|
A measurement of hemoglobin oxygen saturation in the peripheral tissues
|
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ET protective equipment
|
Gloves, mask, eyeware
|
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Common Paraalytic Agents
|
Succinylcholine
Vecuronium Atracurium Pancuronium |
|
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Pneumothorax
|
A collection of air in the pleural space, causing a loss of the negative pressure that binds the lung to the chest wall.
•Open Pneumothorax – air enters the pleural space through an injury to the chest wall. •Closed Pneumothorax – air enters the pleural space through an opening in the pleura that covers the lung. •Tension Pneumothorax – develops when air in the pleural space cannot escape, causing a build-up of pressure and collapse of the lung. |
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Esphageal Detector Device
(EDD) |
A bulb syringe used to detect proper placement of the endotracheal tube
|
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Cor Pumonale
|
Hypertrophy of the right ventricle resulting from disorders of the lung.
|
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Positive End-Expiratory Pressure (PEEP):
|
A method of holding the alveoli open by increasing expiratory pressure.
Some bag-valve units used in EMS have PEEP attachments. Also EMS personnel sometimes transport patients who are on ventilators with PEEP attachments |
|
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Croup
|
laryngotracheobronchitis
The respiratory symptoms are caused by inflammation of the larynx and upper airway, with resultant narrowing of the airway. Croup is characterized by a harsh 'barking' cough, stridor (a high-pitched sound heard on inhalation) and fever. Hoarseness is usually present. More severe cases will have respiratory distress. |
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Forms of respirations
|
Coughing
Sneezing Sighing Grunting |
|
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How many cc does ETT Pilot Balloon need?
|
10cc. Be sure not to overinflate the balloon, as this could cause tracheal necrosis.
|
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Major Purpose for using a Stylet during endotracheal intubation.
|
To maintain a preset curve in the tube.
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How to Manage Severe Epiglottitis
|
DO NOT intubate unless airway failure in imminent. This may cause a sever laryngospasm. Oxygenate without agitation and rapid transport to OR.
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Maximum time limit for each intubation attempt
|
30 seconds and wait 30 seconds between each attempt while hyperventilating the pt. Do not try more than 3 times to intubate the pt.
|
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How to correct Esophageal intubation.
|
Take out immediateley, hyperventillate for 30 seconds and re-intubate the pt. Esophageal intubation is lethal and can cause regurgitation.
|
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Indications for Rapid Sequence intubation
|
Impending Respiratory Failure
Acure Airway Disorder (facial burns, upper airway trauma, epiglottitis) AMS with risk of vomiting and aspiration (Glascow score of 8 or less) Status Elipticus |
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Depolarizing RSI Drugs
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Succinycholine: Substitute acetylcholine, has a stimulating effect and causes fasiculations (muscle twitching). Most commonly used due to fast action and short duration.
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Non-depolarizing RSI Drugs
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Vecuronium
Atracurium Pancuronium Block Acetylcholine uptake, do not allow stimulation and do not cause fasiculations. |
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Pediatric Airway
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Structures are preportionally smaller and more flexible.
The tongue is larger. The epiglottis is floppy and round. The glottic opening is higher and more anterior in the neck. The vocal chords slant upward, toward the back of the head and are closer to the base of the tongue. The narrowest part of the airway is the cricoid cartilage, not the glottic opening as in adults. |
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hilum
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Point at which the bronchi and blood vessels enter the lung
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Bronchial Arteries
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Branch from the aorta provide most of the blood supply to the lungs. Bronchial veins returns blood from the lungs to the superior vena cava.
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Lung capacity/Volume in mL
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TLC 6,000
Vital Capacity 4,800 inspiratory reserve 3,000 tidal volume 500 expiratory volume 1,200 residual volume 1,200 |
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Tactile Fremitus
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Vibratory tremors felt through the chest by palpation.
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Subcutaneous emphysema
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Presence of air in the subcutaneous tissue
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Capnogram
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Reflects CO2 concentrations overtime. Divided into 4 phases: Phase I-Baseline (no CO2)
Phase II- Respiratory Upstroke (CO2 in alveoli) Phase III- Repiratory Plateau (nearly contant CO2 level) Phase IV - Inspiratory phase sudden downstroke returns to baseline |
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Why do you not give lasix to someone with pneumonia?
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Because it dries the secretions and causes them to become thick and sticky blocking the airways.
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Peak Flow
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Handheld device that determines peak expiratory flow rate (PEFR). Can measuer tidal volume.
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Leading cause of sepsis
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pneumonia
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Pink Puffer
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Emphysema
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Blue Bloater
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Chronic Bronchitis
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Why do you not give aspirin to an asthma patient?
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It can exacerbate the asthma by releasing histamines. Always ask pt if they have asthma before giving aspirin.
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Diaphoresis
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(sweat) results from release of epinephrine
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FVC
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Forced Vital Capacity
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FEV
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Forced expiratory Volume
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