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160 Cards in this Set
- Front
- Back
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Trachea anatomy |
-Large membranous Tube reinforced by cartilage rings - Extends from Larynx to Bronchioles |
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Esophagus anatony |
- Food pipe - Part of the Alignmentary canal that connects the throat to the stomach |
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Pharynx anatomy |
- Throat - Body cavity that connects the Nasal/oral cavity with thr larynx and esophagus |
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Nasopharynx |
- Passageway for air moving through the nose - Most superior |
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Epistaxis |
Nosebleed |
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Oropharynx |
- Passageway for food - Behind soft palate of mouth - Provides movement for food and air |
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Epiglottis |
- Barrier for trachea (guide) - Flap of connective tissue at the bottom of the oropharynx - Makes sure food doesnt ebter trachea |
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Larynx |
- Voice box - Hollow muscular organ forming an air passage to the lungs - Holds the vocal cords - Allows cough reflex |
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Trachea / Esophagus are? |
Wind pipe/ Food pipe |
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Major differences in Pediatric Airway |
- Size of airway is smaller and clog easily - Frequent infections - Resistance is lower |
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Pediatric Difference: Epiglottis complications |
- epiglottis gets inflamed, it could potentially obstruct airway |
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Infants are what kind of breathers? |
Obligated nose breathers |
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Pediactric airway: Respiratory infection diff. |
If upper resp. tract gets infected it can lead to lower resp. tract infection due to close proximity |
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Children are what lind of breathers? |
Belly breathers due to weak abdominal muscles |
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Pediactric vs Adult airway: Larynx is located? |
- C3 - 4 for pediactrics - C6 for adults |
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Infant: Infant:Cricoid cartilage is? Cricoid cartilage is? |
- Narrowest part of airway - Only complete ring of cartilage, therefore not expandable |
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What intubation blade is used for Pediactrics? |
Miller blade ( Straight blade ) |
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Upper airway consist of: |
Nasopharynx (nasal) Oropharynx (oral) Pharynx ( back of throat) Larynx ( Voice box) |
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Upper airway function |
Air passage Warms air Filters Himidifies Vocalization / reonance Protects airway Smell / taste |
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Larynx cartilages are? |
Epiglottis Thyroid Cricoid ring |
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Lobule contains what generations of bronchial tree? |
4th - 7th Generation |
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Levels of airway passage ( superior - inferior) |
Bronchi Bronchioles Alveoli Acinus ( air ducts ) |
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Lower airway structure |
Trachea Bronchi Bronchioles Alveoli Surfactant |
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Anatomy of Trachea |
Mucosa ( goblet cells/ cilia ) Submucosa ( loose CT ) Cartilage rings ( trach muscle ) Adventitia ( outer most layer ) |
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Carina |
Division between two main Bronchi |
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3 parts Bronchi breaks off to? |
Primary Secondary Tertiary |
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Oxygenation starts in which generation? |
17 - 19 generation |
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Bronchi: primary layer |
Long and narrow / enters lungs |
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Bronchi: primary layer |
Long and narrow / enters lungs |
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Bronchi : Secondary |
Carrues air to different lobes |
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Bronchi : Teritary |
Carry air to different segments |
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Bronchioles |
- Tiny branch of air tubes - Continuation of the bronchi - Connect to the alveoli ( air sacs ) |
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Alveoli ( alveolus - pural ) |
- tiny air sacs - allows for rapid gaseous exchange |
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Acinus |
- Where alveoli sacs are located - At the ends of tiny airway ducts |
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Acinus |
- Where alveoli sacs are located - At the ends of tiny airway ducts |
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Alveolar ducts |
- connects bronchioles to Alveolar sacs - tiny end ducts |
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Surfactant |
- reduces surface tension - increases compliance - reduce work of breathing - prevents atelectasis ( lung collapse ) |
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Atelectasis |
Lung collapse |
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Anatomy of the lung |
- parenchyma tissue - pleura cavity |
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Parenchyma tissue |
- Portion of the lung involved in gas transfer - consist of alveoli, alveolar ducts and respiratory bronchioles |
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Pleura cavity |
- aids optimal function of lungs - contains plueral fluid - lubricates repiratory movement |
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Lobes of lung |
- consist of 5 lobes - R / 3 lobes - L / 2 lobes - consist of lobules |
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Lobe function |
- Brings oxygen ( 02 ) into the bloodstream and removing carbon dioxide (co2) |
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Lobules |
- smaller lobe - division of lobe |
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Pleural membranes |
- Paritel ( lines inner chest wall outside lungs ) - visceral ( envelopes the lungs ) |
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Lung compliance |
- Lungs ability to stretch and expand |
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Lung compliance mesured in? |
- static compliance - dynamic compliance |
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Static compliance |
Change in volume for any given applied pressure |
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Dynamic compliance |
- compiance of lung during any actual movement of air |
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Gas exchange |
- occurs in lungs between air ocygen and blood - oxygen is exchaged for carbon dioxide across the repiratory surface |
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Efficiency of gas exchange |
- Depends on our bodies ability to obtain oxygen - needs to get ride of carbon dioxide |
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Gas exchange occures in which zones? |
Zones 2-3 |
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Systemic circulation |
- Carries oxygenated blood away from the heart to the body - Returns deoxygenated blood back to the heart - Feeds living tissue |
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Pulmonary circulation |
- Moves deoxygenated blood from the heart, to the lungs, and back to the heart - Deoxygenated blood leaves thrpugh the right ventricle thrpugh the pulmonary artery |
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Pressure differences between pulmonary and systemic circulation? |
Pulmonary - 10mmhg Systemic - 100mmhg - pulmonary is a 10th of the vescular resistance of that of the systemic |
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Brochodilation |
- decreases resistance - increases air / gas flow - smooth muscle relaxes |
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Bronchoconstriction |
- increase resistance - decreases air / gas flow - smooth muscle constricts |
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Muscles of respirations |
- diaphram - intercostal muscles |
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Diaphram |
- dome shaped muscle - separates the thorax and abdomen - contracts, increasing volume of the thorax, whuch inflates the lungs |
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Intercostal muscles |
- Responsible for forced and quiet inhalation - Abdominal muscles - raises ribs / expands the chest cavity - originates in ribs 1-11 |
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Accessory muscles |
- Sternocleidomastoid - scalene muscle |
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Scalene muscle |
- Anterior/ middle (SM) - elevate first rib and laterally flex (bend) neck at the same time - Posterior (SM) - elevate the second rib and tilt neck at the same time |
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Sternocleidomastoid (2-headed muscle) |
- Anterior muscle - connects to breastbone - bends neck and head forward - bends neck sidways - assist in chewing and swallowing |
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Tidal volume |
Total amount of air into lungs during each breath ( 500 ml ) |
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Minute volume |
- the amount of gas inhaled or exhaled through lungs in a min |
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Inspiratory reserve volume |
- Max amount of additional air that can be drawn into the lungs, after normal respiration ( 2100 - 3200 ml ) |
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Expiratory reserve volume |
- Additional amount of air that can be expired from lung after normal expiration |
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Anatomical dead space |
- space where the dead space fills with inspired air and unchanged with exhaled |
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Dead space |
Total volume of a breath that DOES NOT participate in gas exchange |
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Physiological dead space |
- total dead space - sum of anatomical dead space and alveolar dead space |
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Residual volume |
- Volume of air still remaining after main expiration possible ( 60 - 100 cubic inch. ) |
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Physiology of breathing |
- Process of breathing ( respiration) -inpiration - expiration |
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Inspiration |
- flow of breath into the lungs - diaphram contracts and pulls down - ribs contract and pull upward |
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Expiration |
- flow of air out of lung - passive process - Diaphram abd ribs relax |
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Gas exchange ( simple difussion ) |
- Between aveolar spaces and capillaries - exchange of oxygen ( 02) and carbon dioxide (co2) - takes place in the aveoli and aveoli ducts |
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Oxygen passes through.. |
Passes quickly through the air-blood barrier into the blood in the capillaries |
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Carbin dioxide passes through... |
Passes from blood into the alveoli and then exhaled |
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Breathing is controlled by? |
Repiratory centers (RC's) |
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Respiratory center (RC's) |
- Located in the medulla oblangata and pons - Are part of the brainstem - Recieve control signals of neural, chemical and hormonal nature and control rate, depth of respiratory movements of the diaphram and other respiratory muscles |
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Chemoreceptors |
- Peripheral chemoreceptors - Central chemoreceptors |
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Peripheal chemoreceptor |
Aortic body - detects changes in blood oxygen and carbon dioxide, but not pH Carotid body - detects all three, blood oxygen, carbon dioxide and pH levels. They do not desensitize - Located high in the neck, in the thorax, on the arch of the aorta |
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Central chemoreceptors |
- regulates respiratory activity - important mechanism for regulating ( o2, co2, pH) |
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Hemoglobin |
- carries blood, oxygen (o2) |
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Bicarbonate |
- carries carbon dioxide (co2) And pH ( acidity ) |
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Stretch receptors |
- receptors responds to the stretching and expandong of surrounding muscle - cordination of the muscle tissue |
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Mechanoreceptors |
- in the lungs - initiate the Hering-breuer reflex - increases production of the pulmonary surfactant |
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Hering- Breuer reflex |
- reflex preventing over- inflation of the lungs |
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Chemical irritants |
- chemicals that damage lungs - may penetrate deep into lung causing: - oedema ( alveolar filled with liquid) -inflamation ( chemical pneumonitis) |
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Importance of advanced airway |
adequate/ opeb airway Proper ventilations Adequate oxygenation |
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Complications in advanced airway management causes |
Improper sevice usage Failure to reasses Skills taken for granted |
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Indication of advanced airway |
Obstructions Unable to self mantain Breathing fatigue |
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Respiratory monitoring |
Rate Rate factors Adequate breath given |
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Basic airway devices |
Bvm Opa Npa Supplemental oxygen |
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Bvm indications |
Pt having difficulty breathing Maintaining adequate ventalations on their own |
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Bvm contraindications |
None |
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Opa indications |
Unresponsive / no gag reflex |
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Opa contraindications |
Responsive / gag reflex intact |
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Supp. Oxygen indication |
Medium flow o2 desired Mild resp. Distress |
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Supp. Oxygen contraindications |
Poor respiratory effort Severe hypoxia Apnea ( suspension of breathing) |
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ET intubation indications |
Chest compressions ongoing Pt unable to protect airway Require high flow oxygen Ventillary impaired required assissted ventalations |
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ET intubations contraindications |
Pharynx obstructed C-spine injury is possible |
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Dual lumen airway ( combi tube ) Indications |
Intubation was unsuccessful and ventalation is difficult Provider untrained on oral intubation |
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Dual airway lumen ( combi tube) Contra. |
Ingested caustic substances Gag reflex intact Esophageal disease |
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Laryngeal mask (lma) Indications |
Difficult mask fit Intubation unsuccessful Untrained in oral intubation |
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Laryngeal mask ( lma) Contra. |
Untrained in LMA If risk of aspirating exsist |
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Nasotracheal airway Indication |
Breathing pt needs to be intubated Suspected spinal injury Jaw/oral trauma Pt with short, fat neck |
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Nasotracheal airway Contra. |
Facial fx Nasal obstruction Apneic pt Untrained Pt younger then 10 yrs old |
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Nasogastric intu. Indications |
Decompression of stomach Reduce incidence/ aspirating Prolonged ileus ( inability of intestines to expell bowel or waste out of body) |
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Nasogastric tube Contra . |
Mid face fx/ trauma History of gastric bypass Esphageal strictures/ alkali injury |
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Cricothyroidotomy Indications |
Sever facial/ nasal trauma Anaphylaxsis Chemical inhilation injuries |
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Cricothyroidotomy Contra. |
Inability to identify landmark Underlyning anatomical abnormality Laryngeal disease |
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Ventalation |
Exchange of air between lungs and the atmosphere |
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Oxygenation |
Addition of oxygen to human system |
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5 top functions of respiratory System |
Inhalation Exhalation Internal gas exchange Vibrating vocal cords = sound Olfactory (cn1) |
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Peripheal chemorectors monitor what? |
Aortic: Blood oxygen Carbon dioxide Not pH Carotid: All 3 Does not desensitize |
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Central chemoreceptors monitor what? |
Repiratory activity |
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Hypoxemia |
Fall in arterial Po2 - ( partial pressure oxygen ) |
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Hypercarbia |
Increase in Pco2 ( partial pressure carbon dioxide) Leads to increase in resp. Rate and depth |
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Hypercarbia caused by?? |
Hyperventalation Co2 retention -Results in poor perfusion |
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Field airway management consist of? |
Uncontrolled environment Diffivult airway |
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What makes field airways difficult? |
Trauma Combative Anatomy Facial / larnygeal / jaw trauma Environment |
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RSI |
Rapid sequence intubation |
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Decision in Rsi |
Safety abc's |
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When to intubate |
Is there a condition which hightens requirment for ET tube |
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Nasotracheal approach Indication |
Always urgent not emergent |
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Nasotracheal approach Contra. |
Apneic pt Mid face trauma |
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Orotracheal approach Indication |
Emergent |
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Orotracheal approach Contra. |
Gag reflex intact Uncontrolled bleeding Unrelieved obtruction (peanut) |
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Cricothyrotomy |
When all else fails Provides limited oxygenation (30 min) Provides limited ventilation |
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Pitfall (common failure in intubation) |
Not having plan Forgetting team effort Proper spinal immobilization Failure to reassess Failure to secure Inadequate documentation |
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Confirmation of advanced airway insertion - Primary (direct) |
Visualize through vocal cords Symmetrical chest rise Bilateral breath sounds |
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Confirmation of advanced airway insertion - secondary (indirect) |
End tidal co2 Esophageal detection device |
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Nasal turbinates |
Help warm and moisturizes air while flow through nasal passage |
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Olfactory membrane |
Smell Thick brown structure CN1 ( olfactory nerve ) Nerve receptors relay info to brain, resulting in smell |
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Function of paranasal sinus |
Reduce weight of skull Resonance of speech chamber |
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Thyroid cartilage |
Forms Adams apple Houses vocal cords |
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Uvula |
Prevents body from launching immunological attack Keeps throat lubricated Keeps food from going up nose Triggers gag reflex |
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Vallecula |
Depression site at base of tounge Spit trap To prevent initiation of swallowing reflex |
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Hyoid bone |
Anchors toungue At root of tounge Nit attached to any other bone |
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Lingual tonsil |
At base of tounge Assist in immune system in production of antibodies, in response to invading bacteria + virisus |
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Adipose tissue |
Fatty tissue Provides insulation |
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Thyroid gland |
Hormonal gland Located in neck below adams apple Releases hormones into blood stream Major role is metabolism, growth, maturation of human body |
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Cricothyroid cartilage |
Only complete ring of cartilage Cricothyrotomy is performed |
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Arytenoid cartilage |
Allows vical vords to tense/relax |
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Path of oxygenation |
Bronchi Bronchioles Alveolar ducts Alveolar sacs Alveoli Alveoli ducts |
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Mechanics of inspiration |
Increases volume Decrease pressure |
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Mechanics of expiration |
Decreased volume Increases preasure |
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How are chemoreceptors carried in blood stream |
In result of bohr effect Red blood cells/ hemoglobin |
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Bohr effect |
Decreased oxygen levels/ Increased co2 levels/ Rssults in lowered pH levels/ Results in poor perfusion |
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King Lt (laryngeal tube) |
Superglottic airway device Alternative to ET tube Can be inserted blindly through oropharynx into hypopharynx |
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King Lt Indication |
Pt in need of airway management Pts over 4ft tall For controlled or spontaneous ventilation |
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King lt Contra. |
Intact gag reflex Pt with esphageal disease Pt who ingested caustic sunstances |
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Rapid sequence intubation (RSI) |
Airway management that introdyces an inducing agent, creating an unresponssive and muscular relaxation Fastest and most effective means of controlling emergency airway |
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Mallampati classification |
Test to check if uvula + tonsils are present 1 - easy 2 - moderate 3 - difficult 4 - very difdicult |
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Cormack- lahane classification |
Test in grade to check if epiglottis + coniculate cartilage is present 1 - easy 2 - moderate 3 - difficult 4 - very difficult |
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Anatomy that makes advanced airways difficult |
Neck size Teeth Mandible Mouth Tounge |
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Pathological that make advanced airways difficult |
Acute: Trauma Edema Blood secretions Trismus (lock jaw) Chronic: TMJ ( jaw joint disorder) Osteoarthritus of the spine |
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BURP |
Backward,upward,rightwards pressure Improve visual of larynx |
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Sellicks manuver |
Apply pressure cricoid Prevents regurgitation of gastric content |
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Bronchi: primary layer |
Long and narrow / enters lungs |
